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Gilligan C, Volschenk W, Russo M, Green M, Gilmore C, Mehta V, Deckers K, De Smedt K, Latif U, Sayed D, Georgius P, Gentile J, Mitchell B, Langhorst M, Huygen F, Baranidharan G, Patel V, Mironer E, Ross E, Carayannopoulos A, Hayek S, Gulve A, Van Buyten JP, Tohmeh A, Fischgrund J, Lad S, Ahadian F, Deer T, Klemme W, Rauck R, Rathmell J, Maislin G, Heemels JP, Eldabe S. Five-Year Longitudinal Follow-Up of Restorative Neurostimulation Shows Durability of Effectiveness in Patients With Refractory Chronic Low Back Pain Associated With Multifidus Muscle Dysfunction. Neuromodulation 2024; 27:930-943. [PMID: 38483366 DOI: 10.1016/j.neurom.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Adults with refractory, mechanical chronic low back pain associated with impaired neuromuscular control of the lumbar multifidus muscle have few treatment options that provide long-term clinical benefit. This study hypothesized that restorative neurostimulation, a rehabilitative treatment that activates the lumbar multifidus muscles to overcome underlying dysfunction, is safe and provides relevant and durable clinical benefit to patients with this specific etiology. MATERIALS AND METHODS In this prospective five-year longitudinal follow-up of the ReActiv8-B pivotal trial, participants (N = 204) had activity-limiting, moderate-to-severe, refractory, mechanical chronic low back pain, a positive prone instability test result indicating impaired multifidus muscle control, and no indications for spine surgery. Low back pain intensity (10-cm visual analog scale [VAS]), disability (Oswestry Disability Index), and quality of life (EuroQol's "EQ-5D-5L" index) were compared with baseline and following the intent-to-treat principle, with a supporting mixed-effects model for repeated measures that accounted for missing data. RESULTS At five years (n = 126), low back pain VAS had improved from 7.3 to 2.4 cm (-4.9; 95% CI, -5.3 to -4.5 cm; p < 0.0001), and 71.8% of participants had a reduction of ≥50%. The Oswestry Disability Index improved from 39.1 to 16.5 (-22.7; 95% CI, -25.4 to -20.8; p < 0.0001), and 61.1% of participants had reduction of ≥20 points. The EQ-5D-5L index improved from 0.585 to 0.807 (0.231; 95% CI, 0.195-0.267; p < 0.0001). Although the mixed-effects model attenuated completed-case results, conclusions and statistical significance were maintained. Of 52 subjects who were on opioids at baseline and had a five-year visit, 46% discontinued, and 23% decreased intake. The safety profile compared favorably with neurostimulator treatments for other types of back pain. No lead migrations were observed. CONCLUSION Over a five-year period, restorative neurostimulation provided clinically substantial and durable benefits with a favorable safety profile in patients with refractory chronic low back pain associated with multifidus muscle dysfunction. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT02577354; registration date: October 15, 2016; principal investigator: Christopher Gilligan, MD, Brigham and Women's Hospital, Boston, MA, USA. The study was conducted in Australia (Broadmeadow, New South Wales; Noosa Heads, Queensland; Welland, South Australia; Clayton, Victoria), Belgium (Sint-Niklaas; Wilrijk), The Netherlands (Rotterdam), UK (Leeds, London, Middlesbrough), and USA (La Jolla, CA; Santa Monica, CA; Aurora, CO; Carmel, IN; Indianapolis, IN; Kansas City, KS; Boston, MA; Royal Oak, MI; Durham, NC; Winston-Salem, NC; Cleveland, OH; Providence, RI; Spartanburg, SC; Spokane, WA; Charleston, WV).
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Affiliation(s)
- Christopher Gilligan
- Division of Pain Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA.
| | | | - Marc Russo
- Hunter Pain Specialists, Newcastle, Australia
| | | | - Christopher Gilmore
- Center for Clinical Research, Carolinas Pain Institute, Winston-Salem, NC, USA
| | - Vivek Mehta
- Barts Neuromodulation Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Kristiaan Deckers
- Department of Physical Medicine and Rehabilitation, GZA - Sint Augustinus Hospital, Wilrijk, Belgium
| | - Kris De Smedt
- Department of Neurosurgery, GZA - Sint Augustinus Hospital, Wilrijk, Belgium
| | - Usman Latif
- Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Dawood Sayed
- Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Peter Georgius
- Sunshine Coast Clinical Research, Noosa Heads, Australia
| | | | | | | | - Frank Huygen
- Department of Anaesthesiology Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ganesan Baranidharan
- Leeds Pain and Neuromodulation Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Vikas Patel
- Department of Orthopedic Surgery, University of Colorado, Denver, CO, USA
| | - Eugene Mironer
- Carolinas Center for the Advanced Management of Pain, Spartanburg, NC, USA
| | - Edgar Ross
- Division of Pain Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA
| | - Alexios Carayannopoulos
- Departments of Physical Medicine and Rehabilitation, Rhode Island Hospital, Brown University Medical School, Providence, RI, USA
| | - Salim Hayek
- Division of Pain Medicine, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Ashish Gulve
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | | | | | - Jeffrey Fischgrund
- Department of Orthopedic Surgery, Oakland University, Beaumont Hospital, Royal Oak, MI, USA
| | - Shivanand Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Farshad Ahadian
- Center for Pain Medicine, University of California, San Diego, CA, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - William Klemme
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Richard Rauck
- Carolinas Pain Institute, Wake Forest University, Winston-Salem, NC, USA
| | - James Rathmell
- Division of Pain Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA
| | - Greg Maislin
- Biomedical Statistical Consulting, Wynnewood, PA, USA
| | | | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
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Ye L, Li Y, Deng Q, Zhao X, Zhong L, Yang L. Acceptance and commitment therapy for patients with chronic pain: A systematic review and meta-analysis on psychological outcomes and quality of life. PLoS One 2024; 19:e0301226. [PMID: 38875241 PMCID: PMC11178235 DOI: 10.1371/journal.pone.0301226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/12/2024] [Indexed: 06/16/2024] Open
Abstract
OBJECTIVES To assess the efficacy of acceptance and commitment therapy (ACT) for patients with chronic pain. MATERIALS AND METHODS The research conducted a systematic search of the Cochrane Library, Web of Science, PubMed, EMBASE, PsycINFO, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases following the PRISMA guidelines. The retrieval time limit was from the establishment of the database to October 2023. A meta-analysis was carried out for the randomized controlled trials (RCTs) that meet the inclusion and exclusion criteria by using RevMan 5.3. RESULTS Twenty-one RCTs were included. At post-treatment, a significant medium effect size (ES) was found in measuring pain interference, functional impairment, pain acceptance, psychological inflexibility, and depression; Pain intensity, anxiety, and quality of life (QOL) had a small ES. At three months post-treatment, a large ES was found in measuring functional impairment, and a medium ES was found in the other indicators. CONCLUSION The researchers provided evidence for the effectiveness of ACT as an intervention for patients with chronic pain, which can be applied by clinicians or nurses in practice. Future research should explore the applicability of ACT to different pain conditions and modalities. IMPLICATIONS FOR NURSING Post-treatment data highlight the efficacy of ACT in moderating pain-related outcomes. Clinical nurses are encouraged to incorporate ACT into routine patient education and interventions, including promoting pain acceptance, promoting mindfulness practices, and using cognitive stress reduction techniques. Standardized follow-up after an ACT intervention for patients with chronic pain is critical, including regular assessment, feedback, and realignment of treatment strategies. Overall, ACT became an important tool for nurses to improve the lives of patients with chronic pain.
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Affiliation(s)
- Lu Ye
- Department of Oncology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Yunhua Li
- College of Education, Chengdu College of Arts and Sciences, Chengdu, Sichuan, China
| | - Qingchuan Deng
- School of Nursing, Sichuan Nursing Vocational College, Chengdu, Sichuan, China
| | - Xin Zhao
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lili Zhong
- Department of Oncology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Li Yang
- Department of Oncology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
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3
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García-Jaén M, Sebastia-Amat S, Sanchis-Soler G, Cortell-Tormo JM. Lumbo-Pelvic Rhythm Monitoring Using Wearable Technology with Sensory Biofeedback: A Systematic Review. Healthcare (Basel) 2024; 12:758. [PMID: 38610180 PMCID: PMC11012179 DOI: 10.3390/healthcare12070758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
As an essential lower-back movement pattern, lumbo-pelvic rhythm (LPR) during forward trunk flexion and backward return has been investigated on a large scale. It has been suggested that abnormalities in lumbo-pelvic coordination are related to the risk of developing low back disorders. However, considerable differences in the approaches used to monitor LPR make it challenging to integrate findings from those investigations for future research. Therefore, the aim of this systematic review was to summarize the use of wearable technology for kinematic measurement with sensory biofeedback for LPR monitoring by assessing these technologies' specific capabilities and biofeedback capacities and exploring their practical viability based on sensor outcomes. The review was developed following the PRISMA guidelines, and the risk of bias was analyzed using the PREDro and STROBE scales. PubMed, Web of Science, Scopus, and IEEEXPLORE databases were searched for relevant studies, initially returning a total of 528 articles. Finally, we included eight articles featuring wearable devices with audio or vibration biofeedback. Differences in protocols and limitations were also observed. This novel study presents a review of wearable tracking devices for LPR motion-mediated biofeedback for the purpose of correcting lower back posture. More research is needed to determine the long-term effectiveness of these devices, as well as their most appropriate corresponding methodologies.
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Affiliation(s)
- Miguel García-Jaén
- Department of General and Specific Didactics, University of Alicante, 03690 San Vicente del Raspeig, Spain; (M.G.-J.); (S.S.-A.); (J.M.C.-T.)
- Health, Physical Activity and Sports Technology (HEALTH-TECH), University of Alicante, 03690 San Vicente del Raspeig, Spain
| | - Sergio Sebastia-Amat
- Department of General and Specific Didactics, University of Alicante, 03690 San Vicente del Raspeig, Spain; (M.G.-J.); (S.S.-A.); (J.M.C.-T.)
- Health, Physical Activity and Sports Technology (HEALTH-TECH), University of Alicante, 03690 San Vicente del Raspeig, Spain
| | - Gema Sanchis-Soler
- Department of General and Specific Didactics, University of Alicante, 03690 San Vicente del Raspeig, Spain; (M.G.-J.); (S.S.-A.); (J.M.C.-T.)
- Health, Physical Activity and Sports Technology (HEALTH-TECH), University of Alicante, 03690 San Vicente del Raspeig, Spain
| | - Juan Manuel Cortell-Tormo
- Department of General and Specific Didactics, University of Alicante, 03690 San Vicente del Raspeig, Spain; (M.G.-J.); (S.S.-A.); (J.M.C.-T.)
- Health, Physical Activity and Sports Technology (HEALTH-TECH), University of Alicante, 03690 San Vicente del Raspeig, Spain
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Ege F. Evaluation of the Efficacy of Caudal Epidural Neuroplasty in Patients With Lumbar Epidural Fibrosis. Cureus 2024; 16:e52606. [PMID: 38260106 PMCID: PMC10803106 DOI: 10.7759/cureus.52606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 01/24/2024] Open
Abstract
Introduction Lumbar and leg pain can be caused by many factors, including scar tissue in the epidural space. Epidural fibrosis may cause chronic radicular low back pain. Adhesions in the epidural space may occur due to surgical or non-surgical reasons. Epidural adhesiolysis, i.e., neuroplasty, eliminates the pain-causing effects of scar tissue by releasing the nerve from the scar tissue or decompressing the nerve. In light of this information, this study was conducted to evaluate the effectiveness of percutaneous epidural neuroplasty interventions performed in the algology clinic in patients with lumbar epidural fibrosis who have and have not undergone lumbar surgery. Methods The sample of this retrospective study consisted of 72 patients with chronic radicular low back pain, finding fibrosis in the epidural region on contrast-enhanced magnetic resonance imaging (MRI), filling defect after epidurogram, and caudal epidural neuroplasty. Patients' visual analog scale (VAS) and Oswestry disability index (ODI) scores, pregabalin, duloxetine, and opioid doses were evaluated before and one month and six months after having neuroplasty. Results The VAS and ODI scores and pregabalin, duloxetine, and opioid doses decreased significantly in patients who had had caudal epidural neuroplasty at post-procedure endpoints compared to before the procedure (p<0.001). The paired temporal comparisons of the data of the patients who underwent epidural neuroplasty procedures before the procedure, one month after the procedure, and six months after the procedure revealed significant differences in the VAS and ODI scores (p<0.001). Additionally, the analysis of patients' VAS scores revealed that the pre-procedure VAS scores decreased significantly more one month after the procedure in patients without a history of lumbar surgery than in patients with a history of lumbar surgery. Conclusions The findings of our study demonstrated that fluoroscopy-guided percutaneous epidural neuroplasty alleviated pain and improved physical functions and quality of life. In conclusion, percutaneous epidural neuroplasty is a safe and effective treatment method for patients with lumbar epidural fibrosis.
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Affiliation(s)
- Ferhat Ege
- Pain Management, Gazi Yasargil Training and Research Hospital, Diyarbakır, TUR
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5
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ElSaban M, Kleppel DJ, Kubrova E, Martinez Alvarez GA, Hussain N, D'Souza RS. Physical functioning following spinal cord stimulation: a systematic review and meta-analysis. Reg Anesth Pain Med 2023; 48:302-311. [PMID: 37080578 DOI: 10.1136/rapm-2022-104295] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/07/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Spinal cord stimulation (SCS) has emerged as an important treatment for chronic pain disorders. While there is evidence supporting improvement in pain intensity with SCS therapy, efforts to synthesize the evidence on physical functioning are lacking. OBJECTIVE The primary objective of this meta-analysis was to assess long-term physical function following 12 months of SCS for chronic back pain. EVIDENCE REVIEW PubMed, EMBASE, Scopus, and CENTRAL databases were searched for original peer-reviewed publications investigating physical function following SCS. The primary outcome was physical function at 12 months following SCS therapy for chronic back pain compared with baseline. A random effects model with an inverse variable method was used. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to determine the certainty of evidence. FINDINGS A total of 518 studies were screened, of which 36 were included. Twenty-two studies were pooled in the meta-analysis. There was a significant reduction in Oswestry Disability Index (ODI) scores at all time frames up to 24 months following implantation. Pooled results revealed significant improvement in ODI scores at 12 months with a mean difference of -17.00% (95% CI -23.07 to -10.94, p<0.001). There was a very low certainty of evidence in this finding as per the GRADE framework. There was no significant difference in subgroup analyses based on study design (randomised controlled trials (RCTs) vs non-RCTs), study funding, or stimulation type. CONCLUSION This meta-analysis highlights significant improvements in physical function after SCS therapy. However, this finding was limited by a very low GRADE certainty of evidence and high heterogeneity.
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Affiliation(s)
- Mariam ElSaban
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Donald J Kleppel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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6
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Hanna M, Perrot S, Varrassi G. Critical Appraisal of Current Acute LBP Management and the Role of a Multimodal Analgesia: A Narrative Review. Pain Ther 2023; 12:377-398. [PMID: 36765012 PMCID: PMC10036717 DOI: 10.1007/s40122-023-00479-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023] Open
Abstract
Acute low back pain (LBP) stands as a leading cause of activity limitation and work absenteeism, and its associated healthcare expenditures are expected to become substantial when acute LBP develops into a chronic and even refractory condition. Therefore, early intervention is crucial to prevent progression to chronic pain, for which the management is particularly challenging and the most effective pharmacological therapy is still controversial. Current guideline treatment recommendations vary and are mostly driven by expertise with opinion differing across different interventions. Thus, it is difficult to formulate evidence-based guidance when the relatively few randomized clinical trials have explored the diagnosis and management of LBP while employing different selection criteria, statistical analyses, and outcome measurements. This narrative review aims to provide a critical appraisal of current acute LBP management by discussing the unmet needs and areas of improvement from bench-to-bedside, and proposes multimodal analgesia as the way forward to attain an effective and prolonged pain relief and functional recovery in patients with acute LBP.
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Affiliation(s)
- Magdi Hanna
- Director of the Analgesics and Pain Research Unit, APR (Ltd) Sunrise, Beckenham Place Park, Beckenham, Kent, London, BR35BN, UK.
| | - Serge Perrot
- Pain Centre, Cochin Hospital, INSERM U987, Université Paris Cité, Paris, France
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7
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Giordano L, Murrell WD, Maffulli N. Prolotherapy for chronic low back pain: a review of literature. Br Med Bull 2021; 138:96-111. [PMID: 33884404 DOI: 10.1093/bmb/ldab004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Low back pain is common and imposes major societal burdens for patient suffering and costs. Prolotherapy injections are used for musculoskeletal conditions including tendinopathies, osteoarthritis and low back pain to enhance soft-tissue healing. This review aims to clarify the place of prolotherapy in chronic low back pain (CLBP). SOURCES OF DATA Using multiple databases, a systematic search was performed to identify studies detailing the use of prolotherapy to manage CLBP. A total of 12 articles was included in the present work. AREAS OF AGREEMENT Considering the level of evidence and the quality of the studies assessed using the modified Coleman Score, prolotherapy is an effective management modality for CLBP patients in whom conservative therapies failed. AREAS OF CONTROVERSY The presence of co-interventions and the clinical heterogeneity of the work contributes to confound the overall conclusions. GROWING POINTS AND AREAS FOR RESEARCH The analysis of the studies included in the review, using appropriate tools, showed how their quality has decreased over the years, reflecting the need for appropriately powered well planned and performed randomized control trials.
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Affiliation(s)
- Lorenzo Giordano
- Department of Trauma and Orthopaedic Surgery, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi D'Aragona, Via San Leonardo 1, Salerno 84131, Italy
| | - William D Murrell
- Emirates-Integra Medical and Surgical Centre, Dubai, United Arab Emirates.,Department of Orthopaedics, Podiatry, and Rehabilitation, Fort Belvoir Community Hospital, 9300 Fort Belvoir, VA 22060, USA
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi D'Aragona, Via San Leonardo 1, Salerno 84131, Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke-on-Trent ST5 5B, England
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8
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Belitskaya-Levy I, Clark JD, Shih MC, Bair MJ. Treatment Preferences for Chronic Low Back Pain: Views of Veterans and Their Providers. J Pain Res 2021; 14:161-171. [PMID: 33536780 PMCID: PMC7850463 DOI: 10.2147/jpr.s290400] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/15/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose This study was conducted to characterize chronic low back pain (cLBP) and to identify treatment histories and preferences for cLBP management among Veterans and primary care providers within the Veterans Affairs (VA) healthcare system. Participants and Methods Veterans with cLBP from five geographically diverse VA medical centers were identified using International Classification of Diseases (ICD) 9 and 10 codes from VA administrative data as were primary care providers at these same sites. From these data, Veterans (200/per site) and providers (160/per site) were selected and mailed surveys. Open-ended interview data were collected from a subset of Veterans and providers. Results In total, 235 Veterans and 67 providers returned completed surveys. More than 80% of the Veteran respondents had daily back pain for more than 1 year. Most Veterans had tried several treatments for their pain with medications and physical therapy being the most commonly used. Veterans and providers had similar attitudes towards many cLBP treatments with the exception of psychological therapies that were more favored by providers. Open-ended interview data showed that Veterans and providers emphasized the need for multi-component approaches to treatment. Conclusion Among Veterans, cLBP is typically of sustained duration, is relatively severe, and also interferes significantly with normal functioning. Veterans are experienced with respect to treatments and had similar attitudes towards many cLBP treatments as their providers, especially tailored approaches.
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Affiliation(s)
- Ilana Belitskaya-Levy
- VA Cooperative Studies Program Coordinating Center - Mountain View Division, Palo Alto Healthcare System, Mountain View, CA, USA
| | - J David Clark
- Anesthesiology Service, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Mei-Chiung Shih
- VA Cooperative Studies Program Coordinating Center - Mountain View Division, Palo Alto Healthcare System, Mountain View, CA, USA
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA
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Fujii K, Yamazaki M, Kang JD, Risbud MV, Cho SK, Qureshi SA, Hecht AC, Iatridis JC. Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment. JBMR Plus 2019; 3:e10180. [PMID: 31131347 PMCID: PMC6524679 DOI: 10.1002/jbm4.10180] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/21/2018] [Accepted: 01/30/2019] [Indexed: 12/11/2022] Open
Abstract
Discogenic back pain is multifactorial; hence, physicians often struggle to identify the underlying source of the pain. As a result, discogenic back pain is often hard to treat—even more so when clinical treatment strategies are of questionable efficacy. Based on a broad literature review, our aim was to define discogenic back pain into a series of more specific and interacting pathologies, and to highlight the need to develop novel approaches and treatment strategies for this challenging and unmet clinical need. Discogenic pain involves degenerative changes of the intervertebral disc, including structural defects that result in biomechanical instability and inflammation. These degenerative changes in intervertebral discs closely intersect with the peripheral and central nervous systems to cause nerve sensitization and ingrowth; eventually central sensitization results in a chronic pain condition. Existing imaging modalities are nonspecific to pain symptoms, whereas discography methods that are more specific have known comorbidities based on intervertebral disc puncture and injection. As a result, alternative noninvasive and specific diagnostic methods are needed to better diagnose and identify specific conditions and sources of pain that can be more directly treated. Currently, there are many treatments/interventions for discogenic back pain. Nevertheless, many surgical approaches for discogenic pain have limited efficacy, thus accentuating the need for the development of novel treatments. Regenerative therapies, such as biologics, cell‐based therapy, intervertebral disc repair, and gene‐based therapy, offer the most promise and have many advantages over current therapies. © 2019 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research
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Affiliation(s)
- Kengo Fujii
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA.,Department of Orthopaedic Surgery University of Tsukuba Tsukuba Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery University of Tsukuba Tsukuba Japan
| | - James D Kang
- Department of Orthopaedic Surgery Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Makarand V Risbud
- Department of Orthopaedic Surgery Sidney Kimmel Medical College Thomas Jefferson University Philadelphia PA USA
| | - Samuel K Cho
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery Hospital for Special Surgery New York NY USA
| | - Andrew C Hecht
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA
| | - James C Iatridis
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA
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10
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Smolanka VI, Fedurtsya VM, Pavlov BB. Discogenic low back pain: interventional treatment. PAIN MEDICINE 2018. [DOI: 10.31636/pmjua.v3i3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Low back pain (LBP) is one of the most common causes of disability in the adult population. A significant place in its genesis is occupied by a degenerative-dystrophic diseases of intervertebral discs. The article highlights the classification and mechanism of discogenic pain origin. Various types of interventions aredescribed for this pathology: indications, specificities of carrying out manipulations and therapeutic effects, efficiency and possible complications of procedures.
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11
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Real-time fusion-imaging in low back pain: a new navigation system for facet joint injections. Radiol Med 2018; 123:851-859. [PMID: 29968070 DOI: 10.1007/s11547-018-0916-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/25/2018] [Indexed: 02/07/2023]
Abstract
AIMS AND OBJECTIVES The aim of the current study is to present our experience in lumbar spine interventional procedures performed with a newly developed multimodal echo-navigator (EcoNav) and to evaluate short-term clinical outcomes of a series of patients affected by facet joint disease (FJD) treated with steroid and anaesthetic injection under fusion-imaging guidance, compared to a cohort of patients that received the same treatment under computed tomography (CT) guidance. METHODS Sixty-five consecutive patients (34 females; mean age 68.3 ± 12.8 years) with a clinical diagnosis of non-radicular low back pain lasting for more than 6-weeks and magnetic resonance (MR) or CT confirmed FJD were enrolled for image-guided FJI. Twenty-eight patients underwent FJI with fusion-guided technique, while CT-guided procedures were performed in the other cases. Clinical and procedural data were recorded and compared at a mean follow-up of 6.1 ± 2.0 months. RESULTS A significant improvement in clinical parameters was observed for both fusion-guided and CT-guided group. Comparing both groups, no statistically significant difference could be detected neither at baseline conditions nor during the follow-up period. No significant periprocedural complication occurred in both groups. A satisfaction rate of 92.3 and 81.1% was reported for fusion-guided and CT-guided group, respectively. CONCLUSION EcoNav fusion-imaging system represents a safe, feasible, effective and reproducible guidance option in FJD infiltration procedures, also avoiding use of ionising radiations.
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Abstract
Chronic low back pain (LBP) places a tremendous economic burden on society due to both direct and indirect costs. Health care costs for adults with chronic LBP have steadily increased over the past 20 years, coinciding with a large increase in the utilization of spinal injections, surgical interventions, opioid medications, and physical therapy. The treatment of LBP is best approached by a multimodal and even multidisciplinary approach with a combination of physical rehabilitation, pharmacologic management, psychological intervention, spinal injections, and surgical intervention with a goal of improving the functional status of the patient. In this review, we discuss the interventional management of LBP secondary to herniated nucleus pulposus, spinal stenosis, facet mediated pain, sacroiliitis, and discogenic pain.
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Hunter CW, Carlson J, Yang A, Deer T. Spinal Cord Stimulation for the Treatment of Failed Neck Surgery Syndrome: Outcome of a Prospective Case Series. Neuromodulation 2018; 21:495-503. [DOI: 10.1111/ner.12769] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 01/02/2018] [Accepted: 01/02/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Ajax Yang
- Department of Physical Medicine & Rehabilitation, Ichan School of Medicine; Mount Sinai Hospital; New York NY USA
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Management Strategies for Chronic Pain. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lee CH, Chung CK, Kim CH. The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials. Spine J 2017; 17:1770-1780. [PMID: 28576500 DOI: 10.1016/j.spinee.2017.05.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/08/2017] [Accepted: 05/02/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial. PURPOSE We aimed to elucidate the precise effects of radiofrequency denervation in patients with low back pain originating from the facet joints relative to those obtained using control treatments, with particular attention to consistency in the denervation protocol. STUDY DESIGN/SETTING A meta-analysis of randomized controlled trials was carried out. PATIENT SAMPLE Adult patients undergoing radiofrequency denervation or control treatments (sham or epidural block) for facet joint disease of the lumbar spine comprised the patient sample. OUTCOME MEASURES Visual analog scale (VAS) pain scores were measured and stratified by response of diagnostic block procedures. METHOD We searched PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trials regarding radiofrequency denervation and control treatments for back pain. Changes in VAS pain scores of the radiofrequency group were compared with those of the control group as well as the minimal clinically important difference (MCID) for back pain VAS. Meta-regression model was developed to evaluate the effect of radiofrequency treatment according to responses of diagnostic block while controlling for other variables. We then calculated mean differences and 95% confidence intervals (CIs) using random-effects models. RESULTS We included data from seven trials involving 454 patients who had undergone radiofrequency denervation (231 patients) and control treatments such as sham or epidural block procedures (223 patients). The radiofrequency group exhibited significantly greater improvements in back pain score when compared with the control group for 1-year follow-up. Although the average improvement in VAS scores exceeded the MCID, the lower limit of the 95% CI encompassed the MCID. A subgroup of patients who responded very well to diagnostic block procedures demonstrated significant improvements in back pain relative to the control group at all times. When placed into our meta-regression model, the response to diagnostic block procedure was responsible for a statistically significant portion of treatment effect. Studies published over the last two decades revealed that radiofrequency denervation reduced back pain significantly in patients with facet joint disease compared with the MCID and control treatments. CONCLUSIONS Conventional radiofrequency denervation resulted in significant reductions in low back pain originating from the facet joints in patients showing the best response to diagnostic block over the first 12 months when compared with sham procedures or epidural nerve blocks.
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Affiliation(s)
- Chang-Hyun Lee
- Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwaro, Ilsan Seo-gu, Goyang, Gyeonggi, 10380, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Neuroscience Research Institute, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Brain and Cognitive Sciences, 203-105B, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Neuroscience Research Institute, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Vakkala M, Järvimäki V, Kautiainen H, Haanpää M, Alahuhta S. Incidence and predictive factors of spinal cord stimulation treatment after lumbar spine surgery. J Pain Res 2017; 10:2405-2411. [PMID: 29042816 PMCID: PMC5634380 DOI: 10.2147/jpr.s143633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Spinal cord stimulation (SCS) is recommended for the treatment of postsurgical chronic back and leg pain refractory to other treatments. We wanted to estimate the incidence and predictive factors of SCS treatment in our lumbar surgery cohort. Patients and methods Three questionnaires (a self-made questionnaire, the Oswestry Low Back Pain Disability Questionnaire, and the Beck Depression Inventory) were sent to patients aged 18–65 years with no contraindications for the use of SCS, and who had undergone non-traumatic lumbar spine surgery in the Oulu University Hospital between June 2005 and May 2008. Patients who had a daily pain intensity of ≥5/10 with predominant radicular component were interviewed by telephone. Results After exclusions, 814 patients remained in this cohort. Of those, 21 patients had received SCS by the end of June 2015. Fifteen (71%) of these received benefit and continued with the treatment. Complications were rare. The number of patients who replied to the postal survey were 537 (66%). Eleven of them had undergone SCS treatment after their reply. Features predicting SCS implantation were daily or continuous pain, higher intensities of pain with predominant radicular pain, more severe pain-related functional disability, a higher prevalence of depressive symptoms, and reduced benefit from pain medication. The mean waiting time was 65 months (26–93 months). One hundred patients were interviewed by telephone. Fourteen seemed to be potential SCS candidates. From the eleven patients who underwent SCS after responding to the survey, two were classified as potential candidates in the phone interview, while nine were other patients. Twelve patients are still waiting for treatment to commence. Conclusion In our region, the SCS treatment is used only for very serious pain conditions. Waiting time is too long and it may be the reason why this treatment option is not offered to all candidates.
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Affiliation(s)
- Merja Vakkala
- Department of Anaesthesiology, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu
| | - Voitto Järvimäki
- Department of Anaesthesiology, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio.,Folkhälsan Research Center, Helsinki
| | - Maija Haanpää
- Department of Neurosurgery, Helsinki University Hospital.,Mutual Insurance Company Etera, Helsinki, Finland
| | - Seppo Alahuhta
- Department of Anaesthesiology, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu
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Koh JC, Kim DH, Lee YW, Choi JB, Ha DH, An JW. Relationship between paravertebral muscle twitching and long-term effects of radiofrequency medial branch neurotomy. Korean J Pain 2017; 30:296-303. [PMID: 29123625 PMCID: PMC5665742 DOI: 10.3344/kjp.2017.30.4.296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 11/26/2022] Open
Abstract
Background To achieve a prolonged therapeutic effect in patients with lumbar facet joint syndrome, radiofrequency medial branch neurotomy (RF-MB) is commonly performed. The purpose of this study was to evaluate the prognostic value of paravertebral muscle twitching when performing RF-MB in patients with lumbar facet joint syndrome. Methods We collected and analyzed data from 68 patients with confirmed facet joint syndrome. Sensory stimulation was performed at 50 Hz with a 0.5 V cut-off value. Patients were divided into 3 groups according to the twitching of the paravertebral muscle during 2 Hz motor stimulation: ‘Complete’, when twitching was observed at all needles; ‘Partial’, when twitching was present at 1 or 2 needles; and ‘None’, when no twitching was observed. The relationship between the long-term effects of RF-MB and paravertebral muscle twitching was analyzed. Results The mean effect duration of RF-MB was 4.6, 5.8, and 7.0 months in the None, Partial, and Complete groups, respectively (P = 0.47). Although the mean effect duration of RF-MB did not increase significantly in proportion to the paravertebral muscle twitching, the Complete group had prolonged effect duration (> 6 months) than the None group in subgroup analysis. (P = 0.03). Conclusions Paravertebral muscle twitching while performing lumbar RF-MB may be a reliable predictor of long-term efficacy when sensory provocation under 0.5 V is achieved. However, further investigation may be necessary for clarifying its clinical significance.
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Affiliation(s)
- Jae Chul Koh
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Do Hyeong Kim
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Youn Woo Lee
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Dong Hun Ha
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Won An
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Giebels F, Prescher A, Wagenpfeil S, Bücker A, Kinzel S. [Nerve distribution and density in the canine hip joint capsule. Comparison of healthy and dysplastic hip joints]. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2017; 45:77-83. [PMID: 28197624 DOI: 10.15654/tpk-160366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 11/02/2016] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The hip-joint capsule is exposed to increased tension forces during canine hip dysplasia, resulting in inflammation of the capsular tissue. It has been postulated that inflammation is associated with an increased nerve-distribution density. Therefore, it could be supposed that the nerve-distribution density in the hip-joint capsule is higher in dogs with dysplastic hip compared to healthy dogs. MATERIAL AND METHODS In 16 Labrador Retriever dogs that had been euthanised due to unrelated reasons, the hip joints were classified as normoplastic (group 1, n = 18) or dysplastic (group 2, n = 14) based on radiography. Following staining of the capsular nerve fibres by the Sihler method, histological specimens of the hip-joint capsules were scanned. By subdividing each specimen into 10 quadrants numbered from dorsomedial (Q01) to craniodorsolateral (Q10), the ratio of black to white pixels was calculated digitally for each specimen and each quadrant by using a semiautomatic image analysis. Statistical analysis was performed using an independent t-test. RESULTS Comparison of the mean values of each quadrant showed a significantly higher (p < 0.03) nerve distribution density for the craniodorsolateral quadrant (Q10) in group 2 when compared to group 1. Mean nerve-distribution density for all quadrants combined was not significantly different between the two groups. CONCLUSION The increase in nerve-distribution density of the craniodorsal region of the hip-joint capsule in dogs with dysplastic hip could be the result of increased tension forces on this area following hip-joint dysplasia. The craniodorsal region of the hip-joint capsule is an important origin of pain and coxarthrosis in canine hip dysplasia. CLINICAL RELEVANCE The results provide the pathophysiological basis for the efficacy of hip-joint denervation. Denervation of the cranial region of the acetabular rim is essential to reduce capsular inflammation and joint-related pain in canine hip dysplasia.
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Affiliation(s)
- Felix Giebels
- Felix Giebels, Jülicher Straße 376, 52070 Aachen, E-Mail:
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Association between Pain in Adolescence and Low Back Pain in Adulthood: Studying a Cohort of Mine Workers. PAIN RESEARCH AND TREATMENT 2017; 2017:3569231. [PMID: 28367328 PMCID: PMC5358449 DOI: 10.1155/2017/3569231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/13/2017] [Accepted: 02/22/2017] [Indexed: 11/25/2022]
Abstract
Purpose. To study the association of self-reported pain in adolescence with low back pain (LBP) in adulthood among mine workers and, also, study associations between the presence of LBP over 12-month or one-month LBP intensity during a health examination and daily ratings of LBP three and nine months later. Methods. Mixed design with data collected retrospectively, cross-sectionally, and prospectively. Data was collected using a questionnaire during a health examination and by using self-reported daily ratings of LBP three and nine months after the examination. Results. Pain prevalence during teenage years was 55% and it was 59% at age 20. Pain during teenage years had a relative risk of 1.33 (95% confidence interval 1.03–1.73) of LBP 12 months prior to the health examination, but with no associations with LBP intensity or LBP assessed by text messaging. Pain at age 20 years was not associated with any measure of LBP in adulthood. Daily ratings of LBP were associated with LBP during the health examination three and nine months earlier. Conclusions. There were no clear associations between self-reported pain in adolescence and LBP in adulthood. Self-reported daily ratings of LBP were associated with LBP from the health examination. Possible limitations for this study were the retrospective design and few participants.
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Maniquis-Smigel L, Dean Reeves K, Jeffrey Rosen H, Lyftogt J, Graham-Coleman C, Cheng AL, Rabago D. Short Term Analgesic Effects of 5% Dextrose Epidural Injections for Chronic Low Back Pain: A Randomized Controlled Trial. Anesth Pain Med 2016; 7:e42550. [PMID: 28920043 PMCID: PMC5554430 DOI: 10.5812/aapm.42550] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/09/2016] [Accepted: 11/25/2016] [Indexed: 12/15/2022] Open
Abstract
Background Hypertonic dextrose injection (prolotherapy) is reported to reduce pain including non-surgical chronic low back pain (CLBP), and subcutaneous injection of 5% dextrose is reported to reduce neurogenic pain, hyperalgesia and allodynia. The mechanism in both cases is unclear, though a direct effect of dextrose on neurogenic pain has been proposed. This study assessed the short-term analgesic effects of epidural 5% dextrose injection compared with saline for non-surgical CLBP. Methods Randomized double-blind (injector, participant) controlled trial. Adults with moderate-to-severe non-surgical low back pain with radiation to gluteal or leg areas for at least 6 months received a single epidurogram-confirmed epidural injection of 10 mL of 5% dextrose or 0.9% saline using a published vertical caudal injection technique. The primary outcome was change in a numerical rating scale (NRS, 0 - 10 points) pain score between baseline and 15 minutes; and 2, 4, and 48 hours and 2 weeks post-injection. The secondary outcome was percentage of participants achieving 50% or more pain improvement at 4 hours. Results and Conclusions No baseline differences existed between groups; 35 participants (54 ± 10.7 years old; 11 female) with moderate-to-severe CLBP (6.7 ± 1.3 points) for 10.6 ± 10.5 years. Dextrose participants reported greater NRS pain score change at 15 minutes (4.4 ± 1.7 vs 2.4 ± 2.8 points; P = 0.015), 2 hours (4.6 ± 1.9 vs 1.8 ± 2.8 points; P = 0.001), 4 hours (4.6 ± 2.0 vs 1.4 ± 2.3 points; P < 0.001), and 48 hours (3.0 ± 2.3 vs 1.0 ± 2.1 points; P = 0.012), but not at 2 weeks (2.1 ± 2.9 vs 1.2 ± 2.4 points; P = 0.217). Eighty four percent (16/19) of dextrose recipients and 19% (3/16) of saline recipients reported ≥ 50% pain reduction at 4 hours (P < 0.001). These findings suggest a neurogenic effect of 5% dextrose on pain at the dorsal root level; waning pain control at 2 weeks suggests the need to assess the effect of serial dextrose epidural injections in a long-term study with robust outcome assessment.
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Affiliation(s)
| | - Kenneth Dean Reeves
- Private Practice PM&R and Pain Management, Roeland Park, Kansas, Past Clinical Assistant/Associate Professor (1986-2015) University of Kansas Department of PM&R, Kansas City, Kansas
- Corresponding author: Kenneth Dean Reeves, Private Practice PM&R and Pain Management, Roeland Park, Kansas, Past Clinical Assistant/Associate Professor (1986-2015) University of Kansas Department of PM&R, Kansas City, Kansas. Tel: +1-9133621600, Fax: +1-913362-4452, E-mail:
| | - Howard Jeffrey Rosen
- Private Practice Anesthesiology and Pain Management, Anaheim and Monterey, California, U.S.A
| | | | | | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, 64108
| | - David Rabago
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Court, Madison, Wisconsin, U.S A. 53715
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Vazirian M, Van Dillen LR, Bazrgari B. Lumbopelvic rhythm in the sagittal plane: A review of the effects of participants and task characteristics. ACTA ACUST UNITED AC 2016; 38:51-58. [PMID: 29034002 DOI: 10.1080/17536146.2016.1241525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Abnormalities of lumbopelvic coordination have been suggested to relate to risk of developing low back pain. The objective of this study is to review and summarize the findings of studies that have implemented and reported on lumbopelvic rhythm during trunk forward bending and backward return. METHODS The PUBMED and CINAHL databases were searched for studies related to LPR using appropriate keywords. The references of each study from the database search were further investigated to identify any missed study. RESULTS The findings includes results related to lumbopelvic rhythm, and how it varies due to participant characteristics such as age, gender, and presence of low back pain as well as due to variations in the experimental procedures such as pace of motion, presence of external load, and muscle fatigue. CONCLUSION In general, the magnitude of lumbar contribution is smaller in people with low back pain, in the elderly and females, as well as with greater pace of motion, but is larger with greater external load or back muscle fatigue. The compiled data in this review are expected to serve as a foundation for implementation of this kinematic-based measure in the conduct of future research.
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Affiliation(s)
- Milad Vazirian
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
| | - Linda R Van Dillen
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, MO, USA
| | - Babak Bazrgari
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
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Velickovic M, Ballhause TM. Delayed onset of a spinal epidural hematoma after facet joint injection. SAGE Open Med Case Rep 2016; 4:2050313X16675258. [PMID: 27803810 PMCID: PMC5077070 DOI: 10.1177/2050313x16675258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 09/12/2016] [Indexed: 11/20/2022] Open
Abstract
The treatment of chronic back pain is a challenging problem. Facet joint infiltration is an established treatment for chronic low back pain caused by arthrosis of the lumbar facet joints. Due to the increasing number of patients with chronic low back pain, this therapy has become more frequent. We treated a 51-year-old male patient, who developed an epidural hematoma 2 months after infiltration therapy. Our case shows that even a delayed onset of spinal epidural hematoma is possible and should be kept in mind as a possible cause of acute myelopathy after spinal intervention.
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Affiliation(s)
- Mirko Velickovic
- Department of Orthopedic Surgery, Sports Traumatology and Trauma Surgery, Wolfenbüttel Municipal Hospital, Wolfenbüttel, Germany
| | - Tobias M Ballhause
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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