scholarly journals Perspectives of targeted therapy for nonspecific back pain: a review of recent publications

2021 ◽  
pp. 321-326
Author(s):  
T. M. Manevich ◽  
E. A. Mkhitaryan ◽  
A. V. Naumov
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Targeted Therapy ◽  
Pain Treatment ◽  
Pain Syndrome ◽  
Immune Disorders ◽  
Aseptic Inflammation ◽  
Genetic Changes ◽  
High Incidence

The high incidence of back pain in older people, its effect on quality and duration of life, and insufficient effectiveness of existing treatment methods determine the need to search for methods of back pain treatment that will reduce inflammatory and degenerative changes and the pain syndrome itself. The review analyzes the epidemiology, pathogenesis, current methods of pharmacotherapy for back pain, the role of genetic changes and biomarkers of chronic pain, discusses current prospects for the use of targeted therapy for the treatment of chronic nonspecific back pain based on pathogenetic mechanisms (genetic changes, aseptic inflammation, immune disorders, disorders of chondrogenesis, etc.).

scholarly journals A new look at back pain treatment in light of the latest ESCEO guidelines

2020 ◽  
Vol 12 (6) ◽  
pp. 90-95
Author(s):  
O. A. Shavlovskaya ◽  
I. A. Zolotovskaya ◽  
Yu. A. Prokofyeva
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Pain Treatment ◽  
Pain Syndrome ◽  
Modern Medicine ◽  
Economic Aspects ◽  
Immune Disorders ◽  
Inflammatory Drugs ◽  
Disease Modifying

Chronic pain (CP) is still one of the urgent problems of modern medicine. The paper provides a review of the main pharmacotherapeutic approaches from the standpoint of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) guidelines. When preparing this material, the authors have analyzed the publications available in the resources: PubMed, EMBASE, Cochrane, and еLIBRARY. The paper presents the main pathogenetic mechanisms of pain syndrome development in osteoarthritis (OA), including synovial inflammation and associated immune disorders. It considers the types of development of pain syndrome and the main prognostic outcomes according the mechanism of pain, providing a rationale for the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or chondroprotectors (CPs). In accordance with the ESCEO guidelines, it is noted that when starting OA therapy, CPs should be considered as the first step (in their long-term prescription and pharmaceutical quality), then NSAIDs should be added (topically), then (if ineffective) orally, by excluding patients with hip OA. It is known that the intramuscular administration of CPs (chondroitin sulfate (CS) in particular) can increase their bioavailability. The use of glucosamine sulfate (GS) is recommended for patients over 60 years of age. According to the recommendations of the 2019 ESCEO experts, CS and GS should be used as a disease-modifying OA drug from the first step and at all subsequent stages.

scholarly journals Interactions between Musculoskeletal Dysfunction, Emotional Distress and Cytokines in Patients with Chronic Low Back Pain Syndrome

2020 ◽  
Vol 1 (6) ◽  
Author(s):  
Daina Šmite ◽  
Gunta Ancāne ◽  
Pēteris Tretjakovs
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Motor Control ◽  
Back Pain ◽  
Lumbar Spine ◽  
Emotional Distress ◽  
Chronic Low Back Pain ◽  
Pain Syndrome ◽  
Low Back

Despite different treatment methods, for approximately 30% of patients acute back pain turns into chronic pain syndrome which accompanied by disability creates remarkable material damage to patients themselves, to health care and to the society. The aim of the study was to analyse the interaction between musculoskeletal dysfunction, emotional distress and related disability, and their underlying neuroimonological pathophysiological mechanisms, in patients with chronic low back pain syndrome. The subjects were 43 patients, mean age 45 ± 1.3 years, with clinical diagnosis of lumbar spine disk pathology with chronic low back pain syndrome and present manifestation of emotional distress. All patients had complex assessment that included lumbar spine and pelvic motor control tests, muscle and ligaments palpation tests, Hospital Anxiety and Depression Scale, PF subscale of SF-36 survey, Visual Analogue Scale, immunological analysis of blood to detect the level of cytokines. The results approved interaction (p < 0.05) between motor control and palpation tests results, emotional distress features and pain intensity. Therefore musculoskeletal dysfunction in patients with chronic low back pain is connected both with physical and psycho-emotional factors, which has to be taken into account both when evaluating functional tests and during the treatment process. Clinically important finding is that limitation in physical activities in chronic low back pain patients are affected both by motor control impairment and depression symptoms, as well as pain intensity, which has to be remembered during rehabilitation planning process. Some of cytokines (TNF-a, IL-6, IL-8, IL-10, IL-2) correlated with emotional disturbances physical disturbances, pain syndrome characteristics and physical disability in patients with chronic low back pain. IL-10 and IL-8 appeared to be two of the most characteristic cytokines. It is interesting to note, that in literature studies have approved the role of IL-10 in the pathogenesis of chronic, widespread pain syndrome, but IL-8 has been shown in the role of the pathogenesis of radicular pain syndrome in patients with lumbar spine disk pathology [1, 2]. Studies of cytokines extend the understanding of bio-psycho-social aspects of chronic pain syndrome pathogenesis therefore improving process of assessment, clinical reasoning and therapy.Keywords: musculoskeletal dysfunction, emotional distress, chronic pain, cytokines.

scholarly journals The role of B vitamins in the treatment of back pain

2018 ◽  
pp. 38-43
Author(s):  
N. Svyrydova
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Back Pain ◽  
Pain Syndrome ◽  
Epidemiological Studies ◽  
B Vitamins ◽  
Chronic Pain Syndrome ◽  
Occupational Risk Factors ◽  
Inflammatory Drugs

In 2018, an analysis of epidemiological studies was conducted that provided information on the prevalence of back pain and identified individual, psychosocial and occupational risk factors for the onset of this pathology. It is important that when choosing the tactics of treatment, it is necessary to take into account the risk of complications in the presence of multimorbid pathology in patients with acute or chronic pain syndrome. Increasing the effectiveness and safety of therapy based on the use of nonsteroidal anti-inflammatory drugs, the risk of which can be minimized, is associated with the inclusion of B vitamins. The results of various clinical studies on the use of the B complex of vitamins showed a significant decrease in the severity of the pain syndrome and a significant improvement in motor functions, regression of sensitive disorders.

scholarly journals Prospects for the Personalized Multimodal Therapy Approach to Pain Management via Action on NO and NOS

Molecules ◽  
2021 ◽  
Vol 26 (9) ◽  
pp. 2431
Author(s):  
Natalia A. Shnayder ◽  
Marina M. Petrova ◽  
Tatiana E. Popova ◽  
Tatiana K. Davidova ◽  
Olga P. Bobrova ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Molecular Genetic ◽  
Pain Syndrome ◽  
Medical Problem ◽  
Single Nucleotide Variants ◽  
Genetic Studies ◽  
Pain Syndromes ◽  
Nos Inhibitors ◽  
Peripheral Pain

Chronic pain syndromes are an important medical problem generated by various molecular, genetic, and pathophysiologic mechanisms. Back pain, neuropathic pain, and posttraumatic pain are the most important pathological processes associated with chronic pain in adults. Standard approaches to the treatment of them do not solve the problem of pain chronicity. This is the reason for the search for new personalized strategies for the prevention and treatment of chronic pain. The nitric oxide (NO) system can play one of the key roles in the development of peripheral pain and its chronicity. The purpose of the study is to review publications devoted to changes in the NO system in patients with peripheral chronical pain syndromes. We have carried out a search for the articles published in e-Library, PubMed, Oxford Press, Clinical Case, Springer, Elsevier, and Google Scholar databases. The search was carried out using keywords and their combinations. The role of NO and NO synthases (NOS) isoforms in peripheral pain development and chronicity was demonstrated primarily from animal models to humans. The most studied is the neuronal NOS (nNOS). The role of inducible NOS (iNOS) and endothelial NOS (eNOS) is still under investigation. Associative genetic studies have shown that single nucleotide variants (SNVs) of NOS1, NOS2, and NOS3 genes encoding nNOS, iNOS, and eNOS may be associated with acute and chronic peripheral pain. Prospects for the use of NOS inhibitors to modulate the effect of drugs used to treat peripheral pain syndrome are discussed. Associative genetic studies of SNVs NOS1, NOS2, and NOS3 genes are important for understanding genetic predictors of peripheral pain chronicity and development of new personalized pharmacotherapy strategies.

Problematic Prescription Opioid Use in a Chronic Pain Treatment Facility: The Role of Emotional Processes

2018 ◽  
Vol 54 (3) ◽  
pp. 495-505 ◽  
Author(s):  
Lindsay M. S. Oberleitner ◽  
Mark A. Lumley ◽  
Emily R. Grekin ◽  
Kathryn M. Z. Smith ◽  
Amy M. Loree ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Treatment Facility ◽  
Emotional Processes ◽  
Chronic Pain Treatment ◽  
Prescription Opioid Use

scholarly journals Optogenetics and photopharmacology in pain research and therapeutics

STEMedicine ◽  
2020 ◽  
Vol 1 (3) ◽  
pp. e43 ◽  
Author(s):  
Federico Iseppon ◽  
Manuel Arcangeletti
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Molecular Switches ◽  
Genetic Profiling ◽  
Pain Research ◽  
Recent Advances ◽  
Cellular Components ◽  
The Brain

Pain afflicts billions of people worldwide, who suffer especially from long-term chronic pain. This gruelling condition affects the nervous system at all levels: from the brain to the spinal cord, the Dorsal Root Ganglia (DRG) and the peripheral fibres innervating the skin. The nature of the different molecular and cellular components of the somatosensory modalities, as well as the complexity of the peripheral and central circuitry are yet poorly understood. Light-based techniques such as optogenetics, in concert with the recent advances in single-cell genetic profiling, can help to elucidate the role of diverse neuronal sub-populations in the encoding of different sensory and painful stimuli by switching these neurons on and off via optically active proteins, namely opsins.  Recently, photopharmacology has emerged from the efforts made to advance optogenetics. The introduction of azo-benzene-based light-sensitive molecular switches has been applied to a wide variety of molecular targets, from ion channels and receptors to transporters, enzymes and many more, some of which are paramount for pain research and therapy. In this Review, we summarise the recent advances in the fields of optogenetics and photopharmacology and we discuss the use of light-based techniques for the study of acute and chronic pain physiology, as well as their potential for future therapeutic use to improve pain treatment.

scholarly journals Complex Regional Pain Syndrome and Failed Back Surgery Syndrome With Failed High-Frequency Spinal Cord Stimulation Salvaged With Arthrodesis Revision Surgery and Burst Therapy

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Erin McCormack ◽  
Mansour H Mathkour ◽  
Lora Wallis Kahn ◽  
Maged Guirguis ◽  
Gassan Chaiban ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Back Pain ◽  
Pain Relief ◽  
High Frequency ◽  
Pain Syndrome ◽  
Failed Back Surgery Syndrome ◽  
Foot Pain ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract INTRODUCTION Complex regional pain syndrome (CRPS) is a disabling form of constant and intense chronic pain involving a limb. Failed back surgery syndrome (FBSS) is chronic back pain following back surgery. Burst stimulation is a novel concept applied recently to treat chronic pain through spinal cord stimulation (SCS). The impulses are thought to travel to the thalamus to treat sensory, affective, and attentional components of neuropathic pain by targeting both the somatosensory cortex and the limbic system. METHODS A 50-yr-old female presented 1 yr after L5-S1 posterior instrumentation and posterolateral arthrodesis for spondylolisthesis with disabling Type I CRPS of her left foot and back pain. Postoperative improvement in back pain was noted but her left leg pain became worse despite SCS reprogramming. Two months later, she underwent placement of a different paddle lead at T12 and a new pulse generator using burst therapy. This resulted in complete resolution of foot pain. She remains pain-free 5 mo postoperatively. RESULTS Our patient underwent a T9-T10 high frequency (10 kHz) SCS trial followed by permanent paddle lead placement at T9-10 which provided more than 50% foot pain relief resulting in improved range of motion. However, worsening back pain and pseudoarthrosis mandated a revision of her prior arthrodesis 6 mo after SCS surgery. CONCLUSION In selected patients with FBSS and CRPS, revision of arthrodesis combined with SCS may be needed to achieve adequate pain relief. Burst therapy may be superior to high frequency stimulation in select patients.

scholarly journals Comprehensive Review of Epidemiology, Scope, and Impact of Spinal Pain

2009 ◽  
Vol 4;12 (4;7) ◽  
pp. E35-E70
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Neck Pain ◽  
Pain Syndrome ◽  
Spinal Pain ◽  
The United States ◽  
Low Back ◽  
Chronic Pain Syndrome

Persistent pain interfering with daily activities is common. Chronic pain has been defined in many ways. Chronic pain syndrome is a separate entity from chronic pain. Chronic pain is defined as, “pain that persists 6 months after an injury and beyond the usual course of an acute disease or a reasonable time for a comparable injury to heal, that is associated with chronic pathologic processes that cause continuous or intermittent pain for months or years, that may continue in the presence or absence of demonstrable pathologies; may not be amenable to routine pain control methods; and healing may never occur.” In contrast, chronic pain syndrome has been defined as a complex condition with physical, psychological, emotional, and social components. The prevalence of chronic pain in the adult population ranges from 2% to 40%, with a median point prevalence of 15%. Among chronic pain disorders, pain arising from various structures of the spine constitutes the majority of the problems. The lifetime prevalence of spinal pain has been reported as 54% to 80%. Studies of the prevalence of low back pain and neck pain and its impact in general have shown 23% of patients reporting Grade II to IV low back pain (high pain intensity with disability) versus 15% with neck pain. Further, age related prevalence of persistent pain appears to be much more common in the elderly associated with functional limitations and difficulty in performing daily life activities. Chronic persistent low back and neck pain is seen in 25% to 60% of patients, one-year or longer after the initial episode. Spinal pain is associated with significant economic, societal, and health impact. Estimates and patterns of productivity losses and direct health care expenditures among individuals with back and neck pain in the United States continue to escalate. Recent studies have shown significant increases in the prevalence of various pain problems including low back pain. Frequent use of opioids in managing chronic non-cancer pain has been a major issue for health care in the United States placing a significant strain on the economy with the majority of patients receiving opioids for chronic pain necessitating an increased production of opioids, and escalating costs of opioid use, even with normal intake. The additional costs of misuse, abuse, and addiction are enormous. Comorbidities including psychological and physical conditions and numerous other risk factors are common in spinal pain and add significant complexities to the interventionalist’s clinical task. This section of the American Society of Interventional Pain Physicians (ASIPP)/EvidenceBased Medicine (EBM) guidelines evaluates the epidemiology, scope, and impact of spinal pain and its relevance to health care interventions. Key words: Chronic pain, chronic spinal pain, chronic low back pain, chronic neck pain, chronic thoracic pain, prevalence, health care utilization, loss of productivity, interventional techniques, surgery, comorbid factors, socioeconomic effects, health care impact

scholarly journals FACTORS OF INFLUENCE ON PAIN INTENSITY AND FUNCTIONAL ACTIVITY OF PATIENTS WITH BACK PAIN OF DIFFERENT LOCALIZATION

2019 ◽  
pp. 35-43
Author(s):  
I. G. Maslova ◽  
N. O. Mykhailovska ◽  
T. M. Slobodin
Keyword(s):  
Mental Health ◽  
Chronic Pain ◽  
Back Pain ◽  
Pain Syndrome ◽  
Anxiety And Depression ◽  
Vital Activity ◽  
Lower Back ◽  
Sf 36 ◽  
Factors Of Influence ◽  
High Level

In order to identify the probable factors of the effect on the intensity of the pain syndrome and the parameters of the functioning of patients with back pain, depending on the location of the pain syndrome and concomitant pathology, 139 patients with non-specific back pain who were in inpatient treatment in the medical and sanitary part of JSC "Motor -Sich "with the first detected acute pain syndrome and acute exacerbation of chronic. The results of the study revealed a decrease in the level of physical functioning, deterioration of vital activity and the state of general and mental health (on the scale of SF-36) in patients with exacerbation of chronic pain, the lowest indicators of vital activity, social functioning, mental health and a high level of anxiety and depression - in patients with cervical and cranial localization of pain syndrome, despite the fact that patients with localized pain in the lower back are markedly higher levels of pain not only for YES, but also zg BP bottom axis scale SF-36. Patients with a combination of arterial hypertension and diabetes have been shown to have chronic pain syndrome.

scholarly journals ROLE OF AGNI VAISHAMYA IN CHRONIC PAIN PATHOLOGIES WITH SPECIAL REFERENCE TO NECK AND BACK PAIN- A CROSS SECTIONAL STUDY.

2016 ◽  
Vol 7 (3) ◽  
Author(s):  
Mukesh Edavalath
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Cross Sectional Study ◽  
Low Back ◽  
College Hospital ◽  
Cross Sectional ◽  
Treatment Regimens ◽  
Ayurvedic Treatment ◽  
Sectional Analysis

Chronic back and neck pain are common clinical entities in ayurvedic practice. Most of the patients are not rendered pain free with the current ayurvedic treatment regimens. Ayurveda considers agni (digestive power) derangements as the basic cause for all nija rogas (endogenous diseases). The term agnivaishamya is implied for functional derangement of agni. Emerging evidences through modern researches point to the role of GI dysfunctions in pain pathologies.  A cross sectional analysis of patients with chronic pain in the neck and back was conducted at VPSV Ayurveda college hospital to explore associations between pain and features of agnivaishamya in koshta (GIT). In the twenty eight patients analyzed, significant association has been found between pain in low back and koshta (GIT) features like Arsas (hemorrhoids) and vibandha (Constipation). Strength of association was more between arsas and low back pain with OR  of 4.2 (P<0.05). In the case of cervical pain , multiple features of Koshta like avipaka (feeling of indigestion), aruchi (anorexia), amlodgara (sour eructations), urodhumayana (chest burn) and muhurbadha muhurdrava pureesha (alternating constipation and loose stools) were found to be associated. Hence it can be concluded that there is significant association of agnivaishamya with chronic pain in neck and back.

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