DOCSLIB.ORG

Low Back Pain Final 4/12/02 1:53 PM Page 1

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Low Back Pain Final 4/12/02 1:53 PM Page 1 low back pain final 4/12/02 1:53 PM Page 1 PRESCRIBING GUIDELINES FOR PRIMARY CARE CLINICIANS NSW THERAPEUTIC LOW BACK ASSESSMENT GROUP First Published 1998. Revised 2002 PAIN Rational Use of Opioids in Chronic or Recurrent Non-malignant Pain Background Diagnosis and Management Physical dependence will occur after as little Low back pain is one of the most prevalent The key to managing acute low back pain as one week of continuous opioid therapy, problems in the general population.1 is assessment, which assists in distinguishing but is usually not associated with drug- 11 Consultations in general practice involving serious pathology from benign musculoskeletal seeking behaviour. If opioid requirements management of back pain are frequent. causes. The latter constitute well over 90% appear inappropriate based on observation of The most common presentation is non- of back pain cases.2 Table 1 lists ‘red flags’. the person’s behaviour, consideration should specific lower back pain associated with These should alert clinicians to potentially be given to referring the person to a specialist decreased spinal movement.Other less serious conditions which require further in drug dependence or a specialist pain common causes of back pain include trauma, investigation and possible referral.2 service. If early referral is impractical, advice disorders producing neurological lesions, can usually be obtained by telephone. infection, neoplasm and metabolic bone Where pain persists either intermittently or disease. While well over 90% of patients with continuously for an extended period, there For clinical advice on the management of acute back pain recover within 2 weeks, is a risk of progression to chronic pain. a patient with problems related to opioid recurrence is reported in 20-60% of patients.2 There are psychosocial risk factors that are dependence, call the NSW Drug and Alcohol associated with an increase in the likelihood Specialist Advisory Service on 1800 023 687 Several guidelines3-10 have been produced of progression to chronic pain. These have or 02 9557 2905. to assist clinicians manage acute back pain. been referred to as ‘yellow flags’ and an Satisfactory relief of acute pain may help to adaptation of these is provided in Table 2.9 Doctors can call the Commonwealth prevent the development of chronic pain. For further information on the cognitive and Health Insurance Commission (HIC) behavioural aspects of chronic pain, refer on 1800 631 181 or the NSW HIC on Patients with chronic pain may present for to Therapeutic Guidelines: Analgesic, 02 9895 3333 to check whether there treatment of 4th Edition, published by Therapeutic is any information on a patient seeking • acute pain from unrelated injury or illness, Guidelines Limited (2002)11, which contains benzodiazepines or opioids who may be • exacerbation of chronic pain, or useful information for clinicians and patients. seeing other doctors or obtaining multiple • ongoing management of chronic pain. A self-help book which may also be helpful PBS prescriptions. However there may be is Manage Your Pain: practical and positive limitations to the value of such information These guidelines are intended to assist ways of adapting to chronic pain, (eg it may not be current or comprehensive). general practitioners and other primary care by Nicholas et al, published by ABC The pharmacological options for management clinicians to manage the complex medical, Books (2001).12 psychosocial, ethical and regulatory are discussed in the following paragraphs. considerations involved in treating patients Referral to a multidisciplinary treatment It is important that these options are explored with chronic low back pain, especially where program is important in managing patients in conjunction with the patient to develop there is exacerbation of their chronic pain. with chronic low back pain,13 particularly a management plan. The patient should They integrate key points from evidence- those with multiple risk factors (yellow flags). understand the goals of drug management based guidelines with experience from Early referral is desirable for these individuals. and how these relate to the outcomes of general practice. The use of long acting oral opioids may be adjunctive therapies. appropriate in a small number of patients. The limitations of drug therapy as a The recommendations are based, wherever Ideally, pain clinic assessment should means of achieving favourable outcomes are possible, on published evidence. The level precede the prescription of oral opioids. of evidence is noted against each treatment acknowledged. Although guidelines provide to assist interpretation and implementation On occasion, a general practitioner may see the best options based on available evidence, of the guideline in practice (see Table 3). a new patient who complains of severe pain, they may not ensure a successful outcome and who is already taking a mixture of opioid in all patients. This document deals principally with the and non-opioid drugs and is seeking ongoing pharmacological management of chronic treatment. Contact should be made with the non-malignant low back pain. Non-drug previous prescriber. Assessment by a pain therapies also have an important place in clinic should be arranged as soon as possible. pain management. Active rehabilitation is particularly important in preventing progression to a chronic condition. ISBN 0 9586069 27 1 Funded by low back pain final 4/12/02 1:53 PM Page 2 Evidence for Efficacy of Drug Treatments TABLE 1 Paracetamol Paracetamol has been proposed as first line Red flags* for potentially serious conditions therapy in all reviewed guidelines for treatment of acute low back pain. Although it has not requiring medical intervention been tested in placebo controlled trials in in acute low back pain patients with acute or chronic back pain its efficacy for a wide variety of pain is well Possible fracture Possible tumour or Infection Possible cauda equina established and it is considered relatively safe syndrome (ie it does not cause physical dependence and is not associated with gastrointestinal FROM MEDICAL HISTORY side effects). This view is supported by the 14 Major trauma, such as vehicle Age over 50 or under 20. Saddle anaesthesia. study of Coste et al in which 90% of accident or fall from height. patients presenting with a first episode of History of cancer. Constitutional Recent onset of bladder back pain recovered on paracetamol and, Minor trauma or even strenuous symptoms, such as recent fever dysfunction, such as urinary in a few cases, rest. lifting in an older or potentially or chills or unexplained retention, increased frequency, osteoporotic patient. weight loss. or overflow incontinence. Non-steroidal anti-inflammatory Risk factors for spinal infection: Severe or progressive drugs (NSAIDS) recent bacterial infection (eg neurological deficit in the lower Evidence for the efficacy of NSAIDs in low urinary tract infection), IV drug extremity. back pain is limited. A systematic review15 abuse; or immune suppression of 51 randomised clinical trials evaluating (from corticosteroids, transplant NSAIDs in acute or chronic low back pain or HIV). found treatment with an NSAID for one week provided a small but significant short term Pain that worsens when supine, global improvement compared with placebo severe night-time pain. (relative risk 1.24; 95% confidence interval 1.10-1.41). There was not enough information FROM PHYSICAL EXAMINATION to determine the effectiveness of NSAIDs over Peri-anal/perineal sensory loss. placebo in chronic low back pain specifically. NSAIDs were only slightly more effective than Major motor weakness: paracetamol for both acute and chronic low quadriceps (knee extension back pain, and none of the studies showed weakness); plantar flexors, a difference between NSAIDs and opioids evertors and dorsiflexors such as codeine or dextropropoyphene. (foot drop). There was no difference between the various NSAIDs tested. TABLE 2 Because adverse effects are common with NSAIDs, they should not replace paracetamol Yellow flags* to alert to psychosocial factors as first line therapy. NSAIDs should be avoided in patients who are volume depleted, which may contribute to long-term distress, elderly, have renal dysfunction or a history disability and chronic pain of peptic ulcer. NSAIDs exert an immediate analgesic effect, The following factors may be important in Suggested questions (to be phrased in however their anti-inflammatory effect, which predicting poor outcomes: treatment provider’s own words): is related to the achievement of steady state, • presence of a belief that back pain is harmful or • Have you had time off work in the past with is only evident after dosing for three to five half-lives. This means that NSAIDs with shorter potentially severely disabling back pain? half-lives, such as ibuprofen and diclofenac, • fear-avoidance behaviour (avoiding a movement or • What do you understand is the cause of your should be prescribed in preference to those activity due to misplaced anticipation of pain) and back pain/ with longer half-lives, such as piroxicam and reduced activity levels • What are you expecting will help you? sulindac, for non-specific low back pain due to acute injury. • tendency to low mood and withdrawal from • How is your employer responding to your back social interaction pain? Your co-workers? Your family? Although COX-2 selective inhibitors (eg • an expectation that passive treatment rather than celecoxib, rofecoxib) may reduce the risk of • What are you doing to cope with back pain? active participation will help. serious gastrointestinal (GI) events,16, 17 they • Do you think that you will return to work? are no more effective than traditional NSAIDs. If so, when? They should be reserved for patients at high risk for upper GI bleeding. *Adapted from: New Zealand Acute Low Back Pain Guide. Wellington,19979. 2 low back pain final 4/12/02 1:53 PM Page 3 Opioids Because it has relatively weak opioid (SSRIs) are more effective than noradrenergic There is no place for the general use of effects, constipation is less common with reuptake inhibitors such as the tricyclic injectable opioids such as pethidine.
Load more

Recommended publications
  • Download the Herniated Disc Brochure
    AN INTRODUCTION TO HERNIATED DISCS This booklet provides general information on herniated discs. It is not meant to replace any personal conversations that you might wish to have with your physician or other member of your healthcare team. Not all the information here will apply to your individual treatment or its outcome. About the Spine CERVICAL The human spine is comprised 24 bones or vertebrae in the cervical (neck) spine, the thoracic (chest) spine, and the lumbar (lower back) THORACIC spine, plus the sacral bones. Vertebrae are connected by several joints, which allow you to bend, twist, and carry loads. The main joint LUMBAR between two vertebrae is called an intervertebral disc. The disc is comprised of two parts, a tough and fibrous outer layer (annulus fibrosis) SACRUM and a soft, gelatinous center (nucleus pulposus). These two parts work in conjunction to allow the spine to move, and also provide shock absorption. INTERVERTEBRAL ANNULUS DISC FIBROSIS SPINAL NERVES NUCLEUS PULPOSUS Each vertebrae has an opening (vertebral foramen) through which a tubular bundle of spinal nerves and VERTEBRAL spinal nerve roots travel. FORAMEN From the cervical spine to the mid-lumbar spine this bundle of nerves is called the spinal cord. The bundle is then referred to as the cauda equina through the bottom of the spine. At each level of the spine, spinal nerves exit the spinal cord and cauda equina to both the left and right sides. This enables movement and feeling throughout the body. What is a Herniated Disc? When the gelatinous center of the intervertebral disc pushes out through a tear in the fibrous wall, the disc herniates.
    [Show full text]
  • Lower Back Pain in Athletes EXPERT CONSULTANTS: Timothy Hosea, MD, Monica Arnold, DO
    SPORTS TIP Lower Back Pain in Athletes EXPERT CONSULTANTS: Timothy Hosea, MD, Monica Arnold, DO How common is low back pain? What structures of the back Low back pain is a very common can cause pain? problem in industrialized countries, Low back pain can come from all the affecting over 70 percent of the working spinal structures. The bony elements population. Back pain is also common of the spine can develop stress fractures, in such sports as football, soccer, or in the older athlete, arthritic changes golf, rowing, and gymnastics. which may pinch the nerve roots. The annulus has a large number of pain What are the structures fibers, and any injury to this structure, of the back? such as a sprain, bulging disc, or disc The spine is composed of three regions herniation will result in pain. Finally, the from your neck to the lower back. surrounding muscles and ligaments may The cervical region corresponds also suffer an injury, leading to pain. to your neck, the thoracic region is the mid-back (or back of the chest), How is the lower back injured? and the lumbar area is the lower back. Injuries to the lower back can be the The lumbar area provides the most result of improper conditioning and motion and works the hardest in warm-up, repetitive loading patterns, supporting your weight, and enables excessive sudden loads, and twisting you to bend, twist, and lift. activities. Proper body mechanics and flexibility are essential for all activities. Each area of the spine is composed To prevent injury, it is important to learn of stacked bony vertebral bodies with the proper technique in any sporting interposed cushioning pads called discs.
    [Show full text]
  • Guidline for the Evidence-Informed Primary Care Management of Low Back Pain
    Guideline for the Evidence-Informed Primary Care Management of Low Back Pain 2nd Edition These recommendations are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. They should be used as an adjunct to sound clinical decision making. Guideline Disease/Condition(s) Targeted Specifications Acute and sub-acute low back pain Chronic low back pain Acute and sub-acute sciatica/radiculopathy Chronic sciatica/radiculopathy Category Prevention Diagnosis Evaluation Management Treatment Intended Users Primary health care providers, for example: family physicians, osteopathic physicians, chiro- practors, physical therapists, occupational therapists, nurses, pharmacists, psychologists. Purpose To help Alberta clinicians make evidence-informed decisions about care of patients with non- specific low back pain. Objectives • To increase the use of evidence-informed conservative approaches to the prevention, assessment, diagnosis, and treatment in primary care patients with low back pain • To promote appropriate specialist referrals and use of diagnostic tests in patients with low back pain • To encourage patients to engage in appropriate self-care activities Target Population Adult patients 18 years or older in primary care settings. Exclusions: pregnant women; patients under the age of 18 years; diagnosis or treatment of specific causes of low back pain such as: inpatient treatments (surgical treatments); referred pain (from abdomen, kidney, ovary, pelvis,
    [Show full text]
  • Inflammatory Back Pain in Patients Treated with Isotretinoin Although 3 NSAID Were Administered, Her Complaints Did Not Improve
    Inflammatory Back Pain in Patients Treated with Isotretinoin Although 3 NSAID were administered, her complaints did not improve. She discontinued isotretinoin in the third month. Over 20 days her com- To the Editor: plaints gradually resolved. Despite the positive effects of isotretinoin on a number of cancers and In the literature, there are reports of different mechanisms and path- severe skin conditions, several disorders of the musculoskeletal system ways indicating that isotretinoin causes immune dysfunction and leads to have been reported in patients who are treated with it. Reactive seronega- arthritis and vasculitis. Because of its detergent-like effects, isotretinoin tive arthritis and sacroiliitis are very rare side effects1,2,3. We describe 4 induces some alterations in the lysosomal membrane structure of the cells, cases of inflammatory back pain without sacroiliitis after a month of and this predisposes to a degeneration process in the synovial cells. It is isotretinoin therapy. We observed that after termination of the isotretinoin thought that isotretinoin treatment may render cells vulnerable to mild trau- therapy, patients’ complaints completely resolved. mas that normally would not cause injury4. Musculoskeletal system side effects reported from isotretinoin treat- Activation of an infection trigger by isotretinoin therapy is complicat- ment include skeletal hyperostosis, calcification of tendons and ligaments, ed5. According to the Naranjo Probability Scale, there is a potential rela- premature epiphyseal closure, decreases in bone mineral density, back tionship between isotretinoin therapy and bilateral sacroiliitis6. It is thought pain, myalgia and arthralgia, transient pain in the chest, arthritis, tendonitis, that patients who are HLA-B27-positive could be more prone to develop- other types of bone abnormalities, elevations of creatine phosphokinase, ing sacroiliitis and back pain after treatment with isotretinoin, or that and rare reports of rhabdomyolysis.
    [Show full text]
  • Anesthetic Or Corticosteroid Injections for Low Back Pain
    Anesthetic or Corticosteroid Injections for Low Back Pain Examples Trigger point injections. Sometimes, putting pressure on a certain spot in the back (called a trigger point) can cause pain at that spot or extending to another area of the body, such as the hip or leg. To try to relieve pain, a local anesthetic, either alone or combined with a corticosteroid, is injected into the area of the back that triggers pain (trigger point injection). Facet joint injections. A local anesthetic or corticosteroid is injected into a facet joint, which is one of the points where one vertebra connects to another. Epidural injections. A corticosteroid is injected into the spinal canal where it bathes the sheath that surrounds the spinal cord and nerve roots. These injections can be done by an orthopedist, an anesthesiologist, a neurologist, a physiatrist, a pain management specialist, or a rheumatologist. How It Works Local anesthesia is believed to break the cycle of pain that can cause you to become less physically active. Muscles that are not being exercised are more easily injured. Then the irritated and injured muscles can cause more pain and spasm and can disrupt sleep. This pain, spasm, and fatigue, in turn, can lead to less and less activity. Steroids reduce inflammation. So a corticosteroid injected into the spinal canal can help relieve pressure on nerves and nerve roots. Why It Is Used Injections may be tried if you have symptoms of nerve root compression or facet inflammation and you do not respond to nonsurgical therapy after 6 weeks. How Well It Works Research has not shown that local injections are effective in controlling low back pain that does not spread down the leg.footnote1 Side Effects All medicines have side effects.
    [Show full text]
  • Mechanical Low Back Pain Joshua Scott Will, DO; ​David C
    Mechanical Low Back Pain Joshua Scott Will, DO; David C. Bury, DO; and John A. Miller, DPT Martin Army Community Hospital, Fort Benning, Georgia Low back pain is usually nonspecific or mechanical. Mechanical low back pain arises intrinsically from the spine, interverte- bral disks, or surrounding soft tissues. Clinical clues, or red flags, may help identify cases of nonmechanical low back pain and prompt further evaluation or imaging. Red flags include progressive motor or sensory loss, new urinary retention or overflow incontinence, history of cancer, recent invasive spinal procedure, and significant trauma relative to age. Imaging on initial presentation should be reserved for when there is suspicion for cauda equina syndrome, malignancy, fracture, or infection. Plain radiography of the lumbar spine is appropriate to assess for fracture and bony abnormality, whereas magnetic resonance imaging is better for identifying the source of neurologic or soft tissue abnormalities. There are multiple treatment modalities for mechanical low back pain, but strong evidence of benefit is often lacking. Moderate evidence supports the use of nonsteroidal anti-inflammatory drugs, opioids, and topiramate in the short-term treatment of mechanical low back pain. There is little or no evidence of benefit for acetamin- ophen, antidepressants (except duloxetine), skeletal muscle relaxants, lidocaine patches, and transcutaneous electrical nerve stimulation in the treatment of chronic low back pain. There is strong evidence for short-term effectiveness and moderate-quality evidence for long-term effectiveness of yoga in the treatment of chronic low back pain. Various spinal manipulative techniques (osteopathic manipulative treatment, spinal manipulative therapy) have shown mixed benefits in the acute and chronic setting.
    [Show full text]
  • Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy
    Y Lumbar Disc Herniation with Radiculopathy | NASS Clinical Guidelines 1 G Evidence-Based Clinical Guidelines for Multidisciplinary ETHODOLO Spine Care M NE I DEL I U /G ON Diagnosis and Treatment of I NTRODUCT Lumbar Disc I Herniation with Radiculopathy NASS Evidence-Based Clinical Guidelines Committee D. Scott Kreiner, MD Paul Dougherty, II, DC Committee Chair, Natural History Chair Robert Fernand, MD Gary Ghiselli, MD Steven Hwang, MD Amgad S. Hanna, MD Diagnosis/Imaging Chair Tim Lamer, MD Anthony J. Lisi, DC John Easa, MD Daniel J. Mazanec, MD Medical/Interventional Treatment Chair Richard J. Meagher, MD Robert C. Nucci, MD Daniel K .Resnick, MD Rakesh D. Patel, MD Surgical Treatment Chair Jonathan N. Sembrano, MD Anil K. Sharma, MD Jamie Baisden, MD Jeffrey T. Summers, MD Shay Bess, MD Christopher K. Taleghani, MD Charles H. Cho, MD, MBA William L. Tontz, Jr., MD Michael J. DePalma, MD John F. Toton, MD This clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason- ably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment is to be made by the physi- cian and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution. I NTRODUCT 2 Lumbar Disc Herniation with Radiculopathy | NASS Clinical Guidelines I ON Financial Statement This clinical guideline was developed and funded in its entirety by the North American Spine Society (NASS). All participating /G authors have disclosed potential conflicts of interest consistent with NASS’ disclosure policy.
    [Show full text]
  • Pain Management Injection Therapies for Low-Back Pain: Topic Refinement
    Final Topic Refinement Document Pain Management Injection Therapies for Low back Pain – Project ID ESIB0813 Date: 9/19/14 Topic: Pain Management Injection Therapies for Low-back Pain Evidence-based Practice Center: Pacific Northwest Evidence-based Practice Center Agency for Healthcare Research and Quality Task Order Officer: Kim Wittenberg Partner: Centers for Medicare and Medicaid Services 1 Final Topic Refinement Document Pain Management Injection Therapies for Low back Pain – Project ID ESIB0813 Final Topic Refinement Document Key Questions Key Question 1. In patients with low back pain, what characteristics predict responsiveness to injection therapies on outcomes related to pain, function, and quality of life? Key Question 2. In patients with low back pain, what is the effectiveness of epidural corticosteroid injections, facet joint corticosteroid injections, medial branch blocks, and sacroiliac joint corticosteroid injections versus epidural nonsteroid injection, nonepidural injection, no injection, surgery or non-surgical therapies on outcomes related to pain, function and quality of life? Key Question 2a. How does effectiveness vary according to the medication used (corticosteroid, local anesthetic, or both), the dose or frequency of injections, the number of levels treated, or degree of provider experience? Key Question 2b. In patients undergoing epidural corticosteroid injection, how does effectiveness vary according to use of imaging guidance or route of administration (interlaminar, transforaminal, caudal, or other)? Key Question 3. In randomized trials of low back pain injection therapies, what is the response rate to different types of control therapies (e.g., epidural nonsteroid injection, nonepidural injection, no injection, surgery, or non-surgical therapies)? Key Question 3a. How do response rates vary according to the specific comparator evaluated (e.g., saline epidural, epidural with local anesthetic, nonepidural injection, no injection, surgery, non-surgical therapies)? Key Question 4.
    [Show full text]
  • Treating Lower-Back Pain How Much Bed Rest Is Too Much?
    ® Treating lower-back pain How much bed rest is too much? ack pain is one of the most common reasons why people visit the doctor. The good news is that the pain often goes Baway on its own, and people usually recover in a week or two. Many people want to stay in bed when their back hurts. For many years, getting bed rest was the normal advice. However, newer data have shown that there is little to no role for bed rest in the treatment of low back pain. Here’s why: Staying in bed won’t help you get better faster. If you’re in terrible pain, bed rest may not actually ease the pain, but increase it. Research suggests that if you find comfortable positions and move around sometimes, you may not need bed rest at all. Research shows that: • More than 48 hours of bed rest may actually increase pain, by increasing the stiffness of the • The sooner you start physical therapy or return spine and the muscles. to activities such as walking, the faster you are • Many people recover just as quickly without any likely to recover. Longer bed rest can lead to bed rest. slower recovery. Longer bed rest can lead to slower recovery. What can I do for the pain? When you don’t move and bend, you lose Most people with lower-back pain should apply muscle strength and flexibility. With bed rest, heat or ice. Some people can get pain relief you lose about 1 percent of your muscle from an over-the-counter anti-inflammatory strength each day.
    [Show full text]
  • Acute Low Back Pain
    Acute low back pain Key reviewers: Mr Chris Hoffman, Orthopaedic Surgeon, Mana Orthopaedics, Wellington Dr John MacVicar, Medical Director, Southern Rehab, Christchurch Key concepts: ■ Acute low back pain is common and most patients will recover fully within three months ■ Serious causes are rare and can be excluded with careful history and examination ■ Radiological studies are not required for acute low back pain in the absence of red flags ■ An exact diagnosis is often not possible, nor needed for management ■ Patients’ beliefs and attitudes warrant as much attention as the anatomical and pathological aspects of their condition ■ Fear about pain is a major determinant of disability and possible chronicity ■ Management should include reassurance, education and helping the patient stay active ■ Adequate analgesia is important to allow the patient www.bpac.org.nz keyword: lowbackpain to stay active 6 | BPJ | Issue 21 Acute low back pain is common and often relapsing Red Flags: ▪ Trauma Low back pain is discomfort, muscle tension or stiffness ▪ Unrelenting pain, or pain worse at night localised to the area around the lumbar spine. Back pain (supine) may radiate to the groin, buttocks or legs as referred somatic pain and may be associated with lumbar radicular ▪ Age <20 years, or new back pain age >50 pain such as sciatica. years ▪ History of cancer In any given year approximately one third of adults will ▪ Systemic symptoms suffer from low back pain and one third of these will seek help from a health practitioner.1 Most people with low ▪ IV drug use back pain self-treat with over-the-counter medications and ▪ Immunosuppression or steroids lifestyle changes.2 ▪ Widespread or progressive neurological deficit Low back pain is described as acute if present for less than six weeks, sub-acute between six weeks and three Serious causes of acute low back pain are rare months, and chronic if it continues for longer than three and include:6 months.
    [Show full text]
  • Lumbar Degenerative Disease Part 1
    International Journal of Molecular Sciences Article Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature 1, , 1,2, 1 Hyeun Sung Kim y * , Pang Hung Wu y and Il-Tae Jang 1 Nanoori Gangnam Hospital, Seoul, Spine Surgery, Seoul 06048, Korea; [email protected] (P.H.W.); [email protected] (I.-T.J.) 2 National University Health Systems, Juronghealth Campus, Orthopaedic Surgery, Singapore 609606, Singapore * Correspondence: [email protected]; Tel.: +82-2-6003-9767; Fax.: +82-2-3445-9755 These authors contributed equally to this work. y Received: 31 January 2020; Accepted: 20 February 2020; Published: 21 February 2020 Abstract: Degenerative disc disease is a leading cause of chronic back pain in the aging population in the world. Sinuvertebral nerve and basivertebral nerve are postulated to be associated with the pain pathway as a result of neurotization. Our goal is to perform a prospective study using radiofrequency ablation on sinuvertebral nerve and basivertebral nerve; evaluating its short and long term effect on pain score, disability score and patients’ outcome. A review in literature is done on the pathoanatomy, pathophysiology and pain generation pathway in degenerative disc disease and chronic back pain. 30 patients with 38 levels of intervertebral disc presented with discogenic back pain with bulging degenerative intervertebral disc or spinal stenosis underwent Uniportal Full Endoscopic Radiofrequency Ablation application through either Transforaminal or Interlaminar Endoscopic Approaches. Their preoperative characteristics are recorded and prospective data was collected for Visualized Analogue Scale, Oswestry Disability Index and MacNab Criteria for pain were evaluated.
    [Show full text]
  • The Global Spine Care Initiative: a Summary of the Global Burden of Low Back and Neck Pain Studies
    European Spine Journal https://doi.org/10.1007/s00586-017-5432-9 REVIEW The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies Eric L. Hurwitz1 · Kristi Randhawa2,3 · Hainan Yu2,3 · Pierre Côté2,3 · Scott Haldeman4,5,6 Received: 9 July 2017 / Accepted: 16 December 2017 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Purpose This article summarizes relevant fndings related to low back and neck pain from the Global Burden of Disease (GBD) reports for the purpose of informing the Global Spine Care Initiative. Methods We reviewed and summarized back and neck pain burden data from two studies that were published in Lancet in 2016, namely: “Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015” and “Global, regional, and national disability-adjusted life years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.” Results In 2015, low back and neck pain were ranked the fourth leading cause of disability-adjusted life years (DALYs) globally just after ischemic heart disease, cerebrovascular disease, and lower respiratory infection {low back and neck pain DALYs [thousands]: 94 941.5 [95% uncertainty interval (UI) 67 745.5–128 118.6]}. In 2015, over half a billion people worldwide had low back pain and more than a third of a billion had neck pain of more than 3 months duration.
    [Show full text]