Articles: low-back-pain.
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Randomized Controlled Trial
Who Benefits the Most From Different Psychological Chronic Pain Treatments? An Exploratory Analysis of Treatment Moderators.
Different psychological chronic pain treatments benefit some individuals more than others. Understanding the factors that are associated with treatment response-especially when those factors differ between treatments-may inform more effective patient-treatment matching. This study aimed to identify variables that moderate treatment response to 4 psychological pain interventions in a sample of adults with low back pain or chronic pain associated with multiple sclerosis, spinal cord injury, acquired amputation, or muscular dystrophy (N = 173). ⋯ If additional research replicates the findings, it may be possible to better match patients to their more individually suitable treatment, ultimately improving pain treatment outcomes. PERSPECTIVE: Pre-treatment measures of hypnotizability and EEG-assessed brain activity predicted who was more (or less) likely to respond to different psychological pain treatments. If these findings are replicated in future studies, they could inform the development of patient-treatment matching algorithms.
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Orthobiologics have shown promise in repair, restoration and regeneration of damaged and degenerated spine, joint and musculoskeletal tissues. The role of MSCs is to reduce inflammation, gliosis, and oxidative stress, while encouraging angiogenesis, neuronal proliferation, cell survival, and differentiation. While autologous MSCs have homologous advantages, they present with challenges related to donor predisposition, harvesting skills, and processing times. In this regard, allogenic MSCs show promise, but face ethical challenges, contamination, and survival risks. Ongoing efforts to overcome challenges and enhance performance include bioprinting, tissue engineering, artificial intelligence, nanotechnology, and microenvironmental alteration, among many others. Genetically programmed MSCs are being explored and tissue regeneration is now considered a real possibility. In this article, we discuss some of the leading-edge technologies in the process of being developed and perfected for widespread clinical application. ⋯ The role of MSCs in regenerative medicine is still emerging, but their promise for spinal cord injury and other disorders of the spine is clear. Using allogenic or autologous MSCs can help stimulate healing and neural regeneration remains a tantalizing possibility.
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Randomized Controlled Trial
Comparison of the Low Back Pain Relief and Spread Level After Upper and Lower Lumbar Erector Spinae Plane Block.
The erector spinae plane block (ESPB), which was introduced to manage the thoracic pain, is an ultrasound-guided technique that is relatively easy, less invasive, and safer. In spite of its technical ease and safety of ESPB, few studies have explored the analgesic efficacy and the exact spread level of injected local anesthetics. ⋯ Both the L2 and L4 ESPB groups demonstrated a significant reduction in low back pain and improvement in disability. The L2 ESPB group demonstrated a significantly increased spread level compared to the L4 ESPB group.
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Chronic low back pain (cLBP) is the most common cause of years lived with disability (YLD). Chronic overlapping pain conditions (COPCs) is a relatively new taxonomy for widespread pain. Researchers have postulated that patients with COPCs have more pain-related impact than those with isolated pain conditions. We know little about the combination of COPCs with cLBP. This study aims to characterize patients with isolated cLBP compared to those with cLBP and associated COPCs across multiple domains of physical, psychological, and social functioning. ⋯ COPCs are a common presentation with cLBP. The combination of COPCs with cLBP is associated with significantly worse physical, psychological, social, and global health outcomes. This information may identify patients with COPCs and cLBP to optimally risk and treatment stratify their care and individualize their management.
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Pulsed radiofrequency (PRF) has been used for treatment of chronic pain in several body regions, including axial and radicular pain. However, a limited number of reports have specifically demonstrated the effectiveness of PRF for spine-related pain among nonsurgical patients. Therefore, we evaluated the effectiveness of PRF for lumbar spine-associated pain in patients without recent spine surgery, and identified the factors associated with clinically meaningful improvement in pain and quality of life. ⋯ Our results demonstrated that PRF improved pain and patient-reported outcomes for spine-related pain for at least 6 months in our patient cohort. PRF may be a good option for treating lumbar spine-related issues, even with severe pain and/or dysfunction.