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Low Back Pain: Predominant Neuropathic, Nociceptive, or Central Sensitization Pain

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 11889

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Special Issue Editor

Dr. Hue Jung Park

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Guest Editor

Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul 06591, Republic of Korea
Interests: neuropathic; nociceptive; central sensitization pain; post-operative pain; headache; spinal pain; other non-specific pain; pain management; animal study; clinical study; drug delivery; pain intervention
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Special Issue Information

Dear Colleagues,

Low back pain is the leading cause of disability in many countries and ranked in the top three worldwide, and when grouped with neck pain, it becomes the top cause in the most recent Global Burden of Disease Study. From acute postoperative pain to central sensitization pain, the spectrum of low back pain varies. Low back pain is uncomfortable and often persistent and severe. Sometimes it bothers patients and decreases daily activity and quality of life. Efforts should be made to solve these problems. Diverse pathophysiology of low back pain (acute or chronic) should be understood, proper diagnosis of low back pain needs to be established, and also a variety of treatment options should be evaluated. Please join us in presenting in this Special Issue up-to-date research currently being performed on low back pain: predominant nociceptive, neuropathic, central sensitization pain, post-operative pain, and other non-specific lower back pain in different academic fields in order to provide an update on many of the recent advances and perspectives of this health problem. A number of topics will be covered: prevalence and epidemiological data; imaging study; diagnosis: assessment and treatment approaches including medication, nerve block, intervention (fluoroscopy-guided or ultrasound-guided), and neuromodulation; etc.

Dr. Hue Jung Park
Guest Editor

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Keywords

Neuropathic
Nociceptive
Central sensitization pain
Post-operative pain
Other non-specific lower back pain

Published Papers (6 papers)

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Research

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13 pages, 1010 KiB

Open AccessArticle

Axially Loaded Magnetic Resonance Imaging Identification of the Factors Associated with Low Back-Related Leg Pain

by Tomasz Lorenc, Wojciech Michał Glinkowski and Marek Gołębiowski

J. Clin. Med. 2021, 10(17), 3884; https://doi.org/10.3390/jcm10173884 - 29 Aug 2021

Cited by 2 | Viewed by 2086

Abstract

This retrospective observational study was conducted to identify factors associated with low back-related leg pain (LBLP) using axially loaded magnetic resonance imaging (AL-MRI). Ninety patients with low back pain (LBP) underwent AL-MRI of the lumbar spine. A visual analog scale and patient pain drawings were used to evaluate pain intensity and location and determine LBLP cases. The values of AL-MRI findings were analyzed using a logistic regression model with a binary dependent variable equal to one for low back-related leg pain and zero otherwise. Logistic regression results suggested that intervertebral joint effusion (odds ratio (OR) = 4.58; p = 0.035), atypical ligamenta flava (OR = 5.77; p = 0.003), and edema of the lumbar intervertebral joint (OR = 6.41; p = 0.003) were more likely to be present in LBLP patients. Advanced disc degeneration (p = 0.009) and synovial cysts (p = 0.004) were less frequently observed in LBLP cases. According to the AL-MRI examinations, the odds of having LBLP are more likely if facet effusion, abnormal ligamenta flava, and lumbar facet joint edema are present on imaging than if not. The assessment of lumbar spine morphology in axial loaded MRI adds value to the potential understanding of LBLP, but further longitudinal and loaded–unloaded comparative studies are required to determine the role of acute dynamic changes and instability in LBLP development. Full article

(This article belongs to the Special Issue Low Back Pain: Predominant Neuropathic, Nociceptive, or Central Sensitization Pain)

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7 pages, 563 KiB

Open AccessArticle

Predictors of Opioid Prescribing for Non-Malignant Low Back Pain in an Italian Primary Care Setting

by Simona Cammarota, Valeria Conti, Graziamaria Corbi, Luigi Di Gregorio, Pasquale Dolce, Marianna Fogliasecca, Teresa Iannaccone, Valentina Manzo, Vincenzo Passaro, Bernardo Toraldo, Alfredo Valente and Anna Citarella

J. Clin. Med. 2021, 10(16), 3699; https://doi.org/10.3390/jcm10163699 - 20 Aug 2021

Cited by 1 | Viewed by 1326

Abstract

This study explores which patient characteristics could affect the likelihood of starting low back pain (LBP) treatment with opioid analgesics vs. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in an Italian primary care setting. Through the computerized medical records of 65 General Practitioners, non-malignant LBP subjects who received the first pain intensity measurement and an NSAID or opioid prescription, during 2015–2016, were identified. Patients with an opioid prescription 1-year before the first pain intensity measurement were excluded. A multivariable logistic regression model was used to determine predictive factors of opioid prescribing. Results were reported as Odds Ratios (ORs) with a 95% confidence interval (CI), with p < 0.05 indicating statistical significance. A total of 505 individuals with LBP were included: of those, 72.7% received an NSAID prescription and 27.3% an opioid one (64% of subjects started with strong opioid). Compared to patients receiving an NSAID, those with opioid prescriptions were younger, reported the highest pain intensity (moderate pain OR = 2.42; 95% CI 1.48–3.96 and severe pain OR = 2.01; 95% CI 1.04–3.88) and were more likely to have asthma (OR 3.95; 95% CI 1.99–7.84). Despite clinical guidelines, a large proportion of LBP patients started with strong opioid therapy. Asthma, younger age and pain intensity were predictors of opioid prescribing when compared to NSAIDs for LBP treatment. Full article

(This article belongs to the Special Issue Low Back Pain: Predominant Neuropathic, Nociceptive, or Central Sensitization Pain)

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10 pages, 1545 KiB

Open AccessArticle

Factors Predicting the Success of Adhesiolysis Using a Steerable Catheter in Lumbar Failed Back Surgery Syndrome: A Retrospective Study

by Ji Yeong Kim, Yong Ho Lee, Subin Yoo, Ji Young Kim, Mina Joo and Hue Jung Park

J. Clin. Med. 2021, 10(5), 913; https://doi.org/10.3390/jcm10050913 - 26 Feb 2021

Cited by 2 | Viewed by 1847

Abstract

Failed back surgery syndrome (FBSS) is a commonly encountered disease after lumbar surgery. There are many cases where it is difficult to choose a treatment because no specific cause can be found. Nevertheless, according to recent reports, adhesiolysis has shown reasonable evidence. However, considering its poor cost-effectiveness, adhesiolysis cannot be used as the first line of treatment. FBSS patients often suffer from chronic pain; accordingly, they become frustrated when this treatment produces a poor response. Therefore, before the procedure, the target group must be selected carefully. We sought to identify the pre-procedure factors predicting the effect of adhesiolysis in FBSS. A total of 150 patients were evaluated and analyzed retrospectively. Of these 150 patients, 69 were classified as responders three months after the procedure (46%). The outer diameter of the catheter during the procedure and grade of foraminal stenosis were correlated with the procedure effect. In conclusion, of the 2.1 mm diameter of the catheter, 1.7 mm of it was used during the procedure, and the milder the foraminal stenosis, the greater the pain reduction effect was three months after the procedure. Full article

(This article belongs to the Special Issue Low Back Pain: Predominant Neuropathic, Nociceptive, or Central Sensitization Pain)

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9 pages, 1072 KiB

Open AccessArticle

Predictive Value of the Phase Angle for Analgesic Efficacy in Lumbosacral Transforaminal Block

by Jeayoun Kim, Hue Jung Park, Woo Seog Sim, Seungwon Lee, Keoungah Kim, Woo Jin Kim and Jin Young Lee

J. Clin. Med. 2021, 10(2), 240; https://doi.org/10.3390/jcm10020240 - 12 Jan 2021

Cited by 1 | Viewed by 1338

Abstract

The mechanism of low back and leg pain involves mixed neuropathic and nociceptive components. Spinal neuropathic pain is related to increased levels of inflammatory cytokines and disrupted and increased permeability of the blood–spinal cord barrier, originally composed of tight junctions of capillary endothelial cells surrounded by lamina. The phase angle (PA) estimates cell membrane integrity using bioelectrical impedance analysis. We evaluated the predictive value of the PA for analgesic efficacy in lumbosacral transforaminal block. We retrospectively collected data from 120 patients receiving transforaminal blocks for lumbosacral radicular pain and assessed the PA before and 5 min following the block. Responders (group R) and non-responders (group N) were defined by ≥50% and <50% pain reduction, respectively, on a numerical rating scale, 30 min following the block; clinical data and the PA were compared. Among the 109 included patients, 50 (45.9%) and 59 (54.1%) had ≥50% and <50% pain reduction, respectively. In group N, the PA change ratio showed 88.1% specificity, 32.0% sensitivity, and 62.4% accuracy; a ratio of <0.087 at 5 min following the block predicted non-response. A PA change ratio of <0.087 at 5 min following lumbar transforaminal blocks predicted non-responders with high specificity. Full article

(This article belongs to the Special Issue Low Back Pain: Predominant Neuropathic, Nociceptive, or Central Sensitization Pain)

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9 pages, 206 KiB

Open AccessArticle

Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome

by Jin Young Lee, Woo Seog Sim, Ji Yeong Kim, Yu Ri Ko, So Young Lee, Mihyeon Lee, Seunghee Cho and Hue Jung Park

J. Clin. Med. 2020, 9(10), 3132; https://doi.org/10.3390/jcm9103132 - 28 Sep 2020

Cited by 1 | Viewed by 2075

Abstract

Persistent or recurrent back and leg pain following spinal surgery, known as failed back surgery syndrome (FBSS), significantly limits daily life activities. A lumbar epidural injection can reduce adhesions, inflammation, and nerve compression, although the epidural space can be distorted due to dura mater and epidural tissues changes after spinal surgery. This study analyzed subdural injection during lumbar epidural injection in FBSS patients. We retrospectively analyzed data from 155 patients who received a lumbar interlaminar epidural injection to manage FBSS. We grouped the patients based on the injected contrast medium appearance in the subdural (group S) or epidural spaces (group E) in fluoroscopic contrast images. Demographic, clinical, surgical and fluoroscopic data were recorded and evaluated, as were the pain scores before and after injection. There were 59 patients (38.1%) in the subdural group. Injection distance from the surgery level differed between the groups. Risk of subdural injection at level 1 distance from the surgery level had an odds ratio of 0.374, and at level ≥2, it was 0.172, when compared to level 0. Subdural incidence differed with the distance from surgical site. Physicians should strive to reduce subdural incidence when the injection is planned at surgery site in FBSS. Full article

(This article belongs to the Special Issue Low Back Pain: Predominant Neuropathic, Nociceptive, or Central Sensitization Pain)

Review

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13 pages, 1897 KiB

Open AccessReview

Changes in Back Pain Scores after Bariatric Surgery in Obese Patients: A Systematic Review and Meta-Analysis

by Froukje W. Koremans, Xiaolong Chen, Abhirup Das and Ashish D. Diwan

J. Clin. Med. 2021, 10(7), 1443; https://doi.org/10.3390/jcm10071443 - 01 Apr 2021

Cited by 6 | Viewed by 2538

Abstract

Bariatric surgery produces significant and quantifiable reductions in back pain. However, there is a lack of information on the association of weight changes after bariatric surgery with changes in pain score. We aim to evaluate the impact of bariatric surgery on back pain in obese patients and to address the association between changes in body mass index (BMI) and pain score. In obese patients eligible for bariatric surgery, the changes in pre- and post-operative pain scores, assessed by the Numeric Rating Pain Scale (NPS) or Visual Analogue Scale (VAS), were considered as primary outcomes. Mean difference (MD) and their 95% confidence intervals (CI) were evaluated. Eight cohort studies were included in the analysis of 298 obese patients undergoing bariatric surgery. All studies showed a reduction in back pain, with a mean change of −2.9 points in NPS and of −3.8 cm in VAS. There was a significant reduction in back pain (NPS: (MD = −3.49) (95% CI = −3.86, −3.12); VAS: MD = −3.75, (95% CI = −4.13, −3.37)) and BMI (MD = −12.93, (95% CI = −13.61, −12.24)) following bariatric surgery. No significant relationship between BMI change and decrease in clinical scores could be established. However, it was evident that bariatric surgery had a significant effect on back pain scores in severely obese patients. Ideally, a prospective study including spinal imaging, inflammatory markers, a longer follow-up period, and larger study groups with a randomized control group needs to be performed. Full article

(This article belongs to the Special Issue Low Back Pain: Predominant Neuropathic, Nociceptive, or Central Sensitization Pain)

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