scholarly journals Back pain

2021 ◽  
pp. 70-77
Author(s):  
N. V. Pizova
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Correct Diagnosis ◽  
Cauda Equina ◽  
Warning Signs ◽  
Oral Drug ◽  
Low Back ◽  
Red Flags ◽  
Yellow Flags

Low back pain is a major cause of disability worldwide. Data on the prevalence of low back pain are presented. Information on the pathogenesis of pain is given. The temporal characteristics of pain are presented. Risk factors and triggers for episodes of low back pain are reviewed. The most common causes of specific and non-specific low back pain are described. Non-specific low back pain is more common, as no specific pathological-anatomical cause can be identified. Specific pain includes nociceptive and neuropathic pain. In order to make a correct diagnosis in a patient with low back pain, a thorough medical history must be taken, which usually provides important information in identifying the cause of the pain syndrome. The warning signs (‘red flags’) for specific causes of low back pain requiring urgent treatment and specific psychosocial factors contributing to chronic pain (‘yellow flags’) are considered separately. ‘Red flags’ include conditions such as suspected traumatic injury, tumour, infection or radiculopathy and cauda equina syndrome. «Yellow flags» include individual cognitive, emotional and behavioural factors that contribute to the development of chronic pain. The main aim of pharmacotherapy for low back pain is to enable patients to continue or resume their normal daily activities. The main recommended approaches in the treatment of acute and chronic low back pain are presented. The main non-steroidal anti-inflammatory drugs for the oral drug treatment of non-specific low back pain are described, with evidence-based doses. Special attention is given to the role of diclofenac in the treatment of pain. The authors present the results of systematic reviews that analyse the available data on the efficacy and safety of topical transdermal dosage forms that contain NSAIDs.

scholarly journals LO75: Utility of red flags to identify serious spinal pathology in patients with low back pain: a retrospective analysis

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S33-S34
Author(s):  
J. Kiberd ◽  
J. Hayden ◽  
K. Magee ◽  
S. Campbell
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Emergency Departments ◽  
Cauda Equina ◽  
Patient Characteristics ◽  
Unstable Fracture ◽  
Low Back ◽  
Red Flags ◽  
Likelihood Ratios ◽  
Predictive Values

Introduction: Practice guidelines discourage routine imaging for low back pain and recommend selective use when serious underlying conditions are suspected. Evidence about prevalence of serious pathologies and accuracy of red flags for decision-making is limited. We describe rates of serious low back pathology, assess the accuracy of three red flags and model the utility of combining administratively available red flags to reduce imaging. Methods: A seven-year retrospective study of patients presenting with low back pain to four emergency departments in Nova Scotia, Canada. Patient characteristics were available from administrative data. We test sensitivity, specificity, positive and negative predictive values, and likelihood ratios of individual and combinations of red flags. We use decision curve analyses to assess the clinical utility of three red flags to inform imaging. Results: We included data from 38,714 patients presenting with low back pain. Serious low back pathology was diagnosed in 1196(3.09%): 847 (2.19%) were vertebral fractures, 184 (0.48%) unstable fracture, 262 (0.68%) cancer, 57 (0.15%) cauda equina syndrome, and 30 (0.08%) spinal infection. Value of combining three red flags (age>65, female sex, and trauma) was found: positive likelihood ratios of 4.36 and 9.74 for vertebral fracture and unstable fracture, respectively. Imaging for low back pain could be reduced by 28 per 100 patients using a model that incorporates sex, age >65, and trauma. Conclusion: Serious low back pathology is extremely rare in patients presenting with low back pain. Combinations of red flags readily available in emergency departments have the potential to reduce unnecessary imaging tests.

scholarly journals Brain-Derived Neurotrophic Factor and Immune Cells in Osteoarthritis, Chronic Low Back Pain, and Chronic Widespread Pain Patients: Association with Anxiety and Depression

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 327
Author(s):  
Dominique Josephine Dimmek ◽  
Christoph Korallus ◽  
Sabine Buyny ◽  
Gutenbrunner Christoph ◽  
Ralf Lichtinghagen ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Immune Cells ◽  
Chronic Widespread Pain ◽  
Anxiety And Depression ◽  
Low Back ◽  
Widespread Pain ◽  
Chronic Pain Patients ◽  
Pain Patients

Background and Objectives: Musculoskeletal dysfunction can induce several types of chronic pain syndromes. It is of particular interest to elucidate the pathomechanism of different forms of chronic pain. It is possible that patients who have developed chronic widespread pain (CWP) may endure different pathomechanisms as compared to those who suffer from local pain (osteoarthritis, OA) and regional pain (chronic low back pain, cLBP), especially with regard to pain regulation and its related biomediators. The aim of this study was to determine the differences in pathomechanisms among these patients by measuring pain-related biomediators, particularly brain-derived neurotrophic factor (BDNF). Additionally, subpopulations of immune cells were determined in parallel. Materials and Methods: Patients and healthy subjects (HSs) were recruited (age and gender-matched). BDNF was measured from serum samples of patients and HSs and the data of body composition parameters were recorded. Additionally, both patients and HSs were asked to fill in questionnaires related to pain intensity, anxiety, and depression. Results: Our results highlight that the levels of both free and total BDNF are significantly lower in pain patients compared to HSs, with p values of 0.041 and 0.024, respectively. The number of CD3− CD56bright natural killer (NK) cells shows significant differences between the groups. Comparing all chronic pain patients with HSs reveals a significantly lower number of CD4+ CD8+ T cells (p = 0.031), CD3− CD56bright NK cells (p = 0.049) and CD20+ CD3− cells (p = 0.007). Conclusions: To conclude, it seems that a general conformity between the pathomechanisms of different chronic pain diseases exists, although there are unique findings only in specific chronic pain patients.

scholarly journals Estimating the population health burden of musculoskeletal conditions using primary care electronic health records

Rheumatology ◽  
2021 ◽  
Author(s):  
Dahai Yu ◽  
George Peat ◽  
Kelvin P Jordan ◽  
James Bailey ◽  
Daniel Prieto-Alhambra ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Electronic Health Records ◽  
High Impact ◽  
Low Back ◽  
Musculoskeletal Health ◽  
Health Records ◽  
Electronic Health

Abstract Objectives Better indicators from affordable, sustainable data sources are needed to monitor population burden of musculoskeletal conditions. We propose five indicators of musculoskeletal health and assessed if routinely available primary care electronic health records (EHR) can estimate population levels in musculoskeletal consulters. Methods We collected validated patient-reported measures of pain experience, function and health status through a local survey of adults (≥35 years) presenting to English general practices over 12 months for low back pain, shoulder pain, osteoarthritis and other regional musculoskeletal disorders. Using EHR data we derived and validated models for estimating population levels of five self-reported indicators: prevalence of high impact chronic pain, overall musculoskeletal health (based on Musculoskeletal Health Questionnaire), quality of life (based on EuroQoL health utility measure), and prevalence of moderate-to-severe low back pain and moderate-to-severe shoulder pain. We applied models to a national EHR database (Clinical Practice Research Datalink) to obtain national estimates of each indicator for three successive years. Results The optimal models included recorded demographics, deprivation, consultation frequency, analgesic and antidepressant prescriptions, and multimorbidity. Applying models to national EHR, we estimated that 31.9% of adults (≥35 years) presenting with non-inflammatory musculoskeletal disorders in England in 2016/17 experienced high impact chronic pain. Estimated population health levels were worse in women, older aged and those in the most deprived neighbourhoods, and changed little over 3 years. Conclusion National and subnational estimates for a range of subjective indicators of non-inflammatory musculoskeletal health conditions can be obtained using information from routine electronic health records.

scholarly journals Guillain-Barré syndrome and Low back pain: two cases and literature review

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 503-508
Author(s):  
Xianjun Ding ◽  
Hong Jiang ◽  
Xingyue Hu ◽  
Hong Ren ◽  
Huaying Cai
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina ◽  
Guillain Barre Syndrome ◽  
Low Back ◽  
Mri Features ◽  
Prominent Symptom ◽  
Guillain Barré Syndrome ◽  
Lumbar Mri ◽  
Guillain Barré

AbstractPurpose. To describe the clinical, electrophysiological, and lumbar magnetic resonance imaging (MRI) features of two cases of atypical Guillain-Barré syndrome (GBS). Methods We reported two GBS variant cases with initial and prominent symptoms of low back pain. We analysed their clinical, electrophysiological, and lumbar MRI features. Results Two patients with GBS reported low back pain as the initial and prominent symptom, which was not accompanied by limb weakness. The electrophysiological study showed abnormal F-waves in the common peroneal and tibial nerves, and acute polyradiculoneuropathy in the cauda equina. Examination of the cerebrospinal fluid (CSF) showed albuminocytologic dissociation. Serum was positive for GQ1b-IgM antibodies. Lumbar MRI showed gadolinium enhancement of the nerve roots and cauda equina. A standard regime of intravenous immunoglobulin markedly alleviated the low back pain. Conclusions Low back pain caused by GBS should be differentiated from other diseases. This initial or early prominent symptom may delay the diagnosis of GBS; therefore, it is important to conduct a detailed electrophysiological, CSF, and gadolinium-enhanced lumbar MRI analysis.

scholarly journals An Observational Study Comparing Fibromyalgia and Chronic Low Back Pain in Somatosensory Sensitivity, Motor Function and Balance

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1533
Author(s):  
José Antonio Mingorance ◽  
Pedro Montoya ◽  
José García Vivas Miranda ◽  
Inmaculada Riquelme
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Observational Study ◽  
Motor Function ◽  
Chronic Low Back Pain ◽  
Functional Performance ◽  
Low Back ◽  
Somatosensory Sensitivity ◽  
Chronic Pain Conditions

Fibromyalgia (FM) and chronic low back pain (CLBP) have shared pathophysiology and have a considerable impact on patients’ daily activities and quality of life. The main objective of this study was to compare pain impact, somatosensory sensitivity, motor functionality, and balance among 60 patients with FM, 60 patients with CLBP, and 60 pain-free controls aged between 30 and 65 years. It is essential to know the possible differences existing in symptomatology of two of the major chronic pain processes that most affect the population, such as FM and CLBP. The fact of establishing possible differences in sensory thresholds, motor function, and proprioceptive measures among patients with FM and CLBP could bring us closer to a greater knowledge of the chronic pain process. Through an observational study, a comparison was made between the three groups (FM, CLBP, and pain-free controls) evaluating functional performance, postural balance, kinematic gait parameters, strength, depression, fatigue, and sensitivity to pain and vibration. Patients with chronic pain showed worse somatosensory sensitivity (p < 0.001) and motor function (p < 0.001) than pain-free controls. Moreover, patients with FM showed greater pain impact (p < 0.001) and bigger somatosensory (p < 0.001) and motor deficiencies (p < 0.001) than patients with CLBP. Further research should explore the possible reasons for the greater deterioration in patients with FM in comparison with other chronic pain conditions. Our results, showing the multiple areas susceptible of deterioration, make it necessary to adopt interdisciplinary interventions focused both on physical and emotional dysfunction.

scholarly journals Effect of the duration of chronic low back pain on pain sensitivity of patients undergoing lumbar fusion surgery

Pain medicine ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 8-15
Author(s):  
Mei-ping Qian ◽  
Mei-rong Dong ◽  
Fang Kang ◽  
Juan Li
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Hospital Stay ◽  
Chronic Low Back Pain ◽  
Pain Sensitivity ◽  
Lumbar Fusion ◽  
Low Back ◽  
Fusion Surgery ◽  
Lumbar Fusion Surgery

Background: chronic low back pain is a serious social problem. In recent years, patients who choose lumbar fusion surgery due to chronic low back pain has been increasing. Pre-existing chronic pain has been associated with severe postoperative pain. In this study, we have sought to prospectively analyze the association between the duration of chronic low back pain and pain sensitivity after lumbar fusion surgery. Methods: 400 patients who underwent lumbar fusion surgery were divided into three groups based on the duration of chronic pain. During the first postoperative day, the maximum pain scores of each patient day and night, the pain scores at the day of discharge, the consumption of postoperative analgesics and the length of hospital stay were recorded. Results: of 400 patients recruited, 369 patients completed the experiment. There was no significant difference in gender, age, height, weight, pre-operative pain at rest, and operation time in the three groups. During the day, the pain sensitivity of the three groups were 1.71 ± 0.66, 2.40 ± 0.74, 2.90 ± 0.80. During the night, the pain sensitivity of the three groups were 3.45 ± 0.81, 4.31 ± 1.06, 4.86 ± 1.05. At the day of discharge, the pain sensitivity of three groups were 1.26 ± 0.46, 1.47 ± 0.58, 1.96 ± 0.64. There were significant differences in pain sensitivity among the three groups during the day and night on the first postoperative day and at the day of discharge (p < 0.05). The length of hospital stay (7.31 ± 1.36 days, 8.82 ± 1.48 days, 9.60 ± 1.61 days) and analgesic consumption (25.04 ± 36.56 mg, 33.52 ± 24.04 mg, 45.15 ± 24.89 mg, morphine equivalent) were also significant differences (p < 0.05). Conclusion: we found the duration of chronic low back pain before lumbar fusion surgery affects patient’ postoperative pain sensitivity, consumption of analgesic drugs and hospital stay. The longer the preoperative chronic pain lasts, the higher the postoperative VAS score is, the more analgesic drugs were consumed, and the longer hospital stay is.

scholarly journals LOW BACK PAIN

2021 ◽  
Vol 2 (1) ◽  
pp. 13-17
Author(s):  
Andaru Cahya S ◽  
Widodo Mardi Santoso ◽  
Machlusil Husna ◽  
Badrul Munir ◽  
Shahdevi Nandar Kurniawan
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Multidisciplinary Approach ◽  
World Population ◽  
Common Symptom ◽  
Low Back ◽  
Red Flags ◽  
Pain Attack ◽  
Primary Health ◽  
Clinical Presentations

Low back pain is the most common symptom found in the primary health care and is the number one cause of disability throughout worldwide. It is estimated that around 60 – 80% the world population will experience back pain during their lifespan. There are three different source of pain in the spine: axial-lumbosacral, radicular and reffered pain. All of these source brings different clinical presentations. Low back pain could be classified as acute, subacute and chronic low back pain. The pain could be nociceptive or neuropathic, the most common symptoms reported are “pressure pain” and “pain attack”. The physician should be aware of “red flags” symptoms that lead into more serious condition beside back pain and, therefore the patient has to be investigated to further examination whenever these symptoms present. The management of low back pain consist of severe modalities, both therapeutic and rehabilitative procedure. Oftentimes, the management needed multidisciplinary approach. It is important to general practitioners to identify and treat low back pain appropriately to reduce the burden of the disease and to prevent the disabilties caused by this condition.

scholarly journals Clinical principles for the diagnosis and treatment of musculoskeletal (non-specific) lower back pain

2021 ◽  
Vol 13 (3) ◽  
pp. 107-112
Author(s):  
V. A. Golovacheva ◽  
A. A. Golovacheva ◽  
T. G. Fateyeva
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Combination Therapy ◽  
Interdisciplinary Approach ◽  
Interventional Treatment ◽  
Low Back ◽  
Lumbar Stenosis ◽  
Red Flags ◽  
Lower Back ◽  
Symptoms And Signs

Low back pain (LBP) is one of the most common reasons for a neurologist visit. In 90–95% of cases, LBP is nonspecific (musculoskeletal). The diagnosis of nonspecific LBP based on symptoms, somatic and neurological examination data, the absence of «red flags» (symptoms and signs characteristic of specific causes of back pain, discogenic radiculopathy, or lumbar stenosis). We review the modern principles of acute, subacute, and chronic nonspecific LBP treatment. We also discuss interventional and non-interventional treatment approaches, emphasizing the importance of combination therapy and an interdisciplinary approach.

Sign in / Sign up

Export Citation Format

Share Document