Targeting Chronic Recurrent Low Back Pain From the Top-down and the Bottom-up

Abstract

BACKGROUND:

Mechanisms such as neural sensitization and maladaptive cortical organization provide novel targets for therapy in chronic recurrent low back pain (CLBP).

OBJECTIVE:

We investigated the effect of a transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) treatment on pain, cortical organization, sensitization and sensory function in CLBP.

METHODS:

Using a placebo-controlled crossover design, 16 individuals received four treatments in separate sessions: i) anodal tDCS/PES; ii) anodal tDCS/sham PES; iii) sham tDCS/PES; or iv) sham tDCS/sham PES. Pain was assessed at baseline, immediately following, and at 1 and 3 days after treatment. Motor cortical organization, sensitization and sensory function were measured before and immediately after treatment.

RESULTS:

Combined tDCS/PES reduced pain and sensitization, normalized motor cortical organization and improved sensory function. The reduction in pain was greater in individuals with more pronounced sensitization. Applied alone, tDCS or PES also reduced pain. However, with the exception of improved sensory function and reduced map volume following PES, clinical and neurophysiological outcomes were unaltered by tDCS or PES applied separately. No changes were observed following sham treatment.

CONCLUSION:

Our data suggest a combined tDCS/PES intervention more effectively improves CLBP symptoms and mechanisms of cortical organization and sensitization, than either intervention applied alone or a sham control.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS:

Chronic low back pain, Peripheral electrical stimulation, Transcranial direct current stimulation, Treatment

PMID:

 

24582372

 

[PubMed - as supplied by publisher]

Significant differences of brain blood flow in patients with chronic low back pain and acute low back pain

Abstract

BACKGROUND:

The aim of this study was to examine and compare the areas of brain blood flow in patients with chronic low back pain (CLBP) without structural abnormality and acute low back pain (ALBP) with lumber disc herniation (LDH). Functional neuroimaging studies provide evidence of abnormalities in the regional cerebral blood flow during low back pain. Recent studies have shown that CLBP is associated with plastic, pathophysiological changes in the brain. However, there has been no report yet statistically or by neuro-images on the compared brain single photon-emission computed tomography (SPECT) findings between CLBP and ALBP patients.

METHODS:

The subjects comprised 14 patients, 7 CLBP and 7 ALBP patients. The CLBP group included the patients who had no or minor structural abnormality in the lumbar spine on magnetic resonance imaging (MRI) and met the criteria for a classification of "pain disorder" (chronic) according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. The ALBP group included the patients who had symptoms within 3 months of onset and LDH revealed by MRI. All patients were assessed using brain SPECT. We then performed a two-tailed view analysis using the easy Z score imaging system, determined the mean Z scores, and performed vBSEE software (Fujifilm RI Pharma, Tokyo, Japan) for both CLBP and ALBP patients.

RESULTS:

The CLBP group showed significantly reduced blood flow in the bilateral prefrontal cortex of the frontal lobe and increased blood flow in the bilateral posterior lobe of the cerebellum.

CONCLUSIONS:

SPECT images and statistical analyses revealed the brain blood flow alterations in the patients with ALBP and CLBP. These results may suggest that the dysfunction of the prefrontal cortex could lead to the appearance of unconscious pain behavior controlled by the cerebellum in the patients with CLBP.

PMID:

 

24500293

 

[PubMed - as supplied by publisher]

Chronic Low Back Pain (CLBP)

Chronic Low Back Pain (CLBP) is a major health problem in the world. This summary describes the main finding of a supplement in the journal Acta Orthopaedica which is based on the doctoral thesis by Paul Willems. In CLBP-patients imaging often reveals degenerative findings of the disc or facet joints. However those findings can also be observed in the asymptomatic population.

Lumbar spinal fusion can be beneficial for some people. However it is difficult to predict which individual patient will benefit. Many surgeons make use of some test that are assumed to predict the outcome of spinal fusion. The three most common used tests are 1) immobilization in lumbosacral orthosis, provocative discography and trial immobilization by temporary external transpedicular fixation.

The studies presented in this thesis concluded that none of those three tests are proven by current evidence. Also no patient characteristics are available for whom spinal fusion is an effective treatment. Several studies have currently shown that conservative treatment results in similar outcomes compared to spinal fusion. Conservative treatment has less complications, morbidity and costs. Therefore spinal fusion should not be proposed as a standard treatment for CLBP. > From: Willems, Acta Orthopaedica (Suppl. 349) 84 (2013) 1-37. All rights reserved to Informa Healthcare Ltd.