Articles: low-back-pain.
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The objective of the review is to determine whether conditioned pain modulation (CPM) is impaired in adults with chronic low back pain (CLBP) when compared with pain-free individuals. ⋯ High-quality research is strongly recommended to determine the function of endogenous pain modulatory mechanisms in CLBP.
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Arch Phys Med Rehabil · Feb 2020
Conservative Interventions Reduce Fear in Individuals With Chronic Low Back Pain: A Systematic Review.
To systematically review and critically appraise the effectiveness of conservative and surgical interventions to reduce fear in studies of people with chronic low back pain, based on the analysis of randomized controlled trials for which fear was a primary or secondary outcome. ⋯ The present systematic review highlights the potential effectiveness of conservative interventions to reduce kinesiophobia and fear-avoidance beliefs in individuals with chronic low back pain. This information can help health professionals to reduce fear when treating patients with this condition.
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Case Reports Pragmatic Clinical Trial
T12 Dorsal Root Ganglion Stimulation to Treat Chronic Low Back Pain: A Case Series.
Dorsal root ganglion stimulation (DRG-S) is a neuromodulation technique for treating neuropathic pain syndromes. Research has demonstrated DRG-S to be more effective than conventional SCS in treating RSD/CRPS, particularly of the lower extremities. Results from recent case series and prospective studies suggest that DRG-S may be effective in treatment of pain syndromes considered to have non-neuropathic components and characteristics (e.g. nociceptive). There have been multiple, small studies demonstrating efficacy of DRG-S for axial low back pain. There has, however, been no consensus regarding the best location for DRG lead placement in the treatment of low back pain. ⋯ T12 DRG-S can be an effective treatment for chronic axial low back pain. Stimulation results in reduced pain and disability, while improving quality of life. These outcomes can be achieved without paresthesias.
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Nociceptive signals from lumbar intervertebral discs ascend in the sympathetic chain via the L2 dorsal root ganglion (L2 DRG), a potential target for discogenic low back pain in neuromodulation. Positron Emission Tomography/Computed Tomography (PET-CT) measures functional changes in the brain metabolic activity, identified by the changes in the regional cerebral blood flow (rCBF) as determined by the changes of F-18 Fluoro-deoxyglucose (18 F FDG) tracer within brain tissues. ⋯ This is the first ever study reporting the changes in cerebral metabolic activity and multi-frame static brain 18 F FDG PET imaging after L2 DRG stimulation for discogenic low back pain. Predominantly an increased metabolic activity in nociceptive brain matrices are seen with an increased in F18 F FDG uptake following L2 DRG stimulation.
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We recently proposed the Pain and Disability Drivers Management (PDDM) model, which was designed to outline comprehensive factors driving pain and disability in low back pain (LBP). Although we have hypothesized and proposed 41 elements, which make up the model's five domains, we have yet to assess the external validity of the PDDM's elements by expert consensus. ⋯ This expert consensus-derived list of clinical elements related to the management of LBP represents a first step in the validation of the PDDM model.