Development Of Chronic Back Pain Research Articles

Gray matter volume of limbic brain structures during the development of chronic back pain: a longitudinal cohort study.

This study set out to investigate in a population-based longitudinal cohort, whether chronification of back pain (BP) is related to structural gray matter changes in corticolimbic brain structures. Gray matter volume (GMV) was measured in participants with chronic BP (CBP, n = 168) and controls without chronic pain (n = 323) at 2 time points with an interval of 7 years (baseline t1, follow-up t2). Over this time period, participants with CBP showed an increase of GMV in the left ventral striatum, whereas controls showed a decrease. By contrast, participants with CBP had a GMV decrease in the left parahippocampal gyrus. Within the CBP group, pain duration was negatively associated with GMV in the left caudate. Those with emerging CBP had less GMV in the right entorhinal area, right amygdala, and left medial frontal cortex. Additional variables differing between those who had BP at t1 and later developed CBP or not were pain intensity, body mass index, and depression score. In sum, these findings are in accordance with the notion that limbic brain properties are both predisposing risk factors and drivers of brain reorganization during the development of CBP.

Effect of gender on the evolution of pain and quality of life after treatment of symptomatic vertebral fragility fractures

SummaryThe evolution of pain and quality of life after a symptomatic vertebral fracture differs according to patient gender, with a worse evolution in women independently of the treatment received.PurposeIn a previous randomized clinical study comparing the effect of vertebroplasty (VP) vs. conservative therapy (CT) on pain evolution and quality of life (QoL) of patients with symptomatic vertebral fractures (VF), we observed the development of chronic back pain in 23% of subjects, independently of the therapy received. This study analyses the effect of gender on the evolution of pain and QoL in these subjects.Methods118/125 randomized patients (27 males/91 females) with recent symptomatic VFs were evaluated. All received a standardized analgesic and antiosteoporotic format of treatment. Pain and QoL were evaluated by VAS and Qualeffo-41, respectively, at baseline, at 2 weeks and 2 and 6 months. We compared pain evolution and QoL after treatment (CT vs. VP) according to gender, and analysed factors including age, time of evolution, treatment received, baseline VAS, previous VFs (total and recent), incidental VFs, lumbar and femoral T-scores, and analgesic and antiosteoporotic treatment.ResultsAt baseline, there were no differences in age (males 74.8 ± 11.2 vs. females:73.2 ± 8.7 years), time of evolution, number of VFs (males:3.8 ± 2.4 vs. females: 3.1 ± 2.4), treatment received (VP, males:59%, females:45%), lumbar or femoral T-score, baseline VAS (males:6.8 ± 2.1 vs. females:6.8 ± 2.2) or Qualeffo score (males:52.2 ± 24.4 vs. females:59.7 ± 20.6). Pain and QoL evolution differed according to gender, being better in males. These differences were significant after two months independently of the treatment and the development of incidental VF during follow-up.ConclusionsPain and QoL evolution after a symptomatic VF differs according to gender, with a worse evolution in women independently of the treatment received.

Robust estimation of lumbar joint forces in symmetric and asymmetric lifting tasks via large-scale electromyography-driven musculoskeletal models

Low back joint compression forces have been linked to the development of chronic back pain. Back-support exoskeletons controllers based on low back compression force estimates could potentially reduce the incidence of chronic pain. However, progress has been hampered by the lack of robust and accurate methods for compression force estimation. Electromyography (EMG)-driven musculoskeletal models have been proposed to estimate lumbar compression forces. Nonetheless, they commonly underrepresented trunk musculoskeletal geometries or activation–contraction dynamics, preventing validation across large sets of conditions. Here, we develop and validate a subject-specific large-scale (238 muscle–tendon units) EMG-driven musculoskeletal model for the estimation of lumbosacral moments and compression forces, under eight box-lifting conditions. Ten participants performed symmetric and asymmetric box liftings under 5 and 15 kg weight conditions. EMG-driven model-based estimates of L5/S1 flexion–extension moments displayed high correlation, R2 (mean range: 0.88–0.94), and root mean squared errors between 0.21 and 0.38 Nm/kg, with respect to reference inverse dynamics moments. Model-derived muscle forces were utilized to compute lumbosacral compression forces, which reached eight times participants body weight in 15 kg liftings. For conditions involving stooped postures, model-based analyses revealed a predominant decrease in peak lumbar EMG amplitude during the lowering phase of liftings, which did not translate into a decrease in muscle–tendon forces. During eccentric contraction (box-lowering), our model employed the muscle force–velocity relationship to preserve muscle force despite significant EMG reduction. Our modeling methodology can inherently account for EMG-to-force non-linearities across subjects and lifting conditions, a crucial requirement for robust real-time control of back-support exoskeletons.

Where do people acquire their beliefs about low back pain?

Back pain is a ubiquitous health issue across the globe. Beliefs of patients and health care providers play an important role in the development of chronic back pain and associated disability, as well as subsequent recovery. Recent published literature highlight that beliefs about back pain among the community and health care practitioners are inconsistent with current evidence. Presence of back pain myths negatively impacts individual's back-related behavior in general and may be amplified by the consulting health care provider. Our narrative of the sources of back pain is based on the current literature and reveals our position as practicing physiotherapists who are dealing with back pain patients.

The potential of short and long term health consequences of COVID-19 on back pain among COVID-19 survivors

Introduction. Coronavirus disease 2019 (COVID-19) is an emerging pandemic disease caused by the severe acute respiratory syndrome. Back pain could be triggered by the COVID-19 virus either directly or indirectly. However, to our knowledge, limited studies are addressing the development of chronic back pain or new-onset of back pain among COVID-19 survivors. Therefore, the purpose of this study was to investigate the potential health consequences of COVID-19 on back pain among the COVID-19 survivors. Methods. We used an electronically distributed survey targeting adult Jordanian citizens and residents who recovered from COVID-19 virus infection. The questionnaire composed questions regarding demographic characteristics, COVID-19 and spine injury-related information. Results. 27.2% of participants reported increase of back pain with COVID during the episode and 16% of participants reported increased back pain after COVID with pain lasted less than 3 months in 16.6% and more than 3 months in 17.8% of them. There was significant increase on back pain level during COVID compared to pre COVID. At the same time there was significant increase on back pain post COVID compared to pre COVID. Conclusion. The COVID-19 virus resulted in a significant increase in spine pain among COVID-19 survivors and it lead to chronic back pain among patients with risk factors and some develop new spine pain.

Do medical conditions predispose to the development of chronic back pain? A longitudinal co-twin control study of middle-aged males with 11-year follow-up

BackgroundPoor general health predicts the transition to chronic back pain (CBP), but the role of specific medical conditions in the development of CBP is unclear. The study aim was to examine the association of medical conditions with the development of CBP (“incident CBP”), while controlling for familial factors, including genetics.MethodsThis was a longitudinal co-twin control study conducted in a nationwide United States sample from the Vietnam Era Twin Registry. The study sample included 3045 males without back problems at baseline, including 662 complete twin pairs, who were followed for 11 years. Baseline surveys inquired about self-reported medical conditions (arthritis, diabetes, hypertension, and coronary artery disease [CAD]). A medical comorbidity score was calculated based on the presence and/or treatment of 8 medical conditions. Covariates included age, race, and education. At 11-year follow-up, participants reported ever having had CBP. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated when considering twins as individuals, and in matched-pair co-twin control analyses adjusting for familial/genetic factors.ResultsMean age at baseline was 51 years and 17% of participants developed CBP over the 11-year follow-up. Arthritis was significantly associated with incident CBP in individual-level analysis (OR 1.8 [95% CI 1.4–2.2]), but not within-pair analysis (OR 0.9 [95% CI 0.4–1.9]. CAD (OR 1.6 [95% CI 1.0–2.3]), hypertension (OR 1.3 [95% CI 1.0–1.5]), and the medical comorbidity score (OR 1.2 [95%CI 1.1–2.2]) were significantly associated with incident CBP in individual-level analyses; associations in within-pair analyses were of comparable magnitude, but not statistically significant. Diabetes was not associated with incident CBP.ConclusionsArthritis, hypertension, CAD, and medical comorbidity score were associated with incident CBP in the current study. However, the association between arthritis and incident CBP was confounded by familial factors. This suggests that prevention or treatment of arthritis is unlikely to be useful for CBP prevention. Our findings cannot exclude the possibility of causal associations between CAD, hypertension, and medical comorbidities and incident CBP.

Burst Spinal Cord Stimulation Increases Peripheral Antineuroinflammatory Interleukin 10 Levels in Failed Back Surgery Syndrome Patients With Predominant Back Pain

Burst spinal cord stimulation (SCS) has been reported to reduce back pain and improve functional capacity in Failed Back Surgery Syndrome (FBSS). However, its mechanism of action is not completely understood. Systemic circulating cytokines have been associated with the development of chronic back pain. This prospective, feasibility study enrolled 12 refractory FBSS patients with predominant back pain (70% of overall pain) suitable for Burst SCS. Back and leg pain intensity (back pain [VASB ]/leg pain [VASL ]), functional capacity (sleep quality [PSQI]), depressive symptoms (BDI), body weight, stimulation parameters, and plasma levels of pro-inflammatory (Il-1b; TNF; HMGB1)/anti-inflammatory (Il-10) cytokines were collected at baseline and after three months of Burst SCS and compared to healthy controls. Pain intensity (pre VASB : 8.25 ± 0.75 vs. post 1.42 ± 1.24) and functional capacity (PSQI: pre 7.92 ± 3.92 vs. post 3.42 ± 1.24; BDI: pre 20.83 ± 3.56 vs. post 10.92 ± 0.75) significantly improved compared to baseline. Pro-inflammatory HMGB1 remained unchanged (preburst: 3.35 ± 3.25 vs. postburst: 3.78 ± 3.83 ng/mL; p = 0.27; W = -30) versus the HC group (2.53 ± 2.6 ng/mL; p = 0.47; U = 59), while anti-inflammatory IL-10 levels were significantly elevated after burst SCS as compared to baseline (preburst 12.54 ± 22.95 vs. postburst 43.16 ± 74.71 pg/mL; p = 0.03; W = -48) and HC group (HC: 7.03 ± 11.6 vs. postburst 43.16 ± 74.71 pg/mL; p = 0.03; W = -48; p = 0.04). Baseline preburst IL-10 values and preburst VASB significantly correlated (Spearman correlation r = -0.66; p = 0.05; 95 CI -0.86 to -0.24), while correlation was not significant between postburst IL-10 values and postburst VASB (Spearman correlation r = -0.49; p = 0.18; 95 CI -0.83 to -0.15). Postburst IL-10 values correlated significantly with postburst PSQI scores (Spearman correlation r = -0.66; p = 0.05; 95 CI -0.86 to -0.24), while no correlation was found between preburst and postburst changes related to the BDI. Burst SCS increased systemic circulating anti-inflammatory IL-10, improved FBSS back pain and back pain associated co-morbidities like disrupted sleep architecture and depressive symptoms in FBSS patients. Thus, suggesting a possible relationship between burst SCS and burst-evoked modulation of peripheral anti-inflammatory cytokine IL-10 in chronic back pain.

Diabetes and Back Pain: Markers of Diabetes Disease Progression Are Associated With Chronic Back Pain.

IN BRIEF Diabetes has been associated with the incidence of back pain. However, the relationship between markers of diabetes progression and back pain has not been studied. The objective of this study was to correlate clinical and laboratory measures of diabetes disease severity to the presence of back pain to provide insight into the relationship between these conditions. Findings showed that markers of diabetes disease progression were associated with the presence of back pain, suggesting that uncontrolled diabetes may contribute to the development of chronic back pain.

Motor Imagery in People With a History of Back Pain, Current Back Pain, Both, or Neither

There is mounting evidence that cortical maps are disrupted in chronic limb pain and that these disruptions may contribute to the problem and be a viable target for treatment. Little is known as to whether this is also the case for the most common and costly chronic pain-back pain. To investigate the effects of back pain characteristics on the performance of left/right trunk judgment tasks, a method of testing the integrity of cortical maps. A total of 1008 volunteers completed an online left/right trunk judgment task in which they judged whether a model was rotated or laterally flexed to the left or right in a series of images. Participants who had back pain at the time of testing were less accurate than pain-free controls (P=0.027), as were participants who were pain free but had a history of back pain (P<0.01). However, these results were driven by an interaction such that those with current back pain and a history of back pain were less accurate (mean [95% CI]=76% [74%-78%]) than all other groups (>84% [83%-85%]). Trunk motor imagery performance is reduced in people with a history of back pain when they are in a current episode. This is consistent with disruption of cortical proprioceptive representation of the trunk in this group. On the basis of this result, we propose a conceptual model speculating a role of this measure in understanding the development of chronic back pain, a model that can be tested in future studies.

Risk factors for the development of chronic back pain after percutaneous vertebroplasty vs conventional treatment

Risk factors for the development of chronic back pain after percutaneous vertebroplasty vs conventional treatment

P-157 - The association between chronic back pain and psychiatric disorders; results from a longitudinal population-based study

Although various epidemiologic studies have found that chronic back pain is comorbid with psychiatric disorders, little is known about the temporal relationship between the two. In this study, the relationship between chronic back pain and psychiatric disorders was disentangled both cross-sectionally and longitudinally. Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective survey conducted among adults in the Netherlands. Anxiety, mood and substance use disorders were diagnosed with the Composite International Diagnostic Interview (CIDI). Self-report was used to ascertain chronic back pain. The key findings are that persons with chronic back pain are more likely to have anxiety, mood and substance use disorders. These results add to the growing body of knowledge that chronic back pain is associated not only with depression but also with anxiety and substance use disorder. Secondly, this study provides support for both the consequence (chronic back pain precedes the development of anxiety disorders) and the antecedent hypothesis (anxiety disorders precede the development of chronic back pain). Regarding the consequence hypothesis, it was found that pre-existing chronic back pain not only elevates the risk of developing a mood disorder, but also of anxiety disorders. Regarding the antecedent hypothesis, it was found that anxiety disorders predict new onset chronic back pain. It is concluded that care providers should be aware of the co-occurrence of chronic back pain and psychiatric disorders. Screening tools for psychiatric disorders and guidelines should be made available for the treatment of both chronic back pain and psychiatric disorders.

Scoliosis

Scoliosis

Significant psychological and functional improvement following surgical treatment of lumber spondylosis

Study design This is a retrospective cohort study. Objective The objective of this study is to investigate the incidence of preoperative functional impairment, anxiety and depression in patients presenting for spinal surgery and the effect of surgery on medium term on functional and psychological parameters. Summary of background data Psychological factors may predispose individuals to the development of chronic back pain and also predict the outcome of lumbar surgery, and validated psychological screening tests have previously been applied in the evaluation of spinal disorders. Methods Patients admitted for decompressive lumbar surgery over a 3-year period were evaluated pre- and postoperatively with the Oswestry Disability Index and the Hospital Anxiety and Depression Score. These scores were audited to assess functional benefit following surgery. Results Fifty-three patients had sufficient data for inclusion. Preop and postop scores were compared to evaluate the psychological and functional outcomes, using a one-tailed t test for statistical analysis. Preoperative radiology revealed disc prolapse in 43 patients (predominantly L5), and 7 patients were found to have degenerative spinal stenosis. Twenty-two patients underwent discectomy and 30 patients combined discectomy and decompression. Functional disability was significantly improved in patients undergoing surgery, with higher scores in 79% of patients. Surgery resulted in a significant benefit on depressive scores but not anxiety scores. Outcomes were better in discectomy than stenosis, and with early (< 6 months) surgery. Conclusions Our study quantifies the psychological burden of lumbar spinal disease and demonstrates that pain relief following nerve root decompression in particular has a significant benefit on both physical function and psychological distress.

Employment Outcomes of Persons With a Mental Disorder and Comorbid Chronic Pain

Employment Outcomes of Persons With a Mental Disorder and Comorbid Chronic Pain

Risikofaktoren für Rückenschmerzen bei Kindern und Jugendlichen in Industrienationen

Factors that have led to the increasing prevalence of back pain amongst children and adolescents living in industrialized nations are mostly unknown. The following literature review was aimed at determining the risk factors for back pain amongst children and adolescents. We searched both PUBMED and MEDLINE between the years 1985 and 2003 for the keywords "children or adolescents" and "back pain". Only data published in original articles were used. The risk for suffering back pain is influenced by physical, behavioural, emotional and social factors. The effects of physical activity, sitting, muscle status, weight of schoolbags, exercise, television and computer use, as well as age and gender on the development of back pain in children and adolescents were examined. Associations between continuous or recurring back pain and psychosocial factors (lifestyle, emotional factors, social relationships) could be demonstrated. There was no relationship between changes of the spine seen by radiological tests and the development of chronic back pain. Longitudinal epidemiological studies are urgently needed to delineate the risk factors for the development as well as the natural history of chronic back pain in the young.

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.

Female children of alcoholics and chronic back pain.

A case-controlled retrospective design was used in the present investigation with adult women to explore the relationship between chronic and persistent back pain and a history of being raised by an alcoholic caretaker. A sample of 112 females was obtained from a large university primary care health center. Fifty-nine back pain patients served as cases, while 53 females without histories of chronic pain served as controls. Outcome measures consisted of a seven-question physician back pain checklist. The independent variable, being raised by an alcoholic caretaker, was measured by the Children of Alcoholics Screening Test (CAST). Chronic back pain patients scored significantly higher than the nonpain group on the CAST. The results suggest that additional research should explore and further define the relationship between a childhood history of being raised by an alcoholic parent and the development of chronic back pain as an adult.

A Cognitive-Behavioural Approach to the Secondary Prophylaxis of Work-Related Back Pain

A clear call has been made for the prevention of the development of chronic back pain. Indeed, chronic back pain is quite prevalent, causes great suffering, and is extremely costly. Although several attempts have been made in clinical settings to prevent the development of chronic pain, there are few reports on the techniques involved. Consequently, this paper aims to summarize some current initiatives in secondary prevention which are relevant for health care professionals. After reviewing some background principles, a guide to prevention is provided. This is based on a four-stage approach that includes screening, assessment, preventive intervention, and recycling of the program. Although research to date suggests that these methods are promising, there is a real need to conduct further research to determine the effectiveness of such programs as well as to develop the techniques further.

Low back pain. A primary care challenge.

Back pain is an important problem for primary care physicians; it is common, costly, and controversial. Back pain is the second leading symptom prompting all physician visits in the United States. There are wide geographic variations in medical care for this problem, and surgical rates in the United States are twice those of most developed countries. The treatment of back pain has followed a series of fads and fashions, and work disability resulting from back pain continues to rise. For all these reasons, primary care clinicians have an important role in improving the care of patients with low back pain. Primary care clinicians face unique problems in treating these patients. First, in primary care, most patients have uncomplicated low back pain, and identifying the rare patient with an underlying malignancy or neurologic deficit is like looking for a needle in a haystack. Second, these practitioners face two populations with nonspecific back pain: one that is likely to improve no matter what (who mostly need reassurance), and a smaller group (about 20%) who are prone to development of chronic back pain and who present complex psychosocial and occupational problems. Third, these problems must be dealt with in the typical setting of a 15-minute patient visit. Finally, lifestyle changes in exercise, weight loss, and smoking cessation may be major parts of patient treatment, and improving compliance with such interventions always is a major challenge. Primary care investigators studying back pain face at least three important challenges. One is to identify more efficient diagnostic strategies that will alleviate doctors' and patients' anxieties. Second is to develop a better theory to explain the large majority of episodes of nonspecific low back pain. At present, competing theories generate competing and conflicting treatments, generating frustration among patients and loss of credibility for clinicians. Third, we need better science, with greater methodologic rigor in the evaluation of the many nonsurgical treatments used for back pain in the primary care setting.

Relationship between back pain and personality: Psychologic vulnerability as risk factor for the development of chronic back pain

One hundred and forty-five acute back-pain patients were tested for the presence of personality traits connected with psychologic vulnerability, traits often found among chronic back-pain patients....