Treatment Of Chronic Back Pain Research Articles

Radiofrequency Ablation of Palmar Digital Branches of Ulnar Nerve in a Patient with Ulnar Neuropathy

Ulnar Tunnel Syndrome (UTS) is ulnar neuropathy at the wrist or hand typically caused by ganglion cysts, lipomas, wrist or hand compression, carpal bone fractures, carpal tunnel syndrome, or anything else that can impinge on the nerve. The symptoms of UTS can be uncomfortable and debilitating, with numbness and tingling of the 4th and 5th digits being the most common. Weakness of the ulnar portion of the hand can lead to decreased grip strength. UTS is typically managed with conservative treatment including anti-inflammatory oral medications, splinting, physical therapy, activity modification, acupuncture, and stretching. Second line treatment includes corticosteroid injections, although these have shown to have little efficacy. Surgery is also an option but may lead to iatrogenic ramifications. Radiofrequency ablation (RFA) is a treatment modality used for chronic pain, which utilizes heat to target nociceptive fibers. Traditionally, RFA is used in treating cervical and lumbar radiculopathy, but it is less studied in peripheral nerve areas. This case report examines a patient who had clinically significant pain relief after RFA to the palmar digital branches of the ulnar nerve. The patient was 63-year-old male who presented with left ulnar neuropathy that had been ongoing for 3 years. Despite conservative management, his symptoms of pain, paresthesia, and weakness persisted. The patient then elected to have a left cubital tunnel release at the elbow with anterior subcutaneous transposition. The surgery provided relief for three months but then led to worsening contractures and pain in the 4th and 5th digits of the left hand. Due to persistent symptoms after conservative management and surgical intervention, he was referred to interventional pain clinic. A decision was made to trial a digital nerve block of the left medial and lateral digital palmar nerves. Following the nerve block, the patient reported 100% improvement in pain and increased range of motion and function. Four weeks later, the patient returned for a radiofrequency ablation of the same nerves. In the week following the procedure, the patient reported that the pain in the little finger was entirely resolved. While radiofrequency ablation has become increasingly popular for the treatment of chronic back pain, its use in peripheral nerve pain has been limited to case reports and few randomized control trials. This case report highlights the successful use of radiofrequency ablation in the treatment of little finger pain and ulnar neuropathy by targeting the median and lateral branches of the palmar digital nerve.

A digital values-based microintervention for chronic back pain patients: lessons learned from a randomised experimental single-case study

BackgroundChronic pain usually lasts several years. During this time, value-oriented aspects of life often fade into the background in favour of coping with the pain, which is associated with a lower quality of life. Psychotherapeutic methods such as Acceptance and Commitment Therapy can alleviate this. However, for those who suffer from chronic pain, access to such therapies is limited. Electronic health interventions provide access to evidence-based methods. The aim of this study was to investigate the effectiveness and feasibility of a brief electronic values-based intervention on patients with chronic back pain.MethodsA study with a replicated AB single-case experimental design was conducted with 28 participants suffering from chronic back pain. Participants answered daily questions concerning their pain intensity and quality of life (wellbeing, pain catastrophising, acceptance of chronic pain, engaged living) for 10 to 17 days. The subsequent mobile intervention on value-oriented activities lasted an additional 10 days. During this time, daily assessments continued. Our analysis was performed using a hierarchical two-level modelling approach as well as visual and descriptive analysis.ResultsThe majority of participants did not measurably benefit from the intervention. Neither model-based inference nor visual analysis indicated plausible intervention effects. The results of one responder and one non-responder are presented. In their qualitative feedback, most participants described being satisfied with the intervention. The perceived usefulness of psychotherapy as a treatment for chronic back pain increased from pre- to post-intervention (p < .001, dz = 1.17).ConclusionsThis study shows that microinterventions for chronic back pain patients are feasible, but should be planned over a longer period of time to enable measurable changes. The electronic mobile format did not cause participants any difficulties.Trial registrationClinicalTrials.gov ID: NCT05205889, date of registration: January 12, 2022.

Change in Pain-Related Anxiety Mediates the Effects of Psychophysiologic Symptom Relief Therapy (PSRT) on Pain Disability for Chronic Back Pain: Secondary Results from a Randomized Controlled Trial.

Widely used therapeutic approaches, such as cognitive-behavioral and mindfulness-based therapies, can improve pain and functioning in people with chronic back pain, but the magnitude and duration of their effects are limited. Our team developed a novel 12-week program, psychophysiologic symptom relief therapy (PSRT), to substantially reduce or eliminate pain and disability. This study examined whether PSRT helped more patients achieve large-magnitude (≥30%, ≥50%, ≥75%) reductions in back pain-related disability compared to mindfulness-based stress reduction (MBSR) and usual care (UC), and if the beneficial effects of PSRT were explained by reductions in pain-related anxiety following treatment. Data from a three-armed randomized controlled trial were used (N=35 adults with chronic back pain). Change scores (baseline to 4-, 8-, 13-, and 26-weeks post-enrollment) were computed for back pain disability (RDQ) and pain-related anxiety (PASS-20). Fisher's exact tests and mediation analyses were conducted. Compared to MBSR and UC, PSRT helped significantly more patients achieve ≥75% reductions in back pain disability at all timepoints and in pain anxiety at all timepoints except 13-weeks. Change in pain anxiety significantly mediated the relationship between treatment group and change in back pain disability from baseline to 26-weeks. PSRT helped more patients achieve substantial reductions in disability than an established treatment (MBSR) and usual care. Findings indicate reduced pain anxiety may be a mechanism by which PSRT confers long-term benefits on disability. Importantly, this work aims to move the field toward more precise and effective treatment for chronic back pain.

Incremental Contribution of the Minnesota Multiphasic Personality Inventory - 3 to Predicting One-Year Postoperative Spinal Cord Surgery/Spinal Cord Stimulation Outcomes.

Pre-surgical psychological assessments are becoming common in the United States and are recommended or required prior to surgical/spinal cord stimulator intervention for chronic back pain. Psychological testing is often recommended for these evaluations and the various versions of the Minnesota Multiphasic Personality Inventory (MMPI) have demonstrated utility for predicting outcomes in this setting. This investigation sought to extend that literature with the newest version of the MMPI, the MMPI-3. The sample comprised of 909 patients (50.5% men, 49.5% women) who consented to participating in an outcome study and took the MMPI-3 along with other self-report measures of pain, functional disability, and emotional functioning prior to surgery as part of their pre-surgical psychological assessment. Self-report measures of pain, functional disability, and emotional functioning were administered again one-year following the intervention. MMPI-3 scale scores accounted for up to 9% of additional variance in the outcomes after controlling for pre-surgical measures. Measures of emotional/internalizing dysfunction, somatic dysfunction, and, to a lesser extent, behavioral/externalizing dysfunction contributed the most to the prediction of poorer outcomes.

Is Cannabis Effective in the Treatment of Chronic Back Pain?

Cannabis is commonly recognized as a recreational substance. It has been explored for its potential therapeutic applications in addressing various conditions, such as depression, anxiety, sleep disorders, neurological disorders, and chronic low back pain, which affect a significant portion of the population. In the United Kingdom, cannabis has been recognized and licensed for medical use since November 2018, with about 12 National Health Service prescriptions in circulation largely due to patient pressure, with support from media campaigns for its use when there was growing evidence of its use in intractable epilepsy. Cannabis is beginning to gain traction as an alternative or even a complementary drug to opiates with some pre-clinical studies showing opiate-sparing effects. Despite references to its therapeutic use, cannabis as a therapeutic drug has been controversial due to the negative perception of its use as a recreational drug. As a result, there have been challenges in changing the perception of healthcare authorities and clinicians on the use of cannabis as a therapeutic tool for pain relief. The stigma associated with cannabis could be responsible for the paucity of randomized controlled trials on the efficacy of medical cannabis, further decreasing the credibility of the few trials conducted.

Mindfulness and virtual reality technology in the treatment of chronic back pain

Mindfulness and virtual reality technology in the treatment of chronic back pain

CHRONIC BACK PAIN, LIMITATIONS ON USUAL ACTIVITIES, AND TREATMENT AMONG OLDER BRAZILIANS

Abstract Chronic back pain is prevalent among Brazilian older adults, leading to substantial social and healthcare costs. It also disproportionately affects low-income and less-healthy people. Using the latest Brazil’s National Health Survey (PNS-2019), multivariate logistic regressions were conducted to examine how biopsychosocial factors correlate with chronic back pain, limitations on usual activities, and pain treatment (N=17,184). PNS-2019 data showed that 31.3% (95% CI 30.1-32.5) of older adults ages 65 to 112 reported back pain. Chronic back pain was positively associated with being female, having more chronic conditions, depressive symptoms, and lower education. Among those who reported having back pain, 19.2% reported that pain limited their usual activities. Higher odds of having limitations were found among older adults with three or more chronic conditions, obesity, and depressive symptoms. However, it was lower among those with higher levels of alcohol consumption. Among older adults with back pain, 69.2% received some treatment for their pain - 24.1% exercised regularly, 14.3% received physical therapy, 48.1% medications/injections, 6.1% alternative methods, and 30.7% regularly visited health professionals. Treatment was higher among women and those with higher education. The results show significant disparities in the prevalence, limitations, and treatment of chronic back pain among older adults in Brazil. The findings point to the need for prevention and treatment programs for older Brazilians with lower socioeconomic and worse health conditions.

The treatment lottery of chronic back pain? A case series at a multidisciplinary pain centre.

Despite the number of people affected by chronic back pain, and the many available treatment options, even the best modalities provide limited pain reduction on a group level, often without simultaneous improvements in functioning or health-related quality of life. The objective was to provide an overview of the treatment of chronic back pain in clinical practice at a multidisciplinary pain centre, and to study patient and pain characteristics in different treatment groups. 104 chronic back pain patients (primary ICD-10-SE-diagnosis M53.0-M54.9 excluding M54.1 and M54.3), referred to the Pain and Rehabilitation Centre, University Hospital, Linköping in 2015, were studied using data from the Swedish Quality Registry for Pain Rehabilitation, self-reported medication data, and a retrospective medical record review. The following treatment groups were identified: rehabilitation (n=21), analgesics (n=33), invasive intervention (n=14), and no treatment (n=35). Significant differences between groups were found with regards to age, sick leave, education level, persisting pain duration, punishing responses by significant other, previous invasive intervention, receiving sub-clinic, physician speciality and referring care level. Overall, patient demographics were associated with treatment strategy to a higher degree than patient-reported outcome measures. Moreover, physician speciality and organisational factors seemed to play a role in treatment choice.

Translational methods for the treatment of chronic back pain

Background. Up to 83 % of the working population has a high level of social adaptation disorder due to the pain in the lumbosacral spine. The development of translational approaches in the treatment of degenerative diseases of the spine is becoming increasingly important. The key methods in the differentiated approach to the treatment are laser vaporization of the intervertebral disc and radiofrequency denervation of the facet joints in the case when the pain syndrome is facet-like.Objective. To evaluate the effectiveness of a differentiated approach in the use of minimally invasive surgical methods in patients with discogenic and vertebrogenic pain syndrome based on an analysis of the immediate results of treatment.Design and methods. A retrospective analysis of examination and treatment data of 101 patients with degenerative-dystrophic diseases of the lumbar spine, accompanied by pain, was carried out. In 29 (28.7 %) patients, laser vaporization of the intervertebral disc was performed; in 72 (71.3 %) cases, radiofrequency denervation of the facet joints of the lumbosacral spine was used.Results. Positive outcomes after laser vaporization were observed in 27 patients. A positive result was noted in 67 patients after radiofrequency destruction of the sinuvertebral nerve.Conclusions. Differentiated use of minimally invasive puncture methods for the treatment of osteochondrosis of the spine and adequate selection of patients for these procedures often lead to the positive result.

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.

A personalized approach to the management of patients with chronic nonspecific back pain

Back pain is one of the most common causes of a doctor visit and occupy the first place among all non-infectious diseases in terms of the number of years of life, lost due to persistent deterioration in health. Nonspecific (musculoskeletal) pain represents the most common cause of pain and can be caused by the intervertebral disc extrusion, the lesion of the facet joints, the sacroiliac joints pain (SJP), the myofascial syndrome. A comprehensive (interdisciplinary) approach to the treatment of chronic back pain is aimed not only at reducing pain, but also at increasing physical, social and domestic activity, improving the emotional state, and developing effective stereotypes of behavior. The personalized approach is based on the patient clarifying both anatomical causes of pain and social and psychological, including erroneous ideas about the causes of back pain and its forecast, depression, increased anxiety and insomnia. Kinesitherapy represents the most effective direction when conducting patients with chronic back pain and should be combined with avoiding excessive static and physical exertion. In addition to therapeutic exercises, regular walks are of great importance, the intensity and volume of which can gradually increase. Psychological methods of therapy, mainly cognitive-behavioral therapy (CBT), are effective for chronic nonspecific back pain, they also use in the presence of emotional disorders and insomnia. In case of damage to the facet joints, the SJP, combined osteoarthritis of the knee and hip joints for chronic back pain as additional therapy, combined drugs of chondroitin sulfate and glucosamine sulfate are used. Unfortunately, in our country, a personalized approach is rarely used, including the CBT, but its use can help many patients with chronic back pain.

Psychosocial Treatments for Chronic Back Pain Are Safe and Effective—and Vastly Underutilized

The Back Letter: May 2022 - Volume 37 - Issue 5 - p 49-57 doi: 10.1097/01.BACK.0000830112.77287.60

The Effectiveness of Facet Joint Local Corticosteroid Injection in Diagnosis and Treatment of Facet Joint Syndrome

Objectives: To evaluate outcomes of lumbar facet joint injection with local corticosteroid in treatmentof chronic low back pain according to Oswestry disability Index(ODI).Patients and Methods: Interventional prospective study on 23 patients attended the outpatient clinic ofOrthopedic Surgery in Cairo University Hospitalscomplaining of chronic low back pain not responsiveto medical treatment and physiotherapy from September 2018 to august 2019.Results: The mean age of the patients was 41.17 ± 9.74 years and 47.8% were males. Facet jointcorticosteroid injection resulted in significant reduction of pain severity of patients as it ranged 5:10(mean 7.3 ±1.5) pre-injection and improved to 0 :6 (mean 3.6 ± 1.7) 3-month post injection(Pvalue:0.001)while the ODI score ranged 26:80 (mean 47.4 ±15.7) pre-injection and improved to 4:46 (mean 28.8 ±10.4) three months post injection(Pvalue 0.001).Conclusion: intra-articular facet joint injection is crucial in the diagnosis and treatment of facet jointsyndrome.

Subcutaneous Stimulation as Add-on Therapy to Spinal Cord Stimulation in Patients With Persistent Spinal Pain Syndrome Significantly Increases the Total Electrical Charge per Second: Aspects on Stimulation Parameters and Energy Requirements of the Implanted Neurostimulators

ObjectiveIn our previous multicenter randomized controlled trial, we demonstrated the clinical effectiveness of peripheral nerve field stimulation (PNFS) as add-on therapy to spinal cord stimulation (SCS) for the treatment of chronic back pain in patients with persistent spinal pain syndrome (PSPS) or failed back surgery syndrome (FBSS). To our knowledge, no previous study has investigated the effect of PNFS as an add-on to SCS on the energy consumption of the implanted neurostimulators. Therefore, in this study, we compared the specific stimulation parameters and energy requirements of a previously unreported group of patients with only SCS with those of a group of patients with SCS and add-on PNFS. We also investigated differences that might explain the need for PNFS in the treatment of chronic low back pain. Materials and MethodsWe analyzed 75 patients with complete sets of stimulation parameters, with 21 patients in the SCS-only group and 54 patients in the SCS + PNFS group. Outcome measures were average visual analog scale score, SCS parameters (voltage, frequency, and pulse width), SCS charge per second, and total charge per second. We analyzed baseline characteristics and differences between and within groups over time. ResultsBoth groups had comparable patient characteristics at baseline and showed a significant decrease in back and leg pain. SCS charge per second did not significantly differ between the groups at baseline or at 12 months. The total charge per second was significantly higher in the active SCS + PNFS group than in the SCS-only group at baseline; in the SCS + PNFS group, this persisted for up to 12 months, and the SCS charge per second and total charge per second increased significantly over time. ConclusionsOur results show that add-on PNFS increases the total charge per second compared with SCS alone, as expected. However, further research is needed because our results do not directly explain why some patients require add-on PNFS to treat low back pain.

Evaluation of Radiological and Clinical Findings of Tlif (Transformational Lumbar Inter-Body Fusion)

Objective: The purpose of this research study was to assess radiological as well as clinical outcome of TLIF. Methodology: This is a retrospective research study which covered a time span from May 2018 to June 2021. In this research study, we included the patients who were suffering from chronic pain in their lower back because of degenerative disc disease (DDD), recurring herniation of lumber disc and degenerative spondylolisthesis. We performed a retrospective review of the record files to evaluate the pre-operative as well as post-operative outcomes. We used the fusion and Oswestry Disability Index (ODI) on already set standard for the evaluation of the outcomes. Results: Total twenty-five patients diagnosed with DDD in which 64.0% (n: 16) patients were male and 36.0% (n: 9) patients were females. The average age of these patients was 40.90 years. Four patients were present with recurring disc herniation and twelve patients were suffering from degenerative spondylolisthesis. ODI and VAS (Visual Analogue Scale) for pain displayed the noteworthy improvement from pre-operatively 42.30 and 7.10 to 17.50 and 2.50 post-operatively. The observation of fusion was 92%. Conclusion: There are very effective radiological and clinical results of TLIF in the treatment of chronic back pain in lower part. Keywords: TLIF, radiological outcome, clinical outcome, Back pain.

Minimally invasive surgical methods in the treatment of chronic back pain

Minimally invasive surgical methods in the treatment of chronic back pain

Factor structure and validity of the Inventory of Depression and Anxiety Symptoms-II (IDAS-II) in a chronic back pain treatment-seeking sample.

Many patients who seek treatment for chronic back pain are also at a higher risk of having comorbid anxiety- and depression-related disorders. Measures of mood and anxiety are routinely used in medical settings to screen for depression- and anxiety-related symptoms. However, factor analyses of other measures of mood and anxiety in medical settings often detect a somatization factor which, in turn, limits their discriminant validity for use across medical settings. The Inventory of Depression and Anxiety Symptoms-II (IDAS-II) is a comprehensive self-report inventory that assesses varying aspects of mood and anxiety. The purpose of this investigation is to examine the three-factor structure and validity of the IDAS-II in a chronic pain treatment-seeking sample. A total of 169 patients completed the IDAS-II and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) upon admission. Confirmatory factor analyses were computed using the scales of the IDAS-II and zero-order correlations between the IDAS-II factors from the best-fitting model and scale scores of the MMPI-2-RF. Overall, a three-factor structure of the IDAS-II was not supported; instead, a one-factor solution fit best. Using the MMPI-2-RF as external criteria, the one-factor of the IDAS-II correlated highest with the Somatic Complaints scale and the Demoralization scale. Overall, item content on the IDAS-II shares overlap with many symptoms that patients with chronic pain likely would endorse. Discussion about implications of using mood/anxiety measures and models in medical settings that are in line with the Hierarchical Taxonomy of Psychopathology (HiTOP) are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Post-release of the symposium «How to Deal with Pain in the 21st Century? Expert Opinions» (November 8, 2021, XII Interdisciplinary International Congress «Manage Pain»)

The article presents the chronology of the symposium «How to Deal with Pain in the 21st Century? Experts' opinions», which took place on November 8 during the XII interdisciplinary international congress «Manage Pain». The lectures discussed issues of non-steroidal anti-inflammatory drugs (NSAIDs), including etoricoxib (Atorika tabs), administration on the example of a clinical case, problems of terminology associated with the concepts of «lumbago» and «sciatica», rare clinical syndromes (for example, heavy-purse syndrome) that we need to differentiate nonspecific back pain with, strategies for choosing NSAIDs in patients with osteoarthritis, the importance of timely administration of NSAIDs in the prevention of chronic pain syndromes, the influence of emotional and cognitive factors on the back pain chronization. The benefits of etoricoxib (Atorika) in the treatment of chronic back pain were reviewed, as well as the evidence for its safety.

Cell sources proposed for nucleus pulposus regeneration.

Lower back pain (LBP) occurs in 80% of adults in their lifetime; resulting in LBP being one of the biggest causes of disability worldwide. Chronic LBP has been linked to the degeneration of the intervertebral disc (IVD). The current treatments for chronic back pain only provide alleviation of symptoms through pain relief, tissue removal, or spinal fusion; none of which target regenerating the degenerate IVD. As nucleus pulposus (NP) degeneration is thought to represent a key initiation site of IVD degeneration, cell therapy that specifically targets the restoration of the NP has been reviewed here. A literature search to quantitatively assess all cell types used in NP regeneration was undertaken. With key cell sources: NP cells; annulus fibrosus cells; notochordal cells; chondrocytes; bone marrow mesenchymal stromal cells; adipose‐derived stromal cells; and induced pluripotent stem cells extensively analyzed for their regenerative potential of the NP. This review highlights: accessibility; expansion capability in vitro; cell survival in an IVD environment; regenerative potential; and safety for these key potential cell sources. In conclusion, while several potential cell sources have been proposed, iPSC may provide the most promising regenerative potential.

Idiopathic scoliosis: general characteristics and analysis of etiological theories (literature review)

Idiopathic scoliosis is a severe pathology of the musculoskeletal system that affects children and adolescents all over the world. The disease occurs in approximately 0.2-0.6% of the general population, and is the largest subgroup of spinal curvature in humans (70-90% of all known scoliosis cases). In idiopathic scoliosis, a threedimensional deformation of the vertebral column is formed, leading to the formation of a rib hump, curvature of the ribs and chest, asymmetry of the pelvis and impaired development of internal organs. The main feature of the disease is the spontaneous development of deformity during the growth of the child and the tendency to progress. Scoliosis is not only an orthopedic disease, but also a ignificant cosmetic, and, consequently, a psychological and social problem. The standard of treatment for scoliotic disease remains unchanged for a long time: observation, corset treatment and surgical correction. The prognosis for the development of pathology varies depending on the degree of deformation. The corset-therapy, hospitalization, surgery and treatment of chronic back pain have a negative impact on the psychoemotional state of children and adolescents. Despite significant advances in the methods of diagnosis of deformity, improvement of surgical treatment methods and in the study of pathogenesis, the etiological factor of pathology is still unknown. The search for the causes of idiopathic scoliosis covers almost all aspects of its possible origin: genetic, environmental, hormonal, metabolic, biochemical, neurological, and others. In recent decades, relevant theories of the development of scoliosis have been formulated, but none of the theories reveals the essence of the pathological process and has no clear justification. The greatest number of supporters is the genetic theory: genetic factors play a key role in the occurrence and development of idiopathic scoliosis. Understanding the underlying factors of the disease will enable prevention, early diagnosis, and identification of the risk groups of the patients in question.