Evaluation Of Chronic Back Pain Research Articles

830 SPECT-CT as a Predictor of Pain Generators in Patients Undergoing Intraarticular Injections for Chronic Neck and Back Pain

INTRODUCTION: The ability to accurately predict pain generators for chronic neck and back pain remains elusive. The use of hybrid single-photon emission computerized tomography- computerized tomography (SPECT-CT) to guide facet injections has emerged as a potential approach to improve patient outcomes with unclear effectiveness. METHODS: A retrospective review was completed on all patients who had a SPECT-CT for evaluation of chronic back pain between January 2016 and June 2020 at a single tertiary academic center. Patients’ records were reviewed for demographic, clinical, imaging, and outcomes data. Only patients who had facet injections following SPECT-CT were included in this evaluation. Patients undergoing injections targeted at foci of abnormal radiotracer uptake were compared to patients without uptake concerning immediate positive response, visual analog score – VAS -, and need for additional injection or surgery at the target level. RESULTS: A total of 2849 patients were evaluated with a SPECT-CT for chronic neck and back pain. Of those, 340 (11.9%) patients received facet joint injections following SPECT-CT. A propensity score regression analysis adjusted for age, gender, bone mass index (BMI), hypertension, multiple targets injections and injection location showed uptake targeted injections not being associated with an improved immediate positive response (OR=0.64; 95%CI=0.34-1.21; p=0.172). In patients with a failed facet injection preceding SPECT-CT, adding SPECT-CT to guide facet injections was associated with a decrease in VAS pain scores two weeks after injection (p=0.018), particularly when changes were made to the facets being targeted (p=0.047). CONCLUSIONS: This study suggests that there is benefit with SPECT-CT especially to guide facet injections after a failed prior facet injections.

Dynamics of Chronic Back Pain

<h4 class="maintitle">Abstract</h4> <b>Introduction: </b>Chronic back pain is a major cause of physical disability, absenteeism from work, and legal claims. Its prevalence has increased from almost 4% to over 10% in recent decades, using substantial healthcare services. The persistence and chronic back pain after multiple operations and treatments is often called “failed back syndrome.” <b>Method: </b>This paper investigates how chronic back pain develops, why it may be associated with psychosocial change, and why it is important to evaluate and treat each patient as an individual based on evidence. It is based on literature review and personal experience. <b>Results: </b>The anatomical structure specific to the spine, the outcome of treatments, and the patient’s perception of pain are the most contributing factors for chronic back pain. The closely located facet joints, discs, ligaments, muscles, spinal cord, and nerve roots, each can be involved in causing back pain and each may need a specific treatment. Those increase the chance for difficulty in determining where the pain comes from, complication, inadequate treatment, and recurrence of the pain. Because of extension of the nerve roots away from the spine, erroneous operation can take place in other organs. <b>Conclusion: </b>Treatment of chronic back pain is difficult unless its source is clearly identified and its correlation with the neurological and radiological finding is clearly determined. Yet not every chronic back pain is a failed back syndrome. Each chronic back pain has a different cause, each needs a different solution, and each patient needs a new evaluation first, disregarding previous diagnosis. <h4 class="maintitle">Keywords</h4> Dynamics of chronic back pain; Failed back syndrome; Emotional change in chronic back pain; Evaluation of chronic back pain; Management of chronic back pain

Use of nuclear medicine methods in surgical treatment of lumbar spine degeneration.

Chronic back pain (CBP) is avery common symptom. Multiple modalities are used in its evaluation. However, according to current evidence, none of them can be used with certainty to predict the success of fusion surgery. Given the growing experience with bone tissue examination using the methods of nuclear medicine, we have used this possibility in patients with CBP without disc herniation, degenerative spinal stenosis or instability. We present case reports of 11 patients who underwent lumbar fusion (during two years period) for degenerative disc disease or facet arthropathy with adequate activity on PET or SPECT/CT examination. Rolland-Morris Questionnaire (RMQ), Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS) were filled out pre-operatively and 24 months after surgery. Six patients after one-level stabilization for active osteochondrosis and one for active facet arthropathy improved on average by 82% (64-92%) in RMQ, by 72% (48-100%) in ODI and 75% (55-100%) in VAS. Results in cases after multilevel stabilizations were slightly worse, but still very significant in most parameters. Only one patient with the most severe morphological and clinical findings did not benefit from surgery. In 10 out of 11 patients, the lower back pain and quality of life improved significantly after lumbar fusion performed in levels diagnosed by PET or SPECT/CT. These methods certainly have their place in the evaluation of CBP, especially in the case of unclear findings or multiple degenerative changes.

Comparison of Lumbopelvic Motions During Hip Medial Rotation Depending on Sex Differences and Chronic Lower Back Pain

Purpose: Hip rotation testing is important in the evaluation of chronic back pain. The purpose of this study was to investigate hip and lumbopelvic movement during hip medial rotation (HMR) in individuals with chronic lower back pain (CLBP). Methods: This study targeted 112 subjects in total: 28 healthy males and 28 healthy females, and 27 males with CLBP and 29 females with CLBP. Motion-capture device was used to measure the hip medial rotation angle (HMRA), lumbopelvic rotation angle (LPRA), and the rotation angle of the hip when lumbopelvic rotation starts during hip medial rotation. Results: When evaluating the healthy males and females using the hip medial rotation test (HMRT), healthy males showed a smaller HMRA than did healthy females (p<0.05). When evaluating the healthy males and the males with CLBP using the HMRT, males with CLBP showed a smaller HMRA and more lumbopelvic movements than did healthy males (p<0.05) in addition, their lumbopelvic move ments occurred earlier during HMR (p<0.05). Finally, when evaluating the males and the females with CLBP using the HMRT, males with CLBP showed a smaller HMRA and more lumbopelvic movements (p<0.05), and their lumbopelvic movements occurred earlier during HMR (p<0.05). Conclusion: The HMRT is an important test for the evaluation of males, and especially males with CLBP, as they often experience an in creased LPRA and decreased HMRA, with lumbopelvic movement occurring earlier during HMR when compared to other groups.

Frequency of Axial Spondyloarthritis Diagnosis Among Patients Seen by US Rheumatologists for Evaluation of Chronic Back Pain.

ObjectiveTo determine the proportion of patients with axial spondyloarthritis (SpA) among those with chronic back pain and ≥1 of 3 SpA features in the US.MethodsThe study was conducted at rheumatology practices in the US. Patients were required to have chronic back pain for ≥3 months beginning at <45 years of age, no prior SpA diagnosis, and ≥1 of the following 3 SpA features: HLA–B27 positivity, current inflammatory back pain, and magnetic resonance imaging (MRI) or radiographic evidence of sacroiliitis. Medical history and physical examination findings, pelvic radiographs, MRIs of sacroiliac joints, C‐reactive protein (CRP) level, and HLA–B27 status were obtained. Investigators were asked if a clinical diagnosis of axial SpA could be made based on the results. Data were also analyzed separately to determine if patients fulfilled the Assessment of SpondyloArthritis international Society (ASAS) criteria for axial SpA and/or modified New York criteria for ankylosing spondylitis (AS).ResultsA total of 751 patients were enrolled (46% were existing patients in rheumatology practices, 40% were new referrals, and 14% were self referred). Among patients with available data, 319 of 697 (46%) were diagnosed as having axial SpA by the investigator, and 348 of 744 (47%) fulfilled the ASAS criteria, of whom 238 were classified as having nonradiographic axial SpA and 108 as having AS; 2 had missing data. Using investigator's clinical diagnosis as the gold standard, the specificity and sensitivity of the ASAS criteria were 79% and 81%, respectively.ConclusionOur findings indicate that among patients with chronic back pain for ≥3 months beginning at ages younger than 45 years, the presence of ≥1 of 3 SpA features is an effective way to identify those with possible axial SpA.

Primary amyloidosis-induced nail dystrophy

Primary amyloidosis is caused by a monoclonal proliferation of plasma cells and is capable of producing cutaneous lesions. A 56-year-old male was admitted to the hospital for evaluation of chronic back pain and acute lower extremity weakness. On examination, he was noted to have subungual verrucous plaques with overlying nail dystrophy on his bilateral thumbs. A biopsy of one subungual lesion showed a deposition of amorphous material in the dermis that stained with Congo red and crystal violet. These cutaneous lesions ultimately led to the diagnosis of plasma cell dyscrasia and primary amyloidosis. Based on the literature search, primary amyloidosis presenting with this degree of subungual thickening and overlying nail dystrophy has not been previously reported.

AB0887 Low dose computed tomography (low dose CT) for assessing sacroiliitis in patients with suspected axial spondyloarthritis and inconclusive radiographs

BackgroundSensitivity and specificity of conventional radiographs of the sacroiliac joints (SI-joints) for assessing sacroiliitis is limited. Low dose CT may better visualise SI joints than plain radiographs and is associated...

Liquid crystal thermography in the evaluation of chronic back pain: A comparative study

This research involves the relative value of liquid crystal contact thermography (LCT) as compared to the physical examination, myelography, electromyography and CT scanning in the examination of 155 chronic low back pain patients. Thermograms were interpreted by two independent examiners as positive for nerve root compromise. Results demonstrate excellent interobserver reliability when used for this specific purpose and respectable correlations with the physical examination and EMG studies were obtained. Somewhat less correlation was found between LCT and the diagnostic procedures of CT scanning and myelography, especially in the postoperated patient. Liquid crystal contact thermography shows some promise as an adjunctive diagnostic tool in the assessment of chronic back pain patients with radicular symptoms, especially where further surgery is contemplated and the more structural tests of CT scanning and myelography may be falsely positive as a result of previous back surgery.