A retrospective study evaluating the trend of opioid prescribing in low back pain at a UK teaching hospital

2021 ◽  
Vol 17 (6) ◽  
pp. 465-479
Author(s):  
Ben Hunter, MBChB, BSc (Hons) ◽  
Shiva Tripathi, MBBS, FRCA, CCT
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Teaching Hospital ◽  
Current Data ◽  
Pain Clinic ◽  
Low Back ◽  
Absolute Change ◽  
Pain Scores ◽  
Strong Opioids

Introduction: Current data suggest that the chronic use of strong opioids in low back pain (LBP) is increasing. There is evidence for the use of opioids in the initial management of LBP, but the efficacy in the long term is unknown. This article intends to examine the use of opioids in patients with chronic LBP over a period of three doctor-led clinics.Methods: Single-center retrospective cohort study following 200 patients through the pain clinic at a UK teaching hospital for more than two clinic visits, up to a maximum of three. Data concerning demographics, pain scores, medication changes, and clinic outcome.Results: Data collected showed that there was a significant correlation between baseline morphine equivalent amount (MEA) and final clinic MEA; initial pain scores and final clinic MEA; cause of LBP and final clinic LBP; and traumatic LBP and absolute change in MEA. There was no association between number of physical interventions and MEA. The sample also showed an average absolute change in MEA by 2.93 ± 57.86 mg. The proportion of patients with a MEA of 50 mg/d increased from 24 to 29 percent. The proportion of patients on opioids at least one opioid increased by 10 percent.Conclusions: Significant predictors of final clinic MEA were initial pain scores, baseline MEA, and the cause of LBP. Duration of pain was a poor predictor of MEA. There was no association between MEA and number of interventions. In this cohort, the trend seems to be increasing the number and dose of opioids in patients with LBP.

scholarly journals Smartphone usage duration is not associated with increased pain or proprioception deficit in young adults with chronic mechanical low back pain: a cross-sectional study

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Mina Magdy Wahba ◽  
Dina Othman Shokri Morsi Galal ◽  
Aliaa Rehan Youssef
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cross Sectional Study ◽  
Task Completion ◽  
Smartphone Addiction ◽  
Low Back ◽  
Cross Sectional ◽  
Pain Scores ◽  
Smartphone Use ◽  
Continuous Use

Abstract Background Smartphone use has been associated with pain in the upper quadrant; however, the relationship between usage duration and low back pain is still unclear. This study investigated the association between continuous smartphone use up to 30-min and back pain severity and proprioception acuity in patients with chronic low back pain. Fifty-eight patients with chronic mechanical LBP played a game for 10- and 30-min. In each session, pain and back repositioning errors were measured at baseline and immediately after task completion. Results Pain significantly but slightly increased following smartphone use, regardless to the duration (after 10 min: mean increase = 0.75 ± 1.17, P value < 0.001, 95% CI 0.44–1.06; after 30 min: mean increase = 0.96 ± 1.93, P value < 0.001, 95% CI 0.44–1.46). However, changes in perceived pain scores were not significantly different between the two tested durations (P value = 0.42). Proprioception repositioning error was not significantly different within the same testing session (mean change = 0.08 ± 1.83, 0.13 ± 1.77, P value = 0.73, 0.58, 95% CI − 0.40–0.56, − 0.60–0.33, for the 10 and 30 min, respectively). The changes in proprioception were not significant between the two-tested durations (P value = 0.56). Further, smartphone addiction did not significantly affect changes in pain and proprioception after game playing, regardless of the duration (P > 0.05). Conclusions These findings show that smartphone use slightly increases back pain immediately after continuous use; with no effect on back proprioception within the duration tested in this study. Changes in pain and proprioception were not influenced by smartphone addiction.

scholarly journals Long-term improvements following a residential combined physical and psychological programme for chronic low back pain

2021 ◽  
Vol 10 (2) ◽  
pp. e001068
Author(s):  
Shaun Wellburn ◽  
Cormac G Ryan ◽  
Andrew Coxon ◽  
Alastair J Dickson ◽  
D John Dickson ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Outcome Measures ◽  
Chronic Low Back Pain ◽  
Rating Scale ◽  
Secondary Outcome ◽  
Low Back ◽  
Residential Setting ◽  
Wide Range

ObjectivesEvaluate the outcomes and explore experiences of patients undergoing a residential combined physical and psychological programme (CPPP) for chronic low back pain.DesignA longitudinal observational cohort design, with a parallel qualitative design using semistructured interviews.SettingResidential, multimodal rehabilitation.Participants136 adults (62 male/74 female) referred to the CPPP, 100 (44 male/56 female) of whom completed the programme, during the term of the study. Ten (2 male/8 female) participated in the qualitative evaluation.InterventionA 3-week residential CPPP.Outcome measuresPrimary outcome measures were the STarT Back screening tool score; pain intensity—11-point Numerical Rating Scale; function—Oswestry Disability Index (ODI); health status/quality of life—EQ-5D-5L EuroQol five-Dimension-five level; anxiety—Generalised Anxiety Disorder-7; depression—Patient Health Questionnaire-9. Secondary outcome measures were the Global Subjective Outcome Scale; National Health Service Friends and Family Test;.ResultsAt discharge, 6 and 12 months follow ups, there were improvements from baseline that were greater than minimum clinically important differences in each of the outcomes (with the sole exception of ODI at discharge). At 12 months, the majority of people considered themselves a lot better (57%) and were extremely likely (86%) to recommend the programme to a friend. The qualitative data showed praise for the residential nature of the intervention and the opportunities for interaction with peers and peer support. There were testimonies of improvements in understanding of pain and how to manage it better. Some participants said they had reduced, or stopped, medication they had been taking to manage their pain.ConclusionsParticipants improved, and maintained long term, beyond minimum clinically important differences on a wide range of outcomes. Participants reported an enhanced ability to self-manage their back pain and support for the residential setting.

Long-term Outcomes in Multidisciplinary Treatment of Chronic Low Back Pain

Spine ◽  
2004 ◽  
Vol 29 (8) ◽  
pp. 850-855 ◽  
Author(s):  
Luke E. Patrick ◽  
Elizabeth M. Altmaier ◽  
Ernest M. Found
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Multidisciplinary Treatment ◽  
Low Back ◽  
Long Term Outcomes

Does early change predict long-term (6 months) improvements in subjects who receive manual therapy for low back pain?

2017 ◽  
Vol 33 (9) ◽  
pp. 716-724 ◽  
Author(s):  
Chad Cook ◽  
Shannon Petersen ◽  
Megan Donaldson ◽  
Mark Wilhelm ◽  
Ken Learman
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Manual Therapy ◽  
Low Back ◽  
Early Change

scholarly journals Intervertebral disc therapies for non-specific chronic low back pain: a systematic review and meta-analysis

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110280
Author(s):  
Camille Daste ◽  
Stéphanie Laclau ◽  
Margaux Boisson ◽  
François Segretin ◽  
Antoine Feydy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Disc ◽  
Chronic Low Back Pain ◽  
Meta Analysis ◽  
Activity Limitations ◽  
Low Back ◽  
Short Term

Objectives: We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP). Methods: We conducted a systematic review and meta-analysis of randomized trials of IDTs versus placebo interventions, active comparators or usual care. EMBASE, MEDLINE, CENTRAL and CINHAL databases and conference abstracts were searched from inception to June 2020. Two independent investigators extracted data. The primary outcome was LBP intensity at short term (1 week–3 months), intermediate term (3–6 months) and long term (after 6 months). Results: Of 18 eligible trials (among 1396 citations), five assessed glucocorticoids (GCs) IDTs and were included in a quantitative synthesis; 13 assessed other products including etanercept ( n = 2), tocilizumab ( n = 1), methylene blue ( n = 2), ozone ( n = 2), chymopapaine ( n = 1), glycerol ( n = 1), stem cells ( n = 1), platelet-rich plasma ( n = 1) and recombinant human growth and differentiation factor-5 ( n = 2), and were included in a narrative synthesis. Standardized mean differences (95% CI) for GC IDTs for LBP intensity and activity limitations were −1.33 (−2.34; −0.32) and −0.76 (−1.85; 0.34) at short term, −2.22 (−5.34; 0.90) and −1.60 (−3.51; 0.32) at intermediate term and −1.11 (−2.91; 0.70) and −0.63 (−1.68; 0.42) at long term, respectively. Odds ratios (95% CI) for serious and minor adverse events with GC IDTs were 1.09 (0.25; 4.65) and 0.97 (0.49; 1.91). Conclusion: GC IDTs are associated with a reduction in LBP intensity at short term in people with NScLBP. Positive effects are not sustained. IDTs have no effect on activity limitations. Our conclusions are limited by high heterogeneity and a limited methodological quality across studies. Registration PROSPERO: CRD42019106336.

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