Treatment Of Spinal Pain Research Articles

Intra-Examiner Reliability and Validity of Sagittal Cervical Spine Mensuration Methods Using Deep Convolutional Neural Networks.

Background: The biomechanical analysis of spine and postural misalignments is important for surgical and non-surgical treatment of spinal pain. We investigated the examiner reliability of sagittal cervical alignment variables compared to the reliability and concurrent validity of computer vision algorithms used in the PostureRay® software 2024. Methods: A retrospective database of 254 lateral cervical radiographs of patients between the ages of 11 and 86 is studied. The radiographs include clearly visualized C1-C7 vertebrae that were evaluated by a human using the software. To evaluate examiner reliability and the concurrent validity of the trained CNN performance, two blinded trials of radiographic digitization were performed by an extensively trained expert user (US) clinician with a two-week interval between trials. Then, the same clinician used the trained CNN twice to reproduce the same measures within a 2-week interval on the same 254 radiographs. Measured variables included segmental angles as relative rotation angles (RRA) C1-C7, Cobb angles C2-C7, relative segmental translations (RT) C1-C7, anterior translation C2-C7, and absolute rotation angle (ARA) C2-C7. Data were remotely extracted from the examiner's PostureRay® system for data collection and sorted based on gender and stratification of degenerative changes. Reliability was assessed via intra-class correlations (ICC), root mean squared error (RMSE), and R2 values. Results: In comparing repeated measures of the CNN network to itself, perfect reliability was found for the ICC (1.0), RMSE (0), and R2 (1). The reliability of the trained expert US was in the excellent range for all variables, where 12/18 variables had ICCs ≥ 0.9 and 6/18 variables were 0.84 ≤ ICCs ≤ 0.89. Similarly, for the expert US, all R2 values were in the excellent range (R2 ≥ 0.7), and all RMSEs were small, being 0.42 ≤ RMSEs ≤ 3.27. Construct validity between the expert US and the CNN network was found to be in the excellent range with 18/18 ICCs in the excellent range (ICCs ≥ 0.8), 16/18 R2 values in the strong to excellent range (R2 ≥ 0.7), and 2/18 in the good to moderate range (R2 RT C6/C7 = 0.57 and R2 Cobb C6/C7 = 0.64. The RMSEs for expert US vs. the CNN network were small, being 0.37 ≤ RMSEs ≤ 2.89. Conclusions: A comparison of repeated measures within the computer vision CNN network and expert human found exceptional reliability and excellent construct validity when comparing the computer vision to the human observer.

Intramuscular paravertebral oxygen-ozone therapy for chronic neck pain and low back pain: evaluation of 6-month clinical outcomes.

Spinal pain is recognized as the most common cause of disability, work absenteeism and need of healthcare services worldwide. Although many strategies have been developed for conservative treatment of spinal pain, its increasing prevalence diagnosis highlights the need for new treatments. Oxygen-ozone (O2-O3) therapy is considered to be an alternative therapy due to its analgesic and anti-inflammatory effects. This retrospective study evaluated the effects of O2-O3 intramuscular paravertebral injections in 76 patients with chronic neck pain or low back pain, in terms of pain and disability reduction, quality of life improvement, and analgesic drug intake. Patients were evaluated before, at the end of the treatment, and at 1, 3 and 6 months after the last treatment, using Numeric Rating Scale, Neck Disability Index or Oswestry Disability Index, and Short Form-12 Health Survey. There were significant beneficial effects of O2-O3 therapy in reducing pain and disability reduction and improving quality of life during the 6-month follow-up period. O2-O3 therapy was associated with a reduction in analgesic drug intake at each assessment. Our results allow us not only to support treatment with O2-O3 intramuscular paravertebral injections as a safe and beneficial treatment for chronic low back pain, but also to consider it as a valuable conservative therapy for patients with chronic neck pain.

Diagnosis and Management of Neuropathic Pain in Spine Diseases

Neuropathic pain is generally defined as a non-physiological pain experience caused by damage to the nervous system. It can occur spontaneously, as a reaction to a given stimulus, or independently of its action, leading to unusual pain sensations usually referred to as firing, burning or throbbing. In the course of spine disorders, pain symptoms commonly occur. According to available epidemiological studies, a neuropathic component of pain is often present in patients with spinal diseases, with a frequency ranging from 36% to 55% of patients. Distinguishing between chronic nociceptive pain and neuropathic pain very often remains a challenge. Consequently, neuropathic pain is often underdiagnosed in patients with spinal diseases. In reference to current guidelines for the treatment of neuropathic pain, gabapentin, serotonin and norepinephrine reuptake inhibitors and tricyclic antidepressants constitute first-line therapeutic agents. However, long-term pharmacologic treatment often leads to developing tolerance and resistance to used medications. Therefore, in recent years, a plethora of therapeutic methods for neuropathic pain have been developed and investigated to improve clinical outcomes. In this review, we briefly summarized current knowledge about the pathophysiology and diagnosis of neuropathic pain. Moreover, we described the most effective treatment approaches for neuropathic pain and discussed their relevance in the treatment of spinal pain.

Effectiveness of ultrasonography-guided caudal epidural steroid injection in improving pain and functional status of geriatric patients with spinal pain

Introduction: Treatment of lumbar spinal pain in geriatric patients is challenging. This study retrospectively investigated the effects of an ultrasonography-guided caudal epidural steroid injection on pain and functional recovery in geriatric patients (age ≥65 years). Materials and Methods: Fifty-eight patients who received ultrasonography-guided caudal epidural steroid injection between December 2019 and March 2023 were retrospectively evaluated. Pain levels were evaluated using the Visual Analog Scale, and functional recovery was assessed using Oswestry Disability Index. The time points for evaluation were preoperative, immediately post-procedure, and at three weeks and three months post-procedure. Results: The main underlying conditions in this cohort were lumbar spondylosis, lumbar disc herniation, and lumbar spondylolisthesis. Thirty patients had multiple-level lumbar canal narrowing, 13 had L4-5 and L5-S1 disc herniation, and five had lumbar spondylolisthesis. Ten patients had a history of lumbar spinal surgery. Fourteen patients had at least three comorbid conditions (cardiovascular disease, morbid obesity, renal disease, etc.), and six had four comorbid conditions. Pain Visual Analog Scale scores in the immediate postoperative period and at three weeks and three months were significantly lower than the preoperative score (p < 0.001). Oswestry Disability Index scores at three weeks and three months postoperatively were significantly better than the pre-procedure scores (p < 0.001). Conclusions: Ultrasonography-guided caudal epidural steroid injection is an excellent pain management modality in the treatment of spinal pain, especially in the geriatric age group. Keywords: Pain; Steroid; Ultrasonography; Comorbidity.

Recommendations for inversion table therapy

In the USA, low back pain related illness accounts for approximately 149 million workdays lost each year. Initial management of back pain typically involves allied healthcare professionals who implement various treatments, such as chiropractic manipulation, physiotherapy, and acupuncture which have varying outcomes and levels of supporting evidence. Another passive treatment for back pain is inversion table therapy (ITT). It is a form of spinal traction which is thought to have a role in relieving low back pain due to the gravity-facilitated traction of the spine which distracts the lumbar vertebrae. However, ITT is not without risk. According to the Food and Drug Administration (FDA) Medical Device Reporting Events Database, ITT has resulted in serious injuries including spinal cord injury, fractures, lacerations, and death. The FDA has regulated ITT for only manufacturers that indicated medical use; however, most manufacturers have not made such medical claims and were exempt from FDA regulation. This article discusses the risks of ITT, the current regulatory process for ITT, and the need for a better understanding of the role of ITT in the treatment of spinal pain while optimizing consumer safety. Implications for rehabilitation Inversion table therapy (ITT) is a form of spinal traction which is thought to have a role in relieving low back pain due to the gravity-facilitated traction of the spine which distracts the lumbar vertebrae. According to the Food and Drug Administration (FDA) statistics, injuries due to non-powered traction from various medical devices have been rising since 2011. The FDA has regulated ITT for only manufacturers that indicated medical use; however, most manufacturers have not made such medical claims and were exempt from FDA regulation. This article discusses the risks of ITT, the current regulatory process for ITT, and the need for a better understanding of the role of ITT in the treatment of spinal pain while optimizing consumer safety.

Thoracic Spine Pain and Factors Associated in High School Students

BackgroundThoracic spine pain (TSP) is relatively common in children and adolescents. AimsTo determine the prevalence of TSP in adolescents and analyze its association with sociodemographic characteristics, use of electronic devices, physical activity, and mental health. DesignCross-sectional epidemiological study. SettingA high school in Bauru City, São Paulo, Brazil. Participants/SubjectsIn total, 1,628 students aged 14-18 years. MethodsParticipants were selected by cluster sampling in two stages, and data were collected via face-to-face interviews. Data regarding the following were collected: (1) sociodemographic aspects; (2) use of electronic devices; (3) regular physical activity level; (4) mental health; and (5) TSP. ResultsThe prevalence of TSP was 51.5% (95% confidence interval, 49.1-53.9) and the variables associated with TSP were female participant sex (prevalence ratio [PR] = 1.96; 1.61-2.38), use of computers for >3 hours per day (PR = 1.29; 1.01-1.66), use of computers >3 times per week (PR = 1.35; 1.03-1.75), use of cell phones in a semi-lying position (PR = 1.37; 1.11-1.69), use of cell phones for >3 hours per day (PR = 1.44; 1.12-1.85), use of tablets in the sitting position (PR = 1.47; 1.07-2.01), and presence of mental health problems (PR = 2.10; 1.63–2.70). Physical activity was a protective factor (PR = 0.84; 0.73-0.96). ConclusionsThere is a high prevalence of TSP in adolescents, with a marked association with female participant sex, use of electronic devices, and presence of mental health problems Physical activity is a protective factor. Understanding the relationship between risk factors and adolescent spinal pain may be important in both the prevention and treatment of spinal pain in this age group.

Chinese Association for the Study of Pain: Experts consensus on ultrasound-guided injections for the treatment of spinal pain in China (2020 edition).

Spinal pain (SP) is a common condition that has a major negative impact on a patient’s quality of life. Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice. This clinical expert consensus describes the purpose, significance, implementation methods, indications, contraindications, and techniques of ultrasound-guided injections. This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.

TREATMENT OF BACK PAIN AFTER HIP ARTHROPLASTY, USING DEEP OSCILLATION

Objective: Deep Oscillation® is an electromechanical procedure with deep therapy that allow to create a pulsed electrostatic field between the hand applicator and the processing better tissue nutrition, enhanced cellular metabolism, faster healing. The purpose of this work is to assessment of the outcome of the treatment of spinal pain after hip arthroplasty using Deep osсillation Methods: The study included 85 patients between the ages of 40 and 75 who were referred to the Arena 2 Rehabilitation Center for post hip joint arthroplasty spine pain, including 57 women and 28 men. Patients physical modalities: complex rehabilitation programme including deep oscillation (DO - fibromyalgia programme) and kinesitherapy - active analytic exercises (including isometric exercises) and soft tissue techniques (post-isometric relaxation, stretching of the lumbar fascia, manual massage). Spinal condition was assessed before treatment after treatment using the Modified Oswestry Disability Index (ODI). Results: Mean value of points before treatment - 3.35+1.1, after treatment - 1.36+0.79. p<0.001 Oswestry Disability Index –67% and 27.2% respectively. Conclusion: After total endoprosthesis, there is a change in biomechanics and a shift in the center of gravity, which causes a change in the position of the spine and pain, so we definitely consider the spine examination and adequate rehabilitation and treatment in the post hip joint arthroplasty period. Involvement in the deep spine's treatment method reduces pain and improves the patient's quality of life, improve function and return-to-work status. Keywords: deep oscillation, hip arthroplasty, back pain.

Patient Expectations From Consultation and Treatment of Spine Pain in a Private Spine Rehabilitation Clinic in Urban India.

Despite high prevalence of spine pain among the Indian population, patient expectations regarding consultation and its treatment are unknown. We aimed to determine consultation and treatment expectations among patients visiting a spine rehabilitation clinic in urban India. We included 194 consecutive patients who completed a consultation expectation (CE) and treatment outcome expectation (OE) questionnaires and the Patient-Centered Outcome Questionnaire (PCOQ). To learn about the most suitable treatment for their problem (98%), and to know what kind of activities they could do and should avoid (96%) were the most important CEs, and to achieve complete relief of symptoms (96%), and prevent recurrence of pain (95%) were the most important OEs. For successful treatment, patients expected PCOQ pain levels of 2.0 (96.5% reduction) and interference levels of 1.5 (96% reduction). Patients expected to know the most suitable treatment, activities they could do and avoid after consultation, and to achieve complete relief of symptoms and prevent recurrence after treatment. Incorporating and addressing these expectations may help improve outcomes and satisfaction with the consultation and treatment of spine pain.

Potential treatment effect modifiers for manipulative therapy for children complaining of spinal pain.Secondary analyses of a randomised controlled trial

BackgroundIn children, spinal pain is transitory for most, but up to 20% experience recurrent and bothersome complaints. It is generally acknowledged that interventions may be more effective for subgroups of those affected with low back pain. In this secondary analysis of data from a randomized clinical trial, we tested whether five indicators of a potential increased need for treatment might act as effect modifiers for manipulative therapy in the treatment of spinal pain in children. We hypothesized that the most severely affected children would benefit more from manipulative therapy.MethodThis study was a secondary analysis of data from a randomised controlled trial comparing advice, exercises and soft tissue treatment with and without the addition of manipulative therapy in 238 Danish school children aged 9–15 years complaining of spinal pain. A text message system (SMS) and clinical examinations were used for data collection (February 2012 to April 2014).Five pre-specified potential effect modifiers were explored: Number of weeks with spinal pain 6 months prior to inclusion, number of weeks with co-occurring musculoskeletal pain 6 months prior to inclusion, expectations of the clinical course, pain intensity, and quality of life.Outcomes were number of recurrences of spinal pain, number of weeks with pain, length of episodes, global perceived effect, and change in pain intensity. To explore potential effect modification, various types of regression models were used depending on the type of outcome, including interaction tests.ResultsWe found that children with long duration of spinal pain or co-occurring musculoskeletal pain prior to inclusion as well as low quality of life at baseline tended to benefit from manipulative therapy over non-manipulative therapy, whereas the opposite was seen for children reporting high intensity of pain. However, most results were statistically insignificant.ConclusionsThis secondary analysis indicates that children more effected by certain baseline characteristics, but not pain intensity, have a greater chance to benefit from treatment that include manipulative therapy. However, these analyses were both secondary and underpowered, and therefore merely exploratory. The results underline the need for a careful choice of inclusion criteria in future investigations of manipulative therapy in children.Trial registrationNCT01504698; results

The relationship between spinal pain and temporomandibular joint disorders in Korea: a nationwide propensity score-matched study

BackgroundPatients with temporomandibular joint disorder (TMD) often complain of pain in other areas. Several studies have been conducted on spinal pain in TMD patients, but have contained only limited information. Therefore, this study analyzed the relationship between TMD and spinal pain in greater detail by using nationwide data.MethodsA total of 12,375 TMD patients from the Korean National Health Insurance Review and Assessment database were analyzed. Controls were selected using propensity score-matching. The McNemar test, chi-square test, and paired t-test were used to compare the prevalence and severity of spinal pain between cases and matched controls. Logistic regression and linear regression models were used to analyze factors affecting the prevalence and severity of spinal pain in patients with TMD.ResultsThe annual period prevalence of TMD was 1.1%. The prevalence was higher in younger individuals than in individuals of other ages and was higher in women than in men. The medical expenditure for TMD per person was $86. Among TMD patients, 2.5% underwent surgical procedures and 0.3% were hospitalized. The prevalence of spinal pain in patients with TMD was 48%, whereas that in the control group was 34%. Increased severity of TMD was associated with an increased probability of spinal pain. The medical expenditure, mean number of visits, and lengths of treatment for spinal pain were greater for patients with TMD than for controls ($136 vs. $81, 4.8 days vs. 2.7 days, 5.5 days vs. 3.3 days). Higher TMD grade was associated with greater differences in average medical expenditure, number of visits, and lengths of treatment for spinal pain between cases and controls. Additionally, for women, living in a rural area and having an older age and more severe TMD were associated with a greater probability of spinal pain and higher medical expenditure related to spinal pain.ConclusionA strong association was observed between the presence of TMD and the presence of spinal pain. The association became stronger as the severity of TMD increased, indicating a positive correlation between the severity of TMD and spinal pain.

Evaluating the mechanisms of therapeutic impact of joint manipulation based on the results of experimental studies

Spine joint manipulation is a form of treatment for spinal pain with various etiologies. The most common form of these maneuvers is: HVLA – (High Velocity Low Amplitude); (ICD-9 No. 93.62) which is widely used in everyday clinical practice. HVLA utilizes a mechanical manipulative stimulus characterized by high speed, short duration and low amplitude of displacement of joint surfaces with respect to each other. Despite the long history of use, the mechanisms of their biological impact are still insufficiently explained. In the review, the hypotheses concerning the therapeutic mechanism of HVLA impact were verified based on the analysis of scientific reports available in PubMed database. Reports have been discussed presenting theoretical mechanisms of influence of HVLA techniques and experimental work taking up the issues of manipulation carried out on animal material. The following keywords were used for search: HVLA, spine manipulation, experimental studies, osteopathic treatment. Particular attention was focused on the research examining basic biological mechanisms being the basis for explaining the observed clinical effects. The analysis of scientific reports in recent years has shown that there is no direct evidence pointing to the need for obtaining the phenomenon of cavitation during HVLA procedures. Moreover, studies on an animal model prove that HVLA are safe and non-invasive procedures from the point of view of biomechanics. They inhibit the development of hyperalgesia and allodynia as confirmed by immunohistochemical studies. Previous experimental studies have shown clearly that more than one biological mechanism is responsible for the obtained effects of HVLA therapy, and the patients' reactions to therapy are complex and individually variable.

The association between psychological and social factors and spinal pain in adolescents.

Spinal pain, back pain, and/or neck pain begins early in life and is strongly associated with spinal pain in adulthood. Understanding the relationship between psychological and social factors and adolescent spinal pain may be important in both the prevention and treatment of spinal pain in this age group. We aimed to determine if psychological and social factors were associated with spinal pain in a cross-sectional study of a school-based cohort of 1279 Danish adolescents aged 11-13, who were categorized into "any" and "substantial" spinal pain. "Substantial spinal pain" was defined as a lifetime frequency of "sometimes" or "often" and a pain intensity of at least two on the revised Faces Pain Scale. Logistic regression analyses, stratified by sex, were conducted for single and all variables together. Eighty-six percent of participants reported "any spinal pain" and 28% reported "substantial spinal pain". Frequency of psychological and social factors was significantly higher in those with spinal pain compared to those without. As the frequency of psychological and social factors increased, the odds of both "any spinal pain" and "substantial spinal pain" also increased.Conclusion: Psychological and social factors may be important determinants in adolescent spinal pain. What is Known: • Spinal pain begins early in life to reach adult levels by age 18. Spinal pain in adolescence is strongly associated with spinal pain in adulthood. • In adults, psychological and social factors and spinal pain are strongly related; however, this relationship in adolescence is poorly understood. What is New: • Adolescents with spinal pain reported a significantly higher frequency of psychological factors and loneliness and lower levels of pupil acceptance. • Adolescents reporting higher levels of loneliness, lower levels of pupil acceptance, and increased frequency of psychological factors had increased odds of reporting "substantial spinal pain".

Conservative care with or without manipulative therapy in the management of back and/or neck pain in Danish children aged 9–15: a randomised controlled trial nested in a school-based cohort

BackgroundA substantial number of children experience spinal pain, that is, back and/or neck pain. Today, no ‘gold-standard’ treatment for spinal pain in children exists, but manipulative therapy is increasingly being...

Sufficient explanation of management affects patient satisfaction and the practice of post-treatment management in spinal pain, a multicenter study of 1007 patients.

BackgroundSpinal pain is most common symptom in pain clinic. In most cases, before the treatment of spinal pain, physician explains the patient's disease and treatment. We investigated patient's satisfaction and physician's explanation related to treatments in spinal pain patients by questionnaires.MethodsAnonymous questionnaires about physician's explanation and patient's satisfaction in each treatment and post-treatment management were asked to individuals suffering from spinal pain. Patients who have spinal pain were participated in our survey of nationwide university hospitals in Korea. The relationships between patient's satisfaction and other factors were analyzed.ResultsBetween June 2016 and August 2016, 1007 patients in 37 university hospitals completed the questionnaire. In the statistical analysis, patient's satisfaction of treatment increased when pain severity was low or received sufficient preceding explanation about nerve block and medication (P < 0.01). Sufficient explanation increased patient's necessity of a post-treatment management and patients' performance rate of post-treatment management (P < 0.01).ConclusionsThese results show that sufficient explanation increased patients' satisfaction after nerve block and medication. Sufficient explanation also increased the practice of patients' post-treatment management.

The effects of cervical sustained natural apophyseal glides on neck range of movement and sympathetic nervous system activity

BackgroundCervical sustained natural apophyseal glides (SNAGs) have been advocated for the treatment of spinal pain and range of movement restriction, however little is known about their mechanisms of action. Knowledge about their mechanisms should help understand the factors that influence the effectiveness of this technique. ObjectivesTo study the immediate effects of SNAGs on neck range of movement (ROM) and sympathetic nervous system activity. To assess if a difference exists in the effects of ipsilateral and contralateral cervical SNAGs. DesignSingle blind, intervention randomised, within subject crossover. Method30 asymptomatic subjects were recruited. Subjects were divided into an ipsilateral or contralateral SNAGs group. All subjects experienced a right C5 SNAGs, sham and control intervention on three separate days. Neck ROM, skin conduction (SC) and skin temperature (ST) in the right hand were measured. ResultsRight rotation ROM and SC increased following both SNAGs and sham interventions, with increases reaching statistical significance for ROM in the contralateral SNAGs group and for SC in the ipsilateral SNAGs group. No statistically significant differences were noted between ipsilateral or contralateral SNAGs and sham interventions. No significant changes in ST were noted. ConclusionC5 cervical right rotation SNAGs resulted in improved right rotation ROM and increased SC, however such effect was not greater than sham intervention. No effect was noted on ST. Further research is required to study the mechanism of action of SNAGs on symptomatic participants.

Comparison of Spinal Needle Deflection in a Ballistic Gel Model.

BackgroundPercutaneous diagnostic and therapeutic procedures are commonly used in the treatment of spinal pain. The success of these procedures depends on the accuracy of needle placement, which is influenced by needle size and shape.ObjectivesThe purpose of this study is to examine and quantify the deviation of commonly used spinal needles based on needle tip design and gauge, using a ballistic gel tissue simulant.Materials and MethodsSix needles commonly used in spinal procedures (Quincke, Short Bevel, Chiba, Tuohy, Hustead, Whitacre) were selected for use in this study. Ballistic gel samples were made in molds of two depths, 40mm and 80 mm. Each needle was mounted in a drill press to ensure an accurate needle trajectory. Distance of deflection was recorded for each needle.ResultsIn comparing the mean deflection of 22 gauge needles of all types at 80 mm of depth, deflection was greatest among beveled needles [Short Bevel (9.96 ± 0.77 mm), Quincke (8.89 ± 0.17 mm), Chiba (7.71 ± 1.16 mm)], moderate among epidural needles [Tuohy (7.64 ± 0.16 mm) and least among the pencil-point needles [Whitacre (0.73 ± 0.34 mm)]. Increased gauge (25 g) led to a significant increase in deflection among beveled needles. The direction of deflection was away from the bevel with Quincke, Chiba and Short Beveled needles and toward the bevel of the Tuohy and Hustead needles. Deflection of the Whitacre pencil-point needle was minimal.ConclusionsThere is clinical utility in knowing the relative deflection of various needle tips. When a procedure requires a needle to be steered around obstacles, or along non-collinear targets, the predictable and large amount of deflection obtained through use of a beveled spinal needle may prove beneficial.

A Nationwide Retrospective Study of Opioid Management Patterns in 2,468 Patients with Spinal Pain in Korea.

Study DesignRetrospective patient data collection and investigator survey.PurposeTo investigate patterns of opioid treatment for pain caused by spinal disorders in Korea.Overview of LiteratureOpioid analgesic prescription and adequacy of consumption measures in Korea have markedly increased in the past decade, suggesting changing patterns in pain management practice; however, there is lack of integrated data specific to Korean population.MethodsPatient data were collected from medical records at 34 university hospitals in Korea. Outpatients receiving opioids for pain caused by spinal disorders were included in the study. Treatment patterns, including opioid types, doses, treatment duration, outcomes, and adverse drug reactions (ADRs), were evaluated. Investigators were interviewed on their perceptions of opioid use for spinal disorders.ResultsAmong 2,468 analyzed cases, spinal stenosis (42.8%) was the most common presentation, followed by disc herniation (24.2%) and vertebral fracture (17.5%). In addition, a greater proportion of patients experienced severe pain (73.9%) rather than moderate (19.9%) or mild (0.7%) pain. Oxycodone (51.9%) and fentanyl (50.8%) were the most frequently prescribed opioids; most patients were prescribed relatively low doses. The median duration of opioid treatment was 84 days. Pain relief was superior in patients with longer treatment duration (≥2 months) or with nociceptive pain than in those with shorter treatment duration or with neuropathic or mixed-type pain. ADRs were observed in 8.6% of cases. According to the investigators' survey, "excellent analgesic effect" was a perceived advantage of opioids, while safety concerns were a disadvantage.ConclusionsOpioid usage patterns in patients with spinal disorders are in alignment with international guidelines for spinal pain management. Future prospective studies may address the suitability of opioids for spinal pain treatment by using appropriate objective measurement tools.

Interventional pain management for spinal disorders: a review of injection techniques.

Chronic spinal pain has a high prevalence and a severe economic, societal and health impact. In the last decades the practice and research of interventional techniques for the diagnosis and treatment of spinal pain has increased sharply. The level of evidence of the most common techniques is well documented. With image-guided precise diagnostic blocks it is possible to identify the source of chronic spinal pain in well over 60% of the cases. Nonsurgical specialties such as PM&R increasingly resort to the possibilities of interventional pain management for musculoskeletal disorders. For many forms of spinal pain there is at least fair evidence for long-term pain relief after a guided therapeutic injection often reducing the intake of analgesic medication or the need for surgery. This review focuses on the evidence, the application spectrum and special considerations of injection techniques for the treatment of spinal disorders.

Smart Rehabilitation Garment for posture monitoring.

Posture monitoring and correction technologies can support prevention and treatment of spinal pain or can help detect and avoid compensatory movements during the neurological rehabilitation of upper extremities, which can be very important to ensure their effectiveness. We describe the design and development of Smart Rehabilitation Garment (SRG) a wearable system designed to support posture correction. The SRG combines a number of inertial measurement units (IMUs), controlled by an Arduino processor. It provides feedback with vibration on the garment, audible alarm signals and visual instruction through a Bluetooth connected smartphone. We discuss the placement of sensing modules, the garment design, the feedback design and the integration of smart textiles and wearable electronics which aimed at achieving wearability and ease of use. We report on the system's accuracy as compared to optical tracker method.