Cases Of Chronic Back Pain Research Articles

P46 A rare case of costovertebral arthritis in SLE

P46 A rare case of costovertebral arthritis in SLE

Plain lumbosacral X-rays for low back pain: Findings correlate with clinical presentation in primary care settings

Background:Low back pain (LBP) is a common disabling condition frequently seen and managed in primary care. LBP is considered to be the most common health problem for which general practitioners order an imaging test.Objective:To correlate radiological findings of plain lumbosacral X-rays with the initial clinical presentation of patients with back pain.Materials and Methods:This is a descriptive cross-sectional retrospective chart review study, conducted for 384 adult patients, with back pain who had plain lumbosacral X-rays, at three primary healthcare centers at King Abdul-Aziz Medical City (KAMC) in Riyadh, Saudi Arabia, in the period from 1 Jan 2017 to 31 Dec 2018.Results:The majority of cases had either normal lumbosacral X-rays (32.8%) or incidental findings that were nonspecific. The most abnormal findings were degenerative changes such as spondylosis (osteophytosis) and narrowing of the intervertebral foraminal space (45.3%). The vast majority of cases of chronic back pain was associated with abnormal findings on a plain lumbosacral X-ray, which constituted most cases with abnormal findings among subjects.Conclusion:Lumbosacral X-ray findings in the vast majority of cases do not correlate with clinical presentation and do not justify routinely ordering imaging studies for nonspecific back pain in a primary care setting.

Genome-wide meta-analysis of 158,000 individuals of European ancestry identifies three loci associated with chronic back pain.

Back pain is the #1 cause of years lived with disability worldwide, yet surprisingly little is known regarding the biology underlying this symptom. We conducted a genome-wide association study (GWAS) meta-analysis of chronic back pain (CBP). Adults of European ancestry were included from 15 cohorts in the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, and from the UK Biobank interim data release. CBP cases were defined as those reporting back pain present for ≥3–6 months; non-cases were included as comparisons (“controls”). Each cohort conducted genotyping using commercially available arrays followed by imputation. GWAS used logistic regression models with additive genetic effects, adjusting for age, sex, study-specific covariates, and population substructure. The threshold for genome-wide significance in the fixed-effect inverse-variance weighted meta-analysis was p<5×10−8. Suggestive (p<5×10−7) and genome-wide significant (p<5×10−8) variants were carried forward for replication or further investigation in the remaining UK Biobank participants not included in the discovery sample. The discovery sample comprised 158,025 individuals, including 29,531 CBP cases. A genome-wide significant association was found for the intronic variant rs12310519 in SOX5 (OR 1.08, p = 7.2×10−10). This was subsequently replicated in 283,752 UK Biobank participants not included in the discovery sample, including 50,915 cases (OR 1.06, p = 5.3×10−11), and exceeded genome-wide significance in joint meta-analysis (OR 1.07, p = 4.5×10−19). We found suggestive associations at three other loci in the discovery sample, two of which exceeded genome-wide significance in joint meta-analysis: an intergenic variant, rs7833174, located between CCDC26 and GSDMC (OR 1.05, p = 4.4×10−13), and an intronic variant, rs4384683, in DCC (OR 0.97, p = 2.4×10−10). In this first reported meta-analysis of GWAS for CBP, we identified and replicated a genetic locus associated with CBP (SOX5). We also identified 2 other loci that reached genome-wide significance in a 2-stage joint meta-analysis (CCDC26/GSDMC and DCC).

Chronic back pain cured by low-dose levodopa: is it a variant of restless legs syndrome?

Chronic back pain is one of the most common reasons for missed work and visits to the doctor. This report presents 2 interesting cases of chronic back pain that were effectively relieved by low-dose levodopa. These 2 patients showed no sign of anatomical problem of the spine or relative structures, but the discomforts on the back manifested some characteristics resembling those in restless legs syndrome (RLS), and one of them actually developed RLS after many years of back problem. We believe that this type of chronic back pain might be a variant of RLS, which we would like to call “restless back”, and it can be effectively treated by dopaminergic drugs.

Study on the Effects of Tetrax®-based Combined Rehabilitation Exercise on Chronic Back Pain Cases

The purpose of this research is to utilizing the Tetrax balance measuring instrument in order to analyze the postural balance of males and females in their 30 s diagnosed with chronic lower back pain who have followed a 12-week rehabilitation exercise program. The research also examines the effects on any change in back pain level. In terms of the variables in this research, postural balance (left/right, front/back, postural balance) and pain level change (0~100 mm) were measured. Pre-/post-experimental differences were assessed using the paired-t test. In addition, to identify any gender gap, we set the preliminary scores as a covariate and ran the Analysis of Covariance. Statistical significance (a) herein was set at 0.05. As a result of this research experiment, the left/right, front/back, and overall postural balance were found to increase in both the male and female cases, but with no statistical significance or gender gap. However, both males and females showed a significant decrease in their back pain levels. These findings demonstrate the necessity of continuing clinical research based on the Tetrax equipment for scientific evaluation of the effects of rehabilitation exercises on chronic lower back pain patients and their balancing ability.

Persistent Back Pain after Multiple Operations: Case Presentation From Israel With Commentaries From Austria and The Netherlands

ABSTRACTA case of chronic back pain following multiples spine surgeries is presented as an example of postlaminectomy (failed back surgery) syndrome. The roles of physical modalities and spine rehabilitation rather than additional surgery and pharmacotherapy are described. In the commentaries the potential usefulness of adjunctive pharmacotherapy with opioids and tricyclic antidepressants is mentioned, as is the potential future need for more invasive procedures.

Disc space injection with marcaine as a method to evaluate painful nonunion of an interbody fusion device: a case report

Discography has been successfully used to distinguish painful from asymptomatic intervertebral discs. To report a case of chronic back pain following two-level interbody and posterolateral fusion in the lumbar spine that was evaluated with marcaine injection into the disc space. Case report. A patient with chronic back pain after a two-level anteroposterior lumbar fusion was evaluated. A complete description of the history, physical examination, and relevant radiographic images along with a brief review of the pertinent literature are included. Injection of marcaine into the area of previous interbody fusion resolved the painful symptoms, and surgery confirmed the nonunion. In cases of interbody lumbar fusion with questionable solidity, marcain injection within the disc space can help in the assessment of the source of pain even at the intervertebral spaces with cages.

Stressful Experiences in Childhood and Chronic Back Pain in the General Population

To determine if stressful experiences in childhood are associated with an increased risk of chronic back problems later in life. We conducted a prospective cohort study in the Canadian household population. Study participants were respondents to the first 3 cycles of the National Population Health Survey in Canada who were 18 years of age or older at baseline (n = 9552). Cases of chronic back pain during a 4-year follow-up period were ascertained with an interviewer-administered questionnaire. Stressful experiences in childhood were measured by an index consisting of 7 questions. In multivariate analyses, the risk of back pain was 1.17 (95% confidence interval 0.97-1.41) for 1 stressful event and 1.49 (95% confidence interval 1.21-1.84) for 2 or more events. The effect was consistent across subgroups defined by gender, socioeconomic status, and health status. Specific events associated with an increased risk included fearful experiences, prolonged hospitalization, and parental unemployment. Our study shows that persons reporting multiple stressful experiences in childhood are at increased risk of developing chronic back problems.

More data on major depression as an antecedent risk factor for first onset of chronic back pain

Few epidemiological studies have examined the temporal relationship between chronic pain and depression using longitudinal data. In the present study, we examined major depression as both an antecedent risk factor and consequence of chronic back pain (CBP) in the general population. Data on 9909 pain-free individuals 15 years and older with no history of back problems were drawn from cycle 1 of the National Population Health Survey and followed up 24 months later. Major depression was assessed using a structured diagnostic interview. At cycle 2, the rate of new cases of CBP in persons who were depressed at cycle 1 was 3.6% compared to 1.1% in non-depressed persons. Compared to pain-free individuals, new cases of CBP were more likely to perceive their health status as poor or fair at cycle 1, were less likely to be working, reported more chronic health problems, and sustained a back or neck injury in the preceding 12 months. After controlling for other factors, pain-free individuals diagnosed as major depressed at cycle 1 were almost three times more likely (OR 2.9, 95% CI 1.2-7.0) to develop CBP at cycle 2. Consistent with other longitudinal studies major depression increases the risk of developing future chronic pain. The causal mechanism linking these conditions is unknown however depression may represent a modifiable risk factor in the development of CBP.

Effect of age on outcomes of tertiary rehabilitation for chronic disabling spinal disorders.

A prospective cohort study evaluating age as a factor in treatment outcomes for chronic disabling work-related spinal disorders undergoing tertiary rehabilitation. To assess the association between age and objective psychosocioeconomic treatment outcomes for work-related spinal disorders undergoing functional restoration. As early as the 1950s, a link between age and low back symptoms has been identified in the literature. Several studies have demonstrated that the occurrence of low back pain is positively correlated with age up to about 50-60 years, after which prevalence declines. It has been argued that this pattern is stronger for more severe, chronic back pain cases. Little research attention has been given to age as a factor in treatment outcomes for work-related spinal disorders. A cohort of 1052 chronically disabled (none working full-time when starting the rehabilitation program) spinal disorder (CDSD) patients were placed into five groups based on age: Group 1, <25 years (22 +/- 2 years, n = 59); Group 2, 25-34 years (30 +/- 3 years, n = 301); Group 3, 35-44 years (39 +/- 3 years, n = 381); Group 4, 45-54 (49 +/- 3 years, n = 237); and Group 5, > or =55 years (59 +/- 4 years, n = 74). All patients completed a functional restoration program combining quantitatively directed exercise progression with a multimodal disability management approach using psychological and case management techniques. Before the start of the program, and again on completion of the program, all patients received a psychosocial evaluation and were also assessed on a variety of physical motion, strength, aerobic, and functional factors, and a cumulative score was calculated, which aggregates and averages these physical measures. A structured clinical interview examining socioeconomic outcomes (work return, health utilization, recurrent injury, and resolution of financial disputes) was conducted at 1 year after program completion, and at least partial information was obtained from this interview on all consecutive patients in the study. The length of pretreatment disability increased with age (P < 0.001), as well as pretreatment surgery rates (P < 0.002). A Mantel-Haenzel chi2 test for linear trend across age groups revealed that the percentage of patients who returned to work declined progressively from 100% in Group 1 to 69% in Group 5 (P < 0.001). The same linear trend was revealed for the percentage of patients retaining work at the end of 1 year (98-62%, P < 0.001). Older workers returned to the same job and/or the same employer (P < 0.005). Younger workers found different jobs with new employers (48-11%, P < 0.0001). Analysis of variance for the disability questionnaire revealed that after treatment subjective disability progressively increased (while improvements decreased) from Group 1 to Group 5 (P < 0.01). The cumulative physical score variable, even normalized for age, was progressively lower from Group 1 to Group 5, both at pretreatment (P < 0.03) and post-treatment (P < 0.02). The present study represents the first large-scale examination of the association between age and treatment outcomes for a work-related CDSD population. Age is significantly and linearly related to pretreatment duration of disability and frequency of pretreatment surgeries. After rehabilitation treatment there is a linear decrement in both work return and work retention, so that younger patients are far more likely to return and hold work after functional restoration. Older workers who go back to work are much more likely to return to the same employer and do the same job, or to become self-employed. Calculation of odds ratios revealed that patients >55 years are 5.68 times more likely to return to the same job and employer, relative to those <25 years; those >55 years were also approximately three times more likely than those <25 years to return to the same employer, compared with those <25 years. Younger workers are far more likely to take a different job and/or seek a new employer. Older patients are also somewhat more likely to seek a new health provider to deal with perceived residual pain/disability. This trend coincides with their higher post-treatment subjective disability levels, and their lower cumulative physical scores both prerehabilitation and postrehabilitation. However, age does not affect additional surgery rates, subsequent injuries, or delays in settling financial disputes.

Abnormal brain chemistry in chronic back pain: an in vivo proton magnetic resonance spectroscopy study

The neurobiology of chronic pain, including chronic back pain, is unknown. Structural imaging studies of the spine cannot explain all cases of chronic back pain. Functional brain imaging studies indicate that the brain activation patterns are different between chronic pain patients and normal subjects, and the thalamus, and prefrontal and cingulate cortices are involved in some types of chronic pain. Animal models of chronic pain suggest abnormal spinal cord chemistry. Does chronic pain cause brain chemistry changes? We examined brain chemistry changes in patients with chronic back pain using in vivo single- voxel proton magnetic resonance spectroscopy ( 1H-MRS). In vivo 1H-MRS was used to measure relative concentrations of N-acetyl aspartate, creatine, choline, glutamate, glutamine, γ-aminobutyric acid, inositol, glucose and lactate in relation to the concentration of creatine. These measurements were performed in six brain regions of nine chronic low back pain patients and 11 normal volunteers. All chronic back pain subjects underwent clinical evaluation and perceptual measures of pain and anxiety. We show that chronic back pain alters the human brain chemistry. Reductions of N-acetyl aspartate and glucose were demonstrated in the dorsolateral prefrontal cortex. Cingulate, sensorimotor, and other brain regions showed no chemical concentration differences. In chronic back pain, the interrelationship between chemicals within and across brain regions was abnormal, and there was a specific relationship between regional chemicals and perceptual measures of pain and anxiety. These findings provide direct evidence of abnormal brain chemistry in chronic back pain, which may be useful in diagnosis and future development of more effective pharmacological treatments.

A case of chronic back pain and the “unilateral” treatment of marital problems

When a client's problems are deeply rooted in his or her marriage, a therapist should usually work with both husband and wife. However, when either spouse refuses cooperation, unilateral marriage counseling, in which the client identifies problem areas in the marriage and becomes a behavioral engineer (with the therapist as a consultant), can be employed. This procedure is illustrated in the case of a 52-yr-old woman who reported numerous marital problems accompanied by chronic back pain.

THE NEUROLOGIC ASPECTS OF LOW BACK PAIN AND SCIATICA

There is an erroneous impression among physicians that many cases of chronic back pain are the result of disease of the spinal cord, spinal meninges or spinal nerves. The fact is that disease of these organs rarely causes back pain and, when it does, the pain is overshadowed by such symptoms as paralysis, anesthesia and pain at a distance from the spine. Probably less than 1 per cent of cases of back pain are caused by primary diseases of the central and peripheral nervous systems. These infrequent neurologic causes of back pain are classified and briefly discussed in the following paragraphs. INTRACRANIAL DISEASES CAUSING BACK PAIN Intracranial diseases causing back pain are rare and are mentioned here merely for the sake of completeness. Subarachnoid Hemorrhage.— Blood may enter the spinal subarachnoid space when the head is injured, when a brain tumor bleeds or when an intracranial aneurysm ruptures. Regardless of