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Objective The statistical analysis typically used to compare pain before and after interventions assumes that scores are normally distributed. The present study evaluates whether numeric rating scale (NRS) scores, specifically NRS-11 scores, are indeed normally distributed in a clinically relevant cohort of adults with chronic axial spine pain before and after analgesic intervention. Methods Retrospective review from 4 academic medical centers of prospectively collected data from a uniform pain diary administered to consecutive patients after they had undergone medial branch blocks. The pain diary assessed NRS-11 scores immediately before injection and at 12 different time points after injection up to 48 hours. D'Agostino–Pearson tests were used to test normality at all time points. Results One hundred fifty pain diaries were reviewed, and despite normally distributed pre-injection NRS-11 scores (K 2 = 0.655, P  = .72), all post-injection NRS-11 data were not normally distributed (K 2 = 9.70– 17.62, P  = .0001–.008). Conclusions Although the results of parametric analyses of NRS-11 scores are commonly reported in pain research, some properties of the NRS-11 do not satisfy the assumptions required for these analyses. The data demonstrate non-normal distributions in post-intervention NRS-11 scores, thereby violating a key requisite for parametric analysis. We urge pain researchers to consider appropriate statistical analysis and reporting for non-normally distributed NRS-11 scores to ensure accurate interpretation and communication of these data. Practicing pain physicians should similarly recognize that parametric post-intervention pain score statistics might not accurately describe the data and should expect articles to utilize measures of normality to justify the selected statistical methods. [ABSTRACT FROM AUTHOR]

Background Zygapophysial joints (Z joints) can be a source of back pain and of neck pain, but the cause of pain is not known. Some authors attribute the pain to osteoarthritis but without citing evidence. Objectives The present review was undertaken to determine if there was sufficient evidence of association between spinal pain and osteoarthritis of Z joints to justify osteoarthritis being held to be the cause of pain. The null hypothesis was that osteoarthritis of Z joints does not cause back pain or neck pain. Eligibility criteria Relevant studies were ones that provided primary data on the association between pain and osteoarthritis of Z joints. These could be population studies, diagnostic studies, or case-control studies. Sources of evidence The database of PubMed was searched using the terms: Lumbar or cervical, zygapophysial or facet, pain, and osteoarthritis or degeneration or degenerative. Charting methods Data pertinent to the research question were extracted from original articles and tabulated for reporting. Odds ratios for associations were calculated, as were the prevalence rates of osteoarthritis in subjects with pain, and conversely the prevalence rates of pain in subjects with osteoarthritis. Results The searches retrieved 11 population studies, 4 diagnostic studies, and 3 cases control studies. No study showed any positive association between osteoarthritis of Z joints and pain. All studies found pain to be independent of the presence or severity of osteoarthritis. Osteoarthritis was as common in subjects with no pain as in subjects with pain. The null hypothesis was not refuted. Conclusion The published evidence does not support the belief that osteoarthritis causes Z joint pain. All the evidence contradicts this belief. [ABSTRACT FROM AUTHOR]

Objective We evaluated whether more severe back pain phenotypes—persistent, frequent, or disabling back pain—are associated with higher mortality rate among older men. Methods In this secondary analysis of a prospective cohort, the Osteoporotic Fractures in Men (MrOS) study, we evaluated mortality rates by back pain phenotype among 5215 older community-dwelling men (mean age, 73 years, SD = 5.6) from 6 sites in the United States. The primary back pain measure used baseline and Year 5 back pain questionnaire data to characterize participants as having no back pain, nonpersistent back pain, infrequent persistent back pain, or frequent persistent back pain. Secondary measures of back pain from the Year 5 questionnaire included disabling back pain phenotypes. The main outcomes measured were all-cause and cause-specific death. Results After the Year 5 exam, during up to 18 years of follow-up (mean follow-up = 10.3 years), there were 3513 deaths (1218 cardiovascular, 764 cancer, 1531 other). A higher proportion of men with frequent persistent back pain versus no back pain died (78% versus 69%; sociodemographic-adjusted HR = 1.27, 95% CI = 1.11–1.45). No association was evident after further adjustment for health-related factors, such as self-reported general health and comorbid chronic health conditions (fully adjusted HR = 1.00; 95% CI = 0.86–1.15). Results were similar for cardiovascular deaths and other deaths, but we observed no association of back pain with cancer deaths. Secondary back pain measures, including back-related disability, were associated with increased mortality risk that remained statistically significant in fully adjusted models. Conclusion Although frequent persistent back pain was not independently associated with risk of death in older men, additional secondary disabling back pain phenotypes were independently associated with increased mortality rate. Future investigations should evaluate whether improvements in disabling back pain affect general health and well-being or risk of death. [ABSTRACT FROM AUTHOR]

The article focuses on evaluating chronic pain and its impact on functional capacity in individuals with HTLV-1. Topics include the prevalence and characteristics of chronic pain in these patients, the relationship between chronic pain and functional impairment, and the influence of sociodemographic and clinical factors on pain severity and functional outcomes.

Objective One aim of the Back Pain Consortium (BACPAC) Research Program is to develop an integrated model of chronic low back pain that is informed by combined data from translational research and clinical trials. We describe efforts to maximize data harmonization and accessibility to facilitate Consortium-wide analyses. Methods Consortium-wide working groups established harmonized data elements to be collected in all studies and developed standards for tabular and nontabular data (eg, imaging and omics). The BACPAC Data Portal was developed to facilitate research collaboration across the Consortium. Results Clinical experts developed the BACPAC Minimum Dataset with required domains and outcome measures to be collected by use of questionnaires across projects. Other nonrequired domain-specific measures are collected by multiple studies. To optimize cross-study analyses, a modified data standard was developed on the basis of the Clinical Data Interchange Standards Consortium Study Data Tabulation Model to harmonize data structures and facilitate integration of baseline characteristics, participant-reported outcomes, chronic low back pain treatments, clinical exam, functional performance, psychosocial characteristics, quantitative sensory testing, imaging, and biomechanical data. Standards to accommodate the unique features of chronic low back pain data were adopted. Research units submit standardized study data to the BACPAC Data Portal, developed as a secure cloud-based central data repository and computing infrastructure for researchers to access and conduct analyses on data collected by or acquired for BACPAC. Conclusions BACPAC harmonization efforts and data standards serve as an innovative model for data integration that could be used as a framework for other consortia with multiple, decentralized research programs. [ABSTRACT FROM AUTHOR]

The article centers on the inequality in insurance coverage for acupuncture therapy despite its recommended role in comprehensive pain care, utilizing data from the Medical Expenditure Panel Survey (MEPS). It explores the primary indications for acupuncture visits, disparities in insurance coverage across these indications, and the prevalent use of acupuncture for pain management, uncovering substantial variations in coverage rates among different conditions.

Objective Although there has been increasing interest in the role of systemic cytokines in chronic spinal pain (CSP), the evidence on their potential contribution is still unclear. Therefore, the current study systematically reviewed the evidence on systemic cytokine level differences between people with CSP compared to healthy controls (HCs) and the potential associations with pain severity. Methods An electronic search was conducted on PubMed, Web of Science and Embase. All included studies were classified as observational studies, exploring the comparison between a CSP group and a HC group, and the association between systemic cytokine levels and pain severity. Results Nine articles were included with a total sample of 400 CSP patients suffering from chronic whiplash associated disorder (CWAD) or chronic low back pain (CLBP). In CLBP, moderate evidence was found for elevated tumor necrosis factor (TNF) α, interleukin (IL) 6, IL-1 receptor antagonist (IL-1RA), and soluble TNF receptor (sTNF-R) type 2, for normal interferon (IFN) γ and IL-2 levels, and for reduced IL-10 levels. No association was found between pain severity and these cytokines in CLBP. In CWAD, moderate evidence was found for elevated CRP and evidence for changes in TNF-α was inconclusive. Evidence for the association between pain severity and CRP was limited, and there is probably no association between pain severity and TNF-α with limited evidence in CWAD. Conclusions Moderate evidence indicates the presence of systemic inflammation in CSP. Evidence regarding the association between pain severity and systemic cytokines is inconclusive and limited. [ABSTRACT FROM AUTHOR]

Objective Individuals experience chronic pain differently, not only because of different clinical diagnoses, but also because of differing degrees of influence from biopsychosocial pain modulators. We aimed to cluster patients with chronic pain into distinct subgroups based on psychosocial characteristics and pain intensity, and we subsequently examined group differences in pain-related interference approximately 1 year later. Methods In this observational, longitudinal study, patients with chronic pain (n   =   94) completed validated assessments of psychosocial characteristics and pain intensity at the beginning of COVID-19–related social distancing (April to June 2020). One year later (May to June 2021), patients completed a follow-up survey with assessments of pain interference, loneliness, social support, mindfulness, and optimism. Results A cluster analysis, using psychosocial factors and pain intensity, empirically produced three patient groups: 1) psychosocial predominant (PSP), characterized by high psychosocial distress and average pain intensity; 2) pain intensity predominant (PIP), characterized by average psychosocial distress and high pain intensity; and 3) less elevated symptoms (LES), characterized by low psychosocial distress and low pain intensity. At the 1-year follow-up, patients in the PSP and PIP clusters suffered greater pain interference than patients in the LES cluster, while patients in the PSP cluster also reported greater loneliness and lower mindfulness and optimism. Conclusions An empirical psychosocial-based clustering of patients identified three distinct groups that differed in pain interference. Patients with high psychosocial modulation of pain at the onset of social distancing (the PSP cluster) suffered not only greater pain interference but also greater loneliness and lower levels of mindfulness and optimism, which suggests some potential behavioral targets for this group in the future. [ABSTRACT FROM AUTHOR]

Introduction The zygapophyseal joints represent one possible cause for back pain. Therefore, many interventions are targeting the denervation of the facet joints. The aim of this study is to describe the course of the medial branch of the dorsal branch of the spinal nerve and its articular branches to the zygapophyseal joints in the segments T10–T12. Methods The medial branches in the thoracic segments T10–T12 were dissected in 20 Thiel embalmed cadavers. An Eschenbach magnifying glass (4.0× magnification) was used during dissection preserving the articular branches. The topography and the branching pattern of the medial branches was observed. Results The course of the nerves in the segments T10–T12 differed from each other because of the different osseous anatomy of each segment. The medial branch at the segment T10 crossed the tip of the transverse process in 28 of the 40 hemivertebral specimens. In the remaining cases it passed superior to the transverse process. At T11 the medial branch ran constantly through an osteofibrous canal. At the segment T12 the medial branches showed a similar course to the medial branches in the lumbar region. In many cases two articular branches, which arose from the medial branch were identified. Conclusions The results of this study show a considerable anatomic variety at the segment T10. It also demonstrates that the transverse process is an important landmark to encounter the medial branch. Furthermore, the possibility of a double innervation of the facet joints should always be considered. [ABSTRACT FROM AUTHOR]

Objective This study aimed to explore and compare the associations of psychosocial factors, sleep, and central sensitization with chronic neck, back, limb, and multiregional pain and disability. Methods One thousand seven hundred thirty (n = 1,730) adolescents responded to an online questionnaire containing questions about sociodemographic data, as well as the Nordic Musculoskeletal Questionnaire; the International Physical Activity Questionnaire; the Functional Disability Inventory; the Depression, Anxiety, and Stress Scale; the Basic Scale on Insomnia Complaints and Quality of Sleep; the Pain Catastrophizing Scale; the Tampa Scale of Kinesiophobia; the Child Self-Efficacy Scale; and the Central Sensitization Inventory. Univariable and multivariable regression analysis were used to assess the associations between these variables and pain and disability. Results Groups were categorized into those with neck (n = 54), back (n = 80), upper limb (n = 52), lower limb (n = 109), or multiregional (n = 1,140) pain. Multivariable analysis showed that symptoms of central sensitization increased the odds of neck, back, and multiregional pain; depression, anxiety and stress, and physical activity increased the odds of multiregional pain; and fear of movement increased the odds of lower limb pain. Female gender increased the odds of pain in all groups, except in the lower limb group. Depression, anxiety, and stress also remained associated with disability in neck, back, upper limb, and multiregional pain; poorer sleep remained associated with disability in neck, upper limb, and multiregional pain; catastrophizing remained associated with back and multiregional pain; and fear of movement and symptoms of central sensitization were associated with disability only in multiregional pain. Conclusions There are similar but also different variables associated with the presence of pain and disability in the neck, back, limbs, and multiregional pain. [ABSTRACT FROM AUTHOR]

Objective This study examined potential risk factors associated with healthcare utilization among patients with spine (i.e. neck and back) pain. Methods A two-stage sampling approach examined spine pain episodes of care among veterans with a yearly outpatient visit for six consecutive years. Descriptive and bivariate statistics, followed by logistic regression analyses, examined baseline characteristics of veterans with new episodes of care who either continued or discontinued spine pain care. A multivariable logistic regression model examined correlates associated with seeking continued spine pain care. Results Among 331,908 veterans without spine pain episodes of care during the 2-year baseline observation period, 16.5% (n = 54,852) had a new episode of care during the following 2-year observation period. Of those 54,852 veterans, 37,025 had an outpatient visit data during the final 2-year follow-up period, with 53.7% (n = 19,865) evidencing continued spine pain care. Those with continued care were more likely to be overweight or obese, non-smokers, Army veterans, have higher education, and had higher rates of diagnoses of all medical and mental health conditions examined at baseline. Among several important findings, women had 13% lower odds of continued care during the final 2-year observation period, OR 0.87 (0.81, 0.95). Conclusions A number of important demographics and clinical correlates were associated with increased likelihood of seeking new and continued episodes of care for spine pain; however, further examination of risk factors associated with healthcare utilization for spine pain is indicated. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated trends in the use of epidural steroid injections to treat back pain before spine surgery. The study assessed the association of preoperative epidural steroid injections with postoperative chronic opioid in patients who underwent anterior cervical discectomy and fusion (ACDF) compared to those who underwent microdiscectomy. Mechanisms behind the association of epidural steroid injections with chronic postoperative opioid use are proposed.

Objective Specific pain conditions such as back pain and migraines are associated with increased risk of suicide mortality after accounting for key covariates. The purpose of the current study was to assess the associations of specific pain conditions with suicide attempts. Design Case-control Setting Veterans Health Administration (VHA) Subjects Individuals who utilized VHA services with a record of a suicide attempt (N   =   30,051) in Fiscal Years 2013 and 2014 were identified and propensity score matched with controls with no such record (N   =   30,051). Methods Data on pain condition diagnoses (back pain, arthritis, migraine, headaches, psychogenic pain, neuropathy, fibromyalgia) psychiatric diagnoses, medical comorbidity, and demographics were extracted from VHA medical record and suicide surveillance datasets. Results Unadjusted logistic regression analyses found that each of the pain conditions were associated with suicide attempts (e.g. back pain: Odds ratio [OR]=3.25, 95% Confidence Interval [CI]=3.12–3.39). After adjusting for mental health conditions, medical comorbidity, and each of the pain conditions, the effects were attenuated across pain conditions; however, remained significant for each of the pain conditions except for fibromyalgia. Specifically, back pain (OR = 1.25, 95% CI = 1.19–1.32), migraines (OR = 1.29, 95% CI = 1.14–1.46), headaches (OR = 1.33, 95% CI = 1.19–1.48), and neuropathic pain (OR = 1.52, 95% CI = 1.33–1.74) were each associated with increased odds of a suicide attempt. Fibromyalgia was the only pain condition associated with re-attempt status (OR = 1.25, 95% CI = 1.08–1.45). Conclusions Specific pain conditions are associated with increased odds of suicide attempts even after including key covariates. Limitations Limitations of the study include the retrospective study design and lack of examination into additional variables including prescription opioid use, pain intensity, and pain duration. The case-control design also limits the ability to draw causal or temporal conclusions. [ABSTRACT FROM AUTHOR]

Objective We compared the reduction in pain and opioid consumption in patients with chronic spinal pain on concomitant gabapentinoids and opioids with patients using opioids only. Design This was a retrospective chart review of patients with chronic neck or low back pain who were on opioids with at least a 24-month follow-up. Setting Single-center pain clinic in an urban setting. Subjects 167 patients with chronic spinal pain lasting at least six months. Methods Patients on gabapentin or pregabalin were included in the gabapentinoid group, while the other patients were included in the non-gabapentinoid group. Primary outcome was assessment of pain scores measured via a numeric rating scale (NRS), and secondary outcomes were response to the treatment (>2 point reduction on NRS) and daily opioid use measured in morphine milliequivalents. Results Pain scores were reduced in the first six months and plateaued after that in both groups. At the end of 24 months, the average pain score was 6.71 in the gabapentinoid group, while the average pain score was 7.18 in the non-gabapentinoid group. There was no statistical significance between the groups (p = 0.28). There was no difference in response to treatment in gabapentinoid group (33.3%) when compared with non-gabapentinoid group (32.7%). We also failed to find any significant difference in daily opioid usage between the two groups. Conclusion Gabapentinoids may not lead to reduction in pain or opioid consumption in patients with chronic spinal pain. A careful approach must be adopted while prescribing gabapentinoids in the chronic spinal pain patient population. [ABSTRACT FROM AUTHOR]

Objective 1) To describe a simplified multidisciplinary grading system for the most clinically relevant lumbar spine degenerative changes. 2) To measure the inter-reader variability among non-radiologist spine experts in their use of the classification system for interpretation of a consecutive series of lumbar spine magnetic resonance imaging (MRI) examinations. Methods ATS multidisciplinary and collaborative standardized grading of spinal stenosis, foraminal stenosis, lateral recess stenosis, and facet arthropathy was developed. Our institution's picture archiving and communication system was searched for 50 consecutive patients who underwent non-contrast MRI of the lumbar spine for chronic back pain, radiculopathy, or symptoms of spinal stenosis. Three fellowship-trained spine subspecialists from neurosurgery, orthopedic surgery, and physiatry interpreted the 50 exams using the classification at the L4–L5 and L5–S1 levels. Inter-reader agreement was assessed with Cohen's kappa coefficient. Results For spinal stenosis, the readers demonstrated substantial agreement (κ  = 0.702). For foraminal stenosis and facet arthropathy, the three readers demonstrated moderate agreement (κ  = 0.544, and 0.557, respectively). For lateral recess stenosis, there was fair agreement (κ  = 0.323). Conclusions A simplified universal grading system of lumbar spine MRI degenerative findings is newly described. Use of this multidisciplinary grading system in the assessment of clinically relevant degenerative changes revealed moderate to substantial agreement among non-radiologist spine physicians. This standardized grading system could serve as a foundation for interdisciplinary communication. [ABSTRACT FROM AUTHOR]

Objective Back pain is an elusive symptom complicated by a variety of possible causes, precipitating and maintaining factors, and consequences. Notably, the underlying pathology remains unknown in a significant number of cases. Changes to the intervertebral disc (IVD) have been associated with back pain, leading many to postulate that the IVD may be a direct source of pain, typically referred to as discogenic back pain. Yet despite decades of research into the neuroanatomy of the IVD, there is a lack of consensus in the literature as to the distribution and function of neural elements within the tissue. The current scoping review provides a comprehensive systematic overview of studies that document the topography, morphology, and immunoreactivity of neural elements within the IVD in humans. Method Articles were retrieved from six separate databases in a three-step systematic search and were independently evaluated by two reviewers. Results Three categories of neural elements were described within the IVD: perivascular nerves, sensory nerves independent of blood vessels, and mechanoreceptors. Nerves were consistently localized within the outer layers of the annulus fibrosus. Neural ingrowth into the inner annulus fibrosus and nucleus pulposus was found to occur only in degenerative and disease states. Conclusion While the pattern of innervation within the IVD is clear, the specific topographic arrangement and function of neural elements in the context of back pain remains unclear. [ABSTRACT FROM AUTHOR]

Objective For many medical professionals dealing with patients with persistent pain following spine surgery, the term Failed back surgery syndrome (FBSS) as a diagnostic label is inadequate, misleading, and potentially troublesome. It misrepresents causation. Alternative terms have been suggested, but none has replaced FBSS. The International Association for the Study of Pain (IASP) published a revised classification of chronic pain, as part of the new International Classification of Diseases (ICD-11), which has been accepted by the World Health Organization (WHO). This includes the term Chronic pain after spinal surgery (CPSS), which is suggested as a replacement for FBSS. Methods This article provides arguments and rationale for a replacement definition. In order to propose a broadly applicable yet more precise and clinically informative term, an international group of experts was established. Results 14 candidate replacement terms were considered and ranked. The application of agreed criteria reduced this to a shortlist of four. A preferred option—Persistent spinal pain syndrome—was selected by a structured workshop and Delphi process. We provide rationale for using Persistent spinal pain syndrome and a schema for its incorporation into ICD-11. We propose the adoption of this term would strengthen the new ICD-11 classification. Conclusions This project is important to those in the fields of pain management, spine surgery, and neuromodulation, as well as patients labeled with FBSS. Through a shift in perspective, it could facilitate the application of the new ICD-11 classification and allow clearer discussion among medical professionals, industry, funding organizations, academia, and the legal profession. [ABSTRACT FROM AUTHOR]

Objective Prospectively evaluate the clinical outcomes of acute cervical radiculopathy with respect to soft disc herniations vs osteophytes. Methods Sixty consecutive patients who had had cervical radiculopathy for ≤1 month were enrolled in the study. Inclusion criteria were radicular pain greater than axial pain and a pain score ≥4 out of 10 on a numerical rating scale. Patients had at least one positive clinical finding: motor, sensory, or reflex changes. Plain films and magnetic resonance imaging were ordered. Follow-up was at 6 weeks and 3, 6, and 12 months. Outcomes included pain scores (neck and upper limb), neck disability index, medication use, opioid use, and need for surgery. Two attending musculoskeletal radiologists reviewed imaging findings for osteophytes vs soft disc herniations at the symptomatic level. Results More than 75% reduction in pain was seen in 77% of patients with soft disc herniations and 66% of patients with osteophytes (P  > 0.05) at 12 months. A pain score ≤2 out of 10 within 6 to 12 months was seen in 86% of patients with soft disc herniations and 81% of patients with osteophytes (P  > 0.05). Moderate or marked improvement at 12 months was seen in 85% of patients with soft discs and 77% of patients with osteophytes (P  > 0.05). Baseline–to–12-month numerical rating scale pain scores of patients with soft discs vs osteophytes had overlapping confidence intervals at each follow-up. At 12 months, very few had undergone surgery (7% of patients with soft discs, 11% of patients with osteophytes; P  > 0.05) or were on opioids (7% of patients with soft discs, 9% of patients with osteophytes; P  > 0.05). Conclusions The majority of patients, but not all patients, with acute radiculopathies improved with time. This was seen with both soft disc herniations and osteophytes. [ABSTRACT FROM AUTHOR]

Objective Thoracic spinal pain is common, and patients with this type of pain have limited therapeutic options. The cohort in this study received diagnostic intra-articular zygapophysial joint injections leading to thermal neurotomy to the medial branch nerves to demonstrate improved pain as well as physical and psychological function. Design A consecutive cohort from 2012 to 2018 with retrospective analysis of prospectively gathered data. Setting A private multidisciplinary pain clinic with referrals from primary care. Results Forty-six complete data sets from 39 patients were found using a pre-procedure and 3-month post-procedure questionnaire. Further follow-up results were found for the dual primary outcomes of duration of ≥50% relief using a numeric rating scale (NRS) for the entire group. The group was then divided into three subgroups of T1/2–T3/4, T4/5–T8/9, and T9/10–T12/L1. Success rates of 63% for ≥3 months of ≥50% relief and 46% for ≥6 months of ≥50% relief were found, for an average duration of 7.8 months. Group mean change in the NRS was 6.7, decreasing to 4.3 (P <0.0001). For the first time, there are data showing that the three groups of T1/2–T3/4, T4/5–T8/9, and T9/10–T12/L1 responded equally. Secondary outcomes of physical and psychological function using the Functional Rating Index (FRI) and the Depression Anxiety Stress Scale (DASS) all showed significant improvements with small to moderate effect sizes and with all achieving >36% improvement in scores. Conclusion This cohort demonstrates that there is a pragmatic diagnostic and therapeutic option available for patients with thoracic zygapophysial joint pain that can achieve 50–100% of pain relief in 63% of patients with improved physical and psychological function. [ABSTRACT FROM AUTHOR]

Objectives Recent guidelines advise limiting opioid prescriptions for acute pain to a three-day supply; however, scant literature quantifies opioid use patterns after an emergency department (ED) visit. We sought to describe opioid consumption patterns after an ED visit for acute pain. Design Descriptive study with data derived from a larger interventional study promoting safe opioid use after ED discharge. Setting Urban academic emergency department (>88,000 annual visits). Subjects Patients were eligible if age >17 years, not chronically using opioids, and newly prescribed hydrocodone-acetaminophen and were included in the analysis if they returned the completed 10-day medication diary. Methods Patient demographics and opioid consumption are reported. Opioid use is described in daily number of pills and daily morphine milligram equivalents (MME) both for the sample overall and by diagnosis. Results Two hundred sixty patients returned completed medication diaries (45 [17%] back pain, 52 [20%] renal colic, 54 [21%] fracture/dislocation, 40 [15%] musculoskeletal injury [nonfracture], and 69 [27%] "other"). The mean age (SD) was 45 (15) years, and 59% of the sample was female. A median of 12 pills were prescribed. Patients with renal colic used the least opioids (total pills: median [interquartile range {IQR}] = 3 [1–7]; total MME: median [IQR] = 20 [10–50]); patients with back pain used the most (total pills: median [IQR] = 12 [7–16]; total MME: median [IQR] = 65 [47.5–100]); 92.5% of patients had leftover pills. Conclusions In this sample, pill consumption varied by illness category; however, overall, patients were consuming low quantities of pills, and the majority had unused pills 10 days after their ED visit. [ABSTRACT FROM AUTHOR]

Objective   Back pain is one of the most common pain syndromes in the United States, but there has been limited recent description of the role of emergency departments (EDs) in caring for patients with back pain. We investigated trends in the evaluation and management of back pain in U.S. EDs from 2007 to 2016. Methods   We performed a retrospective analysis of the National Hospital Ambulatory Medical Care Survey, a nationally representative annual survey of ED visits, which includes data on patient-, hospital-, and visit-level characteristics. We evaluated trends among adult ED visits for back pain, including demographics, resource utilization, and disposition. Trends were assessed through the use of survey-weighted analyses. Results   Visit rates as a proportion of overall ED visits were stable from 2007 to 2016 (9.1% [95% confidence interval (CI): 8.5–9.6] vs. 9.3% [95% CI: 8.6–10.0]; P  = 0.44). Admission rates declined from 6.4% (95% CI: 5.1–8.0) to 5.0% (95% CI: 3.5–6.9; P  < 0.001). Imaging utilization increased from 51.7% (95% CI: 49.3–54.1) to 57.6% (95% CI: 53.3–61.7; P  = 0.023), with an increase of 58.3% in computed tomography. Overall opioid utilization declined from 53.5% (95% CI: 49.4–57.5) to 46.5% (95% CI: 43.2–49.8; P  < 0.001). Tramadol use increased over the study period (4.1% [95% CI: 3.0–5.8] vs. 8.4% [95% CI: 6.6–10.7]; P  < 0.001). Conclusions   Opioid utilization during ED visits for back pain decreased from 2007 to 2016, whereas tramadol use more than doubled. Care intensity increased significantly despite declining admission rates. Further research into optimal strategies for back pain management in the ED is needed. [ABSTRACT FROM AUTHOR]

Background Coordinated efforts between the National Institutes of Health, the Department of Defense, and the Department of Veterans Affairs have built the capacity for large-scale clinical research investigating the effectiveness of nonpharmacologic pain treatments. This is an encouraging development; however, what constitutes best practice for nonpharmacologic management of low back pain (LBP) is largely unknown. Design The Improving Veteran Access to Integrated Management of Back Pain (AIM-Back) trial is an embedded pragmatic cluster-randomized trial that will examine the effectiveness of two different care pathways for LBP. Sixteen primary care clinics will be randomized 1:1 to receive training in delivery of 1) an integrated sequenced-care pathway or 2) a coordinated pain navigator pathway. Primary outcomes are pain interference and physical function (Patient-Reported Outcomes Measurement Information System Short Form [PROMIS-SF]) collected in the electronic health record at 3 months (n=1,680). A subset of veteran participants (n=848) have consented to complete additional surveys at baseline and at 3, 6, and 12 months for supplementary pain and other measures. Summary AIM-Back care pathways will be tested for effectiveness, and treatment heterogeneity will be investigated to identify which veterans may respond best to a given pathway. Health care utilization patterns (including opioid use) will also be compared between care pathways. Therefore, the AIM-Back trial will provide important information that can inform the future delivery of nonpharmacologic treatment of LBP. [ABSTRACT FROM AUTHOR]

Objective Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain. Design and Setting We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012–2017. Subjects We included adults aged 18–84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. We identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care. Methods We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as: acute (first chiropractic encounter within 30 days of diagnosis) and nonacute (all other patients). Results The total number of subjects was 101,221. Overall, between 1.55 and 2.03 times more nonrecipients filled an opioid prescription, as compared with recipients (in Connecticut: hazard ratio [HR] = 1.55, 95% confidence interval [CI] = 1.11–2.17, P  = 0.010; in New Hampshire: HR = 2.03, 95% CI = 1.92–2.14, P  < 0.0001). Similar differences were observed for the acute groups. Conclusions Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase. [ABSTRACT FROM AUTHOR]

Objective Chronic musculoskeletal pain disorders (CMPDs) are among the leading causes of disabilities across populations, resulting in high social and financial burden. This persistent pain condition may include the central sensitization (CS) phenomenon, which implies a wide range of symptoms and that may be taken into account in CMPD treatment. CS symptoms can be measured by the Central Sensitization Inventory (CSI). The aims of the study were to describe CS symptoms in patients suffering from several CMPDs and to analyze differences due to gender, age, and body mass index (BMI). Design This cross-sectional study recruited a total of 395 Spanish participants suffering from several CMPDs. Setting CS symptoms were measured with the Spanish Version of the CSI. The total score (0–100) and a cutoff score of 40 were recorded. Subjects A total of 395 participants were included. Results The mean CSI total score for the whole sample was 24.6 ± 12.0 points. CSI total score had subclinical values in the whole sample, whereas participants with scores >40 were found across different CMPDs, such as low back pain (37.8%) and neck pain (32.4%); 14.6% of females and 1.7% of males presented CSI scores >40. Patients showed significant differences in CSI cutoff point by gender (P  = 0.010) and CSI total score by age (P  = 0.014). Conclusions Given the high prevalence of clinically relevant CSI scores (>40) in people with a CMPD, especially low back pain and neck pain, we recommend that clinicians supplement their assessment with the CSI for improved decision-making during treatment. [ABSTRACT FROM AUTHOR]

Objective Examine the interrelationship between smoking and pain in the US population. Design A cross-sectional population-based study. Setting Nationwide survey. Methods Comprehensive pain reports categorically defined as head, spine, trunk, and limb pain; smoking history; demographics; medical history from a total of 2,307 subjects from the 2003–2004 National Health and Nutrition Examination Survey obtained from the Centers for Disease Control were analyzed. Unpaired t tests were used to analyze independent continuous variables, and chi-square tests were used to analyze categorical variables between smoker and nonsmoker groups. Weighted multivariate logistic regression analyses determined the association of current smoking with the presence of pain in various body regions. Results Smoking is most strongly associated with spine pain (odds ratio [OR] = 2.89, 95% confidence interval [CI] = 2.21–3.77), followed by headache (OR = 2.47, 95% CI = 1.73–3.53), trunk pain (OR = 2.17, 95% CI = 1.45–2.74), and limb pain (OR = 1.99, 95% CI = 1.45–2.73). Conclusions Current smoking is associated with pain in every region of the body. This association is strongest for spine and head pain. Given that pain is a strong motivator and that current smoking was associated with pain in all body regions, we recommend that these results be used to further raise public awareness about the potential harms of smoking. [ABSTRACT FROM AUTHOR]

Objective Targeted intrathecal drug delivery (TIDD) is an effective interventional pain management modality often used in postlaminectomy patients with refractory chronic low back pain. A combination of intrathecal bupivacaine with an opioid is often used. However, intrathecal catheter tip granulomas have occurred with use of morphine or hydromorphone but generally not with fentanyl. The objective of this study was to compare the efficacy of TIDD using bupivacaine/fentanyl vs bupivacaine/hydromorphone in patients with chronic intractable low back pain postlaminectomy. Materials and Methods A retrospective comparative analysis of consecutive patients with lumbar postlaminectomy syndrome who were trialed and later received TIDD with a combination of bupivacaine/hydromorphone or bupivacaine/fentanyl between June 2009 and May 2016 at a single tertiary medical center. Results We identified a cohort of 58 lumbar postlaminectomy patients receiving a TIDD admixture of either hydromorphone/bupivacaine (30 patients) or low-dose fentanyl/bupivacaine (28 patients) with at least two years of follow-up. The fentanyl group had significantly lower baseline opioid consumption and a lower rate of intrathecal opioid dose escalation. Both groups had similar and significant reductions in pain scores over the two-year follow-up period. No granulomas were observed. Conclusion TIDD using a low-dose fentanyl admixture with bupivacaine in patients with postlaminectomy syndrome and refractory chronic low back pain results in similar pain relief to TIDD with hydromorphone and bupivacaine. Low-dose intrathecal fentanyl leads to a lower rate of opioid escalation and may be safer than hydromorphone. [ABSTRACT FROM AUTHOR]

Objectives To determine prevalence rates of hemorrhagic complications in patients who either ceased or continued anticoagulants during interventional pain procedures. Methods A total of 1,936 consecutive patients were prospectively monitored during a total of 12,723 injection procedures. The prevalence of hemorrhagic complications was tallied for a variety of procedures performed on patients who ceased or continued various anticoagulants. Results No hemorrhagic complications occurred in any patient who continued anticoagulants. Sufficiently large sample sizes were obtained to conclude that, in patients who continued warfarin or clopidrogel during lumbar transforaminal injections and for lumbar facet procedures, the zero prevalence of complications had 95% confidence intervals of 0% to 0.3%. This prevalence was significantly lower than the risk of medical complications in patients who ceased warfarin. Conclusions Lumbar transforaminal injections and lumbar facet injections have a very low rate of hemorrhagic complications when patients continue to take anticoagulants. [ABSTRACT FROM AUTHOR]

Objective To review the effect of patient decision aids for adults making treatment decisions regarding the management of chronic musculoskeletal pain. Methods We performed a systematic review of randomized controlled trials of adults using patient decision aids to make treatment decisions for chronic musculoskeletal pain in the outpatient setting. Results Of 477 records screened, 17 met the inclusion criteria. Chronic musculoskeletal pain conditions included osteoarthritis of the hip, knee, or trapeziometacarpal joint and back pain. Thirteen studies evaluated the use of a decision aid for deciding between surgical and nonsurgical management. The remaining four studies evaluated decision aids for nonsurgical treatment options. Outcomes included decision quality, pain, function, and surgery utilization. The effects of decision aids on decision-making outcomes were mixed. Comparing decision aids with usual care, all five studies that examined knowledge scores found improvement in patient knowledge. None of the four studies that evaluated satisfaction with the decision-making process found a difference with use of a decision aid. There was limited and inconsistent data on other decision-related outcomes. Of the eight studies that evaluated surgery utilization, seven found no difference in surgery rates with use of a decision aid. Five studies made comparisons between different types of decision aids, and there was no clearly superior format. Conclusions Decision aids may improve patients' knowledge about treatment options for chronic musculoskeletal pain but largely did not impact other outcomes. Future efforts should focus on improving the effectiveness of decision aids and incorporating nonpharmacologic and nonsurgical management options. [ABSTRACT FROM AUTHOR]

Background Back pain is a very prevalent complaint, affecting two-thirds of the US population, and it accounts for $100 billion annually in health care expenditures. The occurrence of depression has been reported in existing literature among patients with back pain, but there is limited information regarding health care expenditures among patients with back pain and concurrent depression. Objective To assess excess total and subtypes of health care expenditures among adults with spondylosis, intervertebral disc disorders, and other back problems who reported having depression compared with those without depression in the United States. Methods We utilized a cross-sectional design, pooling Medical Expenditure Panel Survey data from 2010–2012. The eligible study sample included adults (age ≥18 years) who reported positive health care expenditure. Total and subtypes of health care expenditures constituted the dependent variable. Ordinary least squares (OLS) regressions on logged expenditures were performed. Four models were developed to assess influence of demographics, functional ability, and concurrent diagnoses on health care expenditures. Results A total of 6,739 adults with spondylosis, intervertebral disc disorders, and other back problems were assessed, 20.2% (N = 1,316) of whom had concurrent depression. Adults with concurrent depression had significantly higher total health care expenditures ($13,153) compared with the nondepression group ($7,477, P  < 0.001). Outpatient and prescription expenditures showed similar findings. After adjusting for demographics, functional disabilities, and comorbidities, excess cost remained higher in the group reporting concurrent depression (46%). Conclusions This study demonstrates that the presence of depression in adults with spondylosis, intervertebral disc disorders, and other back problems is associated with greater economic burden. These findings remained consistent after adjusting for all independent sets of variables. The study's findings suggest that interventions resulting in better management of depression have the potential to significantly reduce the economic burden in this population. [ABSTRACT FROM AUTHOR]

The article describes an interdigital approach to injections of corticosteroid for the stenosing tenosynovitis of the finger using ultrasound (US) guidance. Topics covered include the valuable role that US plays in the follow-up phase, the positive outcome of US guidance aids when compared with injecting blindly, and two approaches that maybe used for US-guided technique.

A case study is presented of a 69-year-old man with Adult degenerative scoliosis (ADS), hypertension, and chronic bronchitis presented with chronic progressive lower thoracic and lumbar pain and right anterior thigh pain and paresthesias. It mentions his treatments including oral analgesics, physical therapy, and spinal injections.

Background This study aimed to evaluate the wireless Freedom Spinal Cord Stimulator (WSCS) System for the treatment of chronic back and/or leg pain associated with failed back surgery syndrome (FBSS) refractory to standard medical treatment utilizing 10-kHz stimulation (high-frequency [HF]) in comparison with 10–1,500-Hz stimulation (low-frequency [LF]) waveforms. Methods Ninety-nine subjects were randomized in a 1:1 ratio to receive either HF or LF stimulation waveforms utilizing the same Freedom WSCS System. All subjects were implanted with two 8-electrode arrays in the exact same anatomical positions within the dorsal epidural spinal column, with the top electrode positioned at the T8 and T9 vertebrae levels, respectively, and the wireless receiver placed under the skin in a subcutaneous pocket. Results Seventy-two (HF: N = 38; LF: N = 34) subjects had completed the six-month follow-up after an initial 30-day trial period at the time of this report. For both the HF and LF arms, mean visual analog scale (VAS) scores for back and leg pain decreased significantly: 77% and 76%, respectively, for the HF arm and 64% and 64%, respectively, for the LF arm. In addition, most subjects experienced significant improvements in VAS, Oswestry Disability Index, European Quality of Life 5 Dimension questionnaire, Patient Global Impression of Change, and sleep duration. Conclusions These preliminary results demonstrate that WSCS devices can reduce FBSS chronic pain substantially with both LF and HF stimulation waveforms over a seven-month period (30-day trial period and six-month post-trial evaluation). [ABSTRACT FROM AUTHOR]

Objective To estimate the prevalence of co-occurring pain sites among older adults with persistent back pain and associations of multisite pain with longitudinal outcomes. Design Secondary analysis of a cohort study. Setting Three integrated health systems in the United States. Subjects Eight hundred ninety-nine older adults with persistent back pain. Methods Participants reported pain in the following sites: stomach, arms/legs/joints, headaches, neck, pelvis/groin, and widespread pain. Over 18 months, we measured back-related disability (Roland Morris, scored 0–24), pain intensity (11-point numerical rating scale), health-related quality of life (EuroQol-5D [EQ-5D], utility from 0–1), and falls in the past three weeks. We used mixed-effects models to test the association of number and type of pain sites with each outcome. Results Nearly all (N = 839, 93%) respondents reported at least one additional pain site. There were 216 (24%) with one additional site and 623 (69%) with multiple additional sites. The most prevalent comorbid pain site was the arms/legs/joints (N = 801, 89.1%). Adjusted mixed-effects models showed that for every additional pain site, RMDQ worsened by 0.65 points (95% confidence interval [CI] = 0.43 to 0.86), back pain intensity increased by 0.14 points (95% CI = 0.07 to 0.22), EQ-5D worsened by 0.012 points (95% CI = –0.018 to –0.006), and the odds of falling increased by 27% (odds ratio = 1.27, 95% CI = 1.12 to 1.43). Some specific pain sites (extremity pain, widespread pain, and pelvis/groin pain) were associated with greater long-term disability. Conclusions Multisite pain is common among older adults with persistent back pain. Number of pain sites was associated with all outcomes; individual pain sites were less consistently associated with outcomes. [ABSTRACT FROM AUTHOR]

Objective This study examined the association between daily physical activity and functional disability incidence in community-dwelling older adults with chronic pain. Design Prospective cohort study. Setting Japanese community. Subjects Of the 5,257 participants enrolled for baseline assessment, data on the 693 participants who had chronic lower back or knee pain and underwent daily physical activity assessment using an accelerometer were analyzed. Methods Participants were assessed for regular physical activity (step counts, moderate- to vigorous-intensity physical activity duration, and light-intensity physical activity duration) using an accelerometer at baseline and were followed up for monthly functional disability incidence, based on the national long-term care insurance system, for approximately two years. We determined the effect of physical activity cutoff points on functional disability incidence using receiver operating characteristic curves and Youden index. Cox proportional hazards regression models were used to analyze associations between the cutoff points and disability incidence. Results Among the 693 participants with chronic pain, 69 (10.0%) developed functional disability during the follow-up period. Participants with lower physical activity levels showed significantly higher risk of disability. After adjusting for all covariates, functional disability was associated with step counts (hazard ratio [HR] = 1.79, 95% confidence interval [CI] = 1.02–3.14) and moderate- to vigorous-intensity physical activity duration (HR = 2.02, 95% CI = 1.16–3.51) but had no relationship with light-intensity physical activity duration (HR = 1.72, 95% CI = 0.97–3.05). Conclusions Maintenance of physical activity with at least moderate intensity may be effective in preventing disability even among older adults with chronic pain. [ABSTRACT FROM AUTHOR]

The article focuses on the treatment and management of muscle pain. It mentions that postgraduate training programs are offered by medical schools to teach students how to palpate muscle to diagnose myofascial pain syndromes. It also informs on a table depicting type of pain incluidng visceral pain, low back pain, and muscle pain.

The article offers information on Spine Intervention Society which supports best practice recommendations and statements for the performance of epidural steroid injections in the setting of a preservative-free dexamethasone shortage. Topics include use of nonparticulate steroids; use of methylprednisolone, betamethasone, triamcinolone in the absence of dexamethasone; and performing Clinical judgment when selecting optimal route of epidural injection to balance safety and effectiveness.

Objectives The presence of trigger points (MTrPs) and pressure pain sensitivity has been well documented in subjects with neck and back pain; however, it has yet to be examined in people with upper thoracic spine pain. The purpose of this study was to investigate the presence of MTrPs and mechanical pain sensitivity in individuals with upper thoracic spine pain. Methods Seventeen subjects with upper thoracic spine pain and 17 pain-free controls without spine pain participated. MTrPs were examined bilaterally in the upper trapezius, rhomboid, iliocostalis thoracic, levator scapulae, infraspinatus, and anterior and middle scalene muscles. Pressure pain thresholds (PPTs) were assessed over T2, the C5-C6 zygapophyseal joint, the second metacarpal, and the tibialis anterior. Results The numbers of MTrPs between both groups were significantly different (P  < 0.001) between patients and controls. The number of MTrPs for each patient with upper thoracic spine pain was 12.4 ± 2.8 (5.7 ± 4.0 active TrPs, 6.7 ± 3.4 latent TrPs). The distribution of MTrPs was significantly different between groups, and active MTrPs within the rhomboid (75%), anterior scalene (65%), and middle scalene (47%) were the most prevalent in patients with upper thoracic spine pain. A higher number of active MTrPs was associated with greater pain intensity and longer duration of pain history. Conclusions This study identified active MTrPs and widespread pain hypersensitivity in subjects with upper thoracic spine pain compared with asymptomatic people. Identifying proper treatment strategies might be able to reduce pain and improve function in individuals with upper thoracic spine pain. However, future studies are needed to examine this. [ABSTRACT FROM AUTHOR]

Objective To assess the evidence for the safety and efficacy of invasive procedures for reducing chronic pain and improving function and health-related quality of life compared with sham (placebo) procedures. Design Systematic review with meta-analysis. Methods Studies were identified by searching multiple electronic databases, examining reference lists, and communicating with experts. Randomized controlled trials comparing invasive procedures with identical but otherwise sham procedures for chronic pain conditions were selected. Three authors independently extracted and described study characteristics and assessed Cochrane risk of bias. Two subsets of data on back and knee pain, respectively, were pooled using random-effects meta-analysis. Overall quality of the literature was assessed through Grading of Recommendations, Assessment, Development, and Evaluation. Results Twenty-five trials (2,000 participants) were included in the review assessing the effect of invasive procedures over sham. Conditions included low back (N = 7 trials), arthritis (4), angina (4), abdominal pain (3), endometriosis (3), biliary colic (2), and migraine (2). Thirteen trials (52%) reported an adequate concealment of allocation. Fourteen studies (56%) reported on adverse events. Of these, the risk of any adverse event was significantly higher for invasive procedures (12%) than sham procedures (4%; risk difference = 0.05, 95% confidence interval [CI] = 0.01 to 0.09, P  = 0.01, I 2 = 65%). In the two meta-analysis subsets, the standardized mean difference for reduction of low back pain in seven studies (N = 445) was 0.18 (95% CI = –0.14 to 0.51, P  = 0.26, I 2 = 62%), and for knee pain in three studies (N = 496) it was 0.04 (95% CI = –0.11 to 0.19, P  = 0.63, I 2 = 36%). The relative contribution of within-group improvement in sham treatments accounted for 87% of the effect compared with active treatment across all conditions. Conclusions There is little evidence for the specific efficacy beyond sham for invasive procedures in chronic pain. A moderate amount of evidence does not support the use of invasive procedures as compared with sham procedures for patients with chronic back or knee pain. Given their high cost and safety concerns, more rigorous studies are required before invasive procedures are routinely used for patients with chronic pain. [ABSTRACT FROM AUTHOR]

Objective To assess inflammatory back pain (IBP) and neuropathic pain (NP) in patients with axial spondyloarthritis (axSpA) and explore their relationships with disease activity and functional status. Design Descriptive, cross-sectional study. Setting and Subjects A convenience sample of 132 patients with axSpA was recruited from a university-affiliated hospital in China. Methods The presence of IBP or NP, pain intensity and quality, pain interference, disease activity, and functional status were assessed. Univariate analyses and binary logistic regressions were used to identify factors related to IBP or NP. Results Fifty patients (37.9%) had IBP, and 22 (16.7%) had NP. Scores of pain intensity and pain interference, disease activity, and functional limitation were significantly higher in patients with IBP or NP than those without either (P  <   0.05). The quality of IBP or NP was mainly presented as sensory descriptors, and patients with IBP had a higher level of "tiring-exhausting" in affective descriptors (P  <   0.05). There was a significant correlation between IBP and disease activity (odds ratio [OR] = 1.813, 95% confidence interval [CI] = 1.196–2.750). NP was related to functional limitation (OR = 1.544, 95% CI = 1.098–2.171). Conclusions Though pain quality (sensory and affective pain descriptors) show differently in patients with IBP or NP, the axSpA patients with IBP or NP experience more severe pain intensity and pain interference, higher disease activity, and greater functional limitation. The presence of IBP or NP could reflect higher disease activity or greater functional limitation in patients with axSpA. [ABSTRACT FROM AUTHOR]

The article discusses the search to improve value for back pain care through a redesign process. The process include four components including literature review and discussion with authors of peer-reviewed publications that examine attempts to improve the value of back pain care, consideration of advances in biomedical and behavioral science-based technologies, and on-site investigations of efforts to deliver back pain care more cost-effectively.

Objective Multiple and specific types of childhood adverse events are risk factors for chronic pain conditions. Although both can covary, no study has evaluated one aspect while controlling for the other. Therefore, the current study examined whether more adverse events would be a risk factor for common chronic pain conditions and pain medication use in young adults after controlling for different adversity types such as physical, emotional, and sexual traumatic events or vice versa. Methods This cross-sectional study recruited 3,073 undergraduates (72% female, mean age = 18.8 years, SD = 1.4 years) who completed the survey for current health status and early life traumatic events. Results More adverse events were associated with a 1.2–1.3-fold increase in the odds of any chronic pain, chronic back pain, headache, and dysmenorrhea with adjusting for adversity types, but they were not associated with the risk of comorbid pain conditions and use of pain medications. In contrast, specific adversity types were unrelated to chronic pain conditions when controlling for the number of adverse events. Conclusions Cumulative childhood adverse events may be a more relevant risk factor for chronic pain conditions than the experience of a specific type of adverse event. Clinicians and researchers need to evaluate cumulative childhood adversity when assessing its link to chronic pain. [ABSTRACT FROM AUTHOR]

In the article, the authors present the cases of two older women who suffer chronic back pain to discuss adjacent intravertebral cement leakage during percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures. Topics include how PVP can provide pain relief and spinal stability and the types of cement leakages using PVP, including type S leak via the segmental vein.

Objective Much is known about racial and ethnic disparities in receipt of opioids for pain in emergency departments. Less is known about such disparities in the evaluation and management of pain in the outpatient setting. Methods Using the nationally representative National Ambulatory Medical Care Survey (NAMCS), we estimated disparities in visit time with physicians and opioid receipt in the outpatient setting. We focused on patients whose reason for visiting was abdominal pain or back pain. Our sample included 4,764 white patients, 692 black patients, and 682 Hispanic patients. Results Back pain visits of Hispanic patients lasted 1.6 fewer minutes than those of white non-Hispanic patients (P  = 0.04 for the difference). Black patients were 6.0% less likely than white patients to receive opioids for abdominal pain (P  = 0.04 for the difference) and 7.1% less likely than white patients to receive opioids for back pain (P  = 0.046 for the difference). Hispanic patients were 6.3% less likely than white patients to receive opioids for abdominal pain (P  = 0.003 for the difference) and 14.8% less likely than white patients to receive opioids for back pain (P  < 0.001 for the difference). Hispanic patients were more likely than white patients to receive nonopioids instead of opioids for both abdominal pain and back pain. Differences in opioid receipt did not narrow during the examined time period. Conclusions Identifying causes of racial and ethnic disparities in the evaluation and treatment of pain in the outpatient setting is important to improving the health and function of patients. [ABSTRACT FROM AUTHOR]

Objective To assess the effect depression has on outcomes after cervical epidural steroid injections (CESIs). Design Retrospective review of a prospectively collected database. Setting Single institution tertiary care center. Subjects Fifty-seven patients with cervical spondylosis and cervical radicular pain who were deemed appropriate surgical candidates but elected to undergo CESI first were included. Methods Twenty-one of 57 (37%) patients with depression (defined as Zung Depression Scale >33) were included. Patient-reported outcomes including Neck Disability Index (NDI), numeric rating scale (NRS) for arm pain (AP), NRS for neck pain (NP), and EuroQol-5D (EQ-5D) were collected at baseline and three-month follow-up. Minimal clinically important differences were then calculated to provide dichotomous outcome measures of success. Results Overall, 24 and 28 patients achieved at least 50% improvement in AP and NP, respectively. In terms of disability, 25/57 (43.9%) patients achieved >13.2-point improvement on the NDI overall. In patients with depression, 4/21 (19.0%) and 5/21 (23.8%) achieved at least 50% improvement on the NRS for AP and NP, respectively, compared with 20/36 (55.5%) and 23/36 (63.8%) in patients without depression. This difference was statistically significant for both pain measures (P  < 0.002 AP, P  < 0.006 NP). Statistically fewer patients, 5/21 (24%), with depression achieved ≥13.2-point improvement on the NDI compared with 20/36 (55%) nondepressed patients (P  < 0.01). There was no difference in outcomes between groups on the EQ-5D. Conclusions Patients with cervical spondylosis and comorbid depression who undergo CESI are less likely to achieve successful outcomes in both pain and function compared with nondepressed patients at three months. [ABSTRACT FROM AUTHOR]

Objective There is increasing evidence that the cerebellum has a role in pain processing. The present study investigates whether chronic pain patients, who are likely to have altered pain processing, exhibit signs of subtle cerebellar dysfunction. We used oculomotor tasks to assess dysfunction of the associated neuronal networks, including the cerebellum. Methods Thirty patients with chronic nonspecific spinal pain and 30 age- and sex-matched controls were enrolled. Using a head-mounted eye tracker (EyeSeeCam), eye movements were quantified during predictable and unpredictable saccade and smooth pursuit tasks in the horizontal plane. Results The initial latency and the velocity variability of smooth pursuit were significantly increased in the chronic spinal pain patients compared with controls (initial latency: 198 ± 20 vs 185 ± 11 ms, P  < 0.01; slow phase velocity standard deviation: 3.31 ± 1.02 vs 2.70 ± 0.83°/s, P  < 0.05). Moreover, the latency of predictable saccades was prolonged in patients (rightward: 161 ± 20 vs 152 ± 12 ms, P  < 0.05; leftward: 164 ± 22 vs 153 ± 18 ms, P  = 0.05). Conclusions Our results show that chronic spinal pain patients display subtle but significant oculomotor changes as compared with healthy controls. Considering the networks involved in the generation of saccades and smooth pursuit, the results would be consistent with a dysfunction of cerebellar regions, especially parts of the cerebellar hemispheres. Alternatively, they could also point toward a dysfunction in the frontal eye field and/or pontine oculomotor nuclei. [ABSTRACT FROM AUTHOR]

Objectives To examine the relationship between the Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference (PI) and PROMIS Physical Function (PF) scales in patients with spinal pain at a university spine center. Design Retrospective analysis of prospectively collected patient-reported outcome data at a university spine clinic. Pearson correlation was done to examine the relationship of the PROMIS PF and PROMIS PI scores. Age, gender, and race were analyzed by subgroups on the PROMIS Physical Function and Pain Interference score. Linear regression analyzed predictive relationships. Statistical significance was set at P  < 0.05. Results A total of 1,992 participants completed an assessment, with 1,923 completing the PF CAT and 1,927 the PI CAT. Participants’ mean age was 52.8 years (range = 18–94 years, SD = 6.5 years). Correlation analysis of the PROMIS PF with the PROMIS PI showed a Pearson correlation value of –0.717 (P  < 0.05). There was a strong linear relationship with a high negative correlation between PF CAT and PI CAT. The PI CAT predicted PF CAT scores (β = –0.707, P  < 0.001). Conclusions For patients with pain from spinal origin, there is a strong negative correlation between self-reported physical function and pain interference related to physical, social, and mental health. The predictive relationship of function from pain scores supports the PROMIS PI being used as an important adjunct measure of physical function in patients with spinal pain. [ABSTRACT FROM AUTHOR]

Objective. Epiduroscopy is a proven method of diagnosis and treatment for chronic radicular pain after spinal surgery, which is known as failed back surgery syndrome (FBSS). The aim of the study was to compare the efficacy of drugs (the enzyme hyaluronidase and corticosteroid DEPO-Medrol) administrated into the epidural space during epiduroscopy, performed within the ventral and ventro-lateral epidural space with a focus on releasing foraminal adhesions. Methods. Forty-eight patients with diagnosed FBBS were randomized into two groups before epiduroscopy. Group A received the standard treatment- mechanical lysis of fibrotic tissue in the epidural space. Group B received hyaluronidase and corticosteroid methylprednisolone acetate during the procedure. Subjects were followed for six and 12 months via scheduled double-blinded examinations by pain physicians. Leg and back pain intensity was assessed by an 11-point numerical rating scale, and patients' functional disability was assessed by the Oswestry Disability Index (ODI). Results. Study subjects showed a significant decrease in ODI score in both groups (P< 0.05). Significantly lower pain scores for leg pain (P< 0.05) and back pain (P< 0.05) were also recorded after the six-month follow-up. However, the one-year followup showed a return to the baseline ODI values of most monitored pain scores in both groups (P> 0.05). Improvement was only noted on the NRS for back pain at one-year follow-up (P< 0.05). Conclusions. A significant improvement of leg and back pain was found in both groups after six months. ODI was significantly improved only in group B in both the six- and 12-month intervals. Back pain at one-year follow-up was only improved in group B. [ABSTRACT FROM AUTHOR]

Objective. These analyses examined opioid initiation and chronic use among Iraq (OIF) and Afghanistan (OEF/OND) veterans with a new diagnosis of traumatic brain injury (TBI) in the Veterans Health Administration (VHA). Methods. Data were obtained from national VHA data repositories. Analyses included OEF/OIF/OND veterans with a new TBI diagnosis in 2010-2012 who used the VHA at least twice, had not received a VHA opioid prescription in the 365 days before diagnosis, and had at least 365 days of data available after TBI diagnosis. Results. Analyses included 35,621 veterans. Twenty-one percent initiated opioids; among new initiators, 23% used chronically. The mean dose was 24.0mg morphine equivalent dose (MED) daily (SD524.26); mean days supplied was 60.52 (SD574.69). Initiation was significantly associated with age 36-45 years (odds ratio [OR]51.09, 95% CI51.01-1.17, P50.04), female gender (OR51.22, P< 0.001), having back pain (OR51.38, P< 0.0001), arthritis/joint pain (OR51.24, P< 0.0001), or neuropathic pain (OR51.415, P< 0.02). In veterans age 36-45 years, those living in small rural areas had higher odds of chronic opioid use (OR51.31, P< 0.0001, and OR51.33, P50.006, respectively) and back pain (OR51.36, P50.003). Headache/migraine pain was associated with decreased odds of chronic opioid use (OR50.639, P50.003). Conclusions. Prevalence of opioid use is relatively low among OEF/OIF/OND veterans with newly diagnosed TBI who are using VHA. Among those who initiated opioids, about 25% use them chronically. Prescribing was mostly limited to moderate doses, with most veterans using opioids for approximately two months of the 12-month study period. [ABSTRACT FROM AUTHOR]

Objective. This project was designed to test the feasibility and effectiveness of acupuncture therapy given in a group setting for chronic pain. Design. Nonrandomized, repeated measures quasiexperimental trial. Setting. Care was delivered in a primary care clinic waiting area after clinic hours. Subjects. Included were primary care patients (≥18 years old) with chronic pain of the neck, back, shoulder, or osteoarthritis of any site of at least three months' duration. Methods. Subjects received eight weekly acupuncture therapy sessions in a group setting. Acupuncture therapy included a combination of palpation, acupuncture needling, Tui na, Gua sha, and auricular treatment. Baseline pain levels were established in a two- to four-week run-in; assessment of the intervention impact on pain intensity, mood, and functional status were made at the end of the treatment period (eight weeks) and 16 weeks after completion of intervention (24 weeks). Results. Of the total 113 participants recruited for the trial, 96 completed the 24-week protocol. We found a statistically and clinically significant decrease in pain severity, pain interference, and depression in our study population. There were no serious adverse events. Conclusions. Acupuncture therapy offered in the group setting was effective in reducing pain severity, pain interference, and depression in patients with chronic neck, back, or shoulder pain or osteoarthritis. Benefit persisted through the 24-week measure despite no additional treatment. This finding has potentially important implications for improving access to effective acupuncture treatment for patients with limited financial resources. [ABSTRACT FROM AUTHOR]