PainRelief.com Interview with: Dr. Douglas Beall, MD Chief of Radiology Services Clinical Radiology of Oklahoma Oklahoma City, OK
Dr. Beall
PainRelief.com: What is the background for this study?
Response: Discogenic low back pain is typically caused by damaged discs in the spine. Viable disc allograft supplementation is a minimally invasive treatment that injects specialized cells and fluid into a damaged disc. The cells of the injected fluid encourage the cells in the damaged disc to regenerate with healthy tissue.
As for the study itself, 50 patients at nine sites participated in an extension of the randomized control Viable Allograft Supplemented Disc Regeneration in the Treatment of Patients With Low Back Pain (VAST) Trial. Of these, 46 received allograft treatment and four received saline. The treatment group was similar to the patient population at the start of the VAST trial in age, sex, race, ethnicity, body mass index and smoking status. Pain levels were evaluated using the VAS Analog Scale, and functionality was measured using the Oswestery Disability Index (ODI).
PainRelief.com Interview with: Filippo Migliorini MD, PhD, MBA Department of Orthopedic, Trauma, and Reconstructive Surgery RWTH University Hospital of Aachen
Dr. Migliorini
PainRelief.com: What is the background for this study?
Response: Acute low back pain imposes a significant socioeconomic burden worldwide. The pharmacological management of acute low back pain aims to restore daily activities and improve the quality of life. No magic bullet exists: interventions to reduce pain and disability are available, but long-term results are unpredictable. This is often hard to accept for clinicians and patients and provides fertile soil to quacks, faith healers, and gurus to promote miraculous non-evidence-based solutions. Education in this regard needs to improve.
Acute low back pain management is not well codified and extremely heterogeneous, and residual symptoms are common. Depending on the individual severity, pharmacological management may range from nonopioid to opioid analgesics. The literature regarding the best non-opioid pharmacological management of acute low back pain is limited, and the indications available in the literature are conflicting. Our investigation aimed to systematically review the level I evidence on the administration of myorelaxants, nonsteroidal anti-inflammatory drugs, and paracetamol in patients with low back pain.
PainRelief.com Interview with: Richard L. Skolasky, Jr., Sc.D. Professor, Orthopaedic Surgery and Physical Medicine & Rehabilitation Vice Chair of Research, Orthopaedic Surgery Director, Surgical Outcomes Research Center Johns Hopkins University 601 North Caroline Street, Room 5244 Baltimore, MD 21287
Dr. Skolasky
PainRelief.com: What is the background for this study?
Response: Low back pain (LBP) affects a sizeable proportion of the US population (from 1.4 to 20%), and accounts for substantial healthcare expenditures (between $12 billion and $91 billion, not accounting for indirect costs associated with loss of productivity and unemployment). Current recommendations for initial treatment of acute low back pain include physical therapy. Earlier initiation of physical therapy has been associated with less healthcare utilization and spending; however, these studies have been limited to single institutions or health systems. Research is needed to evaluate the effects of early physical therapy on healthcare use, particularly within the first 30 days after initial presentation for acute low back pain, when they are most likely to experience pain and seek care.
Michael Perloff, MD PhD Director, Neurology Pain Medicine, Boston Medical Center Assistant Professor, Boston University Medical School
PainRelief.com: What is the background for this study?
Response: Spine-related pain (low back pain/neck pain) is very common in older adults. Physicians can be reluctant to use pain medications older patients due to reduced liver and kidney function, comorbid medical problems and background polypharmacy. We performed an extensive review of the medical literature with a focus on double-blind, placebo controlled, clinical trials.
PainRelief.com Interview with: Douglas P. Beall, MD, FSIR Chief of Radiology Services Clinical Radiology of Oklahoma
Dr. Bealll
PainRelief.com: What is the background for this study?
Response: Degenerative disc disease (DDD) is the leading cause of chronic low back pain and one of the world’s most common medical conditions contributing to high medical and disability costs. Healthy spinal discs act aids spine movement and distributes force which allows for spine flexibility and even distribution of the load that is placed on the spine. Each has a firm outer layer and a soft, jelly-like core. With normal aging, discs tend to become dry, thin, cracked or torn, which can cause pain and abnormal motion.
Substances called hydrogels, with biochemical similarities to the intervertebral disc designed to augment both the core and outer layer, have been used for years to help repair degenerated discs. First-generation hydrogels are placed as a soft solid, through a surgical incision, but were not simple to place and had a tendency to migrate from where they were originally placed.
For a first-in-human trial, our team conducted a prospective, single-arm feasibility study to evaluate an experimental, injectable hydrogel for safety and performance in relieving chronic low back pain caused by DDD. We used a second-generation hydrogel (Hydrafil™) developed by ReGelTec, Inc.. Unlike earlier hydrogels, it can be temporarily modified into a liquid and injected rather than placed through a small incision. In 2020, this product received FDA’s breakthrough device designation, allowing expedited review based on promising early evidence.
We recruited 20 patients, aged 22 to 69, who each described their pain as four or higher on a zero to 10 scale. None had found more than mild relief from non-surgical management, which includes rest, analgesics, physical therapy, and back braces. Patients were sedated for the procedure, and the gel was heated to become a thick liquid. Guided by fluoroscopic imaging, an interventional radiologist used a 17-gauge needle to inject the gel directly into the affected disc(s). The gel filled in cracks and tears and adhered to the disc’s core and outer layer.
PainRelief.com Interview with: Donatella Bagagiolo Osteopath D.O. BSc. (Hons) Ost. Director of Research Department, Scuola Superiore di Osteopatia Italiana Torino Italy
PainRelief.com: What is the background for this study?
Response:Osteopathic medicine, depending on different legal and regulatory structures around the world, is a medical profession (e.g. USA), an allied health profession (e.g. UK) or a part of complementary and alternative medicine (e.g. Italy or France). Osteopathic medicine plays an important role primarily in musculoskeletal healthcare. In recent years, systematic reviews have been published to evaluate the clinical efficacy and safety of osteopathic medicine for conditions such as low back pain, neck pain and migraine. However, due to differences in methodologies and the quality of systematic reviews, no clear conclusions were achieved. The aim of our overview was to summarize the available clinical evidence on the efficacy and safety of osteopathic medicine for different conditions.
Ms Emma Ho | BAppSc(Phty)(Hons), PhD Candidate The University of Sydney Faculty of Medicine and Health | Charles Perkins Centre Musculoskeletal Research Hub | Sydney NeuroMusculoskeletal Research Collaborative Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences
Emma Ho
PainRelief.com: What is the background for this study?
Response: Adults with chronic low back pain (lasting for more than 12 weeks) not only experience physical disability but can also suffer psychological distress in the form of anxiety, depression, and fear avoidance (avoiding movement for fear of pain).
Clinical guidelines therefore consistently recommend a combination of exercise and psychosocial therapies for managing chronic low back pain. However, not much is known about the different types of psychological therapies available as well as their comparative effectiveness and safety, leaving doctors and patients often unclear about the best choice of treatment. Accordingly, the aim of our systematic review with network meta-analysis was to determine the comparative effectiveness and safety of psychological interventions for chronic non-specific low back pain.
PainRelief.com Interview with: Ingrid Heuch MD, PhD Department of Research, Innovation and Education, Division of Clinical Neuroscience Oslo University Hospital, Norway
Dr. Heuch
PainRelief.com: What is the background for this study? What are the main findings?
Response: Low back pain represents a major health problem in today’s society. In this study more than 27 000 women aged 20-69 years were included in the Trøndelag Health Study, HUNT, in Norway. As in most population-based studies, women were more likely to be affected with chronic low back pain than men. Our study showed a U-shaped relationship between age at menarche (age at a woman’s first menstruation) and risk of low back pain, also after many years. Both women with an early or late age at menarche experienced higher risk of low back pain. Compared to women with menarche at age 14 years, menarche at age 11 years increased the risk by 32% and menarche at age 17 years by 43%. No association was found between age at menopause and risk of low back pain.
PainRelief.com Interview with: Mark W Werneke, PT, MS, Dip. MDT Net Health Systems, Inc. Pittsburgh PA
Mark W Werneke
PainRelief.com: What is the background for this study?
Response: Coronavirus pandemic (COVID-19) has had a profound effect on changing health care delivery systems and resulted in a rapid growth of telerehabilitation care models. In addition, patients experiencing chronic low back pain increased during the pandemic which was confounded by mandatory lockdowns and lack of physical activity. There is scant literature demonstrating telerehabilitation’s effectiveness and efficiency for patients with low back pain seeking rehabilitation services during COVID-19 pandemic compared to traditional in-person office visit care.
The primary aim of our study was to examine the association between telerehabilitation treatments administered during every day clinical practice and functional status, number of visits, and patient satisfaction with treatment result outcomes compared to in-person care observed during the height of the pandemic. Using Focus on Therapeutic Outcomes (FOTO) database, our sample consisted of 91,117 episodes of care from 1,398 clinics located in 46/50 US states. Propensity score matching analytics was used to match episodes of care with or without telerehabilitation and standardized differences (S-D) were used to assess whether successful matching between telerehabilitation and no-telerehabilitation subgroups allowed for valid outcome comparisons.
PainRelief.com Interview with: Lauren R. Gorfinkel MPH New York State Psychiatric Institute New York, NY Department of Medicine, University of British Columbia Vancouver, Canada
PainRelief.com: What is the background for this study?
Response: The opioid crisis has led to clear declines in opioid prescribing across North America, however, chronic pain remains an extremely common health problem with limited treatment options. This study was therefore interested in using nationally-representative data to find out whether alternative pain medications are growing more popular as opioid prescriptions decline.
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