The Effect of Chronic Pain Intensity on the Stability Limits in Patients With Low Back Pain

Objective

The purpose of this study was to evaluate if the intensity of recurrent chronic pain would modify postural performance in reaching the functional limits of stability (LOS) in chronic low back pain (CLBP) patients.

Methods

Three groups of subjects were investigated. Healthy persons comprised the asymptomatic group (n = 32) while CLBP patients (n = 36) were divided into 2 subgroups, according to the reported intensity of resting pain on a numerical rating scale: patients with low (LP) and high pain (HP) levels. The maximal displacement of the center of pressure (COP) indexing the LOS magnitude and the COP mean velocity indexing the performance in reaching LOS were calculated on a Kistler force plate during forward and backward voluntary body lean with eyes open (EO) or closed (EC).

Results

The forward LOS was lower in both the LP (P < .01) and HP (P < .01) subgroups than in the asymptomatic under EO and EC conditions, while no differences between the LP and HP groups were found. The backward LOS was lower in the HP group than in asymptomatic but only with EC (P = .01). Eye closure caused an increase in forward (P = .02) and backward (P = .001) COP velocity in the LP group and forward COP velocity in the asymptomatic (P = .04) only. With EC, the only intergroup difference was lower forward COP velocity in the HP than LP group (P = .04).

Conclusion

Subjects with CLBP had reduced forward LOS regardless the pain level. However, the higher level of pain was associated with slower execution of voluntary leaning tasks, with EC only.     

Low Somatosensory Cortex Excitability in the Acute Stage of Low Back Pain Causes Chronic Pain

Determining the mechanistic causes of complex biopsychosocial health conditions such as low back pain (LBP) is challenging, and research is scarce. Cross-sectional studies demonstrate altered excitability and organization of the somatosensory and motor cortex in people with acute and chronic LBP, however, no study has explored these mechanisms longitudinally or attempted to draw causal inferences. Using sensory evoked potential area measurements and transcranial magnetic stimulation derived map volume we analyzed somatosensory and motor cortex excitability in 120 adults experiencing acute LBP. Following multivariable regression modelling with adjustment for confounding, we identified lower primary (OR = 2.08, 95% CI = 1.22–3.57) and secondary (OR = 2.56, 95% CI = 1.37–4.76) somatosensory cortex excitability significantly increased the odds of developing chronic pain at 6-month follow-up. Corticomotor excitability in the acute stage of LBP was associated with higher pain intensity at 6-month follow-up (B = -0.15, 95% CI: -0.28 to -0.02) but this association did not remain after confounder adjustment. These data provide evidence that low somatosensory cortex excitability in the acute stage of LBP is a cause of chronic pain.PerspectiveThis prospective longitudinal cohort study design identified low sensorimotor cortex excitability during the acute stage of LBP in people who developed chronic pain. Interventions that target this proposed mechanism may be relevant to the prevention of chronic pain.     

Behavioral Symptom Clusters,Inflammation, and Quality of Life in Chronic Low Back Pain

BackgroundChronic low back pain is a prevalent condition, often involving an inflammatory process. Behavioral symptoms, including depressed mood, fatigue, and sleep disturbance, intensifies pain and reduces quality of life.AimsThe objectives of this pilot study were to identify behavioral symptom clusters (depressive mood, fatigue, poor sleep) in individuals with chronic low back pain, and to determine whether there are differences in pain, quality of life and inflammation (plasma IL-6) based on cluster membership.Design and SettingsA cross-sectional study was conducted in a pain clinic.Participants/ SubjectsParticipants between ages 21 to 70 years (N=69) were enrolled if they had chronic low back pain for at least six months.MethodsParticipants completed instruments measuring, pain, depressive mood, fatigue, sleep, and demographic form. Blood (10ml) was obtained. Latent class analysis was used to identify clusters.Results and ConclusionsFindings revealed a two-class model, with Class 1 characterized by more depressive mood, fatigue, and sleep disturbance compared to Class 2. Class 1 participants reported worse quality of life than those in Class 2. Pain severity and pain interference were not significantly different between the classes. Levels of IL-6 were significantly greater in Class 1 participants compared to Class 2 with higher levels of IL-6 correlating with greater pain severity and sleep disturbances. Logistic regression revealed higher levels of IL-6 predicted Class 1 membership. Behavioral symptoms cluster exist in chronic low back pain patients and impact quality of life. Inflammation may contribute to relationship between behavioral symptoms and pain severity.     

慢性腰腿痛患者疾病认知水平和症状严重度与生活质量的相关性

目的调查慢性腰腿痛患者疾病相关知识的认知水平、症状严重度和生活质量状况,并探讨三者之间的相关性。方法 2010年12月至2011年3月,采用便利抽样法选择在上海某三级甲等医院门诊就诊或住院的100例慢性腰腿痛患者为研究对象,采用一般资料调查表、疾病相关知识认知水平调查表、日本骨科学会腰痛评估问卷(Japanese orthopaedic association back pain evaluation questionnaire,JOA)和健康调查量表(the 36-item short form health survey,SF-36)对其进行调查。结果慢性腰腿痛患者对疾病相关知识的认知评分为1~11分,平均(6.73±2.64)分;JOA评分为3~28分,平均(16.92±4.92)分;SF-36评分为203~749分,平均(460.51±122.87)分。慢性腰腿痛患者对疾病相关知识的认知评分、JOA评分与SF-36评分均呈正相关(P0.05或P0.01),疾病相关知识的认知评分与JOA评分之间无相关性(r=0.159,P=0.113)。结论慢性腰腿痛患者对疾病相关知识的认知水平较低,自身症状较为严重,生活质量偏低。临床护理工作者应对慢性腰腿痛患者进行有针对性的健康教育,提高其认知水平,缓解其相关症状,从而提高其生活质量。     

Ability of Early Response to Predict Discharge Outcomes With Physical Therapy for Chronic Low Back Pain

Objective: To determine how well early responses to physical therapy for chronic low back pain predict outcomes at discharge. Methods: A prospective single cohort study of chronic low back pain patients seen at a university spine physical therapy clinic. Self‐reported pain severity on a 100‐mm visual analog scale was measured before each physical therapy visit. The predictive variables were the change in pain score at the second, third, and fourth visits. The first outcome variable was discharge change in pain severity for a correlation analysis. The second outcome variable was a dichotomous variable of whether the subjects had achieved at least a 30% reduction in pain severity at discharge for a discriminant analysis. Results: Spearman’s rank order correlation coefficient showed that early responses at the second (r = 0.324, P = 0.02) third (r = 0.342, P = 0.01), and fourth visits (r = 0.615, P < 0.001) were all significantly correlated with discharge change in pain. The discriminant analysis showed that early responses from the second to fourth visits were able to correctly predict 80.4% of the discharge outcomes (P < 0.001). Conclusions: Early responses with physical therapy help predict discharge outcomes for chronic low back pain.     

The Mediating Role of Depression and Negative Partner Responses in Chronic Low Back Pain and Relationship Satisfaction

Chronic low back pain (CLBP) is a prevalent pain condition associated with increased disability, lower quality of life, and poor relationship satisfaction. However, little research has examined the impact of the psychosocial environment in predicting relationship satisfaction among persons with CLBP. This study examined empirically supported psychosocial variables as potential mediators in the association between pain and relationship satisfaction. Patients with CLBP completed depression, partner support, pain, relationship satisfaction, pain catastrophizing, and pain-related fear measures (N = 54). Negative responses by a partner and depression were found to mediate the association between pain and relationship satisfaction, with negative responses emerging as the most important mediator. The current findings are consistent with a biopsychosocial framework of chronic pain and suggest that negative interpersonal interactions in patients with CLBP may be of central importance when considering psychosocial intervention. Theoretical and practical implications for treatment are discussed.PerspectiveThis study suggests that psychosocial variables, specifically depression and perceived negative partner responses, have a significant impact on relationship satisfaction among individuals with CLBP. These findings highlight issues integral to the social adjustment of patients with CLBP.     

Report of the NIH Task Force on Research Standards for Chronic Low Back Pain

Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting “responder analyses” in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement.PerspectiveA task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.     

The Role of Resilience in the Clinical Management of Chronic Pain

Chronic pain affects more individuals than does cancer, heart disease, and diabetes combined. Yet, our treatment options remain remarkably limited. Often, highly effective psychotherapeutic approaches are limited by many barriers such as access, reimbursement, and acceptability; however, resilience-based positive activity interventions could offer a promising alternative. These interventions are engaging, non-stigmatizing, and do not require a mental health professional for their provision. This article reviews the new, but limited, research exploring the use of positive activity interventions for the treatment of patients with chronic pain. The related psychological and biological mechanisms are addressed, as are suggestions for more systematically evaluating the potential for positive activity interventions to become an adjunct to or stand-alone intervention strategy for patients with chronic pain.     

Role of Facet Joints in Chronic Low Back Pain in the Elderly: A Controlled Comparative Prevalence Study

Abstract: Evaluation of the age related prevalence of persistent low back pain has been estimated to be consistently higher in the elderly compared to the younger population. Facet joints have been shown to be the cause of chronic low back pain in 15% to 45% of the patients in controlled studies. Prevalence of facet joint mediated pain has not been studied in the elderly. The study population consisted of 100 patients. Group I consisted of 50 patients that were 64 years of age or younger. Group II consisted of 50 patients 65 years of age or older. The patients were randomly allocated into 1 of the 2 groups. Facet joints were investigated with diagnostic blocks initially using lidocaine 1% followed by bupivacaine 0.25%, usually 2 weeks apart.
The prevalence of facet joint mediated pain was determined to be 30% in the adults and 52% in the elderly, which was significantly higher with a false positive rate of 26% in adults and 33% in the elderly.
In conclusion, the results of this study show that facet joint mediated pain is a significant problem in all patients suffering with chronic low back pain with the prevalence of 52% in the elderly and 30% in adults.     

Long‐term Safety and Tolerability of Tapentadol Extended Release for the Management of Chronic Low Back Pain or Osteoarthritis Pain

Background: Tapentadol is a novel, centrally acting analgesic with 2 mechanisms of action: µ‐opioid receptor agonism and norepinephrine reuptake inhibition. This randomized, open‐label phase 3 study (ClinicalTrials.gov Identifier: NCT00361504) assessed the long‐term safety and tolerability of tapentadol extended release (ER) in patients with chronic knee or hip osteoarthritis pain or low back pain. Methods: Patients were randomized 4:1 to receive controlled, adjustable, oral, twice‐daily doses of tapentadol ER (100 to 250 mg) or oxycodone HCl controlled release (CR; 20 to 50 mg) for up to 1 year. Efficacy evaluations included assessments at each study visit of average pain intensity (11‐point numerical rating scale) over the preceding 24 hours. Treatment‐emergent adverse events (TEAEs) and discontinuations were monitored throughout the study. Results: A total of 1,117 patients received at least 1 dose of study drug. Mean (standard error) pain intensity scores in the tapentadol ER and oxycodone CR groups, respectively, were 7.6 (0.05) and 7.6 (0.11) at baseline and decreased to 4.4 (0.09) and 4.5 (0.17) at endpoint. The overall incidence of TEAEs was 85.7% in the tapentadol ER group and 90.6% in the oxycodone CR group. In the tapentadol ER and oxycodone CR groups, respectively, TEAEs led to discontinuation in 22.1% and 36.8% of patients; gastrointestinal TEAEs led to discontinuation in 8.6% and 21.5% of patients. Conclusion: Tapentadol ER (100 to 250 mg bid) was associated with better gastrointestinal tolerability than oxycodone HCl CR (20 to 50 mg bid) and provided sustainable relief of moderate to severe chronic knee or hip osteoarthritis or low back pain for up to 1 year.     

Prolotherapy in the Treatment of Chronic Low Back Pain: A Literature Review

Abstract

Exercise programs are advocated for the treatment of chronic low back pain, but the client often lacks the appropriate ligamentous support that is optimal for an exercise program to be effective. Once injured, ligaments have a limited capacity for recovery and recovery can be related to the degree of ligament injury. Clients that fail to progress adequately with stabilization programs may require further intervention before exercise therapy can achieve optimal results. Prolotherapy is an example of one intervention that may prove beneficial. Prolotherapy is the injection of a proliferant solution into the osseoligamentous junction of the incompetent ligaments in order to induce a healing response that will help strengthen the ligaments and provide more passive support to the joints. A review of the literature is presented that outlines the benefits of prolotherapy in low back pain.     

社区慢性腰背痛患者自我效能水平及其影响因素

目的调查社区慢性腰背痛患者自我效能水平并分析其影响因素。方法 2014年4月至2015年1月,便利抽样法选取南京市玄武区、栖霞区、河西新区以及常州市天宁区等8个社区的慢性腰背痛患者157例为研究对象,采用一般情况调查表、长海痛尺、慢性病管理自我效能感量表、简易应对方式问卷、简明健康状况量表、中文版恐惧-回避行为量表、社会支持评定量表和综合医院焦虑抑郁量表对其进行调查。结果慢性腰背痛患者自我效能得分为(6.55±1.89)分。患者对于腰背痛感觉描述中使用频率最高的是"痉挛牵扯痛"、"持续固定痛"和"腰痛"。不同婚姻状况及文化程度患者的自我效能评分的差异均有统计学意义(均P0.05)。慢性腰背痛患者自我效能与其当前疼痛、积极应对、生理功能、生理职能、躯体疼痛、总体健康、活力、社会职能、情感职能、情感健康、恐惧-回避信念总分、社会支持总分、焦虑得分和抑郁得分等14个变量均具有相关性(均P0.05)。多元线性回归结果显示,生理职能、总体健康、社会支持和积极应对是慢性腰背痛患者自我效能的主要影响因素。结论建议相关部门针对社区慢性腰背痛患者自我效能的主要影响因素制定相关政策,从而提高其自我效能水平。     

臭氧与等离子射频消融术治疗慢性椎间盘源性腰痛对比研究

[目的]比较臭氧及等离子射频消融技术治疗经保守治疗无效的慢性椎间盘源性腰痛的初步临床疗效.[方法]208例经保守治疗无效的慢性腰痛患者,术前椎间盘经造影显示为阳性,随机分别用臭氧射频消融术(A组)及等离子射频消融术(B组)治疗,其中A组95例:男47例,女48例,平均年龄35.5(17～55)岁,病程7～118个月;B...     

Report of the National Institutes of Health Task Force on Research Standards for Chronic Low Back Pain

Objectives

Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed nonspecific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. The purpose of this article is to disseminate the report of the National Institutes of Health (NIH) task force on research standards for cLBP.

Methods

The NIH Pain Consortium charged a research task force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel developed a 3-stage process, each with a 2-day meeting.

Results

The panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimal data set to describe research subjects (drawing heavily on the Patient Reported Outcomes Measurement Information System methodology); reporting “responder analyses” in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved these recommendations, which investigators should incorporate into NIH grant proposals.

Conclusions

The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of cLBP. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes. We expect the RTF recommendations will become a dynamic document and undergo continual improvement.