The Non-Avoidant Pacing Scale: Development and preliminary validation

Activity pacing has emerged as a common treatment component aimed at improving functioning in patients with chronic pain5,7,35,38,47,48, however, few studies have examined the relationship between pacing and key outcomes. A meta-analysis revealed a correlation between more pacing and reduced depression, but also higher levels of pain and disability1. It appears counterintuitive that pacing, a strategy taught to patients with chronic pain, would be associated with poorer outcomes. However, there is a lack of clarity surrounding the concept itself.

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Extraordinary Altruism and Transcending the Self

Publication date: Available online 28 September 2018

Source: Trends in Cognitive Sciences

Author(s): Molly J. Crockett, Patricia L. Lockwood

Longstanding psychological theories posit a link between empathy and altruism. A new study of anonymous kidney donors finds these ‘extraordinary altruists’ show an increased overlap in neural responses to pain for self and others. These findings, alongside other recent studies of altruism, shed new light on the nature of selflessness.

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Determining Pain Catastrophizing from Daily Pain App Assessment Data: Role of Computer-Based Classification

Persons with chronic pain typically report having ‘good and bad’ days with their pain, yet their condition can persist for years.10 Psychological models of chronic pain, such as the fear-avoidance model, demonstrate that the way people cognitively process their pain sensations is a strong determinant of their future pain-related behavior.34 Catastrophizing is a central variable in the fear-avoidance model that accounts for 7–31% of the variance in pain severity.54 In addition, pain catastrophizing creates maladaptive pain cognitions that can be a risk factor for developing depression, disability, and higher pain intensity.

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SELF-MEDICATION WITH OVER-THE-COUNTER ANALGESICS: A SURVEY OF PATIENT CHARACTERISTICS AND CONCERNS ABOUT PAIN MEDICATION

Pain is a major healthcare problem. According to the most recent Global Burden of Disease Study, several of the most common conditions are pain problems (such as tension-type headache, migraine and low back pain). Also, pain is the leading cause of disability, with low back pain (first), migraine (second), neck pain (sixth), and other musculoskeletal disorders (seventh) dominating the top ten of most important causes of Years Lived with Disability (YLD).4

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Identifying and Engaging Neuronal Oscillations by Transcranial Alternating Current Stimulation in Patients with Chronic Low Back Pain: A Randomized, Crossover, Double-Blind, Sham-Controlled Pilot Study

Chronic pain is associated with pathological changes in neuronal activity over somatosensory, insular, cingulate, and prefrontal cortices.46 These brain regions play a fundamental role in the processing of pain.32,51,57 Several electroencephalography (EEG) and magnetoencephalography (MEG) studies have shown that patients with chronic pain exhibit abnormal neuronal oscillations.43,55 In particular, pathologically increased theta oscillations (4-8Hz) 34,48,49,53,58 have motivated a conceptual framework of thalamo-cortical dysrhythmia (TCD) in chronic pain.

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Two abnormalities on diagnostic laparoscopy

A 29 year old nulliparous woman presented with a two year history of cyclical pelvic pain and dyspareunia. She underwent a diagnostic laparoscopy to identify a cause for the pain, and this revealed...

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What interventions are effective to taper opioids in patients with chronic pain?

What you need to knowFor people with chronic pain and who do not have cancer, the benefits of long term opioids are outweighed by the issues of tolerance, dependence, and the requirement for higher...

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Severe coronary artery calcification in a patient with end stage renal disease

A 42 year old man was referred to the emergency department with a two month history of recurrent chest pain, which had become excruciating for the past 48 hours. His medical history included end...

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Pharmacological Interventions for Pain After Traumatic SCI: A Systematic Review and Network Meta-Analysis

Publication date: October 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 10

Author(s): Jeffrey T.Y. Chow, Danielle B. Rice, Amanda McIntyre, Swati Mehta, Robert Teasell

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The blind leading the not so blind: a meta-analysis of blinding in pharmacological trials for chronic pain

Randomised controlled trials (RCTs) are the cornerstone of evidence-based interventions both for chronic pain and medicine more generally. In particular, double-blind placebo-controlled RCTs have been heavily relied upon to determine treatment efficacy and safety of chronic pain interventions. Hundreds of double-blind placebo-controlled RCTs are run each year worldwide to test various interventions for chronic pain, with hundreds of thousands of people with chronic pain participating in these trials.

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Diagnosing opioid addiction in people with chronic pain

Over the past two decades, a steep rise in the number of opioids dispensed for pain treatment has been accompanied by a dramatic rise in overdose deaths in the United States.1 In 2016, up to 32 000...

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Effectiveness and Downstream Healthcare Utilization for Patients That Received Early Physical Therapy Versus Usual Care for Low Back Pain: A Randomized Clinical Trial

Study Design. Randomized controlled trial. Objective. The aim of this study was to compare early physical therapy versus usual care in patients with low back pain. Summary of Background Data. Early physical therapy (PT) has been associated with reduced downstream healthcare utilization in retrospective studies, but not investigated prospectively in the military health system. Methods. Military service members seeking care from a general practitioner were recruited. Patients attended a 20-minute self-management class with focus on psychosocial resilience and then randomized to usual care only (UC) versus immediately starting a 3-week physical therapy program (PT). Primary outcome was the Oswestry Disability Index at 1 year. Secondary outcomes included Oswestry scores at 4- and 12-week follow-up, numeric pain rating scale, global rating of change, and healthcare utilization at 1 year. Analysis of covariance was used to compare differences between groups, significance set at 0.05. Trial Registration: clinicaltrials.gov: NCT01556581 Results. A total of 119 patients (mean age 27.2 years; mean BMI 27.8 kg/m2; 15.1% female) enrolled (61 randomized to UC; 58 to PT). No between-group differences found on the Oswestry after 1 year. A between-group difference in Oswestry was present at 4 weeks (mean difference = 4.4; 95% CI: 0.41–10.1; P = 0.042) favoring PT. Total 1-year mean healthcare costs did not differ significantly between groups (UC $5037; 95 CI $4171–$6082 and PT $5299; 95 CI $4367–$6431). The portion of total mean healthcare costs related to low back pain was lower for UC ($1096; 95% CI $855–$1405) compared to PT ($2016, 95% CI $1570–$2590). Conclusion. There was no difference between usual care and early PT after 1 year. PT provided greater improvement in disability after 4 weeks. As both groups improved, the impact of the education may have been underestimated. Patients in the PT group utilized greater back-pain-related healthcare resources, but overall healthcare costs did not differ compared to UC. Level of Evidence: 2

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Flexion-Relaxation Phenomenon in Children and Adolescents With and Without Nonspecific Chronic Low Back Pain: An Electromyographic and Kinematic Cross-Sectional Comparative Study

Study Design. A cross-sectional comparative study. Objective. This study aimed to investigate the flexion-relaxation phenomenon (FRP), in standing trunk flexion and slumped sitting tasks, by comparing children and adolescents suffering from nonspecific chronic low back pain (NSCLBP) with controls (CTRL). Summary of Background Data. The absence of the FRP can accurately discriminate adults with NSCLBP from those without during standing trunk flexion and slumped sitting tasks. Even if the FRP has been extensively studied in adults with NSCLBP, only one study has evaluated the FRP in adolescents, during a slumped sitting task, and this suggested that the FRP was also present in adolescents with NSCLBP. Methods. Thirty-seven children and adolescents with NSCLBP and 23 CTRL performed standing trunk flexion and slumped sitting tasks. All participants were equipped with surface electromyography (EMG) electrodes on the erector spinae longissimus (ESL) and multifidus (M) muscles and reflective markers on the spinous processes of C7, L1, and S1. Global (C7-S1), thoracic (C7-L1), and lumbar (L1-S1) trunk flexion absolute angle were measured. The FRP was reported using visual inspection and a flexion-relaxation ratio (FRR). A self-reference threshold was used to identify the time of FRP onset. Repeated-measures analysis of variance (ANOVA) was used to determine the main and interaction effects of task, group and muscle on FRR, and the relative maximal angle at FRP onset of the global trunk (C7-S1). Results. Results showed three main findings: (1) the FRP's low sensitivity in discriminating between NSCLBP and CTRL participants in groups, tasks, or muscles; (2) similar observed maximal flexion angles in both groups during flexion tasks; and (3) similar observed relative maximal global trunk flexion angles at FRP onset in groups, tasks, and muscles. Conclusion. These results are not consistent with the literature on adults and could lead to modified therapeutic management of NSCLBP in children and adolescents. Level of Evidence: 3

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Changes in Lumbar Endplate Area and Concavity Associated With Disc Degeneration

Study Design. Retrospective image-based analysis. Objective. To measure endplate three-dimensional (3D) geometry, endplate changes in vivo and to investigate correlations between disc degeneration and endplate 3D geometry dependent on symptoms of low back pain (LBP). Summary of Background Data. It has been hypothesized that alteration of load transmission from the nucleus pulposus to the annulus fibrosus affects vertebral endplate geometry. Methods. 3D surface models of inferior/superior lumbar endplates were created from computed tomography scans of n = 92 volunteers with and without LBP. Disc degeneration was evaluated using Pfirrmann scale. Concavity in both coronal and sagittal planes was assessed with the Concavity Index (unitless; larger than 1: concave; flat: 1; and less than 1: convex, respectively). Endplate area and disc height distribution were computed and the effects from demographics and spinal degeneration were sought with an analysis of variance model. Results. Both sagittal and coronal planes revealed significantly decreased concavity in those with terminal grade 5 disc degeneration (mean 0.833 ± 0.235) compared to the other grades in the cohort. Older subjects presented with larger endplate areas than the younger subjects (P = 0.0148) at L4-S1. Overall, symptomatic subjects had significantly larger endplate areas (P = 0.022), especially at the lower lumbar levels (P < 0.001). Analysis of variance showed that sex, disc level, disc degeneration grade, and disc height reached significance (P < 0.0001) as influential parameters in both Concavity Index cases. Conclusion. With advancing intervertebral disc degeneration, endplates become more convex over time in both sagittal and coronal planes. Our findings implicate the endplate changes with advancing disc degeneration in the shift in load transmission from the nucleus pulposus to the annulus fibrosus, resulting in changes within the curvature of the endplates. This is also the first study to describe the direct impact of age, sex, and LBP on vertebral endplate anatomy. Level of Evidence: 5

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Preoperative Chronic Opioid Therapy: A Risk Factor for Complications, Readmission, Continued Opioid Use and Increased Costs After One- and Two-Level Posterior Lumbar Fusion

Study Design. Retrospective, economic analysis. Objective. To study patient profile associated with preoperative chronic opioid therapy (COT), and study COT as a risk factor for 90-day complications, emergency department (ED) visits, and readmission after primary one- to two-level posterior lumbar fusion (PLF) for degenerative spine disease. We also evaluated associated costs, risk factors, and adverse events related to long-term postoperative opioid use. Summary of Background Data. Chronic opioid use is associated with poor outcomes and dependence after spine surgery. Risk factors, complications, readmissions, adverse events, and costs associated with COT in patients undergoing lumbar fusion are not entirely known. As providers look to reduce healthcare costs and improve outcomes, identification of modifiable risk factors is important. Methods. Commercial insurance data from 2007 to Q3–2015 was used to study preoperative opioid use in patients undergoing primary one- to two-level PLF. Ninety-day complications, ED visits, readmissions, 1-year adverse events, and associated costs have been described. Multiple-variable regression analyses were done to study preoperative COT patient profile and opioid use as a risk factor for complications and adverse events. Results. A total of 24,610 patients with a mean age of 65.6 ± 11.5 years were included. Five thousand five hundred (22.3%) patients had documented opioid use for more than 6 months before surgery, and 87.4% of these had continued long-term use postoperatively. On adjusted analysis, preoperative COT was found to be a risk factor for 90-day wound complications, pain diagnoses, ED visits, readmission, and continued use postoperatively. Postspinal fusion long-term opioid users had an increased utilization of epidural/facet joint injections, risk for revision fusion, and increased incidence of new onset constipation within 1 year postsurgery. The cost associated with increase resource use in these patients has been reported. Conclusion. Preoperative COT is a modifiable risk factor for complications, readmission, adverse events, and increased costs after one- or two-level PLF. Level of Evidence: 3

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Association of Patient-Reported Narcotic Use With Short- and Long-Term Outcomes After Adult Spinal Deformity Surgery: Multicenter Study of 425 Patients With 2-year Follow-up

Study Design. Retrospective analysis of a prospective registry Objective. To investigate associations of preoperative narcotic use with outcomes after adult spinal deformity (ASD) surgery. Summary of Background Data. We hypothesized that preoperative narcotic use would predict longer hospital stays, greater postoperative narcotic use, and greater disability 2 years after ASD surgery. Methods. A multicenter database of surgical ASD patients was analyzed retrospectively for patients with self-reported data on preoperative narcotic use. Patients were categorized as using narcotics daily or non-daily (including those who used no narcotics), according to self-report. Outcomes were prolonged length of hospital stay (LOS) (>7 days); length of intensive care unit (ICU) stay; and daily narcotic use and Oswestry Disability Index (ODI) scores 2 years postoperatively. Groups were compared by demographic characteristics, pain, disability, radiographic deformity, and surgical invasiveness. Multivariate logistic and linear regression were used to determine associations between preoperative narcotic use and outcomes. Results. Of 575 patients who met the inclusion criteria, 425 (74%) had complete 2-year follow-up data. Forty-four percent reported daily preoperative narcotic use. Compared with non-daily users, daily narcotic users were older, had more comorbidities, more severe back pain, higher ODI scores, longer operative times, and worse preoperative malalignment and were more likely to undergo 3-column osteotomy (all, P < 0.05). Daily narcotic use independently predicted prolonged LOS (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.1–2.9), longer ICU stay (difference = 16 hours, 95% CI = 1.9–30 hours), and daily narcotic use 2 years postoperatively (OR = 6.9, 95% CI = 3.7–13), as well as worse 2-year ODI score (difference = 4.5, 95% CI: 0.7–8.3, P = 0.021). Conclusion. Daily narcotic use before ASD surgery was associated with prolonged LOS, longer ICU stays, and increased risk of daily narcotic use and greater disability 2 years postoperatively. Level of Evidence: 3

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Selective Anterior Lumbar Interbody Fusion for Low Back Pain Associated With Degenerative Disc Disease Versus Nonsurgical Management

Study Design. This is a retrospective cohort study. Objective. To evaluate the long-term outcomes of selective one- to two-level anterior lumbar interbody fusions (ALIFs) in the lower lumbar spine versus continued nonsurgical management. Summary of Background Data. Low back pain associated with lumbar intervertebral disc degeneration is common with substantial economic impact, yet treatment remains controversial. Surgical fusion has previously provided mixed results with limited durable improvement of pain and function. Methods. Seventy-five patients with one or two levels of symptomatic Pfirrmann grades 3 to 5 disc degeneration from L3-S1 were identified. All patients had failed at least 6 months of nonsurgical treatment. Forty-two patients underwent one- or two-level ALIFs; 33 continued multimodal nonsurgical care. Patients were evaluated radiographically and the visual analog pain scale (VAS), Oswestry Disability Index (ODI), EuroQol five dimensions (EQ-5D), and Patient-Reported Outcomes Measurement Information System scores for pain interference, pain intensity, and anxiety. As-treated analysis was performed to evaluate outcomes at a mean follow-up of 7.4 years (range: 2.5–12). Results. There were no differences in pretreatment demographics or nonsurgical therapy utilization between study arms. At final follow-up, the surgical arm demonstrated lower VAS, ODI, EQ-5D, and Patient-Reported Outcomes Measurement Information System pain intensity scores versus the nonsurgical arm. VAS and ODI scores improved 52.3% and 51.1% in the surgical arm, respectively, versus 15.8% and −0.8% in the nonsurgical arm. Single-level fusions demonstrated improved outcomes versus two-level fusions. The pseudarthrosis rate was 6.5%, with one patient undergoing reoperation. Asymptomatic adjacent segment degeneration was identified in 11.9% of patients. Conclusion. Selective ALIF limited to one or two levels in the lower lumbar spine provided improved pain and function when compared with continued nonsurgical care. ALIF may be a safe and effective treatment for low back pain associated with disc degeneration in select patients who fail nonsurgical management. Level of Evidence: 3

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Vertebral Body Lipoma: An Unusual Pathology Treated With Kyphoplasty

Study Design. Case report. Objective. This case report is unique since this is the first vertebral lipom case that was treated by kyphoplasty alone. Summary of Background Data. Vertebral lipoma is extremely rare and our search of the English literature has revealed 20 patients in 16 reports. Methods. A 32-year-old female patient was admitted to our neurosurgery department with the chief complaint of low back pain that had lasted nearly 1 year. A lumbar MR suggested a hemangioma and the patient was operated on. Results. On microscopic examination, the lesion was seen to have a widely infiltrating appearance of mature fat tissue between bone trabeculae diagnosis was intraosseous lipoma. Conclusion. We believe that the management should be surgical total removal of the lesion even in incidentally found cases in order to obtain histologic diagnosis and pain relief. Level of Evidence: 5

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Patients’ experience with opioid tapering: A conceptual model with recommendations for clinicians

Chronic pain is among the most common complaints in primary care,15 yet patients and clinicians consistently report that negotiating treatment plans for chronic pain is often mutually frustrating and unproductive, especially when treatment involves opioid analgesics.11, 24, 30 Substantial increases in the use of opioids to treat chronic pain during the late 1990s and early 2000s16 and the subsequent rise in rates of opioid-related overdose27, 28 have prompted dramatic shifts in clinical practice away from opioid use.

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The effectiveness of exercise interventions for pain reduction in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

Publication date: Available online 19 September 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Thibaut Demaneuf, Zoe Aitken, Amalia Karahalios, Teng Ieng Leong, Alysha M. De Livera, George A. Jelinek, Tracey J. Weiland, Claudia H. Marck

Abstract

Objective

To systematically review the evidence of the effect of exercise compared to passive control on pain in people with multiple sclerosis.

Data source and study selection

Five electronic databases were searched for randomized controlled trials published up to March 2017 that recruited people with multiple sclerosis where exercise was the intervention and pain was an outcome. (PROSPERO registration number CRD42017060489).

Statistical analysis

A random-effects meta-analysis was conducted to estimate the standardized mean difference of the effect of exercise on pain between treatment and control groups. We assessed risk of bias, fitted meta-regression models to explore heterogeneity between studies, and assessed small study effects.

Data synthesis

Ten studies met the inclusion criteria (total sample size = 389) and all studies were at high risk of bias. We found that exercise intervention was associated with less pain compared to passive control groups (standardized mean difference = -0.46; 95% CI: -0.92, 0.00). There was high between study heterogeneity (I2 = 77.0%), which was not explained by the pre-specified study characteristics. There was also some evidence of small study effects.

Conclusion

This is the first systematic review of the effect of exercise interventions on pain in people with multiple sclerosis, a chronic neurological disorder that affects 2.5 million people. We found some evidence that exercise compared to passive control alleviates pain in this population, but there were limitations in reporting and study quality with high risk of bias of individual studies and heterogeneity between studies.

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ALTERATIONS IN TEMPORAL SUMMATION OF PAIN AND CONDITIONED PAIN MODULATION ACROSS AN EPISODE OF EXPERIMENTAL EXERCISE-INDUCED LOW BACK PAIN

Low back pain (LBP) is the leading cause of disability worldwide26, yet up to 90% of patients are diagnosed with non-specific LBP, meaning the pathoanatomical source is unclear10. Further, recurrence following an acute episode may be up to 80%25, with little understanding as to why some patients develop ongoing symptoms9. There has recently been increasing focus on alterations in pro-nociceptive and anti-nociceptive mechanisms, purported to explain or contribute to pain exacerbation and persistence across a range of acute to chronic pain conditions34,45,72.

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CONTRIBUTIONS OF NOCIRESPONSIVE AREA 3A TO NORMAL AND ABNORMAL SOMATOSENSORY PERCEPTION

Somatosensory cortex in the postcentral gyrus of humans and other primates comprises four cytoarchitectonically, connectionally, and physiologically distinct cortical areas – Brodmann areas 3a, 3b, 1, and 2 (Figure 1AB). Each of these areas forms a long strip running along the central sulcus from the midline to the lateral fissure. The most anterior of these areas, area 3a, lies in the fundus of the central sulcus, flanked anteriorly by motor cortical area 4 and posteriorly by somatosensory area 3b.

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A novel finger illusion reveals reduced weighting of bimanual hand cortical representations in people with complex regional pain syndrome

Complex regional pain syndrome (CRPS) is characterised by excessive pain, usually in a peripheral limb such as the hand, and affects sensation, movement and function.32 Quantified deficits include higher thresholds for two-point discrimination in the index finger,45 impaired hand size estimation,35,44 finger misidentification,14,33 tactile processing disturbances;28 errors in bilateral limb positioning,30 fine motor26 and motor imagery performance.34,49,50 These deficits implicate distortions in body representation53 and are corroborated by evidence of cortical re-organisation in CRPS,9,10 although much remains unclear.

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[Clinical Picture] Aortic calcification in longstanding, undiagnosed Takayasu arteritis

A 40-year-old woman presented to our hospital with a 4-year history of recurrent central chest pain. The pain was unrelated to food or exertion, and occurred intermittently during both day and night. The patient had no medical history of diabetes, hypertension, hypercholesterolaemia or hypothyroidism. She did, however, give a history of having a prolonged fever for about 3 months accompanied by arthralgia at the age of 13 years. She said that at the time she had extensive investigations for infections and possible malignancies—but the fever resolved gradually without any cause being identified.

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Design and reporting characteristics of clinical trials of select chronic and recurrent pediatric pain conditions: An ACTTION systematic review

Chronic and recurrent pain are common in the pediatric population, with median prevalences ranging from 11-38% reported in the literature depending on the type of pain and criteria used to define chronic and recurrent pain.25 However, a paucity of clinical trials is available that provide adequate evidence to inform pediatric pain management and evidence-based treatment guidelines.13 Many of the current pediatric pain treatment recommendations, therefore, rely on efficacy data extrapolated from studies that included only adults.

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Higher Dispositional Optimism Predicts Lower Pain Reduction During Conditioned Pain Modulation

Optimism, or a generalized expectancy for positive outcomes, is associated with lower pain sensitivity, higher placebo analgesia, and better adjustment to chronic pain [8,9,26]. The initial conceptualization of optimism was developed from a broader model of behavioral self- regulation [10,32,33]. Based on this model, optimists are people who expect positive outcomes, making them more likely to engage in health promoting behaviors [33]. While optimism is viewed as a stable individual personality difference, it is also associated with coping strategies and positive affect, which lead to better health outcomes [10,26,31].

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Ability of Patient Reported Outcomes to Characterize Patient Acceptable Symptom State (PASS) After Attending a Primary Care Physical Therapist/Medical Doctor Collaborative Service: Cross Sectional Study

Publication date: Available online 13 September 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Jeff Houck, Daniel Kang, Tyler Cuddeford, Sarah Rahkola

Abstract

Objectives

To determine if the patient reported outcome information system (PROMIS) physical function (PF), pain interference (PI), self-efficacy (SE) and global rating of normal function (GRNF) scales are able to accurately characterize a patient’s acceptable symptom state (PASS).

Design

A cross sectional analysis, using receiver operator curves and chi-square analysis to explore criteria to determine thresholds (80/95% sensitivity/specificity) for PASS that are applicable to PROMIS and GRNF scales.

Setting

Phone survey after primary care

Participants

Ninety-four patients attending primary care for musculoskeletal problems.

Interventions

Not Applicable

Main Outcomes Measures

Accuracy and proportion of patients classified as PASS Yes or No.

Results

Receiver operator curve analysis showed significant area under the curve(AUC) values for each PROMIS scale (AUC >0.72) and the GRNF rating (AUC=0.74). Identified PROMIS thresholds suggested PASS was achieved when scores were at or slightly worse than the US population average. A score of 7 or higher and 4 or lower characterized patients that were PASS Yes/No, respectively, on the GRNF rating. A moderate (80%) specificity/sensitivity criteria yielded 72.3-73.5%% accuracy for a majority of participants (>69.9%).

Conclusion

This analysis suggests the PROMIS and GRNF scales are able to characterize PASS status with moderate accuracy (∼70%) for a large portion of patients (∼70%). New to this study is the association of self-efficacy with PASS status. PROMIS scales at or slightly worse than the US population average characterized PASS status.

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Touch and tactile neuropathic pain sensitivity are set by corticospinal projections

Touch and tactile neuropathic pain sensitivity are set by corticospinal projections

Touch and tactile neuropathic pain sensitivity are set by corticospinal projections, Published online: 12 September 2018; doi:10.1038/s41586-018-0515-2

Somatosensory corticospinal neurons facilitate touch sensitivity and touch-evoked neuropathic pain in mice.

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Lancet Series: The “Magnum Opus” Regarding the Evidence on Low Back Pain

No abstract available

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Sex Specific Sacroiliac Joint Biomechanics During Standing Upright: A Finite Element Study

Study Design. The comparison of sacroiliac joint (SIJ) angular motions, pelvis ligaments strain, load sharing, and stress distribution across the joint for male and female spine-pelvis-femur models using finite element analysis. Objective. To quantify biomechanical parameters at SIJ for all motions for both male and female models. Summary of Background Data. SIJ has been recognized as a main source of pain in 13% to 30% of patients with low back pain. It is shown that the SIJ rotation and translation in different planes are not exceeding 2° to 3° and 2 mm, respectively. Due to limitation of in vivo and in vitro studies, it is difficult to quantify certain biomechanical parameters such as load-sharing and stress distribution across the joint. Finite element analysis is a useful tool which can be utilized to understand the biomechanics of the SIJ. Methods. The validated finite element models of a male and a female lumbar spine-pelvis-femur were developed from computer tomography (CT) scans. The models were used to simulate spine physiological motions. The range of motion, ligament strains, load sharing, and stress distribution across the left and right SIJs were compared between male and female models. Results. Motions data at SIJs demonstrated that female model experienced 86% higher mobility in flexion, 264% in extension, 143% in left bending, and 228% in right bending compared with the male model. The stresses and loads on SIJs were higher on the female model compared with the male model. Female model ligaments underwent larger strains compared with the male model ligaments. Conclusion. Female SIJ had higher mobility, stresses, loads, and pelvis ligament strains compared with the male SIJ which led to higher stress across the joint, especially on the sacrum under identical loading conditions. This could be a possible reason for higher incidence of SIJ pain and pelvic stress fracture in females. Level of Evidence: N/A.

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A Comprehensive Review of Low-Speed Rear Impact Volunteer Studies and a Comparison to Real-World Outcomes

Study Design. This study combined all prior research involving human volunteers in low-speed rear-end impacts and performed a comparative analysis of real-world crashes using the National Automotive Sampling System – Crashworthiness Data System. Objective. The aim of this study was to assess the rates of neck pain between volunteer and real-world collisions as well as the likelihood of an injury beyond symptoms as a function of impact severity and occupant characteristics in real-world collisions. Summary of Background Data. A total of 51 human volunteer studies were identified that produced a dataset of 1984 volunteer impacts along with a separate dataset of 515,601 weighted occupants in real-world rear impacts. Methods. Operating-characteristic curves were created to assess the utility of the volunteer dataset in making predictions regarding the overall population. Change in speed or delta-V was used to model the likelihood of reporting symptoms in both real-world and volunteer exposures and more severe injuries using real-world data. Logistic regression models were created for the volunteer data and survey techniques were used to analyze the weighted sampling scheme with the National Automotive Sampling System database. Results. Symptom reporting rates were not different between males and females and were nearly identical between laboratory and real-world exposures. The minimal risk of injury predicted by real-world exposure is consistent with the statistical power of the large number of volunteer studies without any injury beyond the reporting of neck pain. Conclusion. This study shows that volunteer studies do not under-report symptoms and are sufficient in number to conclude that the risk of injury beyond neck strain under similar conditions is essentially zero. The real-world injury analyses demonstrate that rear impacts do not produce meaningful risks of cervical injury at impacts of similar and greater severity to those of the volunteer research. Future work concerning the mechanism of whiplash-related trauma should focus on impacts of severity greater than those in the current literature. Level of Evidence: 3

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