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Alizadeh R, Sharifzadeh SR. Pathogenesis, etiology and treatment of failed back surgery syndrome. Neurochirurgie 2021; 68:426-431. [PMID: 34543614 DOI: 10.1016/j.neuchi.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/22/2021] [Accepted: 09/04/2021] [Indexed: 12/19/2022]
Abstract
Failed back surgery syndrome (FBSS) is associated with persistent lower back pain after and despite one or more surgical interventions. A number of factors underlie and maintain FBSS and successful management of pain chiefly depends on identifying them. Pharmacological, surgical, and non-surgical therapeutic measures are taken to treat the pain. Spinal cord stimulation and nerve stimulation have been widely practiced in this regard and enhanced pain reduction and patient satisfaction. In hernia and recurrent disc degeneration and sagittal imbalance, discectomy and/or fusion are indicated. The present review focuses on FBSS and its underlying components and on available treatment options.
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Affiliation(s)
- R Alizadeh
- Department of Anesthesiology and Intensive Care, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - S R Sharifzadeh
- Department of Orthopedic Surgery, School of Medicine, AJA University of Medical Science, Tehran, Iran.
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2
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Plazier M, Raymaekers V, Bruyneel L, Coeckelberghs E, Sermeus W, Vanhaecht K, Duyvendak W. A 15-Year Follow-up Retrospective Study on 959 Spine Surgeries: What Can We Learn From Real-world Data? Clin Spine Surg 2021; 34:E282-E288. [PMID: 33560014 DOI: 10.1097/bsd.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE The aim of this study was to investigate the patient flow and need for additional surgery after first-time lower back surgery. Next, we analyzed the patients who developed chronic low back pain (LBP) and were treated with spinal cord stimulation. SUMMARY OF BACKGROUND DATA LBP has a lifetime prevalence of 84% and imposes a high economic burden. Treatment is focused on preventing chronic pain. Research has shown the efficacy of treatment options. However, less is known about who benefits the most from which therapy and when they should be positioned in the treatment algorithm. METHODS In this retrospective study, data of all patients who underwent first-time surgery from 2000 to 2004 were included. After 10-15 years, patients were contacted about their quality of life (QoL) (EuroQoL-5 Dimension) and life and heath perception (EuroQoL Visual Analogue Scale). RESULTS In all, 959 patients underwent surgery at the lower back area. Follow-up time ranged from 13 to 17 years; 225 patients (23.5%) underwent a second surgery. In total, 20 patients (2.1%) developed chronic neuropathic back pain and received spinal cord stimulation therapy. Ten years postsurgery, 438 (45.7%) patients completed the QoL and LBP questionnaires. The health-related QoL and health situation were significantly lower in patients with multiple surgeries ( P <0.001). CONCLUSIONS The study results indicate that large data sets, with multiple outcome measurements and long-term follow-up are necessary to improve our knowledge and to optimize the therapeutic pathway. In that way, we might learn how to select a patient for the right treatment or treatments at the right moment and shorten the circulation in our health care system.
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Affiliation(s)
- Mark Plazier
- Department of Neurosurgery, Jessa Hospital
- Neurosurgery Study & Training Center Virga Jesse
- Faculty of Medicine and Life Science, Hasselt University, Hasselt
| | | | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | | | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Wim Duyvendak
- Department of Neurosurgery, Jessa Hospital
- Neurosurgery Study & Training Center Virga Jesse
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3
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Zemedikun DT, Kigozi J, Wynne-Jones G, Guariglia A, Roberts T. Methodological considerations in the assessment of direct and indirect costs of back pain: A systematic scoping review. PLoS One 2021; 16:e0251406. [PMID: 33974661 PMCID: PMC8112645 DOI: 10.1371/journal.pone.0251406] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Back pain is a common and costly health problem worldwide. There is yet a lack of consistent methodologies to estimate the economic burden of back pain to society. Objective To systematically evaluate the methodologies used in the published cost of illness (COI) literature for estimating the direct and indirect costs attributed to back pain, and to present a summary of the estimated cost burden. Methods Six electronic databases were searched to identify COI studies of back pain published in English up to February 2021. A total of 1,588 abstracts were screened, and 55 full-text studies were subsequently reviewed. After applying the inclusion criteria, 45 studies pertaining to the direct and indirect costs of back pain were analysed. Results The studies reported data on 15 industrialised countries. The national cost estimates of back pain in 2015 USD ranged from $259 million ($29.1 per capita) in Sweden to $71.6 billion ($868.4 per capita) in Germany. There was high heterogeneity among the studies in terms of the methodologies used for analysis and the resulting costs reported. Most of the studies assessed costs from a societal perspective (n = 29). The magnitude and accuracy of the reported costs were influenced by the case definition of back pain, the source of data used, the cost components included and the analysis method. Among the studies that provided both direct and indirect cost estimates (n = 15), indirect costs resulting from lost or reduced work productivity far outweighed the direct costs. Conclusion Back pain imposes substantial economic burden on society. This review demonstrated that existing published COI studies of back pain used heterogeneous approaches reflecting a lack of consensus on methodology. A standardised methodological approach is required to increase credibility of the findings of COI studies and improve comparison of estimates across studies.
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Affiliation(s)
- Dawit T. Zemedikun
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
- * E-mail:
| | - Jesse Kigozi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
| | - Gwenllian Wynne-Jones
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, Keele, England, United Kingdom
| | - Alessandra Guariglia
- Department of Economics, University of Birmingham, Birmingham, England, United Kingdom
| | - Tracy Roberts
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
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Coeckelberghs E, Verbeke H, Desomer A, Jonckheer P, Fourney D, Willems P, Coppes M, Rampersaud R, van Hooff M, van den Eede E, Kulik G, de Goumoëns P, Vanhaecht K, Depreitere B. International comparative study of low back pain care pathways and analysis of key interventions. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1043-1052. [PMID: 33427958 DOI: 10.1007/s00586-020-06675-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Low back pain (LBP) is a major public health problem worldwide. Significant practice variation exists despite guidelines, including strong interventionist focus by some practitioners. Translation of guidelines into pathways as integrated treatment plans is a next step to improve implementation. The goal of the present study was to analyze international examples of LBP pathways in order to identify key interventions as building elements for care pathway for LBP and radicular pain. METHODS International examples of LBP pathways were searched in literature and grey literature. Authors of pathways were invited to fill a questionnaire and to participate in an in-depth telephone interview. Pathways were quantitatively and qualitatively analyzed, to enable the identification of key interventions to serve as pathway building elements. RESULTS Eleven international LBP care pathways were identified. Regional pathways were strongly organized and included significant training efforts for primary care providers and an intermediate level of caregivers in between general practitioners and hospital specialists. Hospital pathways had a focus on multidisciplinary collaboration and stepwise approach trajectories. Key elements common to all pathways included the consecutive screening for red flags, radicular pain and psychosocial risk factors, the emphasis on patient empowerment and self-management, the development of evidence-based consultable protocols, the focus on a multidisciplinary work mode and the monitoring of patient-reported outcome measures. CONCLUSION Essential building elements for the construction of LBP care pathways were identified from a transversal analysis of key interventions in a study of 11 international examples of LBP pathways.
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Affiliation(s)
| | - Hilde Verbeke
- Leuven Center for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Anja Desomer
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | - Daryl Fourney
- Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Paul Willems
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maarten Coppes
- Groningen Spine Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Raja Rampersaud
- Department of Surgery, Division of Orthopaedics, University Health Network Toronto, Toronto, Canada
| | | | | | - Gerit Kulik
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pierre de Goumoëns
- Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KULeuven, Leuven, Belgium
| | - Bart Depreitere
- Neurosurgery, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Kaijankoski H, Nissen M, Ikäheimo TM, von Und Zu Fraunberg M, Airaksinen O, Huttunen J. Effect of Spinal Cord Stimulation on Early Disability Pension in 198 Failed Back Surgery Syndrome Patients: Case-Control Study. Neurosurgery 2020; 84:1225-1232. [PMID: 30476235 PMCID: PMC6520102 DOI: 10.1093/neuros/nyy530] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/09/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Spinal cord stimulation (SCS) has proven to be a cost-effective treatment for failed back surgery syndrome (FBSS). However, the effect on patients’ working capability remains unclear. OBJECTIVE To evaluate the impact of SCS on working capability and to identify the factors behind permanent disability in FBSS patients. METHODS The study group consisted of 198 working-age patients with SCS trialed or implanted for FBSS in a single center between 1996 and 2014. For each patient, 3 living controls, matched by age, gender, and birthplace, were otherwise randomly selected by the Population Register Center. The data on working ability were obtained from the Social Insurance Institution. Patients were divided into 3 groups: SCS trial only, SCS implanted permanently, and SCS implanted but later explanted. RESULTS A rehabilitation subsidy was given to 68 patients and 8 controls for a mean of 5.2 (95% confidence interval [CI] 2.4-8.2) and 0.2 (95% CI 0.05-0.6) days per month (P < .05). At the end of follow-up, 16 (37%), 13 (33%), 25 (22%), and 27 (5%) subjects were on disability pension (DP) in the SCS trial, SCS explanted, SCS permanent, and control groups. Patients in the SCS trial-only group were significantly more often on DP than were patients with permanent SCS (odds ratio 2.6; 95% CI 1.2-5.9; P = .02) CONCLUSION Permanent SCS usage was associated with reduced sick leave and DP. Prospective study will be required to assess possible predictive value.
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Affiliation(s)
- Hanna Kaijankoski
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital (KUH), and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mette Nissen
- Department of Neurosurgery, Kuopio University Hospital (KUH), and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tiina-Mari Ikäheimo
- Department of Neurosurgery, Kuopio University Hospital (KUH), and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Department of Neurosurgery, Kuopio University Hospital (KUH), and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Olavi Airaksinen
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital (KUH), and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Department of Neurosurgery, Kuopio University Hospital (KUH), and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Schneider BJ, Doan L, Maes MK, Martinez KR, Gonzalez Cota A, Bogduk N. Systematic Review of the Effectiveness of Lumbar Medial Branch Thermal Radiofrequency Neurotomy, Stratified for Diagnostic Methods and Procedural Technique. PAIN MEDICINE 2020; 21:1122-1141. [DOI: 10.1093/pm/pnz349] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Objective
To determine the effectiveness of lumbar medial branch thermal radiofrequency neurotomy based on different selection criteria and procedural techniques.
Design
Comprehensive systematic review.
Methods
A comprehensive literature search was conducted, and all authors screened and evaluated the studies. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess all eligible studies.
Outcome Measures
The primary outcome measure assessed was the success rate of the procedure, defined by varying degrees of pain relief following neurotomy. Data are stratified by number of diagnostic blocks and degree of pain relief, as well as procedural technique with perpendicular or parallel placement of electrodes.
Results
Results varied by selection criteria and procedural technique. At six months, 26% of patients selected via single medial branch block with 50% pain relief and treated via perpendicular technique achieved at least 50% pain relief; 49% of patients selected via dual medial branch blocks with 50% pain relief and treated via parallel technique achieved at least 50% pain relief. The most rigorous patient selection and technique—two diagnostic medial branch blocks with 100% pain relief and parallel electrode placement—resulted in 56% of patients experiencing 100% relief of pain at six months.
Conclusions
This comprehensive systematic review found differences in the effectiveness of lumbar medial branch radiofrequency neurotomy when studies were stratified by patient selection criteria and procedural technique. The best outcomes are achieved when patients are selected based on high degrees of pain relief from dual medial branch blocks with a technique employing parallel electrode placement.
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Affiliation(s)
- Byron J Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee
| | - Lisa Doan
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU School of Medicine, New York, New York, USA
| | - Marc K Maes
- Department of Anesthesia, Pain Clinic, A.Z. Jan Portaels, Vilvoorde, Belgium, Rugpoli Brabant/Kliniek, Tilburg, the Netherlands
| | | | | | - Nikolai Bogduk
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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Janssens L, Goossens N, Wand BM, Pijnenburg M, Thys T, Brumagne S. The development of the Dutch version of the Fremantle Back Awareness Questionnaire. Musculoskelet Sci Pract 2017; 32:84-91. [PMID: 28917134 DOI: 10.1016/j.msksp.2017.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/05/2017] [Accepted: 09/04/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Disturbed body perception may play a role in the aetiology of chronic low back pain (LBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is currently the only self-report questionnaire to assess back-specific body perception in individuals with LBP. OBJECTIVES To perform a cross-cultural adaptation of the FreBAQ into Dutch. DESIGN Psychometric study. METHODS A Dutch version of the FreBAQ was generated through forward-backward translation, and was completed by 73 patients with LBP and 73 controls to assess discriminant validity. Structural validity was assessed by principal component analysis. Internal consistency was assessed by the Cronbach's alpha coefficient. Construct validity was assessed by examining the relationship with clinical measures (Numerical Rating Scale pain, Oswestry Disability Index (ODI), Tampa Scale for Kinesiophobia). Test-retest reliability was assessed in a subgroup (n = 48 with LBP and 48 controls) using intraclass correlation coefficients (ICC), standard error of measurement (SEM) and minimal detectable change (MDC 95%) RESULTS: The Dutch FreBAQ showed one component with eigenvalue >2. Cronbach's alpha values were respectively 0.82 and 0.73 for the LBP and control group. ICC values were respectively 0.69 and 0.70 for the LBP and control group. In the LBP group, the SEM was 3.9 and the MDC (95%) was 10.8. The LBP group (ODI 22 ± 21%) scored significantly higher on the Dutch FreBAQ than the control group (ODI 0%) (11 ± 7 vs. 3 ± 9, p < 0.001). Within the LBP group, higher Dutch FreBAQ scores correlated significantly with higher ODI scores (rho = 0.30, p = 0.010), although not with pain (rho = 0.10, p = 0.419) or kinesiophobia (r = 0.14, p = 0.226). CONCLUSIONS The Dutch version of the FreBAQ can be considered as unidimensional and showed adequate internal consistency, sufficient test-retest reliability and adequate discriminant and construct validity in individuals with and without LBP. It can improve our understanding on back-specific perception in the Dutch-speaking population with LBP.
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Affiliation(s)
- Lotte Janssens
- KU Leuven - Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3000 Leuven, Belgium; Hasselt University, BIOMED, REVAL, Agoralaan, 3590 Diepenbeek, Belgium; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Nina Goossens
- KU Leuven - Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3000 Leuven, Belgium; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, 32 Mouat Street, Fremantle, WA 6959, Australia.
| | - Madelon Pijnenburg
- Department of Allied Health Professions, Fontys University of Applied Sciences, Ds. Th. Fliednerstraat 2, 5631 BN Eindhoven, The Netherlands.
| | - Tinne Thys
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Simon Brumagne
- KU Leuven - Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3000 Leuven, Belgium; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Andreu V, Arruebo M. Current progress and challenges of nanoparticle-based therapeutics in pain management. J Control Release 2017; 269:189-213. [PMID: 29146243 DOI: 10.1016/j.jconrel.2017.11.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/10/2017] [Accepted: 11/11/2017] [Indexed: 02/07/2023]
Abstract
Pain is a widespread and growing health problem worldwide that exerts a considerable social and economic impact on both patients and healthcare systems and, therefore, on society in general. Although current treatment modalities include a wide variety of pharmacological and non-pharmacological approaches, due to the complexity of pain and individual differences in clinical response these options are not always effective in mitigating and relieving pain. In addition, some pain drugs such as non-steroidal anti-inflammatory drugs (NSAIDs), local anesthetics and opioids show several unfavorable side effects. Therefore, current research advances in this medical field are based on the development of potential treatments to address many of the unmet needs and to overcome the existing limitations in pain management. Nanoparticle drug delivery systems present an exciting opportunity as alternative platforms to improve efficacy and safety of medications currently in use. Herein, we review a broad range of nanoparticle formulations (organic nanostructures and inorganic nanoparticles), which have been developed to encapsulate an array of painkillers, paying special attention to the key advantages that these systems offer, (compared to the use of the free drug), as well as to the more relevant results of preclinical studies in animal models. Additionally, we will briefly discuss the impact of some of these nanoformulations in clinical trials.
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Affiliation(s)
- Vanesa Andreu
- Department of Chemical Engineering, Aragon Institute of Nanoscience (INA), University of Zaragoza, Campus Río Ebro-Edificio I+D, C/Poeta Mariano Esquillor S/N, 50018 Zaragoza, Spain; Aragon Health Research Institute (IIS), Aragón, 50009 Zaragoza, Spain.
| | - Manuel Arruebo
- Department of Chemical Engineering, Aragon Institute of Nanoscience (INA), University of Zaragoza, Campus Río Ebro-Edificio I+D, C/Poeta Mariano Esquillor S/N, 50018 Zaragoza, Spain; Aragon Health Research Institute (IIS), Aragón, 50009 Zaragoza, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine, CIBER-BBN, 28029 Madrid, Spain
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Adnan R, Van Oosterwijck J, Cagnie B, Dhondt E, Schouppe S, Van Akeleyen J, Logghe T, Danneels L. Determining Predictive Outcome Factors for a Multimodal Treatment Program in Low Back Pain Patients: A Retrospective Cohort Study. J Manipulative Physiol Ther 2017; 40:659-667. [DOI: 10.1016/j.jmpt.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/26/2017] [Indexed: 11/27/2022]
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Ökmen K, Ökmen BM. The efficacy of interlaminar epidural steroid administration in multilevel intervertebral disc disease with chronic low back pain: a randomized, blinded, prospective study. Spine J 2017; 17:168-174. [PMID: 27555486 DOI: 10.1016/j.spinee.2016.08.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/21/2016] [Accepted: 08/16/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Epidural steroid injection is commonly used in patients with chronic low back pain. Applying a mixture of a local anesthetic (LA) and steroid using the interlaminar (IL), transforaminal, and caudal techniques is a preferred approach. PURPOSE The present study aims to investigate the efficacy of interlaminar epidural steroid administration in patients with multilevel lumbar disc pathology (LDP) and to assess the possible correlation of the procedure's success with age and body mass index (BMI). STUDY DESIGN A randomized controlled trial was performed. PATIENT SAMPLE We administered interlaminar epidural steroid to a total of 98 patients with multilevel LDP. OUTCOME MEASURES The visual analog scale (VAS) and Oswestry Disability Index (ODI) scoring were performed on the study population at pretreatment (PRT), posttreatment, and 1, 3, 6, and 12 PRT months. A possible correlation of BMI and age with the procedure success was evaluated. METHODS The LA group (Group L, n=50) received 10 mL 0.25% bupivacaine, whereas the steroid+LA group (Group S, n=48) received 10 mL 0.25% bupivacaine+40 mg methylprednisolone at L4-L5 intervertebral space in prone position under the guidance of C-arm fluoroscopy. RESULTS There was no statistical difference in the PRT VAS and ODI scores between the groups (p<.05), whereas the VAS and ODI scores at 1, 3, 6, and 12 posttreatment months were higher in Group L, compared with Group S (p<.05). Age and BMI were not found to be related with the success of the procedure. CONCLUSIONS Our study results showed that the VAS and ODI scores were lower in patients with multilevel LDP receiving steroid, following the administration of IL epidural injection. However, further studies are required to establish a robust conclusion on the dispersion of IL epidural injections in the epidural area and the dose of steroid.
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Affiliation(s)
- Korgün Ökmen
- Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Mah, Emniyet Street, Yıldırım, Bursa 16260, Turkey.
| | - Burcu Metin Ökmen
- Physical Medicine and Rehabilitation, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Mah, Emniyet Street, Yıldırım, Bursa 16260, Turkey
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Gross DP, Armijo-Olivo S, Shaw WS, Williams-Whitt K, Shaw NT, Hartvigsen J, Qin Z, Ha C, Woodhouse LJ, Steenstra IA. Clinical Decision Support Tools for Selecting Interventions for Patients with Disabling Musculoskeletal Disorders: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:286-318. [PMID: 26667939 PMCID: PMC4967425 DOI: 10.1007/s10926-015-9614-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Purpose We aimed to identify and inventory clinical decision support (CDS) tools for helping front-line staff select interventions for patients with musculoskeletal (MSK) disorders. Methods We used Arksey and O'Malley's scoping review framework which progresses through five stages: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies for analysis; (4) charting the data; and (5) collating, summarizing and reporting results. We considered computer-based, and other available tools, such as algorithms, care pathways, rules and models. Since this research crosses multiple disciplines, we searched health care, computing science and business databases. Results Our search resulted in 4605 manuscripts. Titles and abstracts were screened for relevance. The reliability of the screening process was high with an average percentage of agreement of 92.3 %. Of the located articles, 123 were considered relevant. Within this literature, there were 43 CDS tools located. These were classified into 3 main areas: computer-based tools/questionnaires (n = 8, 19 %), treatment algorithms/models (n = 14, 33 %), and clinical prediction rules/classification systems (n = 21, 49 %). Each of these areas and the associated evidence are described. The state of evidentiary support for CDS tools is still preliminary and lacks external validation, head-to-head comparisons, or evidence of generalizability across different populations and settings. Conclusions CDS tools, especially those employing rapidly advancing computer technologies, are under development and of potential interest to health care providers, case management organizations and funders of care. Based on the results of this scoping review, we conclude that these tools, models and systems should be subjected to further validation before they can be recommended for large-scale implementation for managing patients with MSK disorders.
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Affiliation(s)
- Douglas P. Gross
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Susan Armijo-Olivo
- Faculty of Rehabilitation Medicine, University of Alberta, 3-62 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - William S. Shaw
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748 USA
| | - Kelly Williams-Whitt
- University of Lethbridge, Calgary Campus, Suite S6032, 345 - 6th Avenue SE, Calgary, AB T2G 4V1 Canada
| | - Nicola T. Shaw
- Algoma University, 1520 Queen Street East, CC 303, Sault Ste. Marie, ON P2A 2G4 Canada
| | - Jan Hartvigsen
- University of Southern Denmark, Odense, Denmark
- Center for Muscle and Joint Health, Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
| | - Ziling Qin
- Faculty of Rehabilitation Medicine, University of Alberta, 3-62 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Christine Ha
- Faculty of Rehabilitation Medicine, University of Alberta, 3-62 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Linda J. Woodhouse
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Ivan A. Steenstra
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON M5G 2E9 Canada
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12
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Collen MR. A 40-Minute Phone Intervention. J Insur Med 2015; 45:110-2. [PMID: 27584847 DOI: 10.17849/insm-45-02-110-112.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article recounts the experience of an 88-year-old woman with sciatic pain and her attempts to get it treated. Common interventions were utilized and failed, and back surgery was recommended. A patient advocate was consulted who suggested the need to begin to exercise and to reconsider other medical interventions. Within 2 months, she was pain-free and returned to her active lifestyle. The use of scientific evidence and common sense prevented unnecessary surgery and other costly medical treatments.
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Whynes DK, McCahon RA, Ravenscroft A, Hardman J. Cost effectiveness of epidural steroid injections to manage chronic lower back pain. BMC Anesthesiol 2012; 12:26. [PMID: 23016755 PMCID: PMC3468401 DOI: 10.1186/1471-2253-12-26] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 09/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy of epidural steroid injections in the management of chronic low back pain is disputed, yet the technique remains popular amongst physicians and patients alike. This study assesses the cost effectiveness of injections administered in a routine outpatient setting in England. METHODS Patients attending the Nottingham University Hospitals' Pain Clinic received two injections of methylprednisolone plus levobupivacaine at different dosages, separated by at least 12 weeks. Prior to each injection, and every week thereafter for 12 weeks, participants completed the EQ-5D health-related quality of life instrument. For each patient for each injection, total health state utility gain relative to baseline was calculated. The cost of the procedure was modelled from observed clinical practice. Cost effectiveness was calculated as procedure cost relative to utility gain. RESULTS 39 patients provided records. Over a 13-week period commencing with injection, mean quality adjusted life year (QALY) gains per patient for the two dosages were 0.028 (SD 0.063) and 0.021 (SD 0.057). The difference in QALYs gained by dosage was insignificant (paired t-test, CIs -0.019 - 0.033). Based on modelled resource use and data from other studies, the mean cost of an injection was estimated at £219 (SD 83). The cost utility ratio of the two injections amounted to £8,975 per QALY gained (CIs 5,480 - 22,915). However, at costs equivalent to the tariff price typically paid to providers by health care purchasers, the ratio increased to £27,459 (CIs 16,779 - 70,091). CONCLUSIONS When provided in an outpatient setting, epidural steroid injections are a short term, but nevertheless cost effective, means of managing chronic low back pain. However, designation of the procedure as a day case requires the National Health Service to reimburse providers at a price which pushes the procedure to the margin of cost effectiveness. TRIAL REGISTRATION ISRCTN 43299460.
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Affiliation(s)
- David K Whynes
- School of Economics, University of Nottingham, Nottingham, NG7 2RD, UK.
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Burnham RS, Holitski S, Dinu I. A prospective outcome study on the effects of facet joint radiofrequency denervation on pain, analgesic intake, disability, satisfaction, cost, and employment. Arch Phys Med Rehabil 2009; 90:201-5. [PMID: 19236974 DOI: 10.1016/j.apmr.2008.07.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Revised: 07/15/2008] [Accepted: 07/15/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the effect of radiofrequency denervation (RFD) on patients with chronic low back pain (LBP) of facet joint origin. DESIGN Prospective cohort study. SETTING Interventional pain management program. PARTICIPANTS Consecutive subjects (N=44; 101 facet joints) over 2 years with chronic refractory mechanical LBP of facet origin established by 2 local anesthetic blocks (medial branch +/- intra-articular) resulting in more than 50% pain relief. INTERVENTION RFD of the symptomatic lumbar facet joints. MAIN OUTCOME MEASURES Self-reported pain intensity, frequency, bothersomeness, analgesic intake, satisfaction, disability, back pain-related costs, and employment twice prior to and at 1, 3, 6, 9, and 12 months post-RFD. RESULTS Post-RFD, significant improvements in pain, analgesic requirement, satisfaction, disability, and direct costs occurred. They peaked at 3 to 6 months and gradually diminished thereafter. Satisfaction with medical care and living with current symptoms improved similarly. Overall, satisfaction with the RFD procedure was high, and no complications were reported. CONCLUSIONS RFD provides safe and significant short-term improvement in pain, analgesic requirements, function, satisfaction, and direct costs in patients with chronic LBP of facet origin.
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Affiliation(s)
- Robert S Burnham
- Central Alberta Pain and Rehabilitation Institute, Lacombe, Alberta, Canada.
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North RB, Shipley J, Taylor RS. The Cost-effectiveness of Spinal Cord Stimulation. Neuromodulation 2009. [DOI: 10.1016/b978-0-12-374248-3.00027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Racz GB, Heavner JE, Trescot A. Percutaneous Lysis of Epidural Adhesions—Evidence for Safety and Efficacy. Pain Pract 2008; 8:277-86. [DOI: 10.1111/j.1533-2500.2008.00203.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008; 8:8-20. [PMID: 18164449 DOI: 10.1016/j.spinee.2007.10.005] [Citation(s) in RCA: 1340] [Impact Index Per Article: 83.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 10/13/2007] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The economic burden of low back pain (LBP) is very large and appears to be growing. It is not possible to impact this burden without understanding the strengths and weaknesses of the research on which these costs are calculated. PURPOSE To conduct a systematic review of LBP cost of illness studies in the United States and internationally. STUDY DESIGN/SETTING Systematic review of the literature. METHODS Medline was searched to uncover studies about the direct or indirect costs of LBP published in English from 1997 to 2007. Data extracted for each eligible study included study design, population, definition of LBP, methods of estimating costs, year of data, and estimates of direct, indirect, or total costs. Results were synthesized descriptively. RESULTS The search yielded 147 studies, of which 21 were deemed relevant; 4 other studies and 2 additional abstracts were found by searching reference lists, bringing the total to 27 relevant studies. The studies reported on data from Australia, Belgium, Japan, Korea, the Netherlands, Sweden, the UK, and the United States. Nine studies estimated direct costs only, nine indirect costs only, and nine both direct and indirect costs, from a societal (n=18) or private insurer (n=9) perspective. Methodology used to derive both direct and indirect cost estimates differed markedly among the studies. Among studies providing a breakdown on direct costs, the largest proportion of direct medical costs for LBP was spent on physical therapy (17%) and inpatient services (17%), followed by pharmacy (13%) and primary care (13%). Among studies providing estimates of total costs, indirect costs resulting from lost work productivity represented a majority of overall costs associated with LBP. Three studies reported that estimates with the friction period approach were 56% lower than with the human capital approach. CONCLUSIONS Several studies have attempted to estimate the direct, indirect, or total costs associated with LBP in various countries using heterogeneous methodology. Estimates of the economic costs in different countries vary greatly depending on study methodology but by any standards must be considered a substantial burden on society. This review did not identify any studies estimating the total costs of LBP in the United States from a societal perspective. Such studies may be helpful in determining appropriate allocation of health-care resources devoted to this condition.
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Affiliation(s)
- Simon Dagenais
- Division of Orthopaedic Surgery and Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
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Insausti-Valdivia J. Técnicas intervencionistas en el dolor reumático. Radiofrecuencia: técnicas y evidencias. ACTA ACUST UNITED AC 2006; 2 Suppl 1:S28-33. [DOI: 10.1016/s1699-258x(06)73079-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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