Kinesiophobia and Its Association With Health-Related Quality of Life Across Injury Locations

Can Primary Care for Back and/or Neck Pain in the Netherlands Benefit From Stratification for Risk Groups According to the STarT Back Tool Classification?

Benefits of the Restorative Exercise and Strength Training for Operational Resilience and Excellence Yoga Program for Chronic Low Back Pain in Service Members: A Pilot Randomized Controlled Trial

Psychological Features and Their Relationship to Movement-Based Subgroups in People Living With Low Back Pain

Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis

Effect of Soft Braces on Pain and Physical Function in Patients With Knee Osteoarthritis: Systematic Review With Meta-Analyses

Exercise Therapy in Juvenile Idiopathic Arthritis: A Systematic Review and Meta-Analysis

Meta-analysis of transcutaneous electrical nerve stimulation for relief of spinal pain

Abstract

We conducted a systematic review and meta-analysis analysing the existing data on transcutaneous electrical nerve stimulation (TENS) or interferential current (IFC) for chronic low back pain (CLBP) and/or neck pain (CNP) taking into account intensity and timing of stimulation, examining pain, function and disability. Seven electronic databases were searched for TENS or IFC treatment in non-specific CLBP or CNP. Four reviewers independently selected randomized controlled trials (RCTs) of TENS or IFC intervention in adult individuals with non-specific CLBP or CNP. Primary outcomes were for self-reported pain intensity and back-specific disability. Two reviewers performed quality assessment, and two reviewers extracted data using a standardized form. Nine RCTs were selected (eight CLBP; one CNP), and seven studies with complete data sets were included for meta-analysis (655 participants). For CLBP, meta-analysis shows TENS/IFC intervention, independent of time of assessment, was significantly different from placebo/control (p < 0.02). TENS/IFC intervention was better than placebo/control, during therapy (p = 0.02), but not immediately after therapy (p = 0.08), or 1–3 months after therapy (p = 0.99). Analysis for adequate stimulation parameters was not significantly different, and there was no effect on disability. This systematic review provides inconclusive evidence of TENS benefits in low back pain patients because the quality of the studies was low, and adequate parameters and timing of assessment were not uniformly used or reported. Without additional high-quality clinical trials using sufficient sample sizes and adequate parameters and outcome assessments, the outcomes of this review are likely to remain unchanged.

Significance

These data highlight the need for additional high-quality RCTs to examine the effects of TENS in CLBP. Trials should consider intensity of stimulation, timing of outcome assessment and assessment of pain, disability and function.

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Blocking of cytokines signalling attenuates evoked and spontaneous neuropathic pain behaviours in the paclitaxel rat model of chemotherapy-induced neuropathy

Abstract

Background

Chemotherapy-induced peripheral neuropathic pain (CIPNP) is a serious dose-limiting neurotoxic effect of cancer drug treatment. The underlying mechanism(s) of this debilitating condition, which lacks effective drug treatment, is incompletely understood. However, neural–immune interactions, involving increased expression and release of cytokines, are believed to be involved. Here, we examined, in the paclitaxel rat model of CIPNP, whether plasma levels of 24 cytokines/chemokines change after paclitaxel treatment, and whether blocking of signalling of some of those cytokines would reverse/attenuate behavioural signs of CIPNP.

Methods

To achieve these objectives luminex, pharmacological and behavioural experiments were performed on male Wistar rats (250–300 g) 31 days after the last injection of paclitaxel (1 mg/kg, i.p. on four alternate days) as well as on control (vehicle-treated) rats.

Results

Compared with control rats, plasma levels of IL-1α, IL-1β, IL-6, TNF-α, INF-γ and MCP-1 were significantly upregulated in paclitaxel-treated rats. Blocking of TNF-α signalling with etanercept (2 mg/kg, i.p.) or IL-1β with IL-1 receptor antagonist (IL-1ra; 3 mg/kg, i.p.), significantly attenuated established mechanical and cold hypersensitivity as well as spontaneous pain behaviour (spontaneous foot lifting) 24 and 48 h postdrug treatment. Pharmacological blockade of MCP-1/CCL2 signalling with a highly selective CCR2 receptor antagonist (S504393, 5 mg/kg, i.p.) also significantly reduced evoked, but not spontaneous, pain behaviours of CIPNP in paclitaxel-treated rats at the same time points.

Conclusions

The findings support the notion that cytokines/chemokines, particularly TNF-α, IL-1 and MCP-1, are involved in the pathophysiology of CIPNP and suggest that strategies that target their inhibition may be effective in treating CIPNP.

Significance

This study demonstrates that paclitaxel-treated rats exhibit, in addition to indices of mechanical and cold hypersensitivity, a behavioural sign of spontaneous pain, the principal compliant of patients with neuropathic pain. This was accompanied by upregulation in plasma levels of key cytokines/chemokines (IL-1α, IL-1β, IL-6, TNF-α, INF-γ and MCP-1) 31 days post-treatment. However, it is noteworthy that cytokine release, rather than nerve injury per se, may be causative of NP in this model of CIPNP. Nevertheless, our findings that pharmacological blockade of TNF-α, IL-1β and MCP-1 attenuated both evoked and spontaneous pain suggest that strategies that target inhibition of these cytokines may be effective in treating CIPNP.

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Operant self-administration of pregabalin in a mouse model of neuropathic pain

Abstract

Background

Pregabalin is a first-line agent for neuropathic pain treatment whose abuse liability remains controversial. Surprisingly, studies exploring the reinforcing properties of pregabalin in operant mouse models are missing.

Methods

We evaluated the acquisition of operant pregabalin self-administration in mice exposed to a partial sciatic nerve ligation (PSNL) or a sham operation. After surgery, mice were trained in operant boxes to intravenously self-administer pregabalin at 1.5 or 3 mg/kg/inf or saline during 10 days. Thermal and mechanical sensitivity were assessed before and after self-medication, and depressive-like behaviour was evaluated after discontinuation of the treatment.

Results

Partial sciatic nerve ligation and sham-operated mice exposed to pregabalin at 3 mg/kg/inf showed higher active responding compared to mice exposed to saline. The differences in active responding were more robust in nerve-injured than in sham-operated mice. Self-medication at either dose of pregabalin partially inhibited thermal hypersensitivity, whereas only self-medication at 3 mg/kg/inf reduced mechanical sensitivity. Finally, a depressive-like behaviour was revealed after saline treatment in nerve-injured mice, and this emotional manifestation was abolished after pregabalin treatment at the high dose.

Conclusions

Pregabalin showed reinforcing effects both in PSNL and sham-operated mice and attenuated the nociceptive and emotional manifestations of neuropathic pain in mice self-administering this drug. Therefore, pregabalin self-administration was related to neuropathic pain relief, but also to reinforcing properties related to psychotropic drug effects. This study reveals the improvement in nociceptive and emotional manifestations of neuropathic pain after operant pregabalin self-medication in mice and suggests the reinforcing effects of this drug in an operant paradigm.

Significance

This study shows that mice with a nerve injury self-administer pregabalin at doses effective reducing nociceptive hypersensitivity and depressive-like behaviour associated with the neuropathic pain model. Interestingly, mice without neuropathy also develop operant self-administration behaviour, suggesting potential abuse liability of this first-line drug for neuropathic pain treatment.

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Pain patterns during adolescence can be grouped into four pain classes with distinct profiles: A study on a population based cohort of 2953 adolescents

Abstract

Introduction

Although multi-site pain is common in adolescents, pain conditions are frequently diagnosed and treated in isolation. Little is known about whether there are specific sites in which pain commonly co-occurs. This study examines the patterns of pain in adolescents, and whether these are associated with sports participation, health-related quality of life (HRQoL), and sex.

Methods

In previously collected cohort data (‘Adolescent Pain in Aalborg-2011’), adolescents (aged 12–19) completed an online questionnaire, including demographic data, current pain sites, sports participation and HRQoL (assessed by Euro-QoL 5D-3L). Latent class analysis was used to classify spatial pain patterns, based on the pain sites. The analysis included 2953 adolescents.

Results

Four classes were identified as follows: (1) little or no pain (63% of adolescents), (2) majority lower extremity pain (10%), (3) multi-site bodily pain (22%) and (4) head and stomach pain (3%). The lower extremity multi-site pain group reported highest weekly sports participation (p < 0.001; mean: 2.9 days/week; 95% CI 2.7 to 3.2), while the multi-site bodily pain and the multi-site head and stomach pain groups had lowest EQ-5D scores (p < 0.001). Males were more likely to belong to the little or no pain class, whereas females were more likely to belong to the multi-site bodily pain class.

Conclusions

Latent class analysis identified distinct classes of pain patterns in adolescents, characterized by sex, differences in HRQoL and sports participation. The class with multi-site bodily pain and reduced quality of life was the largest among adolescents reporting pain, and future research on treatment strategies should consider targeting this group.

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A biopsychosocial understanding of lower back pain: Content analysis of online information

Abstract

Objectives

(1) To develop a checklist to assess the representation of biopsychosocial lower back pain (LBP) online information; (2) to analyse publicly accessed online LBP information from a Google search for the degree that psychosocial contributors are described alongside the traditional biomedical approach to explaining LBP; (3) whether websites use information on pain biology to educate on LBP; (4) any inaccurate or false information regarding the mechanisms of LBP and; (5) the amount of websites certified by established benchmarks for quality health information.

Materials and methods

An online search was conducted using the Google search engines of six major English-speaking countries. Website content was analysed using three checklists developed for the purpose of this study – Biopsychosocial information categorisation checklist and scoring criteria; pain biology information checklist; and the inaccurate information checklist. Website quality was identified by the presence of an Health on the Net certification (HONcode).

Results

Of the fifteen websites analysed, the content of 26.7% of websites was classified as ‘biomedical’, 60% ‘limited psychosocial’ and 13.3% ‘reasonable psychosocial’; 20% included information on pain biology; 46.7% inaccurately implied pain to be equal to tissue damage and 46.7% implied pathways specific to pain transmission; 40% were HONcode certified.

Conclusion

Online LBP information retrieved through a Google search has limited to no integration of psychosocial or pain biology information. The focus on tissue pathology is further supported by the inaccurate descriptions of pain as equal to tissue damage and as an input to the central nervous system (CNS). Online LBP information needs to be guided by criteria more sensitive to the psychosocial contributors to pain.

Significance

The online LBP information retrieved from a Google search needs to be guided by information more sensitive to the psychosocial contributors to pain and disability. This study also highlights the presence of inaccurate information that implied pain as a measure of tissue damage or as an input to the nervous system.

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The effect of visual feedback of body parts on pain perception: A systematic review of clinical and experimental studies

Abstract

The aim of this systematic review was to evaluate the effect of visual feedback techniques on pain perception by analysing the effect of normal-sized, magnified or minified visual feedback of body parts on clinical and experimentally-induced pain. Databases searched: Medline, Embase, PsychInfo, PEDro, CINAHL, CENTRAL and OpenSIGLE. Studies investigating pain patients and pain-free participants exposed to experimentally-induced pain were analysed separately. Risk of bias was assessed and data were meta-analysed. Thirty four studies were included. A meta-analysis of clinical data favoured mirror visual feedback (six trials; mean difference = −13.06 mm; 95% CI = −23.97, −2.16). Subgroup analysis favoured mirror visual feedback when used as a course of treatment (three trials; mean difference = −12.76 mm; 95% CI = −24.11, −1.40) and when used for complex regional pain syndrome for complex regional pain syndrome (three trials; standard mean difference = −1.44; 95% CI = −1.88, −0.99). There is insufficient evidence to determine differences between normal-sized view and a size-distorted view of the limb. Mirror visual feedback was not superior to object view or direct view of the hand for reducing experimental pain in pain-free participants. There were inconsistencies in study findings comparing normal-sized reflection of a body part and a reflection of an object, or a magnified or minified reflection. There is tentative evidence that mirror visual feedback can alleviate pain when delivered as a course of treatment, and for patients with complex regional pain syndrome. It was not possible to determine whether normal-sized, magnified or minified visual feedback of body parts affects pain perception because of contradictory findings in primary studies.

Significance

It was not possible to determine whether normal-sized, magnified or minified visual feedback of body parts affected pain perception in clinical or experimental settings because of contradictory findings in primary studies. This emphasizes the need for higher quality studies.

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Pain begets pain. When marathon runners are not in pain anymore, they underestimate their memory of marathon pain––A mediation analysis

Abstract

Background

A previous study has shown that memory of pain induced by running a marathon might be underestimated. However, little is known about the factors that might influence such a memory distortion during pain recall. The aim of the study was to investigate the memory of pain induced by running a marathon and the factors that might influence it: (1) present pain during recall and (2) recall delay.

Methods

A total of 127 marathon runners participated in the study, which comprised of two phases. After completion of the marathon, participants were asked to rate the intensity and the unpleasantness of their pain. Either a week or a month later, they were asked again to rate the intensity and the unpleasantness of the remembered and present pain experience.

Results

Participants underestimated remembered pain intensity and pain unpleasantness only if they did not experience pain during recall (p < 0.05). We observed a trend for underestimation after a week (p = 0.09) and significant effect after a month (p < 0.05) of recall delay. Furthermore, present pain intensity during recall significantly mediated the memory of pain intensity induced by running the marathon, but only after a month. Similarly, present pain unpleasantness during recall significantly mediated the memory of pain unpleasantness, but only after a month.

Conclusions

It is concluded that memory of pain induced by running the marathon is underestimated after a month of recall delay and mediated by present pain during recall.

Significance

This study explores factors acting during recall, influencing memory of naturally occurring pain induced by physical effort. The empirical findings provide the first robust evidence for a causal relationship between memory of pain and present pain during recall.

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Laminoplasty Does not Lead to Worsening Axial Neck Pain in the Properly Selected Patient With Cervical Myelopathy: A Comparison With Laminectomy and Fusion

Study Design. Retrospective cohort study of prospectively collected data. Objective. To determine if laminoplasty (LP) is associated with worsening axial neck pain in patients with multilevel cervical myelopathy, and to compare neck pain, clinical outcomes, and radiographic measures in a group undergoing laminectomy and fusion (LF). Summary of Background Data. Postoperative new or worsening axial neck pain is commonly cited as a major disadvantage of laminoplasty. However, there remains a paucity of corroborative data from large series. Methods. Following institutional review board approval, we reviewed the medical records, radiographs, and prospective clinical outcomes database of 85 patients undergoing LP and 52 patients undergoing LF for cervical myelopathy with minimum 1-year radiographic follow-up and average clinical follow-up of 18.5 months. LP was performed in those with neutral to lordotic C2–7 alignment and who did not complain of diffuse axial pain. Otherwise, LF was performed. Clinical outcomes included visual analogue score (VAS)-neck pain, VAS-total pain, neck disability index (NDI), short form 36, modified Japanese Orthopaedic Association (mJOA), and several radiographic parameters. Results. VAS-neck did not worsen in LP (−0.2, P = 0.54) and did improve in LF (−2.0, P = 0.0013). VAS-total improved significantly in both groups (LF −1.04 ± 0.52, P = 0.05; LP −1.4 ± 0.51, P = 0.008). NDI improved in both groups, but was significant in only LP (LP decreased 6.79 ± 2.25, P = 0.0032; LF decreased 4.01 ± 3.05, P = 0.19). mJOA scores improved significantly in both groups (LP improved 2.89 ± 0.27, P < 0.0001; LF improved 2.45 ± 0.33, P < 0.0001). There was a small loss of cervical lordosis in both groups that was significant in LP (LP 2.92° loss, P = 0.0181; LF 1.25° loss, P = 0.53). Conclusion. In a carefully selected group of myelopathic patients without significant diffuse axial pain preoperatively and appropriate sagittal alignment, laminoplasty did not lead to worsening axial neck pain, and it was associated with significant improvements in other clinical and myelopathy outcomes. Although laminoplasty is not indicated in every myelopathic patient, this study exemplifies its efficacy as a non-fusion operation in the appropriately selected patient and assuages concerns regarding worsening axial neck pain in such patients following surgery. Level of Evidence: 3

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Long-term Radiological and Clinical Outcomes After Using Bone Marrow Mesenchymal Stem Cells Concentrate Obtained With Selective Retention Cell Technology in Posterolateral Spinal Fusion

Study Design. Retrospective study. Objective. The aim of this study was to evaluate the long-term clinical and radiological outcomes of the use of bone marrow mesenchymal stem cell concentrate obtained with selective cell retention technology using Cellect with a particular collagen scaffold, Healos for posterolateral spinal fusion. Summary of Background Data. With the increasing rate of spinal fusion, the problem of pseudarthrosis, which contributes to recurrent pain with patient disability, is considered to be the most common cause of revision lumbar spine surgery. Intensive research is being carried out to develop an alternative source of bone grafting and improve the spinal fusion rate. Methods. A retrospective review of hospital records was performed. Identified patients were contacted to have a clinical and radiological evaluation follow-up. Clinical outcome was evaluated using visual analog scales for the back pain (VAS), Oswestry Disability Index (ODI) scores, and quality of life (EQ-5D) questionnaire. Radiological outcome was evaluated by performing dynamic flexion/extension lateral views and calculation of segmental Cobb angle. Any implant-associated complication was reported. Computed tomography (CT) scans were also performed. Results. Twenty-one patients were included and all patients achieved successful fusion. The mean difference of the segmental Cobb angle was 0.48° (range 0.3°–0.7°). Computed tomography scans showed solid bilateral fusion with bridging bone (Grade I) in all patients, but solid unilateral fusion with bridging bone (Grade II) was detected for one patient at one level. Patients started to resume working activities within a mean period of 3.5 months. The VAS score for the residual back pain was 4.1 ± 2.1, whereas the ODI was 10.5 ± 5.6 points, and the mean disability index was 21.1%. Conclusion. The use of bone marrow mesenchymal stem cell concentrate obtained with selective cell retention technology could be considered as an effective means for augmenting spinal fusion. Level of Evidence: 3

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Feasibility and Outcome of an Accelerated Recovery Protocol in Asian Adolescent Idiopathic Scoliosis Patients

Study Design. A prospective cohort study. Objective. The aim of this study was to determine the feasibility of an accelerated recovery protocol for Asian adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF). Summary of Background Data. There has been successful implementation of an accelerated recovery protocol for AIS patients undergoing PSF in the western population. No similar studies have been reported in the Asian population. Methods. Seventy-four AIS (65 F, 9 M) patients scheduled for PSF surgery were recruited. The accelerated protocol encompasses preoperative regime, preoperative day of surgery counseling, intraoperative strategies, an accelerated postoperative rehabilitation and pain management regime. All patients were operated using a dual attending surgeon strategy. Outcome measures included pain scores at five time intervals, length of stay, and detailed recovery milestones. Any complications or readmissions during the first 4 months postoperative period were recorded. Results. Mean duration of operation was 2.2 ± 0.3 hours with a mean blood loss of 824.3 ± 418.2 mL. No patients received allogenic blood transfusion. The mean length of stay was 3.6 ± 0.6 days. Surgical wound pain score was 6.4 ± 2.1 at 12 hours, which reduced to 5.0 ± 2.0 at 60 hours. Abdominal pain peaked at 36 hours with pain scores 2.4 ± 2.9. First liquid intake was at 5.2 ± 7.5 hours, urinary catheter removal at 18.7 ± 4.8 hours, sitting up at 20.6 ± 9.1 hours, ambulation at 27.2 ± 0.5 hours, consumption of solid food at 32.2 ± 0.5 hours, first flatus at 39.0 ± 0.7 hours, and first bowel movement at 122.1 ± 2.0 hours. The complication rate was 1.4% due to superficial wound infection with one patient failed to comply with the accelerated protocol. Conclusion. An accelerated recovery protocol following PSF for AIS is feasible without increasing the complication or readmission rates. The total length of stay was 3.6 days and this is comparable with the outcome in western population. Level of Evidence: 4

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Minimal Clinically Important Difference in Quality of Life for Patients With Low Back Pain

Study Design. Multicenter, prospective, cohort study. Objective. To estimate the Minimal Clinically Important Difference (MCID) for the physical (PCS) and mental (MCS) component summaries of Short Form SF-12 (SF-12), in patients with low back pain (LBP). Summary of Background Data. Quality of life is one of the core domains recommended to be assessed in patients with LBP. SF-12 is the most widely used instrument for this purpose, but its MCID was unknown. Methods. A total of 458 patients with subacute and chronic LBP were consecutively recruited across 21 practices. LBP, referred pain, disability, PCS, and MCS were assessed upon recruitment and 12 months later. Self-reported health status change between baseline and 12 month-assessment, was used as the external criterion. The MCID for SF-12 was estimated following four anchor-based methods; minimal detectable change (MDC); average change (AC); change difference (CD); and receiver operating characteristic curve (ROC), for which the area under the curve (AUC) was calculated. The effect on MCID values of pain duration and baseline scores was assessed. Results. Values for PCS were: MDC: 0.56, AC: 2.71, CD: 3.29, and ROC: 1.14. Values for MCS were: MDC: 3.77, AC: 3.54, CD: 1.13, and ROC: 4.23. AUC values were <0.7; MCID values were smaller among chronic patients and those with better baseline quality of life. Conclusion. Different methods for MCID calculation lead to different results. In patients with subacute and chronic LBP, improvements >3.77 in MCS and >3.29 in PCS, can be considered clinically relevant. MCID is smaller in patients with longer pain duration and better baseline quality of life. Level of Evidence: 2

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Treatment Outcome of Metastatic Spine Tumor in Lung Cancer Patients: Did the Treatments Improve Their Outcomes?

Study Design. A retrospective, single-center study. Objective. Investigation of the changes in the treatment outcomes of patients with lung cancer derived metastatic spine tumors. Summary of Background Data. Metastatic spine tumors derived from lung cancer had been progressive, and their prognosis is poor. It has recently been reported that the use of molecularly targeted drugs and bone-modifying agents (BMAs) improved the treatment outcomes of patients with lung cancer, but no detailed information about the treatment of metastatic spine tumors has been reported. Methods. Two hundred seven patients with lung cancer derived metastatic spine tumors who were examined after 2000 were analyzed. They were divided into 54 patients who were treated in or before 2005 (surgical treatment: 25 patients, conservative treatment: 29 patients) (group B) and 153 patients who were treated from 2006 onwards, when a molecularly targeted drug and BMA were introduced (surgical treatment: 24, conservative treatment: 129) (group A), and the treatment outcomes of the two groups were compared. Results. Significant differences in age and the affected vertebral level, paralysis grade, and Tokuhashi score (general condition, the number of vertebral metastases, and the total score) were detected between the groups. Regarding treatment outcomes, the mean duration of the post-treatment survival period was 5.1 and 9.3 months in groups B and A, respectively, that is, it was significantly longer in group A (P < 0.05). No significant intergroup difference in pain improvement was noted, and no significant post-treatment improvement in paralysis was achieved in either group. The post-treatment discharge-to-home eligibility rate did not differ significantly between the groups, but the Barthel Index improved significantly after treatment in group A (P < 0.05). Conclusion. After molecularly targeted drugs and BMA were introduced as treatments for lung cancer derived metastatic spine tumors, the survival periods of patients with such tumors increased, and their activity of daily living after treatment improved. Level of Evidence: 4

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Does conditioned pain modulation predict the magnitude of placebo effects in patients with neuropathic pain?

Abstract

Background

Conditioned pain modulation (CPM) is a validated measure of the function of endogenous pain inhibitory pathways. Placebo effects reflect top-down inhibitory modulation of pain. CPM and placebo effects are both influenced by expectations, albeit to varying degrees, and are related to neurotransmitter systems such as the endogenous opioid system, and it can be speculated that CPM responses are positively associated with the magnitude of placebo effects. Yet, no studies have tested this.

Methods

The study included 19 patients with neuropathic pain. CPM was quantified as the difference in pressure pain threshold (PPT) as measured at the middle deltoid muscle before and after 5-min exposure to the cold pressor test (CPT) (conditioning pain stimulus). Placebo effects were tested via open and hidden applications of the pain-relieving agent lidocaine (2 mL) using a disinfection napkin controlled for no treatment.

Results

The mean (SD) PPT was 668.7 (295.7) kPa before and 742.3 (370.8) kPa after the CPT. The mean (SD) CPM response was −73.6 (214.0) kPa corresponding to an 11% increase in PPT, reflecting a normally functioning endogenous pain modulatory system. Large and significant placebo effects were observed in ongoing neuropathic pain intensity (p = 0.002). The CPM response did not predict the magnitude of the placebo effect (p = 0.765). Moreover, there were no interaction effects for the moderator variables: clinical pain level (p = 0.136), age (p = 0.347) and gender (p = 0.691).

Conclusions

Conditioned pain modulation and placebo effects do not seem to be associated in patients with neuropathic pain.

Significance

Conditioned pain modulation and placebo effects are endogenous pain-modulating phenomena that are influenced by some of the same mechanisms. This study suggests that CPM and placebo effects in neuropathic pain are independent phenomena that may be mediated by different mechanisms.

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Expectations about the effectiveness of pain- and itch-relieving medication administered via different routes

Abstract

Background

Placebo effects on pain have been found to vary in size for different routes of medication administration (e.g. oral vs. injection). This has important implications for both clinical research and practice. To enhance our understanding of these differential placebo effects, research on the underlying expectations about multiple routes and symptoms other than pain is vital.

Methods

A cross-sectional, Internet-based survey was conducted in a representative sample of the Dutch population (n = 508). Respondents rated the expected effectiveness of pain- and itch-relieving medication in six forms, representing oral, injection and topical routes of administration.

Results

Injected medication was expected to be most effective for relieving pain, and topical medication for relieving itch. Furthermore, exploratory analyses showed that injections were expected to have the most rapid onset and long-lasting effects, and to be most frightening and expensive, while topical medication was expected to be the safest and the easiest to use, and oral medication was expected to have the most side effects. Higher expected effectiveness was moderately associated with expectations of more rapid onset and long-lasting effects, and better safety and ease of use. Associations of expected effectiveness with respondent characteristics (e.g. medication use and personality characteristics) were statistically small or nonsignificant.

Conclusions

Expected effectiveness of medication differed depending on route of administration and targeted symptom. These findings have important implications for the design and interpretation of clinical trials and suggest that medication effects might be enhanced by prescribing medicine via the route that patients expect to be most effective for their complaint.

Significance

Differences in the expected effectiveness of medication depend on the route of administration (oral, injection, topical) and targeted symptom (pain, itch). These findings have important implications for clinical practice and the design and interpretation of clinical trials.

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The Social Regulation of Pain: Autonomic and Neurophysiological Changes Associated with Perceived Threat

• Social support was demonstrated to reduce pain experience.• Social support decreased heart rate and EEG frontal theta to the threat-of-pain.• Decreased heart rate and frontal theta were related to greater pain reduction.• Frontal theta was source localized to the insula and the rostral-ventral ACC.

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Prediction of Cervical Spinal Joint Loading and Secondary Motion Using a Musculoskeletal Multibody Dynamics Model Via Force-Dependent Kinematics Approach

Study Design. A cervical spine biomechanical investigation using multibody dynamics. Objective. To develop a comprehensive cervical spine multibody dynamics model incorporated with the force-dependent kinematics (FDK) approach, and to study the influence of soft tissue deformation on the joint loading prediction. Summary of Background Data. Musculoskeletal multibody dynamics models have been widely used to analyze joint loading. Current cervical spine musculoskeletal models, however, neglect the joint internal motion caused by soft tissue deformation. A novel FDK approach is introduced, which can predict joint internal motion and spinal joint loading simultaneously. Methods. A comprehensive cervical spine musculoskeletal model with the posterior facet joints and essential ligaments was developed. To quantify the influence of soft tissue structures on joint loading prediction, four different models with different features were created. These newly developed models were validated, under flexion-extension movement. The predicted intervertebral disc loads (from C3-C4 to C5-C6) were compared with the published cadaveric experimental results. Moreover, the predicted facet joint forces, ligament forces, and anterior-posterior translations of instantaneous centers of rotation were also studied. Results. The obtained intervertebral disc loads were varied among different models. Model 3 provided the closest prediction of joint loading to the experimental results. Moreover, the facet joint and ligament forces were in similar range of magnitude as literature findings. The predicted instantaneous centers of rotation translational changes were in accordance with the in vivo kinematics observation. Conclusion. In the present study, a validated cervical spine musculoskeletal model was developed, using multibody dynamics and FDK approach. It can simulate the function of musculature and consider joint internal motion, and thus provides more reliable joint loading prediction. This newly developed cervical model can be used as an efficient tool to study the biomechanical behaviors of human cervical spine, and to understand the fundamental pathologies of spinal pains. Level of Evidence: N /A

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Autonomic Arousal as a Mechanism of the Persistence of Nocebo Hyperalgesia

• Nocebo hyperalgesia is more resistant to extinction than placebo analgesia.• Nocebo hyperalgesia is accompanied by elevated anticipatory autonomic arousal.• Placebo analgesia is not associated with changes in anticipatory autonomic arousal.• Heightened autonomic arousal mediates nocebo hyperalgesia's failure to extinguish.

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Reasons for Distress Among Burn Survivors at 6, 12 and 24 Months Post-Discharge: A Burn Injury Model System Investigation

Trunk sway response to consecutive slip perturbations between subjects with and without recurrent low back pain

Trunk sway responses following perturbations are critical to develop adequate prevention strategies. It is unclear how postural responses with a handheld task can validly be transferred to treadmill-induced slip perturbations in subjects with recurrent low back pain (LBP).

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Pain and Fatigue Variability Patterns Distinguish Subgroups of Fibromyalgia Patients

• Fibromyalgia patients experience daily variability in pain, fatigue, and mood.• Differences in pain and social functioning emerged across variability clusters.• Targeting symptom variability may be an important clinical initiative.

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Concurrent validity and interrater reliability of a new smartphone application to assess 3D active cervical range of motion in patients with neck pain

There is a lack of valid, reliable, and feasible instruments for measuring planar active cervical range of motion (aCROM) and associated 3D coupling motions in patients with neck pain. Smartphones have advanced sensors and appear to be suitable for these measurements.

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Daily Fluctuations of Progesterone and Testosterone are Associated with Fibromyalgia Pain Severity

• Relationships between sex hormones and fibromyalgia were assessed daily.• Both progesterone and testosterone were associated with lower self-reported pain.• Estradiol fluctuations were not correlated with self-reported pain.• Pain was particularly elevated when progesterone was low and cortisol was high.

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Feeling the Pressure to be Perfect: Impact on Pain-Related Distress and Dysfunction in Youth with Chronic Pain

• Perfectionism in youth and their parents is contributory to pediatric chronic pain.• Fear of pain mediates relations between perfectionism and pain-related dysfunction.• Socially prescribed perfectionism is particularly influential in pediatric chronic pain.

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Evaluation of Cognitive Behavioral Interventions and Psychoeducation Implemented by Rehabilitation Specialists to Treat Fear-Avoidance Beliefs in Patients with Low Back Pain: A Systematic Review

Association between rainfall and diagnoses of joint or back pain: retrospective claims analysis

AbstractObjectiveTo study the relation between rainfall and outpatient visits for joint or back pain in a large patient population.DesignObservational study.SettingUS Medicare insurance claims data...

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The Involvement of the Endocannabinoid System in the Peripheral Antinociceptive Action of Ketamine

• Several studies about the antinociceptive effects of ketamine were made.• The CB1 cannabinoid receptor and the anandamide participation in ketamine mechanism was tested.• Ketamine induced peripheral antinociception by anandamide release.• ketamine as a peripheral analgesic for inflammatory pain.

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Chronic musculoskeletal pain in European older adults: Cross-national and gender differences

Abstract

Background

In an ageing Europe, chronic pain is a major public health problem, but robust epidemiological data are scarce. This study aimed to analyse the prevalence of and factors associated with chronic musculoskeletal pain by gender in older adults of 14 European countries.

Methods

A cross-sectional study was performed from wave 5 of the Survey of Health, Ageing and Retirement in Europe (SHARE). The study included people ≥50 years residing in Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Italy, Luxembourg, the Netherlands, Slovenia, Spain, Sweden and Switzerland. Chronic pain was defined as being bothered by joint and/or back pain for the previous 6 months. Multivariable Poisson regression models with robust variance were performed to analyse prevalence ratio by covariates, stratified by sex.

Results

A total of 61,157 participants were included. Overall prevalence of chronic musculoskeletal pain was 35.7% (28.8–31.7), ranging from 18.6% (17.1–20.1) for Switzerland to 45.6% (43.3–47.8) for France. Prevalence was higher in women than in men: 41.3% (40.2–42.4) versus 29.1% (28.0–30.3). Chronic musculoskeletal pain was lower in men aged >75 years (PR = 0.82; 0.72–0.92) than the younger (50–59) group. Separated/divorced status presented opposite effects among men (PR = 0.85; 0.76–0.96) and women (PR = 1.12; 1.03–1.21) compared with married, and unemployment was a significant factor in men (PR = 1.21; 95% CI 1.02–1.43) compared with employed.

Conclusions

Musculoskeletal pain in older European adults is very frequent, especially in women, with large differences depending on the country of residence. Health policy makers should prioritize strategies aimed at improving the prevention and management of chronic musculoskeletal pain in Europe.

Significance

This study provides epidemiological data of chronic musculoskeletal pain in older adults. Reported differences contribute to highlight the relevance of considering a gender perspective in chronic musculoskeletal pain research. Cross-national comparison also offers a map of differences that improves the knowledge of this chronic condition in Europe.

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The effects of walking intervention in patients with chronic low back pain: A meta-analysis of randomized controlled trials

The aim of this meta-analysis of randomized controlled trials was to gain insight into the effectiveness of walking intervention on pain, disability, and quality of life in patients with chronic low back pain (LBP) at post intervention and follow ups.

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Efficacy and Safety of Oral and Transdermal Opioid Analgesics for Musculoskeletal Pain in Older Adults: a Systematic Review of Randomized, Placebo-Controlled Trials

This systematic review with meta-analysis was performed to evaluate the efficacy and safety of using opioid analgesics in older adults with musculoskeletal pain. We searched Cochrane Library, MEDLINE, EMBASE, Web of Science, AMED, CINAHL and LILACS for randomized controlled trial with mean population age of 60 years or older, comparing the efficacy and safety of opioid analgesics with placebo for musculoskeletal pain conditions. Reviewers extracted data, assessed risk of bias and evaluated the quality of evidence using the GRADE approach.

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Opposite Effects of Stress on Pain Modulation Depend on the Magnitude of Individual Stress Response

• Acute stress induced opposite effects; decreased CPM and increased pain adaptation• Decreased CPM occurred only among high stress-responders• Increased pain adaptation occurred only among low stress-responders• Individual stress responsiveness determines how acute stress affects pain modulation

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The Impact of a Statewide Mandatory Prescription Drug Monitoring Program on Opioid Prescribing by Emergency Medicine Providers Across 15 Hospitals in a Single Health System

• A state-mandated PDMP reduced opioid prescribing among emergency medicine providers.• There was heterogeneity in opioid prescribing across hospitals as well as by patient diagnosis.• PDMP-associated reductions in opioid prescriptions could curb the prescription opioid epidemic.

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Acute rotator cuff tears

What you need to knowShoulder pain with an inability to abduct above 90° after trauma is a red flag for referral for a same day, plain x ray assessmentRefer the following patients urgently to a...

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Forgetting to remember? Prospective memory within the context of pain

Abstract

Background

Pain interferes with cognitive functioning in several ways. Among other symptoms, pain patients often report difficulties with remembering future intentions. It remains unclear, however, whether it is the pain per se that impairs prospective remembering or other factors that often characterize people with pain (e.g. poor sleep quality). In this experiment, we investigated whether prospective memory is impaired within the context of pain, and whether this impairment is enhanced when the threat value of pain is increased.

Methods

Healthy participants engaged in an ongoing word categorization task, during which they received either experimental pain stimuli (with or without threatening instructions designed to increase the threat value of pain), or no pain stimuli (no somatic stimuli and no threatening instructions). Crucially, participants were also instructed to perform a prospective memory intention on future moments that would be signalled by specific retrieval cues.

Results

Threatening instructions did not differentiate the pain groups in terms of pain threat value; therefore, we only focus on the difference between pain and no pain. Pain and no-pain groups performed the prospective memory intention with similar frequency, indicating that prospective memory is not necessarily impaired when the intended action has to be performed in a painful context.

Conclusions

Findings are discussed in the framework of the multiprocess theory of prospective memory, which differentiates between the spontaneous and the strategic retrieval of intentions. Methodological considerations and suggestions for future research are discussed.

Significance

This laboratory study combines established methods from two research fields to investigate the effects of a painful context on memory for future intentions. Painful context did not impair performance of a prospective memory intention that is assumed to be retrieved by means of spontaneous processing.

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Anti-inflammatory effects of propranolol in the temporomandibular joint of female rats and its contribution to antinociceptive action

Abstract

Background

β-Blockers reduce temporomandibular joint (TMJ) pain. We asked whether they also reduce TMJ inflammation and, if so, whether this anti-inflammatory effect contributes to its analgesic action.

Methods

We measured many parameters of the inflammatory response after co-administration of the β-blocker propranolol with the inflammatory agent carrageenan in the TMJ of female rats. We also hypothesized that the activation of β-adrenoceptors in the TMJ induces nociception mediated, at least in part, by the inflammatory response. To test this hypothesis, we examined the nociceptive response induced by the activation of the β-adrenoceptors in the TMJ in female rats pretreated with thalidomide and fucoidan.

Results

We found that the co-administration of propranolol with carrageenan in the TMJ of female rats significantly reduced several parameters of the inflammatory response induced by carrageenan such as plasma extravasation, neutrophil migration and the release of the pro-inflammatory cytokines TNF-α, IL-1β and CINC-1. Furthermore, the injection of the β-adrenergic receptor agonist isoproterenol in the TMJ induced nociception that was significantly reduced by thalidomide, fucoidan and by the co-administration of propranolol but not of the α-adrenergic receptor antagonist phentolamine.

Conclusions

Propranolol has anti-inflammatory effects that contribute to its antinociceptive action in the TMJ of females.

Significance

β-Blockers have an anti-inflammatory effect on temporomandibular joint (TMJ) that contributes to its analgesic effect. The results of this work suggest that β-blockers can be used to treat the painful conditions of TMJ, especially when they are associated with an inflammatory process.

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Nitrous oxide/oxygen mixture for analgesia in adult cancer patients with breakthrough pain: A randomized, double-blind controlled trial

Abstract

Background

The aim of this study was to assess the efficacy of a fixed nitrous oxide/oxygen mixture for the management of breakthrough cancer pain.

Methods/design

A double-blind, placebo-controlled, randomized clinical trial was undertaken in the Medical ward of Tumor Hospital of General Hospital of Ningxia Medical University. 240 cancer patients with breakthrough pain were recruited and randomly received a standard pain treatment (morphine sulphate immediate release) plus a pre-prepared nitrous oxide/oxygen mixture, or the standard pain treatment plus oxygen. The primary endpoint measure was the numerical rating scale (NRS) score measured at baseline, 5 and 15 min after the beginning of treatment, and at 5 min post treatment.

Result

In all, analysis of pain score (NRS) at 5 min after the beginning of treatment shown a significant decrease in nitrous oxide/oxygen mixture treated patients with 2.8 ± 1.3 versus 5.5 ± 1.2 in controls (p < 0.01). At 15 min during the intervention, the mean pain score for nitrous oxide/oxygen was 2.0 ± 1.1 compared with 5.6 ± 1.3 for oxygen (p < 0.01).

Conclusion

This study shows that self-administered nitrous oxide/oxygen mixture was effective in reducing moderate to severe breakthrough pain among patients with cancer.

Significance

The management of breakthrough cancer pain is always a challenge due to its temporal characteristics of rapid onset, moderate to severe in intensity, short duration (median 30–60 min). Our study find that self-administered nitrous oxide/oxygen mixture was effective in reducing moderate to severe breakthrough cancer pain.

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Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study

The prevalence, cost and disability associated with lumbopelvic pain continues to rise despite the range of available therapeutic interventions, indicating a deficiency in current approaches. A literature base highlighting a correlation between lumbopelvic pain and pelvic floor function is developing; however, the features that characterize this correlation have yet to be fully established.

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Shoe Lifts for Leg Length Discrepancy in Adults with Common Painful Musculoskeletal Conditions: A Systematic Review of the Literature

Self-Guided Online Cognitive Behavioral Strategies for Chemotherapy-Induced Peripheral Neuropathy: a Multicenter, Pilot, Randomized, Wait-List Controlled Trial

• First study to test a cognitive behavioral intervention for painful CIPN.• Worst CIPN pain was assessed at baseline and 8 weeks later via 7-day diary.• Cognitive behavioral intervention was superior to usual care on worst CIPN pain.• Low website usage and high attrition was observed in the intervention arm.• Further research is needed to identify mediators of CIPN pain improvement.

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Altered Neurocognitive Processing of Tactile Stimuli in Patients with Complex Regional Pain Syndrome (CRPS)

• Slower response times (RTs) during digit discrimination in CRPS patients.• RTs correlate with late-latency tactile processing in supplementary motor area.• This P300-like activity is paradoxically related to better limb functioning.• Responses in parietal lobe are decreased in CRPS regardless of task demands.

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The bright spark who lit up Glasgow

Pressure on doctors to keep up with technology can be a pain, but it’s nothing new. For John Macintyre, it was not just a pleasure but an all consuming passion.Macintyre had an astonishingly...

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Bone Marrow Edema Syndrome Of The Medial Femoral Condyle Treated With Extracorporeal Shock Wave Therapy: A Clinical And MRI Retrospective Comparative Study

Assessment of Tapentadol API Abuse Liability with the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System

• Abuse liability of tapentadol API is compared to those of other Scheduled opioids.• Population-level event rates of tapentadol API abuse were lower than comparators.• Drug-availability adjusted event rates of tapentadol abuse were low but not lowest.• Public health burden of tapentadol API appears to be low.

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The relationship between negative metacognitive thoughts, pain catastrophizing and adjustment to chronic pain

Abstract

Background

Cognitive appraisals, most notably pain catastrophizing, play an important role in chronic pain. The role of metacognition and its impact on the relationship between pain catastrophizing and health are understudied. The identification of metacognition as a moderator of psychological constructs may have clinical and empirical implications. We hypothesized that negative metacognitive beliefs would moderate the relationships between pain catastrophizing and emotional functioning and physical activity.

Method

Participants (N = 211) with mixed aetiology chronic pain were primarily Caucasian females with severe average pain intensity. Over the course of 2 weeks, participants completed online daily-diary measures of pain catastrophizing, pain intensity, mood, physical activity and metacognition.

Results

Participants with higher average levels of daily pain intensity and negative metacognitive beliefs about worry reported higher levels of daily pain catastrophizing, as well as daily depression, and anxiety. Some aspects of metacognitive beliefs (i.e. dangerousness and uncontrollability of thoughts) were also negatively associated with average daily levels of positive affect. However, these effects were not interactive; metacognitive beliefs did not moderate the relationships of pain catastrophizing with other daily variables.

Conclusions

From a daily coping perspective, findings reveal that people with stronger negative metacognitive beliefs report greater emotional distress on a day-to-day basis. However, negative metacognitive beliefs did not appear to modify the effects of pain catastrophizing on psychological and physical functioning at the daily level, suggesting that metacognitive beliefs may be better conceptualized as a more parallel indicator of emotional maladjustment to chronic pain whose effects do not reliably manifest in daily measurement models.

Significance

Findings highlight the need to better characterize the value of metacognitive beliefs as an important predictor and therapeutic target. Despite limited evidence of a dynamic relationship between metacognition and daily adjustment to chronic pain, results emphasize the potential importance of interventions that target cognitive appraisal process beyond catastrophizing, including uncontrollability and danger-laden thought patterns.

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Opioids are not just an American problem

The rise in opioid prescriptions and mortality in the US1 has shone a light on similar concerns in the UK. Opioid prescriptions for non-cancer pain rose by about 60% in the UK from 2000 to 2010.2With...

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Investigation of the Effect of Diabetes on Radiculopathy Induced by Nucleus Pulposus Application to the DRG in a Spontaneously Diabetic Rat Model

Study Design. A controlled, interventional animal study. Objective. The aim of this study was to evaluate the effect of diabetes mellitus (DM) on radiculopathy due to lumbar disc herniation (LDH), by investigating pain-related behavior and the expression of tumor necrosis factor-alpha (TNF-α) and growth-associated protein 43 (GAP43) in type 2 diabetic rats following application of nucleus pulposus (NP) to the dorsal root ganglion (DRG). Summary of Background Data. Previous clinical studies suggested negative effects of DM on radiculopathy due to LDH, and that inflammation and nerve regeneration could interact with DM and radiculopathy. Methods. We applied autologous NP to the left L5 DRG of adult male Wistar rats and Goto-Kakizaki rats. Behavioral testing measured the mechanical withdrawal threshold of rats. We immunohistochemically evaluated the localization of ionized calcium-binding adapter molecule-1 (Iba-1), receptor of advanced glycation end products (RAGE), and TNF-α in DRGs. TNF-α and GAP43 expression levels in DRG were determined by quantitative real-time PCR and western blotting. Results. The mechanical withdrawal threshold significantly declined in the non-DM NP group compared with the non-DM sham group for 28 days, whereas the decline in threshold extended to 35 days in the DM NP group compared with the DM sham group. RAGE and TNF-α expression in DRGs was colocalized in Iba-1 positive cells. The non-DM NP rats had higher TNF-α protein expression levels versus the non-DM sham rats on day 7, and the DM NP group had higher levels versus the DM sham group on days 7 and 14. The non-DM NP group had higher GAP43 mRNA expression than the non-DM sham group for 28 days, while the DM NP group had a higher level than the DM sham group for 35 days. Conclusion. DM prolongs the pain-related behavior caused by NP. The prolonged inflammation and nerve regeneration could elucidate the pathogenesis of continuous pain of radiculopathy initiated by LDH. Level of Evidence: N /A

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A Kinematic Symmetry Index of Gait Patterns Between Older Adults With and Without Low Back Pain

Study Design. Cross-sectional study. Objective. To investigate the symmetry index for limb support patterns in right limb–dominant older adults with and without low back pain (LBP). Summary of Background Data. The effects of bilateral asymmetry on gait performance were reported; however, there is a lack of understanding on kinematic symmetry to assess subjects with LBP. This asymmetry might be related to increased compensatory patterns to the dominant side in subjects with LBP. Methods. Eighty-two right limb–dominant older adults (45 control subjects and 37 subjects with LBP) participated in the study. A three-dimensional motion capture system was used to measure temporal-spatial gait parameters (cadence, speed, stride length, step length, and limb support times). The symmetry index was the ratio of the gait cycle between the limbs to compare the dominance pattern between groups. Results. Although the symmetry index was not different between groups, the initial limb support (t = 2.07, P = 0.04) and terminal limb support (t = −2.26, P = 0.02) times were significantly different. The LBP group demonstrated significantly greater nondominant initial support times and dominant terminal support times. The single-limb support was not different between groups (t = 1.72, P = 0.09). The limb support pattern demonstrated a significant interaction between groups (F = 4.72, P = 0.03) regardless of gait speed (F = 0.91, P = 0.34). Conclusion. An asymmetrical gait pattern was evident in the LBP group as they demonstrated a longer double-limb support pattern due to a possible pain avoidance strategy. The control group demonstrated a symmetrical pattern for limb support in the stance phase. Clinicians need to consider asymmetric limb support patterns of gait modification similar to the control group when developing rehabilitation strategies for patients with LBP. Level of Evidence: 3

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Concurrent Validity and Responsiveness of PROMIS Health Domains Among Patients Presenting for Anterior Cervical Spine Surgery

Study Design. Prospective cohort study. Objective. The aim of this study was to determine the validity and responsiveness of Patient-Reported Outcomes Measurement Information System (PROMIS) health domains. Summary of Background Data. PROMIS health domains (anxiety, depression, fatigue, pain, physical function, satisfaction with participation in social roles, sleep disturbance) may measure quality of care and determine minimal important differences (MIDs) after spine surgery. We examined concurrent validity of PROMIS domains before and PROMIS domain MIDs after anterior cervical spine surgery. Methods. We included 148 adults undergoing cervical spine surgery from February 2015 through June 2016. We determined concurrent validity by correlations of preoperative PROMIS domains with legacy measures and responsiveness of PROMIS domains using distribution-based and anchor-based criteria (preoperative to postoperative change, within 6 months) anchored to treatment expectations (assessed using North American Spine Society Patient Satisfaction Index criteria). Statistical significance was accepted as P < 0.05. Results. All PROMIS domains showed moderate to strong correlations with Neck Disability Index, Short-Form Health Survey, version 2 (SF-12v2), and Brief Pain Inventory pain interference and weak correlations with intensity of arm/neck pain (except between PROMIS pain and neck pain [r = 0.45, P < 0.001] and PROMIS physical function and SF-12v2 physical [r = –0.14, P = 0.138] and mental [r = 0.39, P < 0.001] components). PROMIS domains were well correlated with Generalized Anxiety Disorder-7 and Patient Health Questionnaire-8 except PROMIS physical function (r = –0.29, P = 0.002). Distribution-based PROMIS MID estimates ranged from 2.3 to 3.9 points. Incorporating cross-sectional and longitudinal anchor-based criteria, final PROMIS MID estimates were as follows: anxiety, –5.7; depression, –4.6, fatigue, –5.8; pain, –5.2; physical function, 4.5; satisfaction with participation in social roles, 4.4; and sleep disturbance, –7.4. Conclusion. PROMIS domains are a valid assessment of health in this population and were responsive to postoperative improvements in symptoms and quality of life. Level of Evidence: 2

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Does Modic Change Progresss With Age?

Study Design. Cross-sectional imaging study. Objective. The aim of this study was to clarify the trend in the generation distinctions about the prevalence of Modic change (MC) including elderly patients. Summary of Background Data. MC has been discussed regarding its clinical significance, relationship with low back pain, suitable treatments, prevalence, and natural history. However, previous reports have focused on younger subjects, with few studies conducted in elderly patients. If MC is actually a progressive condition of a patient, then it should become more common as the patient ages. We herein report the distribution of MC across several age groups. Methods. Patients who underwent lumbar magnetic resonance imaging (MRI) in our institution from April 2013 to March 2015 were recruited. MC was assessed using T1- and T2-weighted magnetic resonance imaging (MRI) and divided into Modic types (MT) 1, 2, and 3, and mixed type. Trends in the prevalence of MC were analyzed based on age. Results. We ultimately included 585 patients of an initial 937 who underwent lumbar MRI. The mean age was 65 years. MC was identified in 36.0% of the patients. The prevalence of MC by age was 0% for those in their 10 s, 10% for those in their 20 s, 33% for those in their 30 s, 27% for those in their 40 s, 32% for those in their 50 s, 44% for those in their 60 s, 42% for those in their 70 s, and 26% for those in their 80 s. By type, 3.3% were MT1, 81.3% were MT2, 0.5% were MT3, and 14.8% were mixed type. Conclusion. The prevalence of MC increased with age to some degree, with the highest frequency observed in individuals in their 60 s before declining in those in their 70 s and 80 s. These findings suggest that MC might not simply progress with age, particularly after the seventh decade of life. Level of Evidence: 4

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