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Chapter 15 - Chronic Neuraxial Spine Pain

from Part IV - Spine

Published online by Cambridge University Press:  01 December 2023

By
Nazir Noor  and
Shenwari R. Afredi
Edited by
Omar Viswanath  and
Ivan Urits
Omar Viswanath
Affiliation:
Creighton University, Omaha
Ivan Urits
Affiliation:
Southcoast Brain & Spine Center, Wareham
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Summary

Three sources of pain are axial pain (e.g., axial lumbosacral), radiculopathic pain (e.g., lumbosacral radiculopathy), and referred pain. Axial low back pain is pain that is localized to the low back and does not radiate in a known dermatomal pattern; however, it can radiate down the thighs in a nondermatomal pattern. Lumbosacral radiculopathy or radicular pain is low back pain that travels into one or both lower extremities along a dermatomal distribution. Referred pain is pain that spreads to a region remote from sources but in nondermatomal fashion. Low back pain is the fifth most common chief complaint. US annual and lifetime prevalence of low back pain is 10–30% and 65–80%, respectively. Acute = <6 weeks, subacute = 6–12 weeks, chronic >12 weeks. Oftentimes, multidisciplinary approach to treatment is most effective (i.e., medical, psychological, physical, interventional management).

Keywords

neuropathicradiculopathicreferred painback painchronic pain
Type
Chapter
Information
Cambridge Handbook of Pain Medicine , pp. 95 - 106
Publisher: Cambridge University Press
Print publication year: 2023

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References

Bogduk, N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain. 2009;147(1–3):17–19. https://pubmed.ncbi.nlm.nih.gov/19762151/.CrossRefGoogle ScholarPubMed
Atlas, SJ, Deyo, RA. Evaluating and managing acute low back pain in the primary care setting. J Gen Intern Med. 2001;16(2):120–131. https://pubmed.ncbi.nlm.nih.gov/11251764/.CrossRefGoogle ScholarPubMed
Heuch, I, Foss, IS. Acute low back usually resolves quickly but persistent low back pain often persists. J Physiother. 2013;59(2):127. https://pubmed.ncbi.nlm.nih.gov/23663799/.CrossRefGoogle ScholarPubMed
Elkayam, O, Ben Itzhak, S, Avrahami, E et al. Multidisciplinary approach to chronic back pain: Prognostic elements of the outcome. Clin Exp Rheumatol. 1996;14(3):281–288. https://pubmed.ncbi.nlm.nih.gov/8809442/.Google ScholarPubMed
Deyo, R, Weinstein, J. Low back pain. N Engl J Med. 2001;344(5):363–70. https://www-nejm-org.libproxy1.usc.edu/doi/pdf/10.1056%252FNEJM200102013440508.CrossRefGoogle ScholarPubMed
Deyo, RA, Rainville, J, Kent, DL. What can the history and physical examination tell us about low back pain? JAMA J Am Med Assoc. 1992;268(6):760–765.CrossRefGoogle ScholarPubMed
Chou, R. Low back pain. Ann Intern Med. 2021;174(8):ITC113–ITC128. https://pubmed.ncbi.nlm.nih.gov/34370518/.CrossRefGoogle ScholarPubMed
Chou, R, Qaseem, A, Snow, V et al. Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478–491. https://pubmed.ncbi.nlm.nih.gov/17909209/.CrossRefGoogle ScholarPubMed
Deyo, RA, Diehl, AK. Cancer as a cause of back pain: Frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med. 1988;3(3):230–238. https://pubmed.ncbi.nlm.nih.gov/2967893/.CrossRefGoogle ScholarPubMed
Van Tulder, M, Becker, A, Bekkering, T et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(Suppl 2):S169–S191. https://pubmed.ncbi.nlm.nih.gov/16550447/.CrossRefGoogle ScholarPubMed
Urits, I, Burshtein, A, Sharma, M et al. Low back pain, a comprehensive review: Pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep [Internet]. 2019;23(3):23. https://pubmed.ncbi.nlm.nih.gov/30854609/.Google ScholarPubMed
Rubinstein, SM, van Tulder, M. A best-evidence review of diagnostic procedures for neck and low-back pain. Best Pract Res Clin Rheumatol. 2008;22(3):471–482. https://pubmed.ncbi.nlm.nih.gov/18519100/.CrossRefGoogle ScholarPubMed
Partanen, J V, Ojala, TA, Arokoski, JPA. Myofascial syndrome and pain: A neurophysiological approach. Pathophysiol Off J Int Soc Pathophysiol. 2010;17(1):19–28. https://pubmed.ncbi.nlm.nih.gov/19500953/.Google Scholar
Kalichman, L, Hunter, DJ. Lumbar facet joint osteoarthritis: A review. Semin Arthritis Rheum. 2007;37(2):69–80. https://pubmed.ncbi.nlm.nih.gov/17379279/.CrossRefGoogle ScholarPubMed
Park, WM, Kim, K, Kim, YH. Effects of degenerated intervertebral discs on intersegmental rotations, intradiscal pressures, and facet joint forces of the whole lumbar spine. Comput Biol Med. 2013;43(9):1234–1240. https://pubmed.ncbi.nlm.nih.gov/23930818/.CrossRefGoogle ScholarPubMed
Bagwell, JJ, Bauer, L, Gradoz, M, Grindstaff, TL. The reliability of Faber test hip range of motion measurements. Int J Sports Phys Ther. 2016;11(7):1101–1105. www.ncbi.nlm.nih.gov/pubmed/27999724.Google ScholarPubMed
Zelle, BA, Gruen, GS, Brown, S, George, S. Sacroiliac joint dysfunction: Evaluation and management. Clin J Pain. 2005;21(5):446–455. https://pubmed.ncbi.nlm.nih.gov/16093751/.CrossRefGoogle ScholarPubMed
Chou, R, Qasseem, A, Owens, D, Shekelle, P. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann. Intern. Med. 2011;154(3):181–189. https://web-s-ebscohost-com.libproxy1.usc.edu/ehost/pdfviewer/pdfviewer?vid=0&sid=a46376cb-0b2a-4f25-adcf-ed190625a0f0%40redis.CrossRefGoogle ScholarPubMed
Wilkinson, LS, Elson, E, Saifuddin, A, Ransford, AO. Defining the use of gadolinium enhanced MRI in the assessment of the postoperative lumbar spine. Clin Radiol. 1997;52(7):530–534. https://pubmed.ncbi.nlm.nih.gov/9240706/.CrossRefGoogle ScholarPubMed
Simons, DG. New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil. 2008;89(1):157–159. https://pubmed.ncbi.nlm.nih.gov/18164347/.CrossRefGoogle ScholarPubMed
Lucas, N, MacAskill, P, Irwig, L, Moran, R, Bogduk, N. Reliability of physical examination for diagnosis of myofascial trigger points: A systematic review of the literature. Clin J Pain. 2009;25(1):80–89. https://pubmed.ncbi.nlm.nih.gov/19158550/.CrossRefGoogle ScholarPubMed
Giamberardino, MA, Affaitati, G, Fabrizio, A, Costantini, R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2011;25(2):185–198. https://pubmed.ncbi.nlm.nih.gov/22094195/.CrossRefGoogle ScholarPubMed
Bogduk, N. Evidence-informed management of chronic low back pain with facet injections and radiofrequency neurotomy. Spine J. 2008;8(1):56–64. https://pubmed.ncbi.nlm.nih.gov/18164454/.CrossRefGoogle ScholarPubMed
Comer, C, Conaghan, PG. Tackling persistent low back pain in primary care. Practitioner. 2009;253:32–34.Google ScholarPubMed
Aprill, C, Bogduk, N. High-intensity zone: A diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol. 1992;65(773):361–369. https://pubmed.ncbi.nlm.nih.gov/1535257/.CrossRefGoogle Scholar
Taylor, RS, Taylor, RJ. The economic impact of failed back surgery syndrome. Br J Pain. 2012;6(4):174–181. https://pubmed.ncbi.nlm.nih.gov/26516490/.CrossRefGoogle ScholarPubMed
Waguespack, A, Schofferman, J, Slosar, P, Reynolds, J. Etiology of long-term failures of lumbar spine surgery. Pain Med. 2002;3(1):18–22. https://pubmed.ncbi.nlm.nih.gov/15102214/.CrossRefGoogle ScholarPubMed
Orhurhu, V, Urits, I, Olusunmade, M et al. Trends of co-morbid depression in hospitalized patients with failed back surgery syndrome: An analysis of the nationwide inpatient sample. Pain Ther. 2018;7(2):217–226. https://pubmed.ncbi.nlm.nih.gov/30218424/.CrossRefGoogle ScholarPubMed
Chan, C, Peng, P. Failed back surgery syndrome. Pain Med. 2011;12(4):577–606. https://pubmed.ncbi.nlm.nih.gov/21463472/.CrossRefGoogle ScholarPubMed
Weinstein, JN, Lurie, JD, Tosteson, TD et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007;356(22):2257–2270. https://pubmed.ncbi.nlm.nih.gov/17538085/.CrossRefGoogle ScholarPubMed
Koc, Z, Ozcakir, S, Sivrioglu, K, Gurbet, A, Kucukoglu, S. Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine (Phila Pa 1976). 2009;34(10):985–989.CrossRefGoogle ScholarPubMed
Bischoff, R, Rodriguez, R, Gupta, K, Righi, A, Dalton, J. A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis. Journal of Spinal Disorders. 1993;6(4): 289–295. https://oce-ovid-com.libproxy1.usc.edu/article/00002517-199306040-00002/PDF.CrossRefGoogle Scholar
Foley, BS, Buschbacher, RM. Sacroiliac joint pain: Anatomy, biomechanics, diagnosis, and treatment. Am J Phys Med Rehabil. 2006;85(12):997–1006.CrossRefGoogle ScholarPubMed
Mckenzie-Brown, AM, Shah, R V, Sehgal, N, Everett, CR. A systematic review of sacroiliac joint interventions. Pain Physician. 2005;8(1):115–125.Google ScholarPubMed
King, W, Ahmed, SU, Baisden, J et al. Spine section original research articles diagnosis and treatment of posterior sacroiliac complex pain: A systematic review with comprehensive analysis of the published data. Pain Med. 2015;16 (2):257–265. https://academic.oup.com/painmedicine/article/16/2/257/2460376.CrossRefGoogle Scholar
Roelofs, PDDM, Deyo, RA, Koes, BW, Scholten, RJPM, Van Tulder, MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2008;2(1):CD012087. www-cochranelibrary-com.libproxy2.usc.edu/cdsr/doi/10.1002/14651858.CD000396.pub3/fullGoogle Scholar
Sills, GJ. The mechanisms of action of gabapentin and pregabalin. Curr Opin Pharmacol. 2006;6(1):108–113. https://pubmed.ncbi.nlm.nih.gov/16376147/.CrossRefGoogle ScholarPubMed
Fariba, KA, Saadabadi, A. Topiramate. StatPearls. 2022. Treasure Island: StatPearls Publishing. PMID: 32119417. https://www.ncbi.nlm.nih.gov/books/NBK554530/.Google Scholar
Muehlbacher, M, Nickel, MK, Kettler, C et al. Topiramate in treatment of patients with chronic low back pain: A randomized, double-blind, placebo-controlled study. Clin J Pain. 2006;22(6):526–531. https://pubmed.ncbi.nlm.nih.gov/16788338/.CrossRefGoogle ScholarPubMed
Vitoula, K, Venneri, A, Varrassi, G et al. Behavioral therapy approaches for the management of low back pain: An up-to-date systematic review. Pain Ther. 2018;7(1). https://pubmed.ncbi.nlm.nih.gov/29767395/.CrossRefGoogle ScholarPubMed
Manchikanti, L, Staats, PS, Singh, V et al. Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain practice guidelines. Pain Physician. 2003;6(1):3–81.CrossRefGoogle ScholarPubMed
Kumar, K, Taylor, RS, Jacques, L et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132(1–2):179–188. https://pubmed.ncbi.nlm.nih.gov/17845835/.CrossRefGoogle ScholarPubMed
Berger, AA, Liu, Y, Possoit, H et al. Dorsal root ganglion (DRG) and chronic pain. Anesthesiol Pain Med. 2021;11(2):e113020. https://pubmed.ncbi.nlm.nih.gov/34336621/.CrossRefGoogle ScholarPubMed
Kaye, AD, Ridgell, S, Alpaugh, ES et al. Peripheral nerve stimulation: A review of techniques and clinical efficacy. Pain Ther. 2021;10(2):961–972. https://pubmed.ncbi.nlm.nih.gov/34331668/.CrossRefGoogle ScholarPubMed
Jain, S, Deer, T, Sayed, D et al. Minimally invasive lumbar decompression: A review of indications, techniques, efficacy and safety. Pain Manag. 2020;10(5):331–348. https://pubmed.ncbi.nlm.nih.gov/32609052/.CrossRefGoogle ScholarPubMed

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