Influence of BMI, gender, and sports on pain decrease and medication usage after facet–medial branch neurotomy or SI joint lateral branch cooled RF-neurotomy in case of low back pain: original research in the Austrian population

Abstract Background Research suggests that individuals with low back pain (LBP) may have poorer motor control compared to their healthy counterparts. However, the sample population of almost 90% of related articles are young and middle-aged people. There is still a lack of a systematic review about the balance performance of elderly people with low back pain. This study aimed to conduct a systematic review and meta-analysis to understand the effects of LBP on balance performance in elderly people. Methods This systematic review and meta-analysis included a comprehensive search of PubMed, Embase, and Cochrane Library databases for full-text articles published before January 2020. We included the articles that 1) investigated the elderly people with LBP; 2) assessed balance performance with any quantifiable clinical assessment or measurement tool and during static or dynamic activity; 3) were original research. Two independent reviewers screened the relevant articles, and disagreements were resolved by a third reviewer. Results Thirteen case-control studies comparing balance performance parameters between LBP and healthy subjects were included. The experimental group (LBP group) was associated with significantly larger area of centre of pressure movement (P < 0.001), higher velocity of centre of pressure sway in the anteroposterior and mediolateral directions (P = 0.01 and P = 0.02, respectively), longer path length in the anteroposterior direction (P < 0.001), slower walking speed (P = 0.05), and longer timed up and go test time (P = 0.004) than the control group. Conclusion The results showed that balance performance was impaired in elderly people with LBP. We should pay more attention to the balance control of elderly people with LBP.

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Patterns of pain medication usage and personality disturbance in chronic low back pain patients

Pain ◽

10.1016/0304-3959(81)90485-1 ◽

1981 ◽

Vol 11 ◽

pp. S225

Author(s):

C. McCreary ◽

A. Colman

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Pain Medication ◽

Low Back ◽

Medication Usage ◽

Personality Disturbance ◽

Pain Patients

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Chronic Low Back Pain: The Therapeutic Benefits of Diagnostic Medial Branch Nerve Blocks

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e521 ◽

2021 ◽

pp. E521-E528

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Nerve Block ◽

Chronic Low Back Pain ◽

Facet Joint ◽

Small Sample ◽

Therapeutic Effects ◽

Medial Branch ◽

Low Back ◽

Therapeutic Benefits

BACKGROUND: Chronic low back pain (CLBP) is an extremely prevalent disease, whose etiology is often multifactorial. Facet joint arthropathy is one of the most common causes of CLBP. Facet joints are innervated by the medial branches of the primary and adjacent level dorsal rami and are, therefore, key potential targets for the symptomatic management of CLBP. A lumbar medial branch nerve block (MBB) procedure is often used to assist in the diagnosis of facet mediated CLBP. For unclear reasons, some patients experience protracted relief of CLBP after diagnostic MBBs alone. OBJECTIVE: To describe the phenomenon of protracted relief of CLBP after diagnostic MBBs and search for predictors of this response. STUDY DESIGN: A retrospective chart review of patients who underwent MBB procedures by a single practitioner, over a 2 year period, was conducted. SETTING: All patients were seen at the Montefiore Multidisciplinary Pain Program, Bronx, NY. METHODS: Data from follow up visits was used to categorize patient’s response to MBBs as having no relief (NR), transient relief (TR) or protracted relief (PR). Patient demographics and characteristics were collected, and a multivariate analysis investigating associations with PR was conducted. RESULTS: 146 patients met inclusion criteria. 41 patients (28%) had NR, 54 (37%) had TR, and 51 (35%) had PR. CLBP symptom duration of < 6 months (P = 0.013) and unilateral back pain symptoms (P = 0.0253) were significantly associated with PR after MBB. LIMITATION: This is a retrospective study with a relatively small sample size conducted on patients belonging to a single practitioner. Outcomes were based largely on subjective patient satisfaction scores. CONCLUSIONS: In select patients, MBB may produce protracted relief of CLBP symptoms. The authors present distinct hypotheses which may help explain the therapeutic effects of diagnostic MBB procedures. KEY WORDS: Chronic low back pain, facet joint, medial branch nerve block

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Ultrasound-Guided percutaneous neuromodulation in non-radiating low back pain

Revista Fisioterapia Invasiva ◽

10.1055/s-0039-3402503 ◽

2019 ◽

Vol 02 (02) ◽

pp. 124-124

Author(s):

Sanmartin Enriquez F. ◽

Valera Garrido F. ◽

Álvarez Prats D. ◽

Carvajal Fernández O.

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Treatment Protocol ◽

Wilcoxon Test ◽

Medial Branch ◽

Low Back ◽

Ultrasound Guided ◽

Final Sample ◽

Multiple Treatments

Abstract Background Low back pain is very common, affecting 15–20% of the population each year, and representing of the main causes of physical therapy consultations. Multiple treatments have been defined for chronic low back pain, however, the findings are still controversial, and therefore new and improved solutions are necessary for the population who suffers from low back pain. Aims To evaluate the effectiveness of ultrasound-guided percutaneous neuromodulation (US-guided PNM) in patients with non-radiating low back pain. Material and Methods An experimental study was performed in patients with non-radiating low back pain, between the months of march and may of 2018 at the F&S-Narón Physical Therapy clinic, in A Coruña. Functionality was evaluated via the Oswestry questionnaire and pain was evaluated using the visual analog scale (VAS). US-guided NMP was applied to stimulate the medial branch of a L2 posterior ramus and the iliohypogastric and ilioinguinal nerves, following the protocol described by Valera & Minaya, which consists of the application of a PES type current at 10Hz and 240 microseconds, during 15 seconds and for 6 applications. In total, 3 sessions were applied (sequence 1:7:7), once a week after the first week of initiating treatment. Results Initially, 12 patients participated in the study, aged between 32 and 59 years. The mean age was 41.4 years. Two of the patients abandoned the study due to personal reasons, unrelated to the research. The final sample consisted of 10 subjects, 50% of each sex. 80% of patients improved after the application of the treatment protocol. An important decrease in activity limitations was observed, from 14 to 4.35 points out of 100 according to the Oswestry questionnaire, and a decrease of 6.8 to 2.15 points out of 10 was observed on the VAS scale, which was statistically significant according to the Wilcoxon test (p < 0,05). Conclusions The ultrasound-guided percutaneous neuromodulation technique used was effective, obtaining positive results in relation to pain and functionality. Clinical studies are necessary with a greater sample size to confirm these findings.

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Posterior Branches of Lumbar Spinal Nerves – part II: Lumbar Facet Syndrome – Pathomechanism, Symptomatology and Diagnostic Work-up

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/15093492.1237716 ◽

2017 ◽

Vol 19 (2) ◽

pp. 101-109 ◽

Cited By ~ 2

Author(s):

Katarzyna Kozera ◽

Bogdan Ciszek ◽

Paweł Szaro

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Facet Joint ◽

Medial Branch ◽

Low Back ◽

Spinal Nerves ◽

Lower Lumbar Spine ◽

Facet Syndrome ◽

Lumbar Spinal ◽

Lumbar Facet

Posterior branches of the lumbar spinal nerves are the anatomic substrate of pain in the lower back, sacrum and the gluteal area. Such pain may be associated with various pathologies which cause pain in the posterior branches of the lumbar spinal nerves due to entrapment, mechanical irritation or inflammatory reaction and/or degeneration. The posterior branches are of significant functional importance, which is related to the function of the structures they supply, including facet joints, which are the basic biomechanical units of the spine. Low back pain caused by facet joint pathology may be triggered e.g. by simple activities, such as body rotations, unnatural positions, lifting heavy weights or excessive bending as well as chronic overloading with spinal hyperextension. Pain usually presents at the level of the lumbosacral junction (L 5 -S 1 ) and in the lower lumbar spine (L 4-5 , L 3-4 ). In the absence of specific diagnostic criteria, it is only possible to conclude that patients display tenderness at the level of the affected facet joint and that the pain is triggered by extension. Differential diagnosis for low back pain is difficult, since the pain may originate from various structures. The most reliable method of identifying Lumbar Facet Syndrome has been found to be a positive response to an analgesic procedure in the form of a block of the medial branch or intraarticular injection. There appear to be good grounds for conducting further studies and developing unequivocal diagnostic tests.

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Sacroiliac joint pain in the pediatric population

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.2.peds11220 ◽

2012 ◽

Vol 9 (6) ◽

pp. 602-607 ◽

Cited By ~ 11

Author(s):

Ivan Stoev ◽

Alexander K. Powers ◽

Joan A. Puglisi ◽

Rebecca Munro ◽

Jeffrey R. Leonard

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pediatric Patients ◽

Pediatric Population ◽

Response To Treatment ◽

Home Exercise ◽

Dramatic Improvement ◽

Minor Trauma ◽

Low Back ◽

Si Joint

Object The sacroiliac (SI) joint can be a pain generator in 13%–27% of cases of back pain in adults. These numbers are largely unknown for the pediatric population. In children and especially girls, development of the pelvic girdle makes the SI joint prone to misalignment. Young athletes sustain repeated stress on their SI joints, and sometimes even minor trauma can result in lasting pain that mimics radiculopathy. The authors present a series of 48 pediatric patients who were evaluated for low-back pain and were found to have SI joint misalignment as the cause of their symptoms. They were treated with a simple maneuver described in this paper that realigned their SI joint and provided significant improvement of symptoms. Methods A retrospective review of the electronic records identified 48 patients who were referred with primary complaints of low-back pain and were determined to have SI joint misalignment during bedside examination maneuvers described here. Three patients did not have a record of their response to treatment and were excluded. Patients were evaluated by a physical therapist and had the realignment procedure performed on the day of initial consultation. The authors collected data regarding the immediate effect of the procedure, as well as the duration of pain relief at follow-up visits. Results Eighty percent of patients experienced dramatic improvement in symptoms that had a lasting effect after the initial treatment. The majority of them were given a home exercise program, and only 2 of the 36 patients who experienced significant relief had to be treated again. Fifty-three percent of all patients had immediate and complete resolution of symptoms. Three of the 48 patients had missing data from the medical records and were excluded from computations. Conclusions Back pain is multifactorial, and the authors' data demonstrate the potential importance of SI joint pathology. Although the technique described here for treatment of misaligned SI joints in the pediatric patients is not effective in all, the authors have observed significant improvement in 80% of cases. Often it is difficult to determine the exact cause of back pain, but when the SI joint is suspected as the primary pathology, the authors have described a simple and effective bedside treatment that should be attempted prior to the initiation of further testing and surgery.

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Endoscopic Radiofrequency Treatment of the Sacroiliac Joint Complex for Low Back Pain: A Prospective Study with a 2-Year Follow-Up

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.e11 ◽

2019 ◽

Vol 2 (22.2) ◽

pp. E111-E118

Author(s):

Albert E. Telfeian

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Radiofrequency Ablation ◽

Minimally Invasive ◽

Sacroiliac Joint ◽

Sensory Nerve ◽

Case Series ◽

Low Back ◽

Radiofrequency Treatment ◽

Si Joint

Background: The sacroiliac joint complex (SIJC) is considered a major sources of chronic low back pain. Interventional procedures for sacroiliac (SI) joint pain tend to be short-lived and surgical treatment usually involves a fusion procedure. Objectives: To determine the clinical efficacy of endoscopically visualized radiofrequency treatment of the SIJC in the treatment of low back pain. Study Design: Retrospective chart review. Setting: This study took place in a single-center, orthopedic specialty hospital. Methods: Patients received general anesthesia and under endoscopic visualization, radiofrequency ablation was performed on 1) the perforating branches that innervate the posterior capsule of the SI joint capsule, 2) along the course of the long posterior SI ligament, 3) the lateral edges of the S1, S2, and S3 foramen, and 4) the L4, L5, and S1 medial marginal nerve branches along the lateral facet margins. Results: From January 2015 to June 2016, a total of 30 patients who met the precise inclusion criteria were treated with the endoscopic SIJC radiofrequency treatment for low back pain. The average patient was aged 56 years (19 women and 11 men), the average preoperative visual analog scale (VAS) score was 7.23, and the average Oswestry disability index (ODI) score was 44.8. VAS and ODI were measured at 3, 6, 9, 12, 15, 21 and 24 months: VAS was reduced from 7.23 at baseline to 2.82 at 24 months (61% reduction), and ODI was improved from 44.8 at baseline to 22.2 at 24 months (50% reduction). Limitations: Small retrospective case series. Conclusions: Full-endoscopic radiofrequency ablation of the large sensory SI joint innervation complex, that includes the sensory nerve branches along the lateral S1-3 foramina and the L4-S1 medial branches, is perhaps a minimally invasive surgical procedure that could provide significant relief of lumbar back pain in the carefully selected patient. Key words: Endoscopic spine surgery, minimally invasive, low back pain, sacroiliac joint, radiofrequency treatment

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Sacroiliac Joint Injections: Computed Tomography

10.1093/med/9780199908004.003.0039 ◽

2016 ◽

Author(s):

Mira Herman ◽

Amaresh Vydyanathan ◽

Allan L. Brook

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Sacroiliac Joint ◽

Cushing Syndrome ◽

Joint Disease ◽

Outpatient Basis ◽

Low Back ◽

Limited Mobility ◽

Si Joint ◽

Joint Injections

Sacroiliac (SI) joint disease is a common cause of low back pain. It is not easily diagnosed by physical examination, as the joint has limited mobility and referral patterns are not sufficiently delineated from other pathological conditions implicated in low back pain. The accuracy of provocative testing of the sacroiliac joint is controversial. Many physicians use injection of the SI joint with local anesthetic and/or steroid as a diagnostic and therapeutic tool in treating SI joint–related pain. Historically, SI joint intra-articular injections have been performed without imaging guidance. Imaging-guided techniques, often using CT fluoroscopy, increase the precision of these procedures and help confirm needle placement while achieving better results and reduced complications rates. Sacroiliac joint injection is routinely performed on an outpatient basis. The patient is questioned regarding previous steroid use (oral, cutaneous, or injected) to avoid iatrogenic Cushing syndrome. Repeat injections can be administered depending on patient’s response.

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Periprocedural Pain and Outcome Difference of Local Anesthetic vs Mechanodesensitization During Lumbar Facet Blocks for Low Back Pain

Pain Medicine ◽

10.1093/pm/pnaa111 ◽

2020 ◽

Vol 21 (10) ◽

pp. 2100-2104

Author(s):

Bilal Aleem ◽

Muhammad Muslim Mubashir ◽

Erin Clark ◽

Daniel Vardeh

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Local Anesthetic ◽

Secondary Outcome ◽

Medial Branch ◽

Low Back ◽

Pain Scores ◽

Global Comparison ◽

Significant Difference ◽

Lumbar Facet

Abstract Objective To compare periprocedural pain from mechanodesensitization (MD) with local anesthetic (LA) during medial branch blocks (MBBs), with a secondary outcome to compare diagnostic responses during the five hours postprocedure. Methods Forty-four patients with low back pain underwent three level bilateral MMBs. For the LA technique, 0.5 mL of 1% lidocaine was injected subcutaneously on one side, and for MD the skin was stretched using the index finger and thumb on the other. A 25-gauge 3.5-inch spinal needle was inserted over each target area, and the periprocedural pain was recorded on the numeric rating scale (NRS). After fluoroscopic positioning, the patient’s side preference was recorded. Patients were discharged with a pain diary to record pain scores every 30 minutes for five hours. Results Despite reporting higher pain scores with LA vs MD (P = 0.0462, mean difference ± SEM = 0.4924 ± 0.2459), global comparison favored LA. Pain scores with LA dropped from an average baseline of 6.11 to a mean NRS ± SEM of 2.461 ± 0.615, and with MD from 6.11 to 2.599 ± 0.552 (P ≤ 0.001). While there was no significant difference in area under the curve comparison over five hours (P = 0.3341), there was a trend toward lower pain scores with LA use. Conclusions LA before needle insertion for MBBs appears to be more painful compared with MD. Additionally, subcutaneously administered local anesthetic may have a therapeutic effect on nonspecific low back pain, resulting in a potentially false-positive test in the evaluation of lumbar facet pain.

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