Chronic Non-specific Pain Research Articles

Predictors for physical activity and its change after active physical therapy in people with spinal pain and insomnia: Secondary analysis of a randomized controlled trial

BackgroundIn healthy people and people with nonspecific chronic spinal pain (nCSP) and/or insomnia, participation in physical activity on a regular basis has several physical and psychological health benefits. However, people with chronic conditions often tend to reduce physical activity participation which can lead to deconditioning over time. Currently, there are no known predictors for an (in)active lifestyle (before and after physical therapy treatment) in people with chronic spinal pain and comorbid insomnia. ObjectiveTo examine predictors of pre-treatment moderate-to-vigorous physical activity (MVPA) and to examine determinants for a change in MVPA in response to 14-weeks of active physical therapy treatment in people with nonspecific chronic spinal pain (nCSP) and comorbid insomnia. MethodsBaseline data and post-treatment data were analyzed for 66 participants. A linear multiple regression analysis was conducted to examine which factors predict MVPA at baseline. Linear mixed-effects modeling was used to identify determinants for change in MVPA in response to an active physical therapy treatment. ResultsPhysical fatigue (b = -0.9; 95%CI: -1.59, -0.15), less limitations in functioning as a result of emotional problems (b = 0.1; 95%CI: 0.03, 0.10), mental fatigue (b = -1.0; 95%CI: -1.67, -0.43), lower general sleep quality (b= 0.7; 95%CI: 0.22, 1.17), and body mass index (b = -0.5; 95%CI: -0.93, -0.16) were significant predictors of baseline MVPA. The regression model explained 33.3% of the total variance in baseline MVPA. The change of MVPA in response to the treatment ranged from a decrease of 17.5 to an increase of 16.6 hours per week. No determinants for change in MVPA after treatment could be identified. ConclusionPeople with nCSP and comorbid insomnia are more likely to engage in MVPA if they report, at baseline, lower sleep quality, fewer limitations in functioning resulting from emotional problems, lower body mass index, as well as less physical and mental fatigue.

Rapunzel Syndrome in a Teenage Girl: A Case Report

Trichobezoars are concretions of retained, undigested material, mostly hair or hair-like fibers in the stomach. Rapunzel syndrome is the condition when trichobezoars extend into the small bowel, leading to various complications including bowel obstruction, and perforation due to pressure necrosis. We present an interesting case of trichobezoar in a 15-year-old female patient, who presented with abdominal pain for one month duration. The exam was notable for a firm palpable mass in the epigastric area associated with localized tenderness and guarding. Contrast-enhanced CT of the abdomen showed a distended stomach with the bezoar, dilated duodenal loops, and clumping of proximal jejunal loops. Upper gastrointestinal endoscopy showed a trichobezoar extending from the oesophagogastric junction to the pylorus. Endoscopic removal of the trichobezoar was not successful. An elective laparotomy was performed, during which the stomach, duodenum, and proximal jejunum were dilated. The trichobezoar, measuring 35 cm in length, extended from the body of the stomach to the proximal jejunum and caused jejunal perforation due to pressure necrosis. The trichobezoar was removed and primary closure of jejunal perforation with diversion gastrojejunostomy and jejunostomy was done. There were no postoperative complications. The patient followed up with psychiatry in the clinic after discharge, she was diagnosed with trichotillomania and started on fluoxetine, with improvement in her behavioral symptoms. In young female patients with nonspecific chronic abdomen pain and a palpable mass, trichobezoar should be considered in the differential diagnosis. Contrast-enhanced abdomen CT is the preferred imaging modality and removal of the trichobezoar with an appropriate endoscopic or surgical procedure is the treatment of choice. It is essential to diagnose and treat the underlying behavioral condition to prevent recurrent episodes.

Combining Cognitive Behavioral Therapy for Insomnia and Chronic Spinal Pain Within Physical Therapy: A Practical Guide for the Implementation of an Integrated Approach.

Most people who have nonspecific chronic spinal pain (nCSP) report comorbid insomnia. However, in current treatment strategies for nCSP, insomnia is usually not addressed. Considering the bidirectional interaction between pain and sleep and its underlying psychophysiological mechanisms, insomnia may increase the risk of developing adverse physical and psychological health outcomes and should thus no longer be left untreated. As suggested by previous pilot studies, adding cognitive behavioral therapy for insomnia to the contemporary evidence-based biopsychosocial physical therapy approach may also improve pain outcomes in nCSP. This manuscript aims to provide practical guidelines on hybrid physical therapy, including the combination of the following components: (1) pain neuroscience education (eg, to reconceptualize pain) and cognition-targeted exercise therapy (eg, graded exposure to functional daily life movements), and (2) cognitive behavioral therapy for insomnia (sleep psychoeducation, behavioral and cognitive therapy, correction of sleep hygiene, and relaxation therapy) can be deployed for the management of patients who have chronic spinal pain. Impact. Due to the major impact sleep disturbances have on pain and disability, insomnia as a comorbidity should no longer be ignored when treating patients with chronic spinal pain.

Efficacy of high-power laser therapy combined with exercise on wrist pain, function and joint position sense in female gymnasts with non-specific chronic wrist pain

Background: Wrist pain is common and debilitating among gymnasts, presenting a tricky diagnostic and therapeutic challenge resulting in falling down in training sessions and during performance. Objective: To find out the effect of high-power laser treatment, either alone or in combination with exercise, on wrist pain, function and joint position sense in female gymnasts with non-specific chronic wrist pain. Methods: Thirty-six female gymnasts (aged 10 to 16 years) who were diagnosed with non-specific wrist pain were recruited as the participants for the study, and were randomly allocated into three groups. The participants of the laser therapy group received only high power laser therapy, the exercise program group participants received exercises only, and the participants of the combined therapy group received both laser and exercises. Pain, function, and joint position sense were the outcomes measures in the study. Results: In all treatment groups, all measured results improved after therapy. The laser therapy group had the least significant impact, whereas the combined therapy group had the most significant impact. Conclusion: It might be early to say whether solely high-power laser therapy is an effective non-invasive modality for treating female gymnasts with non-specific chronic wrist pain. The addition of associated co-interventions to high power laser treatment can improve the beneficial effects of laser therapy.

Effects of Self-Massage and Foot Exercises on Lumbar Spine Pain and Functional Condition in Sedentary Men

Background. Lumbar pain is one of the most common disorders of the musculoskeletal system in workers who sit for prolonged periods of time. Prolonged sitting hours change muscle activity and create tension, which negatively affects the structure of the fascia. Myofascial exercises for the posterior superficial chain have been shown to reduce lumbar pain, but the effect of self-massage and foot exercises on the functional condition of the lumbar in office workers is unclear.
 The aim. To assess the effect of self-massage and foot exercises on lumbar pain and functional condition in male office workers.
 Methods. The study included 20 men (25.8 ± 2,6 year) (10 in the experimental group, 10 in the control group) engaged in sedentary work and experiencing chronic non-specific lumbar pain. Before and after the study, a pain intensity assessment was performed using the numerical rating scale (NRS), a functional status assessment using the Oswestry questionnaire, and an assessment of the superficial length of the back superficial chain (lower part) using the toe reach test. For the experimental group, 5 times a week for 10 weeks for 10 minutes, self-massage was applied to each foot; and 3 times a week for 30 minutes, exercises for the feet.
 Results. After self-massage and foot exercises, the intensity of pain and functional disability decreased significantly (p <0.001), and the length of the back superficial chain (lower part) increased (p <0.001). Functional disability increased in the control group (p <0.001). After the study, functional disability differed significantly between groups (p = 0.02).
 Conclusion. Self-massage and foot exercises improved functional condition and reduced lumbar pain in male office workers.
 Keywords: low back pain, fascia, myofascial chain, massage, physiotherapy.

Effects of exercise/physical activity on fear of movement in people with spine-related pain: protocol for a systematic review and meta-analysis

IntroductionLow back pain and neck pain are leading causes of disability. Although several studies have examined the effect of exercise on fear of movement in people with spine-related pain, the...

Caudal epidural blockades for chronic pain in the lower back in working age

Introduction. Chronic back pain syndrome, which significantly restricts a person’s daily activity, can cause the formation of depressive states and is a significantly more difficult task for treatment compared to acute pain.Aim. To evaluate the efficacy and safety of caudal epidural catheterization (CEC) and local therapy with anesthetics and glucocorticoids for chronic nonspecific discogenic and chronic radicular low back pain (LBP) in young and middle-aged patients.Materials and methods. 42 patients aged from 29 to 59 years, who in the neurosurgical department of the Vologda City Hospital No. 1 in 2017–2019 underwent an operation to install a caudal epidural catheter and prolonged injection therapy of local anesthetics and glucocorticosteroids for chronic nonspecific discogenic and chronic radicular LBP.Results. There were no purulent-septic complications, hematomas of the spinal canal. In the group of patients with radicular syndrome the average values of LBP according to VAS were as follows: before CEC – 78.5 mm; 5 days after CEC – 24.1 mm; 6 months after CEC – 19.6 mm; after 12 months – 17.9 mm. In the group of patients with nonspecific discogenic LBP the average pain estimates for VAS were as follows: before CEC – 78.1 mm; 5 days after CEC – 21.7 mm; 6 months after CEC – 20.9 mm; after 12 months – 23.4 mm.Сonclusion. Our experience indicates a high long-term efficacy and safety of treatment with caudal epidural catheterization and local prolonged therapy with anesthetics and glucocorticoids for chronic radicular and chronic nonspecific discogenic pain in the lower back in young and middle-aged patients selected on the basis of a special system of criteria.

Evaluation of the effectiveness of treatment of patients with nonspecific pain syndrome in the lower back with celecoxib and a combined preparation of B vitamins

To evaluate the effectiveness of the effect of celecoxib and the combined vitamin complex of group B in comparison with meloxicam in patients with acute and chronic nonspecific lumbar pain (LP). The effectiveness of the effect on acute (44%; acute pain syndrome (APS)) and chronic (56%; chronic pain syndrome (CPS)) LP of moderate intensity (according to VAS/MPQ) (APS 5.7±2.3/2.13±0.67 points; CPS 5.2±2.8/1.47±0.61 points), the leading component of which is sensory sensations (when APS is lower than in CBS; Kr-W=6.15, p=0.04) and affective disorders in CPS (U=117.5, p=0.04) celecoxib without (APS 25%; CPS 75%) and with the addition of Neuromultivit (APS 36%; CPS 64%) and in comparison with meloxicam (APS 100%) against the background of basic therapy in 93 patients (61.3% women and 38.7% men; average age 49.9±9. years) with nonspecific LP pain syndrome in the lower back, with a low degree of severity of motor function (MF) disorders according to the ICF (2±1 points), due to spondyloarthrosis of the lumbosacral spine. It was found that celecoxib and meloxicam cause the same significant remitting decrease in the severity of APS and restoration of MF disorders in patients with APS, equally cause rare adverse events (gastropathy, increased blood pressure) in comorbid pathology. Celecoxib proved to be more effective in relieving CPS and improving MF (p<0.05), and the combination of celecoxib with Neuromultivit caused more pronounced relief of APS and CPS, restoration of MF (p<0.01). A steady decrease in the intensity of PS (1-2 points according to VAS), recovery of MF occurs only on the 10th-11th day of therapy (p<0.01), with complete relief of LP by day 21 only in 60.22% of cases. The results of the study confirm the benefits of celecoxib in combination with a vitamin complex for the relief of CPS.

Leiomiossarcoma de veia cava inferior como etiologia para dor abdominal crônica – um relato de caso

Inferior vena cava leiomyosarcomas are rare tumors that account for less than 0.7% of all retroperitoneal leiomyosarcomas. They are more common in women and cause nonspecific chronic abdominal pain. In this report, we present the case of a 53-year-old female patient complaining of chronic nonspecific periumbilical abdominal pain with initial onset 8 months previously who was diagnosed with inferior vena cava leiomyosarcoma by computed tomography angiography. The patient was treated with complete resection of the tumor and reconstruction of the inferior vena cava with interposition of a Dacron prosthetic graft. The treatment considered the gold standard consists of complete surgical excision, because these tumors are resistant to chemotherapy and radiotherapy. The prognosis of these patients is closely related to early diagnosis. Therefore, it is very important that vascular and general surgeons know that this disease is a possible differential diagnosis of chronic abdominal pains.

Роль алекситимии в клинической картине хронической неспецифической тазовой боли у женщин

The purpose was to evaluate the impact of alexithymia on the severity of clinical manifestations of chronic nonspecific pelvic pain (CNPP) in women. Material and methods. The study included 138 women with CNPP. All patients underwent a neurological examination, assessment of pain intensity using a visual analog scale (VAS), assessment of the level of alexithymia using the Russian version of the 20-item Toronto Alexithymia Scale (TAS). Pharmacotherapy of CNPP included the following sequential prescription: aceclofenac 100 mg, 2 times a day for 7 days, tolperisone 150 mg, 3 times a day for 2 weeks, escitalopram 5 mg, once a day for 2 months. Results. The patients were divided into 2 groups: group A (n = 101) — without alexithymia, group B (n = 37) — with alexithymia (average TAS score = 74 [65; 85]). A positive correlation was established between the level of alexithymia and the intensity of pain according to the VAS in patients of group B. According to the effectiveness of pharmacotherapy, patients of group A were divided into 3 subgroups A1, A2, A3. In subgroup A1, the intensity of pain decreased to 30 [20; 40] mm (p = 0.0032) after taking aceclofenac. In subgroup A2, pain decreased to 30 [10; 40] mm (p = 0.0042) after taking tolperisone. In the A3 subgroup, pain decreased 0 [0; 5] mm (p = 0.012) after taking escitalopram. In patients of group B, no effect of pharmacotherapy was noted. After the completion of pharmacotherapy, the patients were recommended kinesitherapy, after which the patients of group B experienced a decrease in pain to 40 [30; 45] mm (p = 0.00021), and a decrease in the level of alexithymia to 50 [45; 60] points (p = 0.0023 ). Conclusion. Patients with CNPP are low sensitive to traditional pharmacotherapy of pain, including drugs of peripheral and central action. Kinesitherapy has a positive effect, including stretching exercises and relaxation of skeletal muscles.

P-BN05 Solitary jejunal diverticulum: a rare unexpected cause of chronic pneumoperitoneum

Abstract Background Jejunal diverticula are rare acquired herniation of the mucosa and submucosa through the muscularis propria. They are asymptomatic in the majority of cases, however, they can present with non-specific abdominal symptoms and rarely complicate leading to acute abdomen. Perforation usually results in symptoms and signs of acute peritonitis and it is not an identifiable aetiology of chronic pneumoperitoneum. Computed tomography scan may identify intestinal wall oedema, air bubbles travelling through the mesentery, free intra-abdominal air and/or fluid . Radiological diagnosis requires high index of suspicion of such pathology. We report a case of an isolated jejunal diverticulum as a cause for aseptic chronic pneumoperitoneum . Methods A 77-year-old female was referred to the ambulatory emergency surgical unit (AESU) with a 4-month history of nonspecific abdominal pain, considerable weight loss, diarrhea, nausea and a few episodes of vomiting.Physical examination revealed no constitutional signs of sepsis and her abdomen was mildly distended but soft and nontender to palpation. Laboratory investigations were unremarkable. CT scan of her abdomen and pelvis on her first visit showed pneumoperitoneum with associated low volume ascites, which raised the possibility of sealed gastrointestinal perforation. In the absence of any clear signs of sepsis, a strategy of ambulatory, conservative management and follow up was chosen. Four months after her initial presentation our patient presented with ongoing vague abdominal symptoms with weight loss and failure to thrive. A CT colonogram described pneumoperitoneum and larger volume of ascites is in comparison to the previous CT scan. There was an unusual pattern of mural gas in some loops of small bowel in the left side of the abdomen that suggested pneumatosis. MDT decided to proceed with diagnostic laparoscopy. Results Laparoscopy exploration revealed odorless pneumoperitoneum, moderate amount of non-turbid bile stained serous ascites and thin fibrinous covering. We identified a jejunal diverticulum associated with mesenteric air bubbles and moderately enlarged reactive feeling lymph nodes in the diverticular segment . A small bowel resection with a primary side-to-side anastomosis, washout of the abdomen and cholecystectomy were done through a Kocher’s subcostal incision. She made an uneventful post-operative recovery and was discharged home well on day 4. Histopathological examination of the resected specimens confirmed the presence of a ruptured isolated jejunal diverticulum with a breach in muscularis propria and chronic cholecystitis in the gallbladder. Conclusions In summary, our case report highlights the importance of being aware of the possibility of perforated jejunal diverticula as a possible source of chronic pneumoperitoneum causing chronic nonspecific abdominal pain, diarrhea and unexplained weight loss. The surgical option of segmental resection and primary anastomosis was beneficial in this patient. However, calculating the risk benefit ratio remains the mainstay of the management plan, which, as ever, should be tailored to each patient’s general condition and fitness with appropriate counselling and consent.

ROLE OF DIAGNOSTIC LAPAROSCOPY IN NON SPECIFIC ABDOMINAL PAIN

INTRODUCTION:Abdominal pain is very common presentation in emergency department.It is vital that the physician has an understanding and be familiar with the presentations of common diseases that cause abdominal pain. Patients with acute abdominal pain are a heterogenous group that consumes a great deal of a surgical department's resources. AIM AND OBJECTIVE: To evaluate the use of the laparoscopy in the diagnosis and management of patients with nonspecific chronic and acute abdominal pain. MATERIAL AND METHODS: The material consists of patient in all surgical units of P.B.M. and Associated Group of Hospital attached to S.P.Medical College,Bikaner.This study includes 50 patients.In acute NSAP group 21 patients were present and in Chronic NSAP group 29 patients were included. RESULT:We found that the mean age was 29.38 and 26.17 years in acute and chronic group respectively.In acute group additional 4(19%) cases had vomiting, 3(14.2%) had fever, and 2(9.5%) had both vomiting and fever.While in chronic group 3(10.3%) cases had vomiting, 2(6.8%) had fever and 1(3.4%) case had both vomiting and fever. Efficacy of laparoscopy in chronic group was 86.2%.Laparoscopy made correct diagnosis in 25(86.2%) cases,3(10.3%) cases had normal study and 1(3.4%) case diagnosed as PID pain was not relieved. CONCLUSION: Our study establishes role of laparoscopy as a safe and accurate modality in diagnosis of both acute and chronic abdominal pain in cases where diagnosis can't be made with physical examination and non invasive methods.

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Yoga Module for Somatoform Pain Disorders: Development, Content Validation, and Feasibility Testing.

Background:Yoga practices have been found to be useful in chronic pain conditions but studies focussing specifically on somatoform pain disorders (SPDs) are limited.Aims:Current study aims to develop and test the feasibility of a yoga program for patients with SPDs.Materials and Methodology:Athorough search of traditional and contemporary literature was performed with the objective of formulating a yoga program for reducing chronic non-specific pain and associated psychological distress. Content validity of the program was then determined by taking the opinion of 18 yoga experts (who had >5 years of experience in treating mental health disorders) using content validation ratio (CVR) through Lawshe's formula. The feasibility of the module was tested on 10 subjects diagnosed with SPDs as per the International Classification of Diseases (ICD) -10 criteria using standard scales.Results:In the finalized module, 70.83% (34 out of 48 items) of the practices were retained along with the modifications as suggested by the experts. Two practices were not found to be feasible (Trikonasana and Shalabhasana) and hence were removed from the final module. A significant reduction in pain severity was observed in the subjects after practising the yoga module for 2 weeks. The content validity index for the whole module (average of all CVRs) was 0.55.Conclusions:Ayoga module was developed for SPD. The content validity of the module was found to be good. The module was found safe and potentially useful for reducing pain severity in patients with SPD. Future studies should test the efficacy of the developed program through a randomized controlled clinical trial.

Associations of environment and lifestyle factors with suboptimal health status: a population-based cross-sectional study in urban China

IntroductionSuboptimal health status (SHS), an intermediate state between chronic disease and health, is characterized by chronic fatigue, non-specific pain, headaches, dizziness, anxiety, depression, and functional system disorders with a high prevalence worldwide. Although some lifestyle factors (e.g. smoking, alcohol consumption, physical exercise) and environmental factors (e.g. air quality, noise, living conditions) have already been studied, few studies can comprehensively illustrate the associations of lifestyle and environment factors with general, physical, mental, and social SHS.MethodsA cross-sectional study was conducted among 6750 urban residents aged 14 years or over in five random cities from September 2017 to September 2018 through face-to-face questionnaires. There were 5881 valid questionnaires with a response rate of 87%. A general linear model and structural equation model were developed to quantify the effects of lifestyle behaviors and environment factors on SHS.ResultsThe detection rates of general, physical, mental, and social SHS were 66.7, 67.0, 65.5, and 70.0%, respectively. Good lifestyle behaviors and favorable environment factors positively affected SHS (P < 0.001). Lifestyle behaviors had the largest effect on physical SHS (β = − 0.418), but the least on social SHS (β = − 0.274). Environment factors had the largest effect on mental SHS (β = 0.286), but the least on physical SHS (β = 0.225).ConclusionsLifestyle behaviors and environment factors were important influencing factors of SHS. Physical SHS was more associated with lifestyle. Lifestyle and environment were similarly associated with mental and social SHS.

At my own pace, space, and place: a systematic review of qualitative studies of enablers and barriers to telehealth interventions for people with chronic pain.

Telehealth is a promising approach to support self-management with the potential to overcome geographical barriers. Understanding patient perspectives will identify practical challenges to delivering self-management strategies by telehealth. The aim of this study was to synthesize the perceptions of people with chronic musculoskeletal pain for engaging in interventions delivered using telehealth. We searched MEDLINE, Embase, CINAHL, LILACS, and PsycINFO databases. We included qualitative studies that explored perceptions or experiences or attitudes of people with chronic musculoskeletal pain engaging with telehealth. We assessed the methodological quality using the Critical Appraisal Skills Programme checklist. Meta-synthesis was guided by a thematic synthesis approach. The level of confidence of review findings was assessed using the Confidence in the Evidence from Reviews of Qualitative Studies (GRADE-CERQual). Twenty-one studies were included (n = 429). Telehealth comprised web-based, videoconference-based, telephone-based, video-based, and smartphone app-based programs delivered solely or combined. Chronic musculoskeletal conditions included people with knee or hip osteoarthritis, chronic low back pain, persistent pain (chronic joint pain or nonspecific chronic musculoskeletal pain), rheumatoid arthritis, and functional fatigue syndrome. The enablers for engaging in telehealth interventions were as follows: (1) "at my own pace, space, and place" and (2) empowered patient. Barriers to engaging in telehealth interventions were as follows: (1) impersonal, (2) technological challenges, (3) irrelevant content, and (4) limited digital (health) literacy. Telehealth interventions with well-designed interactive platforms, flexibility to fit patients' routine, and the broad availability of material may favor better engagement. Encouragement of self-efficacy is linked to successful telehealth-delivered self-management programs.

Dry Needling Plus Conventional Physiotherapy for Patients With Chronic Nonspecific Neck Pain: A Randomized Clinical Trial

Dry Needling Plus Conventional Physiotherapy for Patients With Chronic Nonspecific Neck Pain: A Randomized Clinical Trial

Osteopathic Manipulative Treatment for Nonspecific Subacute and Chronic Low Back Pain

Data are scant regarding the efficacy of osteopathic manipulative treatment (OMT) for reducing pain and disability in patients with nonspecific

Electromyographic assessment of muscle fatigue after the Biering–Sorensen test in subjects with low back pain who underwent the McKenzie treatment

Chronic low back pain is a common disorder affecting about 80% of the population, caused by a disorder in the muscular system. The main aim of this study was to assess muscle fatigue during the Biering-Sorensen Test in people with chronic low back pain who underwent the McKenzie treatment. Tests were conducted on 19 men (mean age of 41.4 years) with chronic non-specific lumbar-sacral pain syndrome, working in the seated position in front of a computer. Assessment of changes in fatigue of erector spinae, gluteus maximus and biceps femoris using surface electromyography during the Biering-Sorensen Test and subjective pain assessment using Visual Analog Scale were conducted on three test dates. Time-frequency representation of the electromyographic signal (Fourier transform) was used for the examination of muscle fatigue. The McKenzie method of diagnosis and therapy was applied before and between the tests. The McKenzie therapy resulted in increased endurance (test duration) of the examined spinal muscles between the 1st and 3rd test date ( p = 0.043), and a systematic decrease in pain assessment on the three test dates ( p = 0.000-0.004). Correlations were obtained between slope coefficients of the simple regression of median frequency of electromyographic signals on the one hand and duration of the BST ( p = 0.000-0.012) and anthropometric parameters (body mass, height and body mass index, p = 0.001-0.020) on the other. The McKenzie method is an effective tool in reducing the level of lumbar pain and improving muscle endurance.

Incidence of Neuropathic Pain in Patients with Thoracic Disc Pathologies Presenting with Chronic Upper Back Pain and Correlation of Herniation Grade with Pain Severity.

To determine the incidence of neuropathic pain (NP) in patients with thoracic disc herniation (TDH) and to determine whether there is any correlation between pain severity and herniation grade. A total of 110 patients diagnosed with TDH with chronic non-specific thoracic spine pain were included in our cross-sectional observational study. Data including magnetic resonance imaging findings, bulging, protrusion, extrusion and sequestration were retrospectively analysed. We determined the incidence of NP in patients by administering the self report form Douleur Neuropathique 4 (DN4) questionnaire. Pain severity was assessed using Numeric Rating Scale scores. In our study, 79.1% of TDHs were located below the T7-8 level. The patients were divided into two subgroups on the basis of the results of the DN4 questionnaire: NP subgroup, 43 (39.1%), and non-NP subgroup, 67 (60.9%). Although there was no statistically significant association between presence of NP and herniation grade bulging, protrusion or sequestration (p > 0.05), the rate of herniation in the extrusion grade was statistically significantly higher in patients with NP than in those without NP (p=0.004). The pain severity of the patients with herniation grade extrusion was statistically higher than that of patients with other non-extrusion grades (p=0.035). TDH should be considered in patients with neuropathic chronic back, chest and abdominal pain. If the patient?s pain characteristics indicate NP, a diagnosis of TDH becomes more likely, considering that nearly 4 out of 10 patients with TDH have NP.