Structural integration as an adjunct to outpatient rehabilitation for chronic nonspecific low back pain: a randomized pilot clinical trial.

Structural Integration (SI) is an alternative method of manipulation and movement education. To obtain preliminary data on feasibility, effectiveness, and adverse events (AE), 46 outpatients from Boston area with chronic nonspecific low back pain (CNSLBP) were randomized to parallel treatment groups of SI plus outpatient rehabilitation (OR) versus OR alone. Feasibility data were acceptable except for low compliance with OR and lengthy recruitment time. Intent-to-treat data on effectiveness were analyzed by Wilcoxon rank sum, n = 23 per group. Median reductions in VAS Pain, the primary outcome, of -26 mm in SI + OR versus 0 in OR alone were not significantly different (P = 0.075). Median reductions in RMDQ, the secondary outcome, of -2 points in SI + OR versus 0 in OR alone were significantly different (P = 0.007). Neither the proportions of participants with nor the seriousness of AE were significantly different. SI as an adjunct to OR for CNSLBP is not likely to provide additional reductions in pain but is likely to augment short term improvements in disability with a low additional burden of AE. A more definitive trial is feasible, but OR compliance and recruitment might be challenging. This trial is registered with ClinicalTrials.gov (NCT01322399).

Nutrition and eating behavior in patients with chronic pain receiving long-term opioid therapy.

OBJECTIVE: To assess eating behavior and nutrient intake in a group of patients who were diagnosed with chronic pain and received long-term opioid analgesic therapy. DESIGN: A descriptive, exploratory study with a convenience sample. SETTING: An outpatient pain rehabilitation center. PARTICIPANTS: Patients diagnosed with chronic pain who received long-term opioid analgesic therapy (N = 50). MAIN OUTCOME MEASUREMENTS: Body mass index, the Food Frequency Questionnaire developed by the Nutrition Assessment Shared Resource of Fred Hutchinson Cancer Research Center, and the Eating Behavior Inventory. RESULTS: Of 50 participants, 14 (28%) and 22 (44%) were found to be overweight and obese, respectively. Mean (±SD) daily caloric intake (kcal) was 2008.5 ± 926.0 among men and 1694.8 ± 672.4 among women. Daily mean (±SD) consumption of fruit and vegetable servings, calculated with the summation method, was found to be 1.8 ± 1.1 and 1.9 ± 1.5, respectively. Our patient sample showed the following mean (±SD) daily intake of the following substances: added sugars (g), 74.4 ± 43.0; fiber (g), 17.3 ± 7.5; cholesterol (mg), 266.5 ± 234; saturated fat (g), 25.8 ± 16.8; omega-3 fatty acids (g), 1.6 ± 0.99; trans-fatty acids (g), 2.7 ± 1.7; sodium (mg), 2868.5 ± 1388.1; caffeine (mg), 199.9 ± 160.8; alcohol (g), 1.6 ± 0.5; vitamin D (IU), 244 ± 208; and calcium (mg), 1111.7 ± 672.1. The mean (±SD) score as calculated by the Eating Behavior Inventory was 74.9 ± 9.1. CONCLUSIONS: Obesity, deficient nutrient intake, and poor eating behavior were highly prevalent in our sample of patients with chronic pain who underwent long-term opioid therapy. Larger prospective studies are necessary to assess the eating behavior of patients with chronic pain who are treated with or without opioid analgesics.

Demographics and attitudes of chronic-pain patients who seek online pain-related medical information: implications for healthcare providers.

OBJECTIVE: To identify the demographics, search characteristics, and attitudes of chronic-pain patients who access online pain-related medical information. DESIGN: This is a cross-sectional survey study. RESULTS: Ninety percent of patients had access to the Internet; 63% of patients used the Internet to obtain online pain-related medical information, of which 57% and 55% believed that the information was "useful" and "credible," respectively. Ninety-five percent of current online pain-related medical information users and 52% of nonusers planned to use the Internet in the future to obtain online pain-related medical information. Only half of our subjects ever shared the information found on Internet with their treating healthcare provider. CONCLUSIONS: A large proportion of chronic-pain patients use the Internet to obtain online pain-related medical information. This behavior was found to show significant correlation with patients' level of education. Despite multiple previous studies suggesting inaccurate and low quality of online medical information, most of the patients felt confident in the credibility of online pain-related medical information obtained. Furthermore, many patients choose not to share this information with their healthcare providers. Healthcare providers must acknowledge the growing importance of Internet-based health information, be prepared to entertain questions and assist patients in evaluating the quality of online pain-related medical information, and possibly proactively suggest quality third-party pain-related websites.

Neck and back pain: musculoskeletal disorders.

In this article, non-neurologic causes of neck and back pain are reviewed. Musculoskeletal pain generators include muscle, tendon, ligament, intervertebral disc, articular cartilage, and bone. Disorders that can produce neck and back pain include muscle strain, ligament sprain, myofascial pain, fibromyalgia, facet joint pain, internal disc disruption, somatic dysfunction, spinal fracture, vertebral osteomyelitis, and polymyalgia rheumatica. Atlantoaxial instability and atlanto-occipital joint pain are additional causes of neck pain. Back pain resulting from vertebral compression fracture, Scheuermann's disease, spondylolysis and spondylolisthesis, pregnancy, Baastrup's disease, sacroiliac joint dysfunction, and sacral stress fracture is discussed.

Muscle relaxants and antispasticity agents.

Muscle relaxants make up a heterogeneous group of agents and can have a clinically significant role in the treatment of chronic muscle pain. These medications are not without possible serious side effects; hence, care should be taken in deciding on their appropriateness and ongoing monitoring performed, if prescribed.

Neuropathic low back pain.

In this discussion, we hope to advance a clinical approach to low back pain that is more in line with our modern understanding of neuropathic pain. We review the current understanding of normal and pathologic neuroanatomy of the lumbar spine and then outline how pathology in the different structures can lead to neuropathic pain and cause common pain patterns seen in clinical practice. We also detail the available treatments for neuropathic low back pain.