Management Of Chronic Back Pain Research Articles

DISPARITIES AND TRENDS IN COMPREHENSIVE PAIN MANAGEMENT AMONG THE ADULT POPULATION IN THE POST-OPIOID EPIDEMIC

Abstract Introduction Chronic pain is an epidemic, but there are various therapies that are effective at treating it. Disparities in access to chronic back pain management are well documented. However, studies have largely focused on the gap in utilization between Black and White patients, and on the use opioid therapies. The extent of disparities in utilization for other groups and how disparities by demographics interact with socioeconomic characteristics, are unclear. Methods Using insurance claims from Optum Data, we identified patients who had chronic low back pain between 2010- 2020. We measured trends in pharmacological and nonpharmacological therapies, disaggregating measures by sex, age, race/ethnicity, educational attainment, income, and parenthood. We estimated linear probability models to understand which demographic and socioeconomic characteristics were most predictive of utilization. Results There were large differences in the utilization of pharmacological and nonpharmacological pain care, with surprising findings. First, we found that Black patients were the most likely to be prescribed opioids, as well gabapentin, muscle relaxers, and NSAIDs, followed by White patients, Hispanics; Asians were the least likely to engage in pharmacological therapy. Linear probability models indicated that the largest predictor of pharmacological and nonpharmacological pain management was education and income. Discussion We document disparities in pain management, which point to important policy implications. Preferences of pain management warrant further attention, as our findings suggest that income and education are the largest driver. It could be that the time and out-of-pocket costs associated with nonpharmacological pain management reduce the likelihood that patients opt for these therapies.

Clinical outcomes of 3T magnetic resonance imaging-guided lumbar and sacral foraminal injections

PurposeThis article evaluates the feasibility, safety, and efficacy of MRI-guided lumbar or sacral nerve root infiltration for chronic back pain. We compared the outcomes of our MRI-guided infiltrations with data from CT-guided infiltrations reported in the literature and explored the potential advantages of MRI guidance.MethodForty-eight MRI-guided nerve root infiltrations were performed using a 3 T MRI machine. The optimal needle path was determined using breathhold T2-weighted sequences, and the needle was advanced under interleaved guidance based on breathhold PD-weighted images. Pain levels were assessed using a numeric rating scale (NRS) before the procedure and up to 5 months after, during follow-up. Procedure success was evaluated by comparing patients’ pain levels before and after the infiltration.ResultsThe MRI-guided infiltrations yielded pain reduction 1 week after the infiltration in 92% of cases, with an average NRS substantial change of 3.9 points. Pain reduction persisted after 5 months for 51% of procedures. No procedure-related complications occurred. The use of a 22G needle and reconstructed subtraction images from T2 FatSat sequences improved the workflow.ConclusionOur study showed that MRI-guided nerve root infiltration is a feasible, safe, and effective treatment option for chronic back pain. Precise positioning of the needle tip and accurate distribution of the injected solution contributed to the effectiveness of MRI-guided infiltration, which appeared to be as accurate as CT-guided procedures. Further research is needed to explore the potential benefits of metal artifact reduction sequences to optimize chronic back pain management.

86 An Emerging Role of Cannabis as an Anti-Nociceptive Agent in the Treatment of Chronic Back Pain

Abstract Aim This review aims to provide insight into current research regarding a role for the endocannabinoid signalling pathway as a target in the treatment of chronic pain with particular emphasis on potential use as part of the treatment of lower back pain. Method A literature review was conducted using PubMed, Google scholar, and web of science database. The terminologies used were endocannabinoids, cannabis-based medicines, chronic pain, and lower back pain. Results The analgesic effect of cannabinoids is produced by stimulating cannabinoid receptors within the endocannabinoid system. Animal studies show cannabinoid type 2 receptors stimulate the release of endogenous opioids, further enhancing anti-nociceptive properties. Pre-clinical studies demonstrated the amount of morphine required to achieve median effective dose was around 3.6 times lower when morphine was administered with cannabinoids compared to morphine alone. A systematic review of 24 RCT trials and 1334 participants revealed that inhaled cannabis results in improved neuropathic pain symptoms compared to placebo; however, only two studies showed clinical significance. The medicinal use of cannabis comes with adverse effects. Up to a tenth of users are at risk of developing Cannabis use disorder, characterized by psychosocial problems, increased drug-seeking behaviours including craving, withdrawal, and tolerance. Conclusions The use of cannabis is gaining traction as an alternative to opiates despite the ethical and legal considerations. There is scope for cannabinoids to be successful anti-nociceptive agents in the management of chronic back pain. The long-term effects and side effect profile of cannabis- based medicines need more research.

Pain experiences of Hindi-speaking Indian migrants in Sydney: a qualitative study

Cultural beliefs and values are increasingly understood to influence the experience of pain, health-seeking, and pain management behaviours. Research exploring cultural beliefs about pain is particularly needed for Indian migrants, who have a high prevalence of pain and are among the largest migrant communities in Australia and internationally. The objective of this study was to explore pain-related beliefs and coping strategies of Hindi-speaking Indian migrants with chronic back pain living in Sydney. Indian migrants (n = 26) completed a demographic survey, standardised pain questionnaires (RMDQ, PSEQ and BBQ) and participated in one of five focus group discussions. This cohort had low levels of disability: Mean (SD) [RMDQ 5.04 (3.2)], high self-efficacy [PSEQ 44.6 (8.8)], and relatively positive beliefs about back pain [BBQ 28.6 (4.4)]. Three categories of interconnected beliefs emerged from the focus groups: causative, treatment/coping-related, and prognostic beliefs underpinned by a core cultural belief in ‘the philosophy of Karma’. Within this core philosophy, three cultural values were central to the experience of pain and the construction of pain-related beliefs: collectivism and contribution, gendered roles, and mind-body wellness. The incorporation of holistic approaches to back pain management with an emphasis on mindfulness, exercise, and physical activity aligned with family-oriented goals could be considered for management of chronic back pain among Indian migrant communities. Contribution of the Paper•Culture seemed to influence beliefs relating to chronic back pain among Indian migrants, with a core belief in the philosophy of Karma.•Within this core philosophy, three cultural values were central to the experience of pain and the construction of pain-related beliefs: collectivism and contribution, gendered roles, and mind-body wellness.•Indian migrants living with chronic back pain could benefit from planning and delivery of an intervention involving family and community, and Yoga as an adjunct therapy along with exercise and physical activity.

Management of Chronic Back Pain in the Elderly

Management of Chronic Back Pain in the Elderly

Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.

Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.

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

Možnosti intervenční léčby chronické bolesti zad

Z epidemiologických studii vyplýva, že jednou z nejcastěji postižených oblasti lidskeho těla chronickou bolesti jsou zada. Bolest zad patři take mezi nejcastějsi důvody navstěvy zdravotnickeho zařizeni a ma velký dopad na celkove zdravi vcetně socialnich a ekonomických důsledků. Zakladni obecnou přicinou zvysujiciho se výskytu bolesti zad jsou změny v životnim stylu obyvatelstva. V připadě selhani konvencni terapie se v některých připadech mohou uplatnit postupy intervencni algeziologie. Tyto postupy by měl provadět odbornik se zkusenostmi a dovednostmi ziskanými dlouhodobou klinickou praxi a treninkem v oblasti intervencni algeziologie. Precizni topicka diagnostika organickeho původu bolesti je podminkou uspěsne terapie. Ve větsině připadů je nezbytna navigacni technika - ultrasonografie, skiaskopie. Nejcastějsi zakroky jsou: epiduralni aplikace kortikoidů, intradiskalni intervence, radiofrekvencni zakroky.

Opioid Pain Medication Prescription for Chronic Pain in Primary Care Centers: The Roles of Pain Acceptance, Pain Intensity, Depressive Symptoms, Pain Catastrophizing, Sex, and Age.

Background: Psychological factors of patients may influence physicians’ decisions on prescribing opioid analgesics. However, few studies have sought to identify these factors. The present study had a double objective: (1) To identify the individual factors that differentiate patients who had been prescribed opioids for the management of chronic back pain from those who had not been prescribed opioids and (2) to determine which factors make significant and independent contributions to the prediction of opioid prescribing. Methods: A total of 675 patients from four primary care centers were included in the sample. Variables included sex, age, pain intensity, depressive symptoms, pain catastrophizing, and pain acceptance. Results: Although no differences were found between men and women, participants with chronic noncancer pain who were prescribed opioids were older, reported higher levels of pain intensity and depressive symptoms, and reported lower levels of pain-acceptance. An independent association was found between pain intensity and depressive symptoms and opioid prescribing. Conclusions: The findings suggest that patient factors influence physicians’ decisions on prescribing opioids. It may be useful for primary care physicians to be aware of the potential of these factors to bias their treatment decisions.

Radiofrequency denervation for chronic back pain: a systematic review and meta-analysis

ObjectivesTo assess the effectiveness of radiofrequency denervation (RD) of lumbosacral anatomical targets for the management of chronic back pain.DesignSystematic review and meta-analysis of randomised controlled trials (RCTs).MethodsA database search (Medline,...

Comparison of clinical efficacy between dexamethasone and triamcinolone for transforaminal epidural steroid injections in the management of low back pain

The objective of this study was to compare the clinical efficacy of transforaminal epidural injection of dexamethasone and triamcinolone in the management of chronic low back pain with or without radiculopathy due to herniated intervertebral disc. It was a prospective, randomized, single-blind study, conducted in eighty patients of either sex suffering from low back pain of more than 3 months duration due to herniated intervertebral disc. The patients were allocated into two groups to receive either injection dexamethasone 8 mg or injection triamcinolone acetonide 40 mg as 2 ml solution through transforaminal epidural route. Each patient underwent unilateral lumbar transforaminal epidural steroid injections (TFESIs) at one level only depending on predominant involvement of nerve root on magnetic resonance imaging computed tomography of the spine and consistent with a clinical presentation of patients. Patients in both the groups were assessed prior to epidural injection and at the 2nd, 6th, and 12th weeks following epidural injection for the intensity of pain using a numerical rating scale of 0–10 and requirement of analgesics on weekly basis. Any adverse event following epidural injection was also noted during the follow-up period of the study. Improvement in pain score was significantly better with transforaminal epidural injection of triamcinolone acetonide compared to dexamethasone, in patients with chronic low back pain due to herniated intervertebral disc. No major adverse event was reported during the follow-up period in patients of either group.

Management of Chronic Back Pain in the Elderly

Management of Chronic Back Pain in the Elderly

Management of Chronic Back Pain in the Elderly

DelSole, Edward MD; Warnick, Eugene BS; Galetta, Matthew S. BA; Divi, Srikanth N. MD; Goyal, Dhruv K. C. BA; Kepler, Christopher K. MD, MBA; Schroeder, Gregory D. MD; Vaccaro, Alexander R. MD, PhD, MBA Author Information

Multidisciplinary Pain Management of Chronic Back Pain: Helpful Treatments from the Patients' Perspective.

Multidisciplinary pain management programs (MPMP) for patients suffering from chronic back pain include a variety of treatment modalities. The patients’ perceived helpfulness of these treatment modalities remains unclear. The aims of this prospective observational cohort study were to assess (i) the patients’ perceived helpfulness of different treatment modalities, (ii) the influence of sociodemographic characteristics on the patient’s perspective and (iii) whether treatment outcomes are affected by helpfulness ratings. Treatment modalities of this three-week MPMP consisted of individual physiotherapy, group-based physiotherapy, relaxation therapy, aquatic therapy, back education, medical training therapy, biofeedback, psychological pain therapy and music therapy. The study comprised 395 patients. The main outcome was the patients’ perceived treatment helpfulness at the end of the program measured by a self-reported questionnaire ranging from 1 (not at all helpful) to 6 (extremely helpful). Secondary outcomes were treatment effects on pain, pain related disability, functional ability and level of depressive symptoms measured by self-reported questionnaires (NRS, PDI, FFbH-R, ADS-L). A total of 276 patients (22–64 years, 57% female) were available for overall analysis. Multivariate-analysis-of-variance- (MANOVA-) related results revealed that perceived treatment helpfulness (range 1–6) differed significantly between treatment modalities: individual physiotherapy (M = 5.00), group-based physiotherapy (M = 4.87), relaxation therapy (M = 4.6), aquatic therapy (M = 4.54), back education (M = 4.43), medical training therapy (M = 3.38), biofeedback (M = 3.31), psychological pain therapy (M = 3.15), music therapy (M = 3.02). Pain, pain related disability and levels of depressive symptoms significantly improved after the program (p < 0.001) whereas functional ability decreased (p < 0.01). Significant correlations were found between helpfulness ratings and sociodemographic data indicating that perceived treatment helpfulness was influenced by patient-related factors. Importantly, the degree of pain-related improvements was affected by the patients’ perceived treatment helpfulness. In conclusion, patients’ perceived treatment helpfulness differs significantly between treatment modalities and corresponds to treatment outcome.

Retroperitoneal abscess with pylephlebitis caused by lumbar acupuncture: a case report

BackgroundRetroperitoneal abscess (RA) is an unusual life-threatening disease that has insidious and occult presentations. Although the incidence of this disease is low, diagnosis and treatment are challenging due to its nonspecific presentation and the complex anatomy of the retroperitoneal space. Recently, we experienced one case of a RA with extensive thrombophlebitis of the portal venous system.Case presentationAn 80-year-old male presented to the emergency room with symptoms and signs of septic shock; however, the decision making for diagnosis and treatment was difficult, as no clinical and radiological evidence supported key findings regarding the origin of sepsis. Although this patient eventually recovered after surgical drainage, we suggested that more straightforward diagnostic and treatment procedures were required in this patient to avoid possible critical complications. Through a retrospective review of operative findings, patient history, and microbiology, we found that the RA in this patient was caused by lumbar acupuncture, which is usually performed for the management of chronic back pain with long needles.ConclusionEarly surgical intervention should be considered for RA whenever the patient does not respond to broad-spectrum antibiotic treatment. Acupuncture is a possible cause of otherwise unexplained soft tissue infections, such as RA, especially in Asian countries.

Contribution of Chinese and French ear acupuncture for the management of chronic back pain: A randomised controlled trial.

To compare the efficacy of Chinese and French ear acupuncture in people with chronic back pain. Chronic back pain is a common public health problem worldwide. An intervention for this condition is ear acupuncture. Several approaches are used for ear acupuncture, particularly the Chinese and French guidelines. An open, randomised and controlled clinical trial, followed the recommendations of the CONSORT Checklist. One hundred and eleven people were selected and randomised into three groups: Chinese ear acupuncture, French ear acupuncture and Control. Evaluations were performed before the first intervention session (initial), 1week after the fifth session (final) and after a fifteen-day follow-up period (follow-up), using the Brief Pain Inventory, Rolland Morris Disability Questionnaire, and a thermal imaging camera. For data analysis, the Generalized Estimating Equation Model was applied, with significance level set at 5%. Pain severity was significantly decreased by Chinese ear acupuncture throughout intervention period. Both types of ear acupuncture affected pain interference with daily activities. However, in the comparison between initial and final evaluations, only Chinese ear acupuncture produced statistically significant results. A reduction in physical disability was observed in both ear acupuncture-treated groups during the intervention period and, although Chinese ear acupuncture failed to induce significant changes in tissular temperature at individual time points, a significant increase in cutaneous temperature was detected after the follow-up period in the dorsal region of individuals treated with Chinese ear acupuncture. Importantly, at this time point, the mean difference between Chinese and French ear acupuncture revealed a more benefic effect of Chinese procedure on this parameter. The individualised treatment based on the Chinese precepts showed, in an overall evaluation, better results for management of chronic back pain in the present study. Ear acupuncture can be implemented in the nurse's clinical practice to assist the treatment of people with chronic back pain.

Comparison of Lumbar Fusion for Back Pain and Opioid Use at County and Managed Care Hospitals

Opioids may be prescribed for the short-term management of acute-onset back pain in the setting of trauma or for long-term management of chronic back pain. More than 50% of regular opioid users report taking them for back pain. To investigate whether surgical intervention reduces opioid requirements by patients taking opioids for back pain and whether there is a difference between county and managed care hospitals in this postoperative reduction of opioid requirement. A retrospective medical record review of 118 patients who underwent elective lumbar fusion at 4 hospitals (2 county hospitals and 2 managed care hospitals) was conducted. Opioid requirements before and after surgical intervention and at the 30-day outpatient follow-up were evaluated. Forty medical records were included in the study. An overall decrease in opioid use was found in the postoperative follow-up phase after lumbar fusion in both the county and managed care hospitals. This reduction was statistically significant at 3 of 4 hospitals (P<0.01). When the data were pooled by facility type, the significance remained for county facilities (P<.01) but not managed care facilities (P=.18). Moreover, there was a significant decrease in opioid use during the postoperative inpatient phase for county compared with managed care facilities (P=.0427). The pain rating reported by patients during the hospital stay was significantly higher at county compared with managed care hospitals (P=.0088); however, the difference at discharge was not significant (P=.14). Our study indicates that lumbar fusion is associated with a significant decrease in opioid use (P<.05) compared with nonsurgical management. Overall, the difference in decreased opioid use between county and managed care hospitals after lumbar fusion was not significant.

Effect of Dry Needling with K-Taping in Management of Chronic Back Pain- Case Report

Effect of Dry Needling with K-Taping in Management of Chronic Back Pain- Case Report

The Management of Chronic Back Pain in Primary Care Settings: Exploring Perceived Facilitators and Barriers to the Development of Patient-Professional Partnerships.

Supporting patients in forming partnerships with health professionals is the key of effective self-management. This study aimed to explore the nature of patient-professional partnerships and its related factors that create facilitators and barriers to patients' self-management ability. A constructivist grounded theory approach was undertaken. Three main themes emerged: interaction and communication, integrated care, and service and system. A theoretical model was generated that posits effective communication, individualized integrated care, and high-quality service as key influences on the successful development of patient-professional partnerships and patients' ability to self-manage. Giving attention to these factors helps understand the development, implementation, mechanisms, and evaluation of building a patient-professional partnership and maximizes the opportunities for patient self-management of chronic pain. Future research and practice are needed to move beyond a simplistic focus on health outcomes to address the complex links between partnerships and treatment delivery processes, and interventions, effects, and patients' context.

SAT0586 Diagnosing and Managing Inflammatory Back Pain- How Good Are Our GP Trainees?

BackgroundGood Medical Practice for General Practitioners1and RCGP Curriculum 20102 has provided comprehensive and holistic guidance for high standard of patient care. GPs are expected to have an adequate knowledge about...