scholarly journals Use of neuropathic pain questionnaires in predicting persistent postoperative neuropathic pain following lumbar discectomy for radiculopathy

2016 ◽  
Vol 24 (2) ◽  
pp. 256-262 ◽  
Author(s):  
Mohammed F. Shamji ◽  
Alina Shcharinsky
Keyword(s):  
Neuropathic Pain ◽  
Spinal Surgery ◽  
Smoking Status ◽  
Multiple Logistic Regression Analysis ◽  
Failed Back Surgery Syndrome ◽  
Screening Tests ◽  
Leg Pain ◽  
Preoperative Pain ◽  
Pain Scores ◽  
Failed Back Surgery

OBJECT Failed-back surgery syndrome has been historically used to describe extremity neuropathic pain in lumbar disease despite structurally corrective spinal surgery. It is unclear whether specific preoperative pain characteristics can help determine which patients may be susceptible to such postoperative disabling symptoms. METHODS This prospective study analyzed surgical microdiscectomy patients treated for lumbar, degenerative, painful radiculopathy. Clinical parameters included general demographics, preoperative and postoperative clinical examination status, self-reported pain and disability scores, and neuropathic pain scores. The screening tests for neuropathic pain were the Douleur Neuropathique 4 and Leeds Assessment of Neuropathic Symptoms and Signs, with correlation tested for ordinal score and screen positivity. Multiple logistic regression analysis was used to define predictors of postoperative symptomatology. RESULTS Twelve percent of the 250 patients with radiculopathy who underwent microdiscectomy experienced persistent postoperative neuropathic pain (PPNP) with only modest, if any, relief of leg pain. The condition was highly associated with abnormal preoperative screen results for neuropathic pain, but not sex, smoking status, or preoperative pain severity (α = 0.05). Good correlation was seen between the 2 screening tests used in this study for both absolute ordinal score (Spearman ρ = 0.84; p < 0.001) and the threshold for terming the patient as having neuropathic pain features (Spearman ρ = 0.48; p < 0.001). Younger age at treatment also correlated with a higher likelihood of developing PPNP (p = 0.03). CONCLUSIONS This population exhibited a low overall frequency of PPNP. Higher neuropathic pain screening scores correlated strongly with likelihood of significant postoperative leg pain. Further work is required to develop more accurate prognostication tools for radiculopathy patients undergoing structural spinal surgery.

scholarly journals Use of neuropathic pain questionnaires in predicting the development of failed back surgery syndrome following lumbar discectomy for radiculopathy

2015 ◽  
Vol 42 (S1) ◽  
pp. S19-S19
Author(s):  
MF Shamji ◽  
A Shcharinsky
Keyword(s):  
Logistic Regression ◽  
Neuropathic Pain ◽  
Spinal Surgery ◽  
Multiple Logistic Regression Analysis ◽  
Failed Back Surgery Syndrome ◽  
Screening Tests ◽  
Multiple Logistic Regression ◽  
Preoperative Pain ◽  
Failed Back Surgery ◽  
Back Surgery

Objective: Failed back surgery syndrome (FBSS) describes neuropathic pain that occurs when extremity symptoms in lumbar disease persist despite structurally corrective spinal surgery. It is unclear whether specific preoperative pain characteristics predict patients prone to such postoperative disabling symptoms. Methods: This prospective study analyzed surgical patients with painful radiculopathy secondary to lumbar degenerative disease. Clinical parameters included general demographic information, preoperative and postoperative clinical examination, self-reported pain and disability scores, and neuropathic pain scoring. The neuropathic pain screening tests used in this study were the Douleur Neuropathique 4 (DN4) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), with correlation tested for ordinal score and screen positivity. Multiple logistic regression analysis defined predictors of postoperative symptomatology. Results: Among 250 surgical radiculopathy patients, 12% were classified with FBSS. The condition was highly associated with abnormal preoperative screens for neuropathic pain, but not gender, smoking status, or preoperative pain severity (multiple logistic regression, α=0.05). Good correlation was seen between the two screening tests used in this study for absolute ordinal score (Spearman’s ρ=0.84, p<0.001) and thresholding for neuropathic pain features (Spearman’s ρ=0.48, p<0.001). Conclusion: Higher neuropathic pain screening scores correlated with likelihood of postoperative leg pain. Further work will develop more accurate prognostication tools for radiculopathy patients undergoing structural spinal surgery.

scholarly journals Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome

2020 ◽  
Vol 9 (10) ◽  
pp. 3132
Author(s):  
Jin Young Lee ◽  
Woo Seog Sim ◽  
Ji Yeong Kim ◽  
Yu Ri Ko ◽  
So Young Lee ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Epidural Injection ◽  
Failed Back Surgery Syndrome ◽  
Leg Pain ◽  
Daily Life Activities ◽  
Pain Scores ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Before And After ◽  
Interlaminar Epidural Injection

Persistent or recurrent back and leg pain following spinal surgery, known as failed back surgery syndrome (FBSS), significantly limits daily life activities. A lumbar epidural injection can reduce adhesions, inflammation, and nerve compression, although the epidural space can be distorted due to dura mater and epidural tissues changes after spinal surgery. This study analyzed subdural injection during lumbar epidural injection in FBSS patients. We retrospectively analyzed data from 155 patients who received a lumbar interlaminar epidural injection to manage FBSS. We grouped the patients based on the injected contrast medium appearance in the subdural (group S) or epidural spaces (group E) in fluoroscopic contrast images. Demographic, clinical, surgical and fluoroscopic data were recorded and evaluated, as were the pain scores before and after injection. There were 59 patients (38.1%) in the subdural group. Injection distance from the surgery level differed between the groups. Risk of subdural injection at level 1 distance from the surgery level had an odds ratio of 0.374, and at level ≥2, it was 0.172, when compared to level 0. Subdural incidence differed with the distance from surgical site. Physicians should strive to reduce subdural incidence when the injection is planned at surgery site in FBSS.

scholarly journals Neuropathic Pain after Spinal Surgery

2017 ◽  
Vol 11 (4) ◽  
pp. 642-652 ◽  
Author(s):  
Jae Hwan Cho ◽  
Jae Hyup Lee ◽  
Kwang-Sup Song ◽  
Jae-Young Hong
Keyword(s):  
Neuropathic Pain ◽  
Cost Effectiveness ◽  
Clinical Outcomes ◽  
Spinal Surgery ◽  
Complex Disease ◽  
Functional Disability ◽  
Failed Back Surgery Syndrome ◽  
Leg Pain ◽  
Short Period ◽  
Failed Back Surgery

<p>Neuropathic pain after spinal surgery, the so-called failed back surgery syndrome (FBSS), is a frequently observed troublesome disease entity. Although medications may be effective to some degree, many patients continue experiencing intolerable pain and functional disability. Only gabapentin has been proven effective in patients with FBSS. No relevant studies regarding manipulation or physiotherapy for FBSS have been published. Spinal cord stimulation (SCS) has been widely investigated as a treatment option for chronic neuropathic pain, including FBSS. SCS was generally accepted to improve chronic back and leg pain, physical function, and sleep quality. Although the cost effectiveness of SCS has been proved in many studies, its routine application is limited considering that it is invasive and is associated with safety issues. Percutaneous epidural adhesiolysis has also shown good clinical outcomes; however, its effects persisted for only a short period. Because none of the current methods provide absolute superiority in terms of clinical outcomes, a multidisciplinary approach is required to manage this complex disease. Further studies concerning the etiology, diagnosis, treatment, and cost effectiveness of FBSS are warranted to deepen our understanding of this condition.</p>

Electrical (Pain) Thresholds and Conditioned Pain Modulation in Patients with Low Back–Related Leg Pain and Patients with Failed Back Surgery Syndrome: A Cross-Sectional Pilot Study

Pain Medicine ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 538-547
Author(s):  
Lisa Goudman ◽  
Eva Huysmans ◽  
Iris Coppieters ◽  
Kelly Ickmans ◽  
Jo Nijs ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Failed Back Surgery Syndrome ◽  
Pain Modulation ◽  
Leg Pain ◽  
Group Differences ◽  
Low Back ◽  
Cross Sectional ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Symptomatic Side

Abstract Objective When evaluating sensory dysfunctions and pain mechanisms in patients with low back pain (LBP), a specific subgroup of patients with radicular symptoms is often excluded. Comparative studies that evaluate sensory sensitivity in patients with a dominant nociceptive and neuropathic pain component are rarely performed. Therefore, the goal of this study was to examine differences in electrical thresholds and conditioned pain modulation (CPM) between patients with low back–related leg pain (LBRLP) and patients with failed back surgery syndrome (FBSS). Design Cross-sectional study. Setting University Hospital Brussels. Subjects Twenty-one patients with LBRLP and 21 patients with FBSS were included. Methods Electrical detection thresholds (EDTs), electrical pain thresholds (EPTs), and CPM were evaluated on the symptomatic and nonsymptomatic sides. Within- and between-group differences were evaluated for all parameters. Results No between-group differences were found for EDT and EPT at both sides. On the nonsymptomatic side, a significantly lower CPM effect was found in the FBSS group (P = 0.04). The only significant within-group difference was an increased EDT at the symptomatic side in patients with FBSS (P = 0.01). Conclusions LBP patients with a primary neuropathic pain component revealed altered detection sensitivity at the symptomatic side, without severe indications for altered nociceptive processing, compared with LBP patients without a dominant neuropathic pain component. Endogenous modulation is functioning in LBP patients, although it is possible that it might only be functioning partially in patients with a dominant neuropathic pain component.

scholarly journals Long-Term Follow-Up of Inpatients with Failed Back Surgery Syndrome Who Received Integrative Korean Medicine Treatment: A Retrospective Analysis and Questionnaire Survey Study

2021 ◽  
Vol 10 (8) ◽  
pp. 1703
Author(s):  
Ju-Hun Park ◽  
Kang-Eah Choi ◽  
Sang-Gyun Kim ◽  
Hui-Yeong Chu ◽  
Sang-Woon Lee ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Questionnaire Survey ◽  
Failed Back Surgery Syndrome ◽  
Post Treatment ◽  
Leg Pain ◽  
Korean Medicine ◽  
Failed Back Surgery ◽  
Back Surgery

Introduction: this study aimed to investigate the long-term clinical efficacy and satisfaction degree of integrative Korean medicine (KM) treatment for patients with failed back surgery syndrome (FBSS). Methods: we performed a follow-up questionnaire survey and retrospective analysis of medical records for patients with FBSS who underwent inpatient treatment for ≥ 1 week. The primary evaluation indices were numeric rating scale (NRS) scores for low back pain (LBP) and leg pain at admission and discharge. Sub-evaluation indices included the Oswestry Disability Index (ODI) and EuroQol 5-dimension (EQ-5D) score. The follow-up questionnaire survey obtained information regarding previous surgeries; reasons for satisfaction/dissatisfaction with surgical and KM treatment; and current status. Results: compared with at admission, there was a significant post-treatment decrease in the NRS scores for LBP and leg pain, as well as the ODI score. Further, there was a significant post-treatment increase in the EQ-5D score. Regarding the patients’ global impression of change for KM treatment administered during admission and at the follow-up questionnaire survey, 101 (95.3%) patients selected “minimally improved” or better. Conclusion: integrative KM treatment could effectively reduce pain, as well as improve function and health-related quality of life, in patients with FBSS.

scholarly journals High-Frequency Spinal Cord Stimulation at T9/10 in Patients With Failed Back Surgery Syndrome

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Naoki Higashiyama ◽  
Takuro Endo ◽  
Taku Sugawara
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Low Frequency ◽  
The Elderly ◽  
Failed Back Surgery Syndrome ◽  
Leg Pain ◽  
Effective Treatment Option ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract INTRODUCTION Spinal cord stimulation (SCS) is an effective treatment option for low back pain and radicular leg pain of failed back surgery syndrome (FBSS). In a recent study, high-frequency spinal cord stimulation (HFSCS) was found to be more effective in treating chronic pain than traditional paresthesia-based low-frequency SCS (paresthesia SCS). The purpose of this study is to evaluate the efficacy of paresthesia SCS and HFSCS in improving outcomes. METHODS We retrospectively reviewed the outcomes of patients who underwent paresthesia SCS or HFSCS between September 2016 and January 2019. Paresthesia SCS is generally characterized by programming stimulation parameters such that the patient experiences paresthesia, and the paresthesia topography overlaps the pain topography as much as possible. The patient in HFSCS had a placement of cylindrical lead at levels T9-10. Patients were programmed with the electrode overlying the inferior endplate of T9 (+) and the electrode overlying the superior endplate of T10 (–). RESULTS A total of 14 patients (4 males, 10 females) underwent paresthesia SCS implantation. Mean age was 77.2 ± 9.6 yr. A total of 5 patients (2 males, 3 females) underwent HFSCS implantation. Mean age was 78.2 ± 7.5 yr. Operative time was shorter for the HFSCS group compared to the paresthesia SCS group (53.4 ± 4.8 min vs 82.9 ± 20.3 min, respectively; P < .001). A total of 5 out of 5 patients in the HFSCS group (100%) and 10 out of 14 patients in the paresthesia SCS group (71.4%) achieved the outcome of 50% pain relief (P = .25) CONCLUSION To confirm paresthesia during the procedure in the elderly may be complicated by hearing/language difficulties or by sedative-related confusion. Compared to paresthesia SCS, HFSCS allows for lower operative times and a more efficient and accurate positioning of the electrodes.

Edema caused by continuous epidural hydromorphone infusion: A case report and review of the literature

2018 ◽  
Vol 4 (4) ◽  
pp. 255 ◽  
Author(s):  
Xiulu Ruan, MD ◽  
Riaz Tadia, MD ◽  
Hainan Liu, MS ◽  
John Patrick Couch, MD ◽  
John Keun-Sang Lee, MD, PhD
Keyword(s):  
Case Report ◽  
Infusion Pump ◽  
Failed Back Surgery Syndrome ◽  
Outpatient Setting ◽  
Leg Pain ◽  
First Case ◽  
Epidural Opioid ◽  
Failed Back Surgery ◽  
Catheter Tip ◽  
Lockout Interval

Background: Intraspinal drug delivery (IDD) therapy has been increasingly employed in patients with intractable, nonmalignant pain. Before implantation of permanent intraspinal pump, an intraspinal opioid screening trial is conducted to demonstrate the efficacy. The patient-controlled continuous epidural opioid infusion trail, performed in an outpatient setting, is widely accepted by many interventional pain specialists.Objective: To report a case of severe edema observed during the continuous epidural hydromorphone infusion trial.Case Report: An otherwise healthy 68-year-old lady with a 5-year history of severe low back pain and bilateral leg pain because of failed back surgery syndrome was referred to our clinic for IDD therapy.A tunneled lumbar epidural catheter was placed at L2- L3 with catheter tip advanced to L1 under fluoroscopic guidance. Satisfactory catheter placement was confirmed by epidurogram. The catheter was then tunneled subcutaneously and connected to a Microject™ patient-controlled epidural analgesia (PCEA) pump (Codman, Raynham, MA). The pump was programmed to deliver hydromorphone (0.1 mg/ml) at basal rate of 0.3 ml/h. The bolus dose was 0.1 ml with a 60-minute lockout interval. The patient was instructed how to operate the infusion pump. During the following infusion trial, she reported satisfactory analgesia (>70 percent pain reduction) and was able to wean off her other systemic opioids. However, she developed diffuse edema and gained over 16 pounds during the 5-day infusion trial. Her edema finally resolved 3-4 days after termination of the epidural infusion.Conclusion: Edema may occur and persist during epidural hydromorphone infusion. This report represents the first case report, to the best of our knowledge, describing severe edema in a patient on continuous epidural hydromorphone administration during an outpatient epidural infusion trial.

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