Articles: back-pain.
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J Spinal Disord Tech · Nov 2013
Effect of An Annular Closure Device (Barricaid) on Same Level Recurrent Disc Herniation and Disc Height Loss After Primary Lumbar Discectomy: Two-Year Results of a Multi-Center Prospective Cohort Study.
Prospective cohort study. ⋯ Implantation of a novel annular repair device was associated with greater maintenance of disc height and improved one-year leg pain, back pain, and low-back disability. Recurrent disc herniation did not occur in any patients after annular repair. Closure of annular defect after lumbar discectomy may help preserve physiologic disc function and prevent long-term disc height loss and associated back and leg pain.
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The dominant socioaffective model of empathy has emphasized the overlap between brain mechanisms involved in the encoding and the decoding of internal states. The role of dispositional empathy has been extensively studied in this research, but several other individual factors fundamental to communication processes have been largely ignored. We studied the effects of dispositional expressiveness in chronic back pain patients to determine if the decoding of communicative and noncommunicative information signaling pain in others would be enhanced in individuals displaying a spontaneous propensity to consistently express more pain during a behavioral-observational naturalistic standardized lifting task performed on 2 separate occasions. Blood oxygenation level-dependent signal change was measured in response to pictures showing facial pain expressions and hands/feet in pain-evoking situations in chronic back pain patients and healthy controls. Vicarious brain responses to others' pain were comparable between groups. However, more expressive patients rated others' pain higher and showed stronger vicarious pain responses in the right ventral part of the inferior frontal gyrus, the right insula, and the midbrain. Activity in the right insula correlated positively with both the patients' expressiveness (encoding) and the intensity of the pain perceived in the images (decoding), suggesting that this structure linked the dispositional expressiveness with vicarious pain perception. Importantly, these effects were independent from dispositional empathy and were found with both communicative (facial expression) and noncommunicative (hand and foot) cues. These results suggest that dispositional expressiveness is a self-related factor that facilitates vicarious pain processing and might reflect individual tendencies to rely on social coping strategies. ⋯ This article shows that pain expressivity in chronic pain patients increased the vicarious brain responses and the sensibility to others' pain. These results may help provide empirical support for better defining models of pain communication in chronic pain patients.
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Randomized Controlled Trial Multicenter Study
Peripheral nerve field stimulation for the management of localized chronic intractable back pain: results from a randomized controlled study.
Improved device technology has caused a renewed interest in peripheral nerve field stimulation (PNfS). This study sought to obtain preliminary estimates of the safety and efficacy of PNfS in patients with localized chronic intractable pain of the back. ⋯ A total of 44 patients were enrolled at five sites. Of these patients, 32 were implanted with a trial system and 30 completed phase I. During phase I, there were significant differences in mean VAS scores between minimal stimulation and subthreshold stimulation (p = 0.003), low frequency stimulation (p < 0.001), and standard stimulation (p < 0.001). Twenty-four patients were classified as responders to the therapy, and 23 patients received permanent system placement. Significant differences in VAS scores were observed between baseline and all follow-up visits during phase II (p < 0.001) CONCLUSIONS: The results provide evidence to support safety and effectiveness of PNfS as an aid in the management of chronic, localized back pain.