Chronic Back Pain Patients Research Articles

ID: 328186 DTM™ SCS for Indicated Chronic Back Pain Patients Ineligible for Spine Surgery: EU RCT Outcomes

ID: 328186 DTM™ SCS for Indicated Chronic Back Pain Patients Ineligible for Spine Surgery: EU RCT Outcomes

Baseline and 2-year differences in spinal symptoms and spinal and hip mobility in early axial spondyloarthritis and non-axial spondyloarthritis chronic back pain patients

ObjectiveTo compare spinal symptoms and spinal/hip mobility at baseline and 2 years in early axial spondyloarthritis (axSpA) and non-axSpA chronic back pain (BP) patients.MethodsBaseline and 2 years data of the...

Kinesiophobia among health professionals' interventions: a scoping review.

Health professionals are regularly confronted with patients suffering from a fear of movement-related pain (unknown as kinesiophobia). The fear-avoidance attitudes and beliefs of healthcare professionals are likely to play a key role in their patients' therapeutic approach. However, kinesiophobia among health professionals is a relatively young topic. This scoping review aims to explore and catalogue the extent of scientific research that identifies the causes and consequences of kinesiophobia among health professionals while they perform their interventions. The review was based on the Joanna Briggs Institute manual and the PRISMA method for a scoping review. The research was conducted in May 2024 using CINHAL, Medline and Sportdiscus databases with the search terms "fear-avoidance", "kinesiophobia", "pain-related" and "physical therapist". Out of 2,162 potential studies, thirteen articles were included. No study directly mentioned kinesiophobia among health professionals, but it was studied through fear-avoidance beliefs. Two-thirds of the articles indicate that professionals with fear-avoidance beliefs tend to refer their patients to other specialists less frequently and limit their patients' activity, despite treatment guidelines. Most of the studies found were physiotherapists' interventions for chronic back pain patients. The current review emphasizes the need for additional studies involving more healthcare professionals and diverse health conditions.

A systematic review and bayesian meta-analysis of medical devices used in chronic pain management

Whilst. pharmacological therapies remain the cornerstone of pain management in chronic pain, factors including the current opioid epidemic have led to non-pharmacological techniques becoming a more attractive proposition. We explored the prevalence of medical device use and their treatment efficacy in non-cancer pain management. A systematic methodology was developed, peer reviewed and published in PROSPERO (CRD42021235384). Key words of medical device, pain management devices, chronic pain, lower back pain, back pain, leg pain and chronic pelvic pain using Science direct, PubMed, Web of Science, PROSPERO, MEDLINE, EMBASE, PorQuest and ClinicalTrials.gov. All clinical trials, epidemiology and mixed methods studies that reported the use of medical devices for non-cancer chronic pain management published between the 1st of January 1990 and the 30th of April 2022 were included. 13 studies were included in systematic review, of these 6 were used in the meta-analysis. Our meta-analysis for pain reduction showed that transcutaneous electrical nerve stimulation combined with instrument-assisted soft tissue mobilization treatment and pulsed electromagnetic therapy produced significant treatment on chronic lower back pain patients. Pooled evidence revealed the use of medical device related interventions resulted in 0.7 degree of pain reduction under a 0–10 scale. Significant improvement in disability scores, with a 7.44 degree reduction in disability level compared to a placebo using a 50 score range was also seen. Our analysis has shown that the optimal use of medical devices in a sustainable manner requires further research, needing larger cohort studies, greater gender parity, in a more diverse range of geographical locations.

Comparison of the Effects of Lumbar Stabilization Exercise According to the Presence or Absence of Gluteus Medius Muscle Weakness in Chronic Lower Back Pain Patients with Lumbar Instability

Comparison of the Effects of Lumbar Stabilization Exercise According to the Presence or Absence of Gluteus Medius Muscle Weakness in Chronic Lower Back Pain Patients with Lumbar Instability

346 Durable Responses at 24 Months With High-Frequency Spinal Cord Stimulation for Nonsurgical Refractory Back Pain

INTRODUCTION: Chronic refractory back pain causes significant disability and is one of the most common reasons for patients seeking health care. Few treatment options exist for chronic back pain patients who have failed conventional medical management (CMM) and who have not had and are not candidates for spine surgery, a condition we refer to as non-surgical refractory back pain (NSRBP). METHODS: Patients with NSRBP were evaluated after 1:1 randomization to 10kHz SCS plus CMM or CMM alone. Primary endpoint and secondary endpoints were assessed, and optional crossover was allowed at 6 months, with observational follow-up over 12 months (Kapural, 2022). All patients treated with 10kHz SCS were eligible for follow-up through 24 months after implantation. Outcomes included pain, Oswestry Disability Index (ODI), quality-of-life (EQ-5D-5L), 3-item Pain Sleep Questionnaire (PSQ-3), opioid use, patient’s global impression of change (PGIC), and safety. RESULTS: Of the 125 patients who received a permanent implant, 121 completed 12-month follow-up, 101 reconsented for extended follow-up, and 98 completed 24-month follow-up. At 24 months after implantation 82% achieved =50% pain relief. All outcome measures improved by at least double the minimal clinically important difference. Ninety-percent of patients met at least one of the multidimensional outcomes. Of those who reported opioid use during the study, and 62% of decreased or stopped. Through 24 months, 3 of 125 (2.4%) devices were explanted due to patient dissatisfaction with SCS therapy. CONCLUSIONS: The addition of 10kHz SCS to CMM in patients with NSRBP offers profound improvements at 24 months in pain, function, quality-of-life, and reduced opioid use. This study provides much-needed evidence to inform current clinical practice for managing patients with NSRBP.

Research on the multidimensional brain remodeling mechanisms at the level of brain regions, circuits, and networks in patients with chronic lower back pain caused by lumbar disk herniation.

Chronic lower back pain (cLBP), frequently attributed to lumbar disk herniation (LDH), imposes substantial limitations on daily activities. Despite its prevalence, the neural mechanisms underlying lower back pain remain incompletely elucidated. Functional magnetic resonance imaging (fMRI) emerges as a non-invasive modality extensively employed for investigating neuroplastic changes in neuroscience. In this study, task-based and resting-state fMRI methodologies are employed to probe the central mechanisms of lower back pain. The study included 71 chronic lower back pain patients (cLBP group) due to LDH and 80 age, gender, and education-matched healthy volunteers (HC group). The subjects are mainly middle-aged and elderly individuals. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Scores (JOA) were recorded. Resting-state and task-based fMRI data were collected. No significant differences were observed in age, gender, and education level between the two groups. In the cLBP group during task execution, there was diffuse and reduced activation observed in the primary motor cortex and supplementary motor area. Additionally, during resting states, notable changes were detected in brain regions, particularly in the frontal lobe, primary sensory area, primary motor cortex, precuneus, and caudate nucleus, accompanied by alterations in Amplitude of Low Frequency Fluctuation, Regional Homogeneity, Degree Centrality, and functional connectivity. These findings suggest that chronic lower back pain may entail reduced excitability in sensory-motor areas during tasks and heightened activity in the sensory-motor network during resting states, along with modified functional connectivity in various brain regions.

Cognitive behavioral therapy (CBT) and meditation in the treatment of persistent low back pain: Interventional Study

Objective: To compare the effect of both CBT and Meditation in chronic lower back pain patients.
 Method: Participants fulfilling the exclusion and inclusion criteria and who are between the age group of 35-50 years with CLBP were included. Numerical pain rating scale and Montreal Cognitive Assessment (MOCA) was used for the participant selection. The participants were further divided into three groups and 4-week intervention of conventional physiotherapeutic exercise, meditation and CBT, was given to the participants. Numerical Pain Rating Scale and Oswestry Low Back Pain Disability Questionnaire were used as outcome measures.
 Results: 40 chronic back pain patients were enrolled and randomized. All enrolled participants completed baseline tests, providing cross-sectional data for this study. Simple randomization allocated 14 patients to the control group and 13 patients each to Experimental Group 1 and Experimental Group 2. Significant within-group improvements occurred on the Numerical Rating Scale and Oswestry scores between baseline and final visits for all groups. However, the experimental groups showed significantly greater decreases in pain intensity versus controls, evidenced by reduced mean Numerical Rating Scale and Oswestry scores at follow-up. One-way ANOVA and Welch tests revealed significantly reduced Numerical Rating Scale and Oswestry scores after treatment across groups. Both tests yielded statistically significant p-values <0.01.
 Conclusion: The findings show that meditation and cognitive behavioural therapy (CBT) are beneficial in reducing pain. As a result, for patients with persistent low back pain, taking into consideration these two treatment techniques is critical.
 Keywords: Cognitive Behavioural Therapy, Chronic Pain, Oswestry Questionnaire

Applying the Theory of Reasoned Action on the promotion of behaviors related to physical activity in chronic back pain patients

Patient's health with cLBP have a unique place in health policy. This study aimed to evaluate the effect of an educational program based on the TRA on promoting PA - related behavior. The (Reasoned Action theory-based back care) RAT-BAC was a Health Service Center-based RCT comparing the effectiveness of TRA construct. A total of 80 patients who referred to the SBUMS in Tehran, Iran were randomized to a TRA-based intervention group (n=40) and control group (n=40). cLBP completed a self-reported questionnaire at follow-ups; a check list was also used to evaluate the Range of motion of the lumbar spine test skills (LSTS) with modified Schober. The effects investigated the usage of repeated measure analysis Test and analyzed using SPSS 21. There was a significant interaction among the factors “group” and “test time” (p < 0.001), totally, 77 cLBP patients with mean age of (41.04±4.23) in intervention (n=40) and control n=37 an age of (39.03±3.48) in the control group were assessed. At baseline, both groups were identified concerning the TRA constructs (p > 0.05). Following the intervention, there was a significant difference in the course of 3, 6- month follow up (p<0.001). The mean score of PA behavior (8.38±1.05) was significantly better than the control group (3.23±1.04) (p<0.001). The pain severity (3.75±2.24) was significantly less than the control group (4.28±3.02) (p<0.001). The LSTS reduced within the intervention group (p <0.05). It demonstrated promise in improving PA-related behavior in Patients with cLBP, using a range of specific change educational strategies.

A digital values-based microintervention for chronic back pain patients: lessons learned from a randomised experimental single-case study

BackgroundChronic pain usually lasts several years. During this time, value-oriented aspects of life often fade into the background in favour of coping with the pain, which is associated with a lower quality of life. Psychotherapeutic methods such as Acceptance and Commitment Therapy can alleviate this. However, for those who suffer from chronic pain, access to such therapies is limited. Electronic health interventions provide access to evidence-based methods. The aim of this study was to investigate the effectiveness and feasibility of a brief electronic values-based intervention on patients with chronic back pain.MethodsA study with a replicated AB single-case experimental design was conducted with 28 participants suffering from chronic back pain. Participants answered daily questions concerning their pain intensity and quality of life (wellbeing, pain catastrophising, acceptance of chronic pain, engaged living) for 10 to 17 days. The subsequent mobile intervention on value-oriented activities lasted an additional 10 days. During this time, daily assessments continued. Our analysis was performed using a hierarchical two-level modelling approach as well as visual and descriptive analysis.ResultsThe majority of participants did not measurably benefit from the intervention. Neither model-based inference nor visual analysis indicated plausible intervention effects. The results of one responder and one non-responder are presented. In their qualitative feedback, most participants described being satisfied with the intervention. The perceived usefulness of psychotherapy as a treatment for chronic back pain increased from pre- to post-intervention (p < .001, dz = 1.17).ConclusionsThis study shows that microinterventions for chronic back pain patients are feasible, but should be planned over a longer period of time to enable measurable changes. The electronic mobile format did not cause participants any difficulties.Trial registrationClinicalTrials.gov ID: NCT05205889, date of registration: January 12, 2022.

Association of selected inflammatory markers and risk factors with pain in patients undergoing cervical or lumbar disc herniation

Introduction&#x0D; Studies have suggested that radicular pain following disc herniation may be associated with local or systemic inflammatory responses produced in the vicinity of the herniated disc rather than compression of the nerve. Present study assessed the association of serum interleukin-6 (IL-6) levels, high-sensitivity C-reactive protein (hs-CRP) and related risk factors in patients undergoing discectomy following cervical disc herniation (CDH) or lumbar disc herniation (LDH).&#x0D; Methods&#x0D; Study recruited 77 patients undergoing discectomy for LDH and CDH. An interviewer administered questionnaire was used to obtain sociodemographic, behavioral and occupational data. IL-6 and hs-CRP levels were measured in each individual. IL-6 was analyzed by ELISA method and hs-CRP was determined using auto analyzer. Results were analyzed by using SPSS version 25.0.&#x0D; &#x0D; Results&#x0D; Significant correlation was not found with serum IL-6 and hs-CRP levels (r=0.02, p˃0.05) for acute and chronic CDH and LDH. Patients with chronic neck or back pain showed significantly (p=0.043) higher IL-6 level compared to patients with acute neck or back pain. Serum hs-CRP level was significantly higher (p=0.048) in patients with acute neck or back pain compared to patients with chronic neck or back pain. Significant association was not observed between; level of physically demanding nature of occupation (p=0.542), duration of occupation (p=0.446), type of exercise (p=0.371), type of sports (p=0.339) and CDH or LDH.&#x0D; Conclusion&#x0D; Though significant correlation was not observed between inflammatory markers IL-6, hs-CRP and CDH or LDH. The mean IL-6 was higher in chronic back pain and neck pain patients with LDH and CDH whereas mean hs-CRP mean was higher in acute back pain and neck pain patients. Significant association was not reported between selected known risk factors (behavioral, occupational) and CDH or LDH.

Objective Measurement of Subjective Pain Perception with Autonomic Body Reactions in Healthy Subjects and Chronic Back Pain Patients: An Experimental Heat Pain Study.

Multiple attempts to quantify pain objectively using single measures of physiological body responses have been performed in the past, but the variability across participants reduces the usefulness of such methods. Therefore, this study aims to evaluate whether combining multiple autonomic parameters is more appropriate to quantify the perceived pain intensity of healthy subjects (HSs) and chronic back pain patients (CBPPs) during experimental heat pain stimulation. HS and CBPP received different heat pain stimuli adjusted for individual pain tolerance via a CE-certified thermode. Different sensors measured physiological responses. Machine learning models were trained to evaluate performance in distinguishing pain levels and identify key sensors and features for the classification task. The results show that distinguishing between no and severe pain is significantly easier than discriminating lower pain levels. Electrodermal activity is the best marker for distinguishing between low and high pain levels. However, recursive feature elimination showed that an optimal subset of features for all modalities includes characteristics retrieved from several modalities. Moreover, the study's findings indicate that differences in physiological responses to pain in HS and CBPP remain small.

The Lower-Back Painkiller Challenge: Efficacy of Tramadol Versus Tapentadol

Introduction: To reduce pain levels in people with lower back pain, the study looked at the comparative efficacy and tolerability of Tramadol and Tapentadol taken by oral route. Materials &amp; Methods: This comparative study consisted of a total of 126 patients divided into 2 groups, the Tapentadol and Tramadol groups for managing low back pain. Participants aged 18-60 with moderate or higher pain intensity were included. Data on pain intensity, adverse events, and patient-reported outcomes were collected at baseline, day 7, and day 14. Participants were randomly assigned to Tapentadol or Tramadol groups, receiving respective medications for 14 days. Data analysis involved t t-test to compare groups. Means and SD were also calculated. Results: The mean age of the patients in the Tramadol group was 33.1 ± 19.1 and in the Tapentadol group was 37.6 ± 19.9, respectively. Sixty of the total participants were men and sixty-five were women. Participants were split equally between groups A and B, with 30 men and 33 women in group A and 30 men and 32 women in group B. The findings demonstrated that both medications considerably lessened moderate to severe chronic lower back pain (CLBP) patients' pain levels. At 28 days after the baseline, the mean VAS scores for groups A and B were 34.57 and 37.55, respectively. Conclusion: According to the study's findings, these two medications effectively reduce pain in those with chronic lower back pain. Tapentadol is observed to be tolerated well and more effective than Tramadol.

Burden of disease and impact on quality of life in chronic back pain - a comparative cross-sectional study of 150 axial spondyloarthritis and 150 orthopedic back pain patients.

Chronic back pain (CBP) constitutes one of the most common complaints in primary care and a leading cause of disability worldwide. CBP may be of mechanical or inflammatory character and may lead to functional impairment and reduced quality of life. In this study, we aimed to assess and compare burden of disease, functional capacity, quality of life and depressive symptoms in axial spondyloarthritis (axSpA) patients with orthopedic chronic back pain patients (OBP). We further aimed to identify factors associated with quality of life. Cross-sectional survey of a cohort of 300 CBP patients including 150 patients from a University Hospital Orthopedic Back Pain Outpatient Clinic with OBP and 150 patients with confirmed axSpA from a University Hospital Rheumatology Outpatient Clinic. Questionnaire-based assessment of pain character (Inflammatory Back Pain, MAIL-Scale), functional status (FFbH, BASFI), quality of life (WHOQOL-Bref) and depressive symptoms (Phq9) and retrospective medical chart analysis. Both, OBP and axSpA patients reported on average intermediate pain levels of mostly mixed pain character. Both groups demonstrated a reduced health-related quality of life and the presence of depressive symptoms. However, axSpA patients reported a significantly better subjective quality of life, more satisfaction with their health status and better functional capacity compared to OBP patients (all p < 0.001). In a multivariate regression model, depressive symptoms, mechanical back pain, pain level and age were negative predictors of subjective quality of life, whereas functional capacity was a positive predictor. Chronic back pain was associated with a high morbidity and reduced quality of life regardless of pain character. We identified multiple factors associated with reduced quality of life. Awareness and addressing of these factors may help to overcome unmet needs and improve quality of life for these patients.

The Effects of Opioid Dependency Use on Postoperative Spinal Surgery Outcomes: A Review of the Available Literature.

There is a lack of evidence to support the effectiveness of long-term opioid therapy in patients with chronic, noncancer pain. Despite these findings, opioids continue to be the most commonly prescribed drug to treat chronic back pain and many patients undergoing spinal surgery have trialed opioids before surgery for conservative pain management. Unfortunately, preoperative opioid use has been shown repeatedly in the literature to negatively affect spinal surgery outcomes. In this review article, we identify and summarize the main postoperative associations with preoperative opioid use that have been found in previously published studies by searching on PubMed, Google Scholar, Medline, and ScienceDirect; using keywords: Opioid dependency, postoperative, spinal surgery, specifically (1) increased postoperative chronic opioid use (24 studies); (2) decreased return to work (RTW) rates (8 studies); (3) increased length of hospital stay (LOS) (9 studies); and (4) increased healthcare costs (8 studies). The conclusions from these studies highlight the importance of recognizing patients on opioids preoperatively to effectively risk stratify and identify those who will benefit most from multidisciplinary counseling and guidance.

Neural Network Improvements Induced by REST Flotation in Chronic Lower Back Pain Patients: An Exploratory Investigation

Neural Network Improvements Induced by REST Flotation in Chronic Lower Back Pain Patients: An Exploratory Investigation

Predicting heterogeneous treatment effects of an Internet-based depression intervention for patients with chronic back pain: Secondary analysis of two randomized controlled trials

BackgroundDepression is highly prevalent among individuals with chronic back pain. Internet-based interventions can be effective in treating and preventing depression in this patient group, but it is unclear who benefits most from this intervention format. MethodIn an analysis of two randomized trials (N = 504), we explored ways to predict heterogeneous treatment effects of an Internet-based depression intervention for patients with chronic back pain. Univariate treatment-moderator interactions were explored in a first step. Multilevel model-based recursive partitioning was then applied to develop a decision tree model predicting individualized treatment benefits. ResultsThe average effect on depressive symptoms was d = −0.43 (95 % CI: −0.68 to –0.17; 9 weeks; PHQ-9). Using univariate models, only back pain medication intake was detected as an effect moderator, predicting higher effects. More complex interactions were found using recursive partitioning, resulting in a final decision tree with six terminal nodes. The model explained a large amount of variation (bootstrap-bias-corrected R2 = 45 %), with predicted subgroup-conditional effects ranging from di = 0.24 to −1.31. External validation in a pilot trial among patients on sick leave (N = 76; R2 = 33 %) pointed to the transportability of the model. ConclusionsThe studied intervention is effective in reducing depressive symptoms, but not among all chronic back pain patients. Predictions of the multivariate tree learning model suggest a pattern in which patients with moderate depression and relatively low pain self-efficacy benefit most, while no benefits arise when patients' self-efficacy is already high. If corroborated in further studies, the developed tree algorithm could serve as a practical decision-making tool.

ID: 218207 10kHz Spinal Cord Stimulation for Non-Surgical Refractory Back Pain: Objective Functional Outcome to 24-Months

Chronic refractory back pain causes significant disability and has a major negative impact on mental health. Few treatment options exist for chronic back pain patients who have failed conventional medical management (CMM) and who have not had and are not candidates for spine surgery, a condition we refer to as non-surgical refractory back pain (NSRBP). Access to spinal cord stimulation (SCS) is inconsistent in this population due to limited clinical evidence.1 Twenty-four-month outcomes including a functional test is reported from a RCT that compared 10kHz SCS to CMM in the treatment of NSRBP.

Retrospective review of the efficacy for sublingual ketamine in the treatment of chronic low back pain defined by a cause and central functional pain symptom focused clinical model

Purpose Chronic low back pain is a leading cause of disability worldwide. A clinical model for its cause is lacking. Defining a cause based clinical model and a framework of understanding back pain in terms of peripheral structural and central functional pain is essential for optimal management. Materials and methods We describe the results of the largest published audit of 41 chronic low back pain patients, receiving outpatient sublingual ketamine therapy for defined central functional pain along with conventional peripheral structural pain management. Our clinical model assigns Movement Dysfunction as the primary cause for low back pain symptoms and restores it with Movement Therapy focused rehabilitation which is also defined. Patients were derived from a tertiary single neurosurgical specialist practice in Brisbane Australia over a three year period. Results Severe pain and disability measurements more than halved and only 13% of patients ceased ketamine prematurely due to predominantly non-sinister side effects common to all pharmaceutical therapies. All other surveyed metrics of utility were highly favourable in this challenging cohort of chronic back pain patients biased to poor outcomes. Conclusions Outpatient ketamine maintains high efficacy and safety used in conjunction with a unique clinical model that describes chronic low back pain.

Classification of pain intensity with the pain beliefs and perceptions inventory (PBPI) and the pain catastrophizing scales (PCS)

PurposeThe pain beliefs and perceptions inventory (PBPI) and the pain catastrophizing scales (PCS) characterize beliefs or distress dimensions of the pain experience. It is relatively unknown, however, to what degree the PBPI and the PCS are well suited to classifying pain intensity.MethodsThis study applied a receiver operating characteristic (ROC) approach to these instruments against the criterion of a visual analogue scale (VAS) of pain intensity with fibromyalgia and chronic back pain patients (n = 419).ResultsThe largest areas under the curve (AUC) were moderate and limited to the constancy subscale (71%) and total score (70%) of the PBPI and to the helplessness subscale (75%) and total score (72%) of the PCS. The best cut-off scores for the PBPI and PCS were better off at detecting true negatives than true positives, with larger specificity than sensitivity values.ConclusionWhereas, the PBPI and PCS are certainly useful instruments to evaluate diverse pain experiences, they may be inappropriate to classify intensity. The PCS performs marginally better than the PBPI for classifying pain intensity.