Surgery vs Conservative Care Pain Relief from for Persistent Sciatica

PainRelief.com Interview with:

Dr. Chris Bailey
Western Bone and Joint Institute

PainRelief.com:  What is the background for this study? 

Response: Acute and subacute sciatica from a lumbar disc herniation is recognized to have a very good natural history with approximately 90% making significant improvement within 4 months of onset.  Hence, studies have shown that surgery for disc herniation has a short-term benefit over non-operative care. 

In many cases, the patients not receiving surgery will improve to the level of those receiving surgery by 6 months (Peul et al, 2007).  Chronic sciatica we felt was a different situation.  

What are the main findings?

Response: Our study confirmed that surgery has a greater advantage for these patients out to 1 year following surgery.  An unpublished stat from our work found that there is a 70% greater chance of significant improvement in sciatica with surgery compared to non-operative care (including physiotherapy, education, medications, and epidural injections).  We recommend that a referral is made to a surgeon for these patients as the likelihood of improvement without surgery is much less than for acute sciatic.

PainRelief.com: What should readers take away from your report?

Response:  Previous studies have also had a difficult time controlling for cross-over and maintaining distinct treatment cohorts.  Our study was designed in such a way to utilized the inherent wait times for consultation in our Canadian health care system so to prevent crossover from the non-op group to the surgical group.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: Our plan is to perform future cost effectiveness analysis and publish on long term outcomes as well.

Citation:

Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months
Chris S. Bailey, M.D., Parham Rasoulinejad, M.D., David Taylor, M.D., Keith Sequeira, M.D., Thomas Miller, M.D., Jim Watson, M.D., Richard Rosedale, P.T., Stewart I. Bailey, M.D., Kevin R. Gurr, M.D., Fawaz Siddiqi, M.D., Andrew Glennie, M.D., and Jennifer C. Urquhart, Ph.D
Nengl j med 382;12 nejm.org March 19, 2020

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The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Chiropractic Care Linked to Lower Use of Opioids for Spinal Pain Relief

PainRelief.com Interview with:
Jim Whedon DC, MS
Director of Health Services Research
SCU Health System
Southern California University of Health Sciences
Whittier, CA 

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Utilization of nonpharmacological pain management may prevent unnecessary use of opioids.

Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain. Overall, in the states of CT, MA and NH, at any particular time in the study period of 2012-2017, between 1.55 and 2.03 times more nonrecipients of chiropractic care.filled an opioid prescription, as compared with recipients.

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Low Back Pain: AI Can Expedite Pain Relief Recommendations Through Electronic Record

PainRelief.com Interview with:

Ismail Nabeel MD, MPH
Associate Professor
Public Health and General Preventive Medicine
Mount Sinai Medical Center

Dr. Nabeel

PainRelief.com:  What is the background for this study?

Response: Acute and chronic low back pain (LBP) are different conditions with different treatments. However, they are coded in electronic health records with the same International Classification of Diseases, 10th revision (ICD-10) code (M54.5) and can be differentiated only by retrospective chart reviews. This prevents an efficient definition of data-driven guidelines for billing and therapy recommendations, such as return-to-work options, etc.

In this feasibility study, we evaluated if Artificial intelligence can automatically distinguish the quality of Low Back Pain (LBP) episodes by analyzing free-text clinical notes from the treating providers. 

These clinical notes were collected during a previous pilot study evaluating an RTW tool based on EHR data that included nearly 40,000 encounters for 15,715 patients spanning from 2016 to 2018 and clinical notes written by 81 different providers. We used a dataset of 17,409 clinical notes from different primary care practices; of these, 891 documents were manually annotated as “acute low back pain” and 2,973 were generally associated with LBP via the recorded ICD-10 code. 

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Safety And Efficacy Of The Unique Opioid Buprenorphine For Chronic Pain Relief

PainRelief.com Interview with:
Joseph V. Pergolizzi, Jr., M.D.

Co-Founder and Chief Operating OfficerNEMA Research Inc.

Joseph V. Pergolizzi, Jr., M.D.
 Co-Founder and Chief Operating OfficerNEMA Research Inc.

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Chronic low back pain (CLBP) is a leading cause of disability.

  • Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line analgesic options or mild CLBP; however, when certain patients with moderate to severe CLBP do not achieve adequate pain relief, opioids are considered as an add-on therapy. Unfortunately, most opioid analgesics have the potential for adverse effects, abuse, and diversion.
  • Buprenorphine buccal film (Belbuca®) is an opioid analgesic classified as a Schedule III controlled substance in the United States and is a partial μ-opioid receptor agonist.
  • Buprenorphine buccal film is a unique analgesic that is approved by the US Food and Drug Administration for use in patients with chronic pain severe enough to require daily, around-the-clock, long-term opioid treatment for whom alternative treatment options are inadequate.
  • Two pivotal phase 3 clinical trials (Study 307, Clinical Trial ID NCT01675167, and Study 308, Clinical Trial ID NCT01633944) established the efficacy and safety profiles of buprenorphine buccal film.
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Back Pain in Elderly: Most Patients Do Not Receive Physical Therapy

PainRelief.com Interview with:
Dan Ly MD MPP
Staff Physician, VA Boston Healthcare System
Ph.D. Candidate in Health Policy (Economics)
Harvard University

Dan Ly
Ph.D. Candidate in Health Policy (Economics)
Harvard University

PainRelief.com:  What is the background for this study?

Response: New low back pain is a common complaint in primary care clinics. Prior research examining care patterns up to 2010 and sampling individual visits has found increasing use of opioids and advanced imaging and decreasing use of NSAIDs during this time period.

However, because care is delivered longitudinally, this study examined the care delivered to patients for new low back pain over the course of the year, which allowed me to look at the timing and sequence of care.

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Acute Low Back Pain: Does Ibuprofen With or Without Acetaminophen offer Pain Relief?

PainRelief.com Interview with:
Benjamin W. Friedman, MD, MS
Department of Emergency Medicine
Montefiore Medical Center, Albert Einstein College of Medicine
Bronx, NY, 10467

Benjamin W. Friedman, MD, MS
 Department of Emergency Medicine
 Montefiore Medical Center, Albert Einstein College of Medicine
 Bronx, NY, 10467

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Low back pain is a highly prevalent problem that causes more than 2 million visits to American emergency departments annually. Nonsteroidal anti-inflammatory drugs are first line medical management of this ailment, but are only modestly effective. We conducted an RCT to determine if adding acetaminophen to nonsteroidal anti-inflammatory drugs could improve outcomes two days and seven days after an ED visit for low back pain. Unfortunately, acetaminophen did not improve this outcomes.

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Yoga and Physical Therapy Improved Sleep in Patients with Chronic Low Back Pain

PainRelief.com Interview with:
Eric J. Roseen, DC, MSc

Assistant Professsor, Department of Family Medicine
Boston University School of Medicine and Boston Medical Center

Eric J. Roseen, DC, MSc
Assistant Professsor, Department of Family Medicine
Boston University School of Medicine and Boston Medical Center
Dr. Roseen

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Sleep disturbance and insomnia are common among people with chronic low back pain (cLBP). Previous research showed that 59% of people with cLBP experience poor sleep quality and 53% are diagnosed with insomnia disorder. Medication for both sleep and back pain can have serious side effects, and risk of opioid-related overdose and death increases with use of sleep medications. Given the serious risks of combining pain and sleep medications, we evaluated the use of nonpharmacologic approaches to manage sleep quality in adults with chronic low back pain.

Our randomized controlled trial included 320 adults with chronic low back pain from predominantly low-income racially diverse neighborhoods of Boston. At the beginning of the study, over 90 percent of participants with cLBP reported poor sleep quality. Participants were randomly assigned one of three different therapies for cLBP: physical therapy (PT), weekly yoga, or reading educational materials. Our previous research showed that yoga and PT are similarly effective for lowering pain and improving physical function, and reduced the need for pain medication. In this study, results for sleep improvements were compared over a 12-week intervention period and after 1 year of follow-up.

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Chronic Back and Knee Pain Relief: How Do Sham Procedures Compare to Surgery?

MedicalResearch.com Interview with:

Wayne B Jonas MD

Wayne B Jonas MD

H&S Ventures
Samueli Integrative Health Programs

MedicalResearch.com:  What is the background for this study?

Response: The findings of this study are based on a systematic review of 25 randomized clinical trials evaluating surgical type interventions (open surgeries, arthroscopic, endoscopic, laparoscopic, heart catheterization, radiofrequency, laser, and other interventions) for chronic back and knee pain. In each study, researchers had also performed sham procedures on a control group where they replicated the invasive procedure by omitting the step believed to be therapeutically necessary. The purpose of this it to determine how much of the effects are due to the placebo response.

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Self-Administered Acupressure Studied for Chronic Low Back Pain Relief

PainRelief.com Interview with:

Susan Murphy, Sc.D., O.T.R.
Associate Professor
Physical Medicine and Rehabilitation Department
Research Health Science Specialist
VA Ann Arbor Health Care System, GRECC

PainRelief.com:  What is the background for this study?

Response: Chronic low back pain is very common and affects quality of life by reducing the ability to carry out needed and valued activities. In addition, people with chronic low back pain tend to have other symptoms like fatigue, sleep disturbances, and depression. Medications are typically prescribed but have side effects, and in some cases, may increase the risk of abuse and addiction. Non-pharmacological treatments are an important part of chronic pain management and may reduce pain as well as other symptoms.

In this study, we examined the use of self-administered acupressure as a pain management strategy in people with chronic low back pain. Acupressure is a Traditional Chinese Medicine technique in which physical pressure is applied to specific points on the body. It is similar to acupuncture, but instead of needles, pressure is applied with a finger, thumb, or device. In previous studies, people with cancer-related or osteoarthritis pain who self-applied acupressure had reduced symptoms such as pain and fatigue.

PainRelief.com: What are the main findings?

Response: Our pilot randomized controlled trial involved 67 participants with chronic low back pain. They were randomized into one of three groups – relaxing acupressure, stimulating acupressure, or usual care. Participants in the acupressure groups were trained to apply pressure to specific anatomical points on their body, and asked to complete daily treatment sessions for 6 weeks. We found that people who performed stimulating acupressure had improved pain and fatigue, and people who performed relaxing acupressure had improved pain after 6 weeks compared to those in the usual care group. No differences among the groups were found for sleep quality or disability after 6 weeks. Participants performed an average of 85% of the daily acupressure sessions and there were minimal adverse events. Adverse events, such as skin breakdown, muscle spasm, and headache were attributed to applying too much pressure and adjustments in application technique was done to avoid future issues.

PainRelief.com: What should readers take away from your report?

Response: Self-administered acupressure shows some promising effects on pain and fatigue in people with chronic low back pain. It is a low cost and low risk symptom management strategy that people can adhere to.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: Because this was only a pilot study, larger studies are needed to support the effectiveness of this treatment for people with chronic low back pain.

Citation:

Susan Lynn Murphy, Richard Edmund Harris, Nahid Roonizi Keshavarzi, Suzanna Maria Zick, Self-Administered Acupressure for Chronic Low Back Pain: A Randomized Controlled Pilot Trial, Pain Medicine, , pnz138, https://doi.org/10.1093/pm/pnz138

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The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

SEAL Procedure Gives Pain Relief To Some After Failed Back Surgery

MedicalResearch.com Interview with:
"Personal Injury Back Pain" by SanDiego PersonalInjuryAttorney is licensed under CC BY-SA 2.0
Michael Perloff, MD PhD

Assistant Professor of Neurology
Interventional Pain Management
Boston University School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Low back pain is very common. Patients with chronic low back pain that does not benefit from physical therapy, medications, or injections, often get spine surgery. If surgery fails to help (Failed back surgery syndrome-i.e. continued low back and leg pain after surgery), options for pain relief become more complex.

Typically, patients with failed low back surgery syndrome have tried complex procedures, repeat surgery or technology implants as their main options.

The SEAL procedure is a shortened, simple procedure (done in about 20 minutes) that can help as treatment for failed back surgery symptoms. In the published case series of 30 patients, some patients achieved very good, sustained, pain relief. Continue reading