Articles: low-back-pain.
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Dorsal root ganglion stimulation (DRG-S) involves the electrical modulation of the somata of afferent neural fibers to treat chronic pain. DRG-S has demonstrated clinical efficacy at frequencies lower than typically used with spinal cord stimulation (SCS). In a clinical study, we found that the frequency of DRG-S can be tapered to a frequency as low as 4 Hz with no loss of efficacy. This review discusses possible mechanisms of action underlying effective pain relief with very low-frequency DRG-S. ⋯ Sensory neural transmission is a frequency-modulated system, with signal frequency determining which mechanisms are activated in the dorsal horn. In the dorsal horn, low-frequency signaling (<20 Hz) activates inhibitory processes while higher frequencies (>25 Hz) are excitatory. Physiologically, low-threshold mechanoreceptors (LTMRs) fibers transmit or modulate innocuous mechanical touch at frequencies as low as 0.5-5 Hz, while nociceptive fibers transmit pain at high frequencies. We postulate that very low-frequency DRG-S, at least partially, harnesses LTMRs and the native endogenous opioid system. Utilizing lower stimulation frequency decreases the total energy delivery used for DRG-S, extends battery life, and facilitates the development of devices with smaller generators.
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Dorsal root ganglion stimulation (DRG-S) is used as a treatment for chronic low-back pain (CLBP), although its underlying mechanisms remain elusive. CLBP patients have been found to have reduced mechanoreceptive perception, reduced endogenous analgesia, as well as deep-tissue hyperalgesia when compared with healthy controls. Using quantitative sensory testing (QST), we studied if DRG-S in CLBP patients results in changes in pain processing. ⋯ Our results suggest that DRG-S in CLBP patients reduces deep-tissue hyperalgesia in the low back, while improving mechanoreceptive perception. These changes in both neuropathic and nociceptive components of CLBP were accompanied by clinical improvements in pain and function.
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Randomized Controlled Trial
Remote Versus in-Person Exercise Instruction for Chronic Nonspecific Low Back Pain Lasting 12 Weeks or Longer: A Randomized Clinical Trial.
Low back pain is a common health problem. We compared the effects of a remote exercise instruction with in-person exercise instruction on the pain and disability of people with nonspecific low back pain for more than 12 weeks. ⋯ There was no measurable difference between an exercise program delivered remotely compared to in-person.
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Chronic low back pain is a prevalent condition, often involving an inflammatory process. Behavioral symptoms, including depressed mood, fatigue, and sleep disturbance, intensifies pain and reduces quality of life. ⋯ Findings revealed a two-class model, with Class 1 characterized by more depressive mood, fatigue, and sleep disturbance compared to Class 2. Class 1 participants reported worse quality of life than those in Class 2. Pain severity and pain interference were not significantly different between the classes. Levels of IL-6 were significantly greater in Class 1 participants compared to Class 2 with higher levels of IL-6 correlating with greater pain severity and sleep disturbances. Logistic regression revealed higher levels of IL-6 predicted Class 1 membership. Behavioral symptoms cluster exist in chronic low back pain patients and impact quality of life. Inflammation may contribute to relationship between behavioral symptoms and pain severity.
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Manual medicine is the medical discipline that comprehensively deals with the diagnosis, treatment and prevention of reversible functional disorders of the musculoskeletal system and other related organ systems. The article illustrates the neuroanatomical and neurophysiological basic elements and mechanisms of manual medical diagnostics and treatment. Based on the most recent literature and in consideration of various scientific guidelines, the evidence-based effectiveness of manual medical procedures is presented. ⋯ Clinical case examples illustrate the clinical approach. The terminology, origin and clinical presence of "osteopathy" are described in detail and the national and international associations and societies of manual medicine, the German Society for Manual Medicine (DGMM), the European Scientific Society of Manual Medicine (ESSOMM) and the Fédération Internationale de Medicine Manuelle (FIMM) are lexically presented. Finally, contraindications for manual interventions and an outlook on requirements and possibilities of the scientific analysis of pain are presented, as they are postulated in the preamble of the guidelines on specific low back pain of the German Society for Orthopedics and Orthopedic Surgery (DGOOC).