Spinal mechanisms of pain control

Mechanisms behind the Development of Chronic Low Back Pain and Its Neurodegenerative Features

Chronic back pain is complex and there is no guarantee that treating its potential causes will cause the pain to go away. Therefore, rather than attempting to "cure" chronic pain, many clinicians, caregivers and researchers aim to help educate patients about their pain and try to help them live a better quality of life despite their condition. A systematic review has demonstrated that patient education has a large effect on pain and pain related disability when done in conjunction with treatments. Therefore, understanding and updating our current state of knowledge of the pathophysiology of back pain is important in educating patients as well as guiding the development of novel therapeutics. Growing evidence suggests that back pain causes morphological changes in the central nervous system and that these changes have significant overlap with those seen in common neurodegenerative disorders. These similarities in mechanisms may explain the associations between chronic low back pain and cognitive decline and brain fog. The neurodegenerative underpinnings of chronic low back pain demonstrate a new layer of understanding for this condition, which may help inspire new strategies in pain education and management, as well as potentially improve current treatment.

Management of severe low back pain with a focused vibro-percussion wave treatment: A case report

A 49-year-old male with severe low back pain (LBP) showed multilevel disc bulges with spinal stenosis. After 18 novel low-frequency sound wave treatments, initial VAS pain score of 9.5 reduced to 2.5 and the Rolland-Morris score of 13 reduced to 3. MRI showed some resolution of L3-L4 and L4-L5.

Management of pain due to cervical multilevel disk bulges and spinal stenosis with a focused vibro-percussion wave treatment: A case report

A patient presenting with low back pain received 18 treatments of FDA-approved low-frequency vibro-percussion wave stimulation known as Khan Kinetic Treatment (KKT). Following KKT, he demonstrated improvement in pain, function, quality of life, sleep, and trunk range of motion with no adverse events.

Possible Mechanisms for the Effects of Sound Vibration on Human Health

This paper presents a narrative review of research literature to “map the landscape” of the mechanisms of the effect of sound vibration on humans including the physiological, neurological, and biochemical. It begins by narrowing music to sound and sound to vibration. The focus is on low frequency sound (up to 250 Hz) including infrasound (1–16 Hz). Types of application are described and include whole body vibration, vibroacoustics, and focal applications of vibration. Literature on mechanisms of response to vibration is categorized into hemodynamic, neurological, and musculoskeletal. Basic mechanisms of hemodynamic effects including stimulation of endothelial cells and vibropercussion; of neurological effects including protein kinases activation, nerve stimulation with a specific look at vibratory analgesia, and oscillatory coherence; of musculoskeletal effects including muscle stretch reflex, bone cell progenitor fate, vibration effects on bone ossification and resorption, and anabolic effects on spine and intervertebral discs. In every category research on clinical applications are described. The conclusion points to the complexity of the field of vibrational medicine and calls for specific comparative research on type of vibration delivery, amount of body or surface being stimulated, effect of specific frequencies and intensities to specific mechanisms, and to greater interdisciplinary cooperation and focus.

Multi-unit sustained vibration loading platform for biological tissues: design, validation and experimentation

The relationships between mechanical inputs and resulting biological tissue structure, composition, and metabolism are critical to detailing the nuances of tissue mechanobiology in both healthy and injured tissues. Developing a model system to test the mechanobiology of tissues ex-vivo is a complex task, as controlling chemical and mechanical boundary layers in-vitro are difficult to replicate. A novel multi-unit vibration loading platform for intervertebral discs was designed and validated with both independent electronic data and experimental loading of 6 bovine intervertebral discs (IVDs) and an equal number of unloaded controls. Sustained vibration was applied using closed-loop positional control of pushrods within four independent bioreactors with circulating phosphate buffered saline. The bioreactors were designed to be modular with removable components allowing for easy cleaning and replacement. The loading regime was chosen to maximize target mRNA expression as reported in previous research. Aggrecan, decorin, and versican mRNA all reported statistically significant increases above control levels. Biglycan, collagen type I and II showed no significant difference from the control group. Further study is required to determine the resulting effect of increased mRNA expressions on long-term disc health. However these results indicate that this research is past the proof of concept stage, supporting future studies of mechanobiology utilizing this new device. The next stage in developing this novel loading platform should consider modifying the tissue grips to explore the effects of different directional loading on different gene expression, and also loading different types of tissues.

Disc strain and resulting positive mRNA expression from application of a noninvasive treatment

STUDY DESIGN

Bovine caudal intervertebral discs were exposed to a noninvasive vibrating intervention for 10 minutes at amplitudes of 0 or 0.5 to 5 g and frequencies of 0, 16, 50 to 80, and a combined 16+50 to 80 Hz treatment. Expression of mRNA for aggrecan, collagen type I, collagen type II, biglycan, decorin, and versican were assayed.

OBJECTIVE

To determine if the intervention is effective in altering intervertebral disc gene expression.

SUMMARY OF BACKGROUND DATA

Studies have variously suggested either an increased risk of disc degeneration with vibrations, no effect, analgesic effect, or even positive effects within certain loading parameters. The KKT intervention is in clinical use for spinal ailment pain reduction.

METHODS

The intervention was applied in a clinic emulation set-up. Gene expression in the nucleus pulposus was assessed using real-time RT-PCR and SYBR Green chemistry.

RESULTS

Expression of mRNAs for aggrecan, collagen type II, and versican were significantly effected by the intervention. Collagen type I, biglycan, and decorin were uneffected.

CONCLUSION

Expression of the extracellular matrix genes were significantly up-regulated when vibrated with the intervention under specific loading patterns, indicating a potential therapeutic stimulus. Further studies on the protein-level and long-term effects are warranted. Previous studies have indicated a mixed effect of vibrations in the human spine. In this study, a clinical intervention using vibrations was applied to bovine intervertebral discs, and gene expression in the nucleus pulposus was measured. Several extracellular matrix genes were up-regulated, suggesting a potential therapeutic effect.

Free axial vibrations at 0 to 200 Hz positively affect extracellular matrix messenger ribonucleic acid expression in bovine nucleus pulposi

STUDY DESIGN

Bovine caudal intervertebral discs (IVDs) were exposed to free axial vibration for 10 to 60 minutes at 0 to 0.5 g and 0 to 200 Hz. Expression of messenger ribonucleic acid for aggrecan, collagen type I, collagen type II, biglycan, decorin, and versican were assayed, as was apoptosis.

OBJECTIVE

To determine the vibration conditions which are most effective in altering intervertebral disc IVD gene expression.

SUMMARY OF BACKGROUND DATA

Various studies have suggested widely varying effects of vibration in the IVD, ranging from harmful (increased risk of degeneration) to beneficial (increased analgesia) to neutral (no effect).

METHODS

Vibration was applied using a custom designed voice coil system, which generated controlled motion in the axial direction. Gene expression in the nucleus pulposus was assessed using RT-PCR and the SYBR green chemistry; apoptosis was assessed using TUNEL staining.

RESULTS

Expression of messenger ribonucleic acids for biglycan, collagen type I, collagen type II, decorin, and versican were significantly affected by vibration duration, frequency, and amplitude. Aggrecan was unaffected. Of the 3 factors, amplitude had the largest and widest effect.

CONCLUSION

Expression of extracellular matrix genes was significantly upregulated at high amplitudes (>0.4 g) in as little as 10 minutes. This may indicate a potential therapeutic stimulus; periodic application of controlled vibration could positively influence matrix maintenance. Further studies on the protein level and long-term effects are warranted.

Is vibration truly an injurious stimulus in the human spine?

Epidemiological data at one time was taken to suggest that chronic vibrations--for example operating vehicles with low-quality seats--contributed to intervertebral disc degeneration and lower back pain. More recent discussions, based in part upon extended twin studies, have cast doubt upon this interpretation, and question how much of the vibration is actually transmitted to the spine during loading. This review summarizes our recent survey of the current state of knowledge. In particular, we note that current studies are lacking a detailed factorial exploration of frequency, amplitude, and duration; this may be the primary cause for inconclusive and/or contradictory studies. It is our conclusion that vibrations are still an important consideration in discogenic back pain, and further controlled studies are warranted to definitively examine the underlying hypothesis: that chronic vibration can influence IVD cell biology and tissue mechanics.