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Lumbar chronic pain

Catherine E Ferland, Diana-Luk Ye, Jean A Ouellet
This case report illustrates the value of a comprehensive perioperative pain assessment composed of quantitative sensory testing and self-reported measures that highlight the impact of pain experienced by a 14-year-old boy suffering from chronic low back pain and sciatica. Before surgery, the pain assessment revealed inefficient endogenous inhibitory pain control with presence of temporal summation of pain. The severe pain was constant and lasted for 18 months. The patient was in a high-anxiety state, and reported significant functional disability and poor sleep quality...
March 12, 2018: Journal of Pediatric Health Care
Cordula Netzer, Pascal Distel, Uwe Wolfram, Hans Deyhle, Gregory F Jost, Stefan Schären, Jeroen Geurts
Facet joint osteoarthritis is a prominent feature of degenerative spine disorders, highly prevalent in ageing populations, and considered a major cause for chronic lower back pain. Since there is no targeted pharmacological therapy, clinical management of disease includes analgesic or surgical treatment. The specific cellular, molecular, and structural changes underpinning facet joint osteoarthritis remain largely elusive. The aim of this study was to determine osteoarthritis-related structural alterations in cortical and trabecular subchondral bone compartments...
March 14, 2018: International Journal of Molecular Sciences
Mark W Werneke, Susan Edmond, Michelle Young, David Grigsby, Brian McClenahan, Troy McGill
BACKGROUND AND PURPOSE: Physiotherapy has an important role in managing patients with non-specific low back pain who experience elevated psychosocial distress or risk for chronic disability. In terms of evidence-based physiotherapy practice, cognitive-behavioural approaches for patients at high psychosocial risk are the recommended management to improve patient treatment outcomes. Evidence also suggests that directional preference (DP) is an important treatment effect modifier for prescribing specific exercises for patients to improve outcomes...
March 14, 2018: Physiotherapy Research International: the Journal for Researchers and Clinicians in Physical Therapy
Zachary L McCormick, Andrew Hendrix, David Dayanim, Bryan Clay, Amy Kirsling, Norman Harden
Objective: We present a technical protocol for rigorous assessment of patient-reported outcomes and psychophysical testing relevant to lumbar sympathetic blocks for the treatment of postamputation pain (PAP). This description is intended to inform future prospective investigation. Design: Series of four participants from a blinded randomized sham-controlled trial. Setting: Tertiary, urban, academic pain medicine center. Subjects: Four participants with a single lower limb amputation and associated chronic PAP...
March 8, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Richard A Deyo, Sara E Hallvik, Christi Hildebran, Miguel Marino, Nicole OʼKane, Jody Carson, Joshua Van Otterloo, Dagan A Wright, Lisa M Millet, Wayne Wakeland
Lumbar fusion surgery is usually prompted by chronic back pain, and many patients receive long-term preoperative opioid analgesics. Many expect surgery to eliminate the need for opioids. We sought to determine what fraction of long-term preoperative opioid users discontinue or reduce dosage postoperatively; what fraction of patients with little preoperative use initiate long-term use; and what predicts long-term postoperative use. This retrospective cohort study included 2,491 adults undergoing lumbar fusion surgery for degenerative conditions, using Oregon's prescription drug monitoring program to quantify opioid use before and after hospitalization...
March 6, 2018: Pain
Rikke Vibeke Nielsen
Increasing evidence indicate that pain is insufficiently treated following surgical procedures. It is essential that pain treatment is effective with a minimum of side effects in order to promote postoperative rehabilitation. Multimodal analgesia is most likely an important strategy in reducing postoperative pain. Combinations of different analgesics with different mechanisms of action may have an additive analgesic effect with fewer side effects compared to using a single drug. However, there is still a pronounced lack of documentation for the effect and side effects of these multimodal analgesic regimes...
March 2018: Danish Medical Journal
Anne Tabard-Fougère, Romain Dayer, Stéphane Armand, Nicolas Vuillerme
STUDY DESIGN: A cross-sectional comparative study. OBJECTIVE: This study aimed to investigate the flexion-relaxation phenomenon (FRP), in standing trunk flexion and slumped sitting tasks, by comparing children and adolescents suffering from nonspecific chronic low back pain (NSCLBP) with controls (CTRL). SUMMARY OF BACKGROUND DATA: The absence of the FRP can accurately discriminate adults with NSCLBP from those without during standing trunk flexion and slumped sitting tasks...
March 5, 2018: Spine
Xian Wang, Shaolei Ma, Haibo Wu, Xiaofeng Shen, Shiqin Xu, Xirong Guo, Maria L Bolick, Shizheng Wu, Fuzhou Wang
Our previous works disclosed the contributing role of macrophage migration inhibitory factor (MIF) and dopaminergic inhibition by lysine dimethyltransferase G9a/Glp complex in peripheral nerve injury-induced hypersensitivity. We herein propose that the proinflammatory cytokine MIF participates in the regulation of neuropathic hypersensitivity by interacting with and suppressing the descending dopaminergic system. The lumbar spinal cord (L-SC) and ventral tegmental area (VTA) are two major locations with significant upregulation of MIF after chronic constriction injury (CCI) of the sciatic nerve, and they display time-dependent changes, along with a behavioral trajectory...
February 16, 2018: Experimental & Molecular Medicine
A Pranata, L Perraton, D El-Ansary, R Clark, B Mentiplay, K Fortin, B Long, R Brandham, A L Bryant
Differences in synchronous movement between the trunk and lower limb during lifting have been reported in chronic low back pain (CLBP) patients compared to healthy people. However, the relationship between movement coordination and disability in CLBP patients has not been investigated. A cross-sectional study was conducted to compare regional lumbar and lower limb coordination between CLBP (n = 43) and control (n = 29) groups. The CLBP group was divided into high- and low-disability groups based on their Oswestry Disability Index (ODI) score...
February 20, 2018: Journal of Biomechanics
Charlotte Pauwels, Alexandra Roren, Adrien Gautier, Jonathan Linières, François Rannou, Serge Poiraudeau, Christelle Nguyen
BACKGROUND: Lumbar-flexion-based endurance training, namely cycling, could be effective in reducing pain and improving function and health-related quality of life in older people with chronic low back pain. OBJECTIVES: To assess barriers and facilitators to home-based cycling in older patients with lumbar spinal stenosis (LSS). METHODS: We conducted a retrospective mixed-method study. Patients ≥ 50 years old followed up for LSS from November 2015 to June 2016 in a French tertiary care center were screened...
February 27, 2018: Annals of Physical and Rehabilitation Medicine
Mahboobeh Ghasemzadeh Rahbardar, Bahareh Amin, Soghra Mehri, Seyed Javad Mirnajafi-Zadeh, Hossein Hosseinzadeh
BACKGROUND: We aimed to investigate the potential prophylactic and curative effects of rosmarinic acid, one of the main constituents of rosemary, on the neuropathic pain induced by chronic constriction injury (CCI) in rats. MATERIALS AND METHODS: CCI was used to induce peripheral neuropathic pain. In prophylactic groups, rosmarinic acid (10, 20, and 40 mg/kg, i.p.) was administered from the day of surgery (day 0) for 14 days. In treatment group, rosmarinic acid (40 mg/kg) was given from day 5 (after the pain was established), for 7 days...
February 1, 2018: Phytomedicine: International Journal of Phytotherapy and Phytopharmacology
Alex Sabo, Jesse Hatgis, Michelle Granville, Robert E Jacobson
Osteoporotic patients can present with either single or multiple fractures secondary to repeated falls and progressive osteoporosis. Multiple fractures often lead to additional spinal deformity and are a sign of more severe osteoporosis. In the thoracic spine, multiple fractures are associated with the development of gradual thoracic kyphosis but neurologic deficits are uncommon. In the lumbar spine, patients with multiple lumbar fractures have more constant lumbar pain, may have symptoms related to concurrent lumbar stenosis or degenerative scoliosis, and may present with radiculopathy, especially with fractures at L4 and L5...
December 19, 2017: Curēus
Daisuke Ichinose, Satoru Tochigi, Toshihide Tanaka, Tomoya Suzuki, Jun Takei, Keisuke Hatano, Ikki Kajiwara, Fumiaki Maruyama, Hiroki Sakamoto, Yuzuru Hasegawa, Satoshi Tani, Yuichi Murayama
A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted...
February 23, 2018: Neurologia Medico-chirurgica
Viraj Ashok Shinde, Mrunalini Kalikar, Satyajeet Jagtap, Ganesh N Dakhale, Mangesh Bankar, Chaitali S Bajait, Vijay M Motghare, Ashlesha A Pashilkar, Latesh B Raghute, Ajita D Khamkar
Introduction: To compare the efficacy, safety, and tolerability of transdermal patches of diclofenac sodium with oral diclofenac sustained release (SR) in patients of chronic musculoskeletal MSK pain conditions. Materials and Methods: The eligible patients were given either transdermal diclofenac patch or tablet diclofenac SR. Pain was assessed at 2 and 4 weeks using a visual analog scale. Adverse events were recorded. Patients with 18-65 years old of either gender with score of ≥4 on a 11-item numeric rating scale-numeric version of visual analog scale for pain with diagnosis of primary osteoarthritis (OA) of the knee or hand of at least 3 months duration, with independent radiological confirmation of OA or having pain associated with other MSK conditions such as soft-tissue rheumatism, cervical and lumbar back pain, and fibromyalgia, of at least 3 months duration were included in this study...
October 2017: Journal of Pharmacology & Pharmacotherapeutics
Jun-Ying Wang, Yong-Hui Gao, Li-Na Qiao, Jian-Liang Zhang, Cheng-Lin Duan-Mu, Ya-Xia Yan, Shu-Ping Chen, Jun-Ling Liu
BACKGROUND: Cumulated evidence reveals that glial cells in the spinal cord play an important role in the development of chronic neuropathic pain and are also complicated in the analgesic effect of EA intervention. But the roles of microgliacytes and astrocytes of spinal cord in the process of EA analgesia remain unknown. METHODS: A total of 120 male Wistar rats were used in the present study. The neuropathic pain model was established by chronic constrictive injury (CCI) of the sciatic nerve...
February 21, 2018: BMC Complementary and Alternative Medicine
Aatit Paungmali, Leonard Henry Joseph, Khanittha Punturee, Patraporn Sitilertpisan, Ubon Pirunsan, Sureeporn Uthaikhup
OBJECTIVE: The main objective of the study was to measure the levels of plasma β-endorphin (PB) and plasma cortisol (PC) under lumbar core stabilization exercise (LCSE), placebo and control conditions in patients with chronic nonspecific low back pain. METHODS: Twenty-four participants with chronic nonspecific low back pain participated in a randomized, placebo-controlled, crossover design study. There were 3 experimental exercise conditions: control condition (positioning in crook lying and rest), placebo condition (passive cycling in crook lying using automatic cycler), and LCSE on a Pilates device tested with a 48-hour interval between sessions by concealed randomization...
February 17, 2018: Journal of Manipulative and Physiological Therapeutics
Adriaan Louw, Kevin Farrell, Merrill Landers, Martin Barclay, Elise Goodman, Jordan Gillund, Sara McCaffrey, Laura Timmerman
Objective: To determine if a neuroplasticity educational explanation for a manual therapy technique will produce a different outcome compared to a traditional mechanical explanation. Methods: Sixty-two patients with chronic low back pain (CLBP) were recruited for the study. Following consent, demographic data were obtained as well as pain ratings for low back pain (LBP) and leg pain (Numeric Pain Rating Scale), disability (Oswestry Disability Index), fear-avoidance (Fear-Avoidance-Beliefs Questionnaire), forward flexion (fingertips-to-floor), and straight leg raise (SLR) (inclinometer)...
December 2017: Journal of Manual & Manipulative Therapy
Rozalin R Dickson, Joel M Reid, Wayne T Nicholson, Tim J Lamer, W Michael Hooten
BACKGROUND: Facet joint steroid injections are used to treat chronic low back. However, little is known about the systemic absorption and serum levels of steroids following intra-articular facet joint injections. The primary objective of this preliminary study was to investigate the pharmacokinetics of triamcinolone acetonide following fluoroscopically guided intra-articular lumbar facet joint injections in a cohort of patients with chronic low back pain. A secondary aim was to investigate the effects of triamcinolone on serum cortisol levels following lumbar facet joint injections...
February 12, 2018: Pain Practice: the Official Journal of World Institute of Pain
Ashley P Marek, Jean Dominique Morancy, Jeffrey G Chipman, Rachel M Nygaard, Robert M Roach, Michele M Loor
The incidence of thoracolumbar spine fractures in blunt trauma is 4 to 5 per cent. These fractures may lead to neurologic injury, chronic back pain, and disability. Most studies from United States trauma centers focus on neurologic sequelae and/or compare treatment modalities. However, most patients with spine fractures do not have a neurologic deficit. Our primary objective was to determine the long-term outcome of traumatic thoracolumbar spine fractures, specifically addressing quality of life, chronic pain, and employment using a validated patient outcome survey...
January 1, 2018: American Surgeon
Daniel Albrecht, Shihab Ahmed, Norman Kettner, Ronald Borra, Julien Cohen-Adad, Hao Deng, Timothy Houle, Arissa Opalacz, Sarah Roth, Marcos Vidal Melo, Lucy Chen, Jianren Mao, Jacob Hooker, Marco L Loggia, Yi Zhang
Numerous preclinical studies support the role of spinal neuroimmune activation in the pathogenesis of chronic pain, and targeting glia (e.g., microglia/astrocyte)- or macrophage-mediated neuroinflammatory responses effectively prevents or reverses the establishment of persistent nocifensive behaviors in laboratory animals. However, thus far the translation of those findings into novel treatments for clinical use has been hindered by the scarcity of data supporting the role of neuroinflammation in human pain...
February 5, 2018: Pain
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