scholarly journals Is The Pain Real or Not?

2018 ◽  
pp. 45-46
Author(s):  
Nelson Hendler
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Nerve Conduction Velocity ◽  
Subjective Experience ◽  
Chronic Back Pain ◽  
Organic Basis ◽  
X Ray ◽  
Extensive Evaluation ◽  
Constant Pain ◽  
Objective Tests

Chronic pain (constant pain lasting 6 months or longer) is a subjective experience, which is influenced by many pre-morbid (before the onset of pain) psychological problems. However, chronic pain often can produce depression, anxiety, and marital difficulties. Although physical examination and other studies, including x-ray studies, 3D-CT, electromyelograms (EMG), nerve conduction velocity studies and MRI in many cases may document an organic basis of chronic back pain, some organic syndromes defy definition by objective tests. This may be a greater problem for women, where physician prejudice can result in a significantly less extensive evaluation of their complaints of back pain. Also, any litigation may influence symptoms and the type of litigation may influence outcomes [8]. Therefore, there is a need to differentiate between “organic” and “functional” (negative physical and laboratory examination) back pain.

scholarly journals Is The Pain Real or Not?

2018 ◽  
pp. 45-46
Author(s):  
Nelson Hendler
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Nerve Conduction Velocity ◽  
Subjective Experience ◽  
Chronic Back Pain ◽  
Organic Basis ◽  
X Ray ◽  
Extensive Evaluation ◽  
Constant Pain ◽  
Objective Tests

Chronic pain (constant pain lasting 6 months or longer) is a subjective experience, which is influenced by many pre-morbid (before the onset of pain) psychological problems. However, chronic pain often can produce depression, anxiety, and marital difficulties. Although physical examination and other studies, including x-ray studies, 3D-CT, electromyelograms (EMG), nerve conduction velocity studies and MRI in many cases may document an organic basis of chronic back pain, some organic syndromes defy definition by objective tests. This may be a greater problem for women, where physician prejudice can result in a significantly less extensive evaluation of their complaints of back pain. Also, any litigation may influence symptoms and the type of litigation may influence outcomes. Therefore, there is a need to differentiate between “organic” and “functional” (negative physical and laboratory examination) back pain.

scholarly journals NUMERICAL RATING SCALE AS A PREDICTOR OF AN UNDERLYING PATHOLOGY IN PEDIATRIC BACK PAIN USING MAGNETIC RESONANCE IMAGE AS DIAGNOSTIC TOOL

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
Eduardo A. Lindsay ◽  
Gerardo Olivella ◽  
Manuel Rodríguez ◽  
Edwin Burgos-Rossy ◽  
Natalia Torres-Acevedo ◽  
...  
Keyword(s):  
Back Pain ◽  
Magnetic Resonance Image ◽  
Rating Scale ◽  
Chronic Back Pain ◽  
Numerical Rating Scale ◽  
Children And Adolescent ◽  
Constant Pain ◽  
Neurological Exam ◽  
Numerical Rating ◽  
Underlying Pathology

Background & Objectives: Recently, constant and night pain has been discarded as adequate clinical markers to predict the presence of an underlying pathology in pediatric back pain. The pain intensity has been recognized as an important domain in the pain assessment. Numerical Rating Scale (NRS) is one of the most common validated tools to assess pediatric pain intensity in children above 8 years of age. The aim of this study is to assess NRS as a predictor of underlying pathologies found by magnetic resonance image (MRI) in pediatric back pain. We hypothesize that a higher NRS score is associated with a high sensitivity, specificity and likelihood ratio to identify the present of organic pathology in pediatric chronic back pain. Methodology: After obtaining Institutional Review Board approval, a retrospective electronical medical record review was conducted. All pediatric patients who reported back pain lasting > 4 weeks between 2009 to 2018 were enrolled in the study. As per regular protocol, a pediatric orthopedic surgeon evaluated all patients who presented with back pain. After a non-diagnostic history, physical examination and spinal x-ray; spine MRI was order. Pain was graded with the use of NRS from 0 to 10. Patients were divided in two groups: NRS (1-5) & NRS (6-10). Variables such as gender, age, pain frequency, night pain, neurological exam, and the presence of an underlying pathology were compared between both groups. Patients that presented with injury due to trauma, previous diagnosis of back pain or cervical pain were excluded. Results: A total of 467 patients were evaluated in the study. Mean age of subjects was 15 years; 69% being female. An underlying pathology was identified in 131/315 (41.6%) patients with NRS (6-10), and 55/152 (36.2%) patients with NRS (1-5) (P=0.27). Patients with NRS (6-10) had two times more probability of suffering constant pain (P<0.03) and three times more likely of having an abnormal neurological examination (P<0.05). See table 1. Conclusion: Evaluation and treatment of children and adolescent with chronic back pain is challenging. Our study shows a strong association between NRS high (6-10) and constant pain and/or abnormal neurological exam. However, the use of NRS of (6-10) was not found as adequate predictor for the presence of an underlying organic pathology in children and adolescent patients. Therefore, physicians should not rely only high NRS score to recommend advance imaging study to assess chronic back pain in children and adolescent patients. Summary [Table: see text]

The periaqueductal gray and descending pain modulation: why should we study them and what role do they play in chronic pain?

2015 ◽  
Vol 114 (4) ◽  
pp. 2080-2083 ◽  
Author(s):  
Kasey S. Hemington ◽  
Marie-Andrée Coulombe
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Functional Connectivity ◽  
Recent Literature ◽  
Chronic Back Pain ◽  
Periaqueductal Gray ◽  
Pain Modulation ◽  
Pain Research ◽  
Descending Pain Modulation ◽  
Pain Patients

In this Neuro Forum we discuss the significance of a recent study by Yu et al. ( Neuroimage Clin 6: 100–108, 2014). The authors examined functional connectivity of a key node of the descending pain modulation pathway, the periaqueductal gray (PAG), in chronic back pain patients. Altered PAG connectivity to pain-related regions was found; we place results within the context of recent literature and emphasize the importance of understanding the descending component of pain in pain research.

scholarly journals Feasibility and Acceptability of Mobile Phone–Based Auto-Personalized Physical Activity Recommendations for Chronic Pain Self-Management: Pilot Study on Adults (Preprint)

2018 ◽  
Author(s):  
Mashfiqui Rabbi ◽  
Min SH Aung ◽  
Geri Gay ◽  
M Cary Reid ◽  
Tanzeem Choudhury
Keyword(s):  
Physical Activity ◽  
Chronic Pain ◽  
Back Pain ◽  
Pilot Study ◽  
Mobile Phone ◽  
Chronic Back Pain ◽  
Positive Effects ◽  
Future Improvement ◽  
Physical Activity Recommendations ◽  
Activity Recommendations

BACKGROUND Chronic pain is a globally prevalent condition. It is closely linked with psychological well-being, and it is often concomitant with anxiety, negative affect, and in some cases even depressive disorders. In the case of musculoskeletal chronic pain, frequent physical activity is beneficial. However, reluctance to engage in physical activity is common due to negative psychological associations (eg, fear) between movement and pain. It is known that encouragement, self-efficacy, and positive beliefs are effective to bolster physical activity. However, given that the majority of time is spent away from personnel who can give such encouragement, there is a great need for an automated ubiquitous solution. OBJECTIVE MyBehaviorCBP is a mobile phone app that uses machine learning on sensor-based and self-reported physical activity data to find routine behaviors and automatically generate physical activity recommendations that are similar to existing behaviors. Since the recommendations are based on routine behavior, they are likely to be perceived as familiar and therefore likely to be actualized even in the presence of negative beliefs. In this paper, we report the preliminary efficacy of MyBehaviorCBP based on a pilot trial on individuals with chronic back pain. METHODS A 5-week pilot study was conducted on people with chronic back pain (N=10). After a week long baseline period with no recommendations, participants received generic recommendations from an expert for 2 weeks, which served as the control condition. Then, in the next 2 weeks, MyBehaviorCBP recommendations were issued. An exit survey was conducted to compare acceptance toward the different forms of recommendations and map out future improvement opportunities. RESULTS In all, 90% (9/10) of participants felt positive about trying the MyBehaviorCBP recommendations, and no participant found the recommendations unhelpful. Several significant differences were observed in other outcome measures. Participants found MyBehaviorCBP recommendations easier to adopt compared to the control (βint=0.42, P<.001) on a 5-point Likert scale. The MyBehaviorCBP recommendations were actualized more (βint=0.46, P<.001) with an increase in approximately 5 minutes of further walking per day (βint=4.9 minutes, P=.02) compared to the control. For future improvement opportunities, participants wanted push notifications and adaptation for weather, pain level, or weekend/weekday. CONCLUSIONS In the pilot study, MyBehaviorCBP’s automated approach was found to have positive effects. Specifically, the recommendations were actualized more, and perceived to be easier to follow. To the best of our knowledge, this is the first time an automated approach has achieved preliminary success to promote physical activity in a chronic pain context. Further studies are needed to examine MyBehaviorCBP’s efficacy on a larger cohort and over a longer period of time.

scholarly journals Classification and characterisation of brain network changes in chronic back pain: A multicenter study

2018 ◽  
Vol 3 ◽  
pp. 19
Author(s):  
Hiroaki Mano ◽  
Gopal Kotecha ◽  
Kenji Leibnitz ◽  
Takashi Matsubara ◽  
Aya Nakae ◽  
...  
Keyword(s):  
Machine Learning ◽  
Chronic Pain ◽  
Deep Learning ◽  
Back Pain ◽  
Sensorimotor Cortex ◽  
Network Architecture ◽  
Chronic Back Pain ◽  
Open Data ◽  
Brain Network

Background. Chronic pain is a common, often disabling condition thought to involve a combination of peripheral and central neurobiological factors. However, the extent and nature of changes in the brain is poorly understood. Methods. We investigated brain network architecture using resting-state fMRI data in chronic back pain patients in the UK and Japan (41 patients, 56 controls), as well as open data from USA. We applied machine learning and deep learning (conditional variational autoencoder architecture) methods to explore classification of patients/controls based on network connectivity. We then studied the network topology of the data, and developed a multislice modularity method to look for consensus evidence of modular reorganisation in chronic back pain. Results. Machine learning and deep learning allowed reliable classification of patients in a third, independent open data set with an accuracy of 63%, with 68% in cross validation of all data. We identified robust evidence of network hub disruption in chronic pain, most consistently with respect to clustering coefficient and betweenness centrality. We found a consensus pattern of modular reorganisation involving extensive, bilateral regions of sensorimotor cortex, and characterised primarily by negative reorganisation - a tendency for sensorimotor cortex nodes to be less inclined to form pairwise modular links with other brain nodes. In contrast, intraparietal sulcus displayed a propensity towards positive modular reorganisation, suggesting that it might have a role in forming modules associated with the chronic pain state. Conclusion. The results provide evidence of consistent and characteristic brain network changes in chronic pain, characterised primarily by extensive reorganisation of the network architecture of the sensorimotor cortex.

Attributional Style and Depression in Men Receiving Treatment For Chronic Pain

1995 ◽  
Vol 26 (4) ◽  
pp. 21-25 ◽  
Author(s):  
Jane Boyer McGuigan
Keyword(s):  
Chronic Pain ◽  
Multivariate Analysis ◽  
Back Pain ◽  
Attributional Style ◽  
Analogue Scale ◽  
Chronic Back Pain ◽  
Demographic Information ◽  
Attributional Style Questionnaire ◽  
Control Pain ◽  
Negative Attributional Style

This study explored the applicability of Seligman's leamed helplessness theory to men receiving treatment for chronic back pain. Negative attributional style and depression scores for 112 men receiving treatment for chronic pain were obtained. Fifty-four men were receiving worker's compensation; fifty-eight were not. Participants voluntarily completed the Attributional Style Questionnaire, the Beck Depression Inventory, and a visual analogue scale measuring perceived ability to control pain. Demographic information was also obtained. Multivariate analysis of variance indicated that the groups did not differ in negative attributional style scores, but that they did differ in depression scores. No relationship was found between depression, negative attributional style, and perceived level of pain.

Use of the MMPI with Patients Who Report Chronic Back Pain

1981 ◽  
Vol 48 (3) ◽  
pp. 855-866 ◽  
Author(s):  
Kenneth M. Adams ◽  
Mary Heilbronn ◽  
Susan D. Silk ◽  
Eve Reider ◽  
Dietrich P. Blumer
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Back Pain ◽  
Low Back

The report describes previous efforts to develop distinctive MMPI scales or profiles relating to chronic pain. While most efforts are directed towards low back pain, other forms and sites of chronic pain have produced comparable results. Consistency in results across samples may suggest a common series of routes or mechanisms which characterize patients who report chronic pain.

Spinal disorders and back pain

2018 ◽  
pp. 605-622
Author(s):  
Gavin Clunie ◽  
Nick Wilkinson ◽  
Elena Nikiphorou ◽  
Deepak R. Jadon
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Children And Adolescents ◽  
Chronic Back Pain ◽  
Holistic Approach ◽  
Musculoskeletal Symptoms ◽  
Spinal Disorders ◽  
Specific Diagnosis ◽  
Pain Syndromes ◽  
Chronic Pain Syndromes

The Oxford Handbook of Rheumatology, 4th edition, chapter on ‘Spinal disorders and back pain’ brings together a pragmatic approach to categorizing back pain, how to investigate disorders presenting with back pain, and how to treat adults, children, and adolescents with back pain. In the chapter, the management of back pain is separated into acute, subacute, and chronic presenting scenarios and the text makes reference to other chapters in the book where there may be some additional useful information (e.g. spondyloarthritis-associated back pain in Chapter 8 and chronic pain syndromes in Chapter 22). Notably the chapter is best read in conjunction with relevant sections in Chapter 3 (‘Regional musculoskeletal symptoms: making a working diagnosis’). The chapter makes reference to the need for a rigorous diagnostic approach to all the conditions which cause back pain, and at whatever age. There are subsections on how to assess paediatric spinal disorders and how to take a broad holistic approach to managing chronic back pain where there is no specific diagnosis.

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