Component Of Low Back Pain Research Articles

Getting what you pay for: impact of copayments on physical therapy and opioid initiation, timing, and continuation for newly diagnosed low back pain

BACKGROUND CONTEXTPhysical therapy (PT) is an important component of low back pain (LBP) management. Despite established guidelines, heterogeneity in medical management remains common. PURPOSEWe sought to understand how copayments impact timing and utilization of PT in newly diagnosed LBP. STUDY DESIGN/SETTINGThe IBM Watson Health MarketScan claims database was used in a longitudinal setting. PATIENT SAMPLEAdult patients with LBP. OUTCOME MEASURESThe primary outcomes-of-interest were timing and overall utilization of PT services. Additional outcomes-of-interest included timing of opioid prescribing. METHODSActual and inferred copayments based on nonnonprimary care provider visit claims were used to evaluate the relationship between PT copayment and incidence of PT initiation. Multivariable regression models were used to evaluate factors influencing PT usage. RESULTSOverall, 2,467,389 patients were included. PT initiation, among those with at ≥1 PT service during the year after LBP diagnosis (30.6%), occurred at a median of 8 days postdiagnosis (IQR 1–55). Among those with at least one PT encounter, incidence of subsequent PT visits was significantly lower for those with high initial PT copayments. High initial PT copayments, while inversely correlated with PT utilization, were directly correlated with subsequent opioid use (0.77 prescriptions/patient [$0 PT copayment] versus 1.07 prescriptions/patient [$50–74 PT copayment]; 1.15 prescriptions/patient [$75+ PT copayment]). Among patients with known opioid and PT copayments, higher PT copayments were correlated with faster opioid use while higher opioid copayments were correlated with faster PT use (Spearman p<.05). For multivariable whole-cohort analyses, incidence of PT initiation among patients with inferred copayments in the 50–75th and 75–100th percentiles was significantly lower than those below the 50th percentile (HR=0.893 [95%CI 0.887–0.899] and HR=0.905 [95%CI 0.899–0.912], respectively). CONCLUSIONSHigher PT copayments correlated with reduced PT utilization; higher PT copayments and lower opioid copayments were independent contributors to delayed PT initiation and higher opioid use. In patients covered by plans charging high PT copayments, opioid use was significantly higher. Copays may impact long-term adherence to PT.

LITERATURE REVIEW: KOMPONEN NYERI NEUROPATIK PADA NYERI PUNGGUNG BAWAH

Low back pain is a very common health problem and can affect the quality of life. Pain that arises in low back pain can be either nociceptive pain or neuropathic pain. This literature review discusses the neuropathic pain component of low back pain. This review uses a narrative review method. The articles were obtained from keyword searches in the Science Direct, PubMed, and ProQuest databases with a publication range of 2011-2021 in Indonesian or English, and research on the components of neuropathic pain in low back pain. Of the eight articles included in this literature review, the prevalence of neuropathic pain in low back pain was 2.8% - 65.3%. Neuropathic pain can be ruled out using LANSS, DN4, and PDQ. Low back pain with neuropathic pain had symptoms of burning (34.58% - 82.9%), pinpricks (31.77% - 78%), tingling (32.71% - 84.8%), numbness (42.05% - 97%), electric shock (38.97% - 78%), itching (16.82% - 42.4%), cold sensation (12.15% - 48.5%), allodynia (19.62% - 85.4%), 61% hyperalgesia, 14.6% autonomic dysfunction, 100% had dysesthesia, and 100% experienced a decrease in tenderness/prickling. Radicular low back pain is often caused by L5 or S1 root compression and rarely L4. Neuropathic low back pain can be based on an assessment of the symptom profile. Associated risk factors are older age, being a female, greater anthropometric status, the habit of drinking alcohol, smoking, and history of previous lumbar, abdominal or pelvic surgery

Effectiveness between Duloxetine and Pregabalin for the Management of Neuropathic Chronic Low Back Pain

Background: Chronic low back pain has as a mixture of nociceptive and neuropathic component. This neuropathic component is often overlooked during management which increases the sufferings of patients. Prevalence of neuropathic pain is quite high and approximately 37% of chronic low back patients suffer from predominantly neuropathic pain. Treatment of neuropathic component of low back pain remains challenging and multiple modalities of treatments have been tried but not all of them are satisfactory. Among these, duloxetine and pregabalin have been shown to be promising in treatment of various neuropathic syndromes, but there is no direct comparative study between these two drugs in patients with back pain with neuropathic component. Objective of this study was to compare the effcetiveness between duloxetine and pregabalin which one reduce the pain and improve quality of life better.Methods: This is a prospective, observational study. Chronic low back pain patients with neuropathic components were recruited according to inclusion and exclusion criteria. Pain was measured by visual analog scale and neuropathic component measured by painDETECT questionnaire score. Patients were randomly assigned to either duloxetine or pregabalin group. Both drugs were initiated with their lowest dose. Duloxetine was started with 20mg/day with optional up titration to 60mg/day (20mg, weekly increments) and pregabalin was started with 50mg/day with optional up titration to 300mg/day (50mg weekly increments) for six weeks. A fixed dose combination of paracetamol and tramadol (325mg + 37.5mg) was used as rescue medication for breakthrough pain. Follow up were carried out weekly by face to face visits or over phone. At week four and six, additional assessment of patients’ quality of life was assessed by SF-36. The primary outcome parameter was mean VAS score and quality of life improvement by assessing SF-36 was secondary outcome parameter.Results: Out of 80 patients enrolled, 62 completed trial, eight patients in duloxetine and ten patients in pregabalin group dropped out. In this study, a significant reduction of pain intensity was observed with both Duloxetine and Pregabalin compared with their baseline values, but there was no statistically significant difference between the two treatments. The SF-36 score at the end of each treatment phase was significantly improved with both treatments. But when comparing in between two groups, the changes of mean SF-36 score was not significant as well.Conclusion: Both duloxetine and pregabalin are well-tolerated having good safety profiles. Further clinical trials with long term follow up are needed to determine their long term effect.

Ankilozan Spondilitli Hastalarda Nöropatik Bel Ağrısı ve Hastalık Aktivitesi, Fonksiyonel kapasite ve Yaşam kalitesi ile İlişkisi

Amaç: Bu çalışmada Ankilozan spondilit (AS)’li hastalarda bel ağrısının nöropatik komponentinin değerlendirmesi ve nöropatik ağrının; hastalık aktivitesi, fonksiyonel kapasite ve yaşam kalitesi ile ilişkisini araştırması amaçlandı.&#x0D; Gereç ve yöntemler: Çalışmaya 15 AS tanılı hasta dahil edildi. Hastalık aktivitesini değerlendirmek için Bath Ankilozan Spondilit Hastalık Aktivite İndeksi (BASDAI), fonksiyonel durumu değerlendirmek için Bath Ankylosing Spondylitis Functional Index (BASFI), ve yaşam kalitesini değerlendirmek için Ankylosing Spondylitis Quality of Life (ASQoL), bel ağrısının şiddetinin değerlendirmek için visual analog scale (VAS), nöropatik ağrıyı değerlendirmek için ise painDETECT anketi kullanıldı. &#x0D; Bulgular: PainDETECT skoru hastaların % 13'ünde kesin nöropatik ağrı, % 33'ünde ise olası nöropatik ağrı saptandı. PainDETECT skorları ile bel ağrısı VAS değerleri, BASFI ve CRP düzeyleri arasında anlamlı düzeyde pozitif korelasyon saptandı (p

Association of Foot Posture with Lumbar Lordosis Angle in Teachers

Context: Anatomical alteration in the alignment of the foot leads to changes in proximal joints that in turn cause mechanical variations in the spine. Changes in the lower kinematic chain can have functional consequences in the form of low back pain and may be seen in professions requiring long-standing. This is often an unexplored, under-evaluated component of low back pain and hence proves its need. Aim: To study the relationship between ankle-foot complex and lumbar spine, and also to determine the association between Foot Posture and Lumbar Lordosis angle in teachers. Settings and Design: Data for the observational study were collected from school and college teachers of Belagavi city. Materials and Methods: Foot posture of 200 teachers in the age group of 20–50 years was assessed using Chippaux Index and Foot Posture Index-6 (FPI-6). Lumbar curvature was measured using Flexi curve ruler and angle was calculated. Functional limitation was assessed using Low Back Pain Rating Scale and Modified Oswestry Low Back Pain Disability Questionnaire. Statistical Analysis Used: Spearman's rank correlation and t-test were used for analysis. Results: Statistically significant association was noted between FPI-6, lumbar angle, Low back pain scores, and Modified Oswestry score with P = 0.0001. Gender comparison of the outcome measures did not reveal any significant relationship. Conclusion: Alteration in foot posture leads to changes in lumbar lordosis angle, which in turn may cause low back pain.

Neuropathic component of low back pain in patients with ankylosing spondylitis

Objective The aim of this cross sectional study was to evaluate frequency of neuropathic back pain in ankylosing spondylitis (AS) patients and to determine the relation with disease variables and occurrence of neuropathic pain. Methods Fifty-eight AS patients who were not having any comorbid disease and/or using drugs that would cause neuropathy, were recruited to the study. Demographic properties and clinical characteristics (functional status and disease activity assessed by BASFI and BASDAI respectively, ESR, CRP) and quality of life determined by AS quality of life-QoL questionnaire, were recorded. The neuropathic property of back pain was assessed by both Leeds Assessment of Neuropathic symptoms and signs (LANSS) and Douleur Neuropathique 4 (DN4) scales. Results 58 AS patients (17 female, 41 male) with a mean age of 45 ± 18 years were included. 33 patients (56.9%) and 31 patients (53.4%) were defined as having neuropathic pain depending on the LANSS (scores > 12) and DN4 (scores > 4) questionnaire scores respectively. The mean score of LANSS scale was correlated with ASQoL, BASFI, BASDAI, and DN4; and the mean score of DN4 scale was correlated with ASQoL, BASFI and LANSS. The mean levels of BASFI and ASQoL scores were significantly higher in patients having neuropathic pain than in patients not having (p < .05). Conclusion Neuropathic pain is common and determined in more than half of the patients with AS and related with functional status and quality of life. Diagnosis and treatment of neuropathic pain are warranted in order to increase functional ability and quality of life in patients suffering from AS.

Nonoperative Treatment Options for Patients With Sacroiliac Joint Pain.

Sacroiliac joint (SIJ) pain is thought to be a component of low back pain in 20% of people who suffer with it chronically. There is no consistent objective diagnostic testing that includes SIJ pain as the diagnosis and thereby it can become a diagnosis of exclusion. Treatment of SIJ pain is variable, and no set method or protocol of treatment has been found to be efficacious or reliable. Thus, the healthcare provider is often left to create an individual treatment plan based on their own experiences and expertise. The purpose of this narrative review is to describe and discuss nonoperative treatment options for patients with SIJ pain. Further, coordination of treatment options and progression of treatment will be offered.

Discussion paper: what happened to the ‘bio’ in the bio-psycho-social model of low back pain?

Over 20years ago the term non-specific low back pain became popular to convey the limitations of our knowledge of the pathological source of most people's low back pain. Knowledge of underlying pathology has advanced little since then, despite limited improvements in outcomes for patients with low back pain. This paper discusses potential misunderstandings related to diagnostic studies in the field of low back pain and argues that future diagnostic studies should include and investigate pathological sources of low back pain. Six potential misunderstandings are discussed. (1) Until diagnosis is shown to improve outcomes it is not worth investigating; (2) without a gold standard it is not possible to investigate diagnosis of low back pain; (3) the presence of pathology in some people without low back pain means it is not important; (4) dismissal of the ability to diagnose low back pain in clinical guidelines is supported by the same level of evidence as recommendations for therapy; (5) suggesting use of a diagnostic test in research is misinterpreted as endorsing its use in current clinical practice; (6) we seem to have forgotten the 'bio' in biopsychosocial low back pain. We believe the misunderstandings presented in this paper partly explain the lack of investigation into pathology as an important component of the low back pain experience. A better understanding of the biological component of low back pain in relation, and in addition, to psychosocial factors is important for a more rational approach to management of low back pain.

Efficacy of Transverse Tripolar Stimulation for Relief of Chronic Low Back Pain

The goal of this study was to evaluate the efficacy of the transverse tripolar spinal cord stimulation system (TTS) in providing relief of low back pain in patients with chronic non-malignant pain. Transverse tripolar electrodes were implanted in the lower thoracic region (T_8–9 to T₁₂–L₁) in 10 patients with chronic neuropathic pain, all of whom reported a significant component of low back pain in combination with unilateral or bilateral leg pain. One patient reported inadequate pain relief during the trial and was not implanted with a permanent generator. A visual analogue scale of low back pain showed a nonsignificant decrease from 64 ± 19 to 47 ± 30 (p = 0.25; paired t test) after 1 month of stimulation. Similarly, functional disability evaluated using Oswestry Low Back Pain Questionnaire was not improved (p = 0.46; paired t test). We conclude that chronic low back pain is not particularly responsive to the transverse stimulation provided by the TTS system.

CAN INFANT MALNUTRITION CAUSE ADULT VERTEBRAL STENOSIS?

Does infant malnutrition produce smaller adult spinal canals? Lumbar and thoracic vertebrae (n X 1073), from a prehistoric American Indian population (15-55 yrs of age), were measured for anteroposterior (AP) and transverse (TR) vertebral canal sizes, nerve root tunnel (intervertebral foramen) widths (NRT), vertebral heights (VH), vertebral osteophytosis (VO), and tibial lengths. They underwent a dietary change from hunting-gathering, protein rich (PR), to maize agriculture, protein deficient (PD), between 950 and 1300 A.D. Multivariate analyses controlled for age, sex, culture, NRT, VH, VO, and wedging. Canal size was significantly smaller in the PD. AP diameters were generally and highly correlated with NRT, and thus both spinal stenosis and sciatica may have a developmental basis. Canal size was independent of statural components. Consequently, canal size is a most powerful tool in assessing the presence infant malnutrition. Moreover, perhaps the association between canal size and low-back pain (LBP) found in living populations has been underestimated, and this component of LBP is preventable.

Can infant malnutrition cause adult vertebral stenosis?

Does infant malnutrition produce smaller adult spinal canals? Lumbar and thoracic vertebrae (n X 1073), from a prehistoric American Indian population (15-55 yrs of age), were measured for anteroposterior (AP) and transverse (TR) vertebral canal sizes, nerve root tunnel (intervertebral foramen) widths (NRT), vertebral heights (VH), vertebral osteophytosis (VO), and tibial lengths. They underwent a dietary change from hunting-gathering, protein rich (PR), to maize agriculture, protein deficient (PD), between 950 and 1300 A.D. Multivariate analyses controlled for age, sex, culture, NRT, VH, VO, and wedging. Canal size was significantly smaller in the PD. AP diameters were generally and highly correlated with NRT, and thus both spinal stenosis and sciatica may have a developmental basis. Canal size was independent of statural components. Consequently, canal size is a most powerful tool in assessing the presence infant malnutrition. Moreover, perhaps the association between canal size and low-back pain (LBP) found in living populations has been underestimated, and this component of LBP is preventable.