Asunto(s)
Síndrome de Fracaso de la Cirugía Espinal Lumbar/rehabilitación , Complicaciones Posoperatorias/rehabilitación , Enfermedades de la Columna Vertebral/terapia , Dolor de Espalda/etiología , Terapia Cognitivo-Conductual , Terapia por Estimulación Eléctrica , Humanos , Complicaciones Posoperatorias/etiología , Recurrencia , Enfermedades de la Columna Vertebral/etiología , Resultado del TratamientoAsunto(s)
Síndrome de Fracaso de la Cirugía Espinal Lumbar/rehabilitación , Dolor de la Región Lumbar/cirugía , Estimulación de la Médula Espinal/métodos , Fusión Vertebral/efectos adversos , Estenosis Espinal/cirugía , Síndrome de Fracaso de la Cirugía Espinal Lumbar/diagnóstico , Estudios de Seguimiento , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/rehabilitación , Dimensión del Dolor , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/rehabilitación , Medición de Riesgo , Índice de Severidad de la Enfermedad , Fusión Vertebral/métodos , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/rehabilitación , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Descending nociceptive inhibitory pathways often malfunction in people with chronic pain. Conditioned pain modulation (CPM) is an experimental evaluation tool for assessing the functioning of these pathways. Spinal cord stimulation (SCS), a well-known treatment option for people with failed back surgery syndrome (FBSS), probably exerts its pain-relieving effect through a complex interplay of segmental and higher-order structures. OBJECTIVE: To the best of our knowledge, no clinical studies have thoroughly investigated the associations between SCS and CPM. DESIGN: This was a prospective cohort study in people with FBSS. METHODS: Seventeen people who had FBSS and were scheduled for SCS were enrolled in this study. The CPM model was evaluated at both sural nerves and was induced by electrical stimulation as the test stimulus and the cold pressor test as the conditioning stimulus. RESULTS: Before SCS, less than 30% of the participants with FBSS showed a CPM effect. Significant increases in the electrical detection threshold on the symptomatic side and the nonsymptomatic side were found. On the symptomatic side, no differences in the numbers of CPM responders before and after SCS could be found. On the nonsymptomatic side, more participants showed a CPM effect during SCS. Additionally, there were significant differences for CPM activation and SCS treatment. LIMITATIONS: Limitations were the small sample size and the subjective outcome parameters in the CPM model. CONCLUSIONS: This study revealed a bilateral effect of SCS that suggests the involvement of higher-order structures, such as the periaqueductal gray matter and rostroventromedial medulla (key regions in the descending pathways), as previously suggested by animal research.
Asunto(s)
Dolor Crónico/rehabilitación , Síndrome de Fracaso de la Cirugía Espinal Lumbar/rehabilitación , Manejo del Dolor/métodos , Estimulación de la Médula Espinal , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios ProspectivosRESUMEN
BACKGROUND: Spinal cord stimulation (SCS) has proven to be a cost-effective treatment for failed back surgery syndrome (FBSS). However, the effect on patients' working capability remains unclear. OBJECTIVE: To evaluate the impact of SCS on working capability and to identify the factors behind permanent disability in FBSS patients. METHODS: The study group consisted of 198 working-age patients with SCS trialed or implanted for FBSS in a single center between 1996 and 2014. For each patient, 3 living controls, matched by age, gender, and birthplace, were otherwise randomly selected by the Population Register Center. The data on working ability were obtained from the Social Insurance Institution. Patients were divided into 3 groups: SCS trial only, SCS implanted permanently, and SCS implanted but later explanted. RESULTS: A rehabilitation subsidy was given to 68 patients and 8 controls for a mean of 5.2 (95% confidence interval [CI] 2.4-8.2) and 0.2 (95% CI 0.05-0.6) days per month (P < .05). At the end of follow-up, 16 (37%), 13 (33%), 25 (22%), and 27 (5%) subjects were on disability pension (DP) in the SCS trial, SCS explanted, SCS permanent, and control groups. Patients in the SCS trial-only group were significantly more often on DP than were patients with permanent SCS (odds ratio 2.6; 95% CI 1.2-5.9; P = .02). CONCLUSION: Permanent SCS usage was associated with reduced sick leave and DP. Prospective study will be required to assess possible predictive value.
Asunto(s)
Síndrome de Fracaso de la Cirugía Espinal Lumbar/rehabilitación , Pensiones , Ausencia por Enfermedad , Estimulación de la Médula Espinal/métodos , Adulto , Estudios de Casos y Controles , Síndrome de Fracaso de la Cirugía Espinal Lumbar/economía , Femenino , Finlandia , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Estimulación de la Médula Espinal/economía , Resultado del Tratamiento , Adulto JovenRESUMEN
Importance: Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs. Objective: To compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain. Design, Setting, and Participants: Multicenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months. Interventions: Participants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy). Main Outcomes and Measures: Primary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health). Results: There were 22 men and 38 women in the experimental group (mean [SD] age, 39.9 [12.0] years) and 25 men and 35 women in the control group (mean [SD] age, 40.5 [12.9] years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal [EM] mean, 0.971; 95% CI, -0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, -5.684; 95% CI, -10.589 to -0.780) and 12 months (EM mean, -6.053; 95% CI, -10.781 to -1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, -5.113; 95% CI, -9.994 to -0.232), 6 months (EM mean, -6.351; 95% CI, -11.153 to -1.550), and 12 months (EM mean, -5.779; 95% CI, -10.340 to -1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical health at 3 months (EM mean, 39.263; 95% CI, 9.644-66.882), 6 months (EM mean, 53.007; 95% CI, 23.805-82.209), and 12 months (EM mean, 32.208; 95% CI, 2.402-62.014). Conclusions and Relevance: Pain neuroscience education combined with cognition-targeted motor control training appears to be more effective than current best-evidence physiotherapy for improving pain, symptoms of central sensitization, disability, mental and physical functioning, and pain cognitions in individuals with chronic spinal pain. Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population. Trial Registration: clinicaltrials.gov Identifier: NCT02098005.
Asunto(s)
Dolor de Espalda/rehabilitación , Dolor Crónico/rehabilitación , Terapia por Ejercicio/métodos , Dolor de Cuello/rehabilitación , Modalidades de Fisioterapia , Adulto , Dolor de Espalda/diagnóstico por imagen , Dolor de Espalda/fisiopatología , Dolor de Espalda/psicología , Sensibilización del Sistema Nervioso Central , Dolor Crónico/diagnóstico por imagen , Dolor Crónico/fisiopatología , Dolor Crónico/psicología , Cognición , Síndrome de Fracaso de la Cirugía Espinal Lumbar/diagnóstico por imagen , Síndrome de Fracaso de la Cirugía Espinal Lumbar/fisiopatología , Síndrome de Fracaso de la Cirugía Espinal Lumbar/psicología , Síndrome de Fracaso de la Cirugía Espinal Lumbar/rehabilitación , Femenino , Sustancia Gris/diagnóstico por imagen , Humanos , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/fisiopatología , Dolor de la Región Lumbar/psicología , Dolor de la Región Lumbar/rehabilitación , Masculino , Persona de Mediana Edad , Dolor de Cuello/diagnóstico por imagen , Dolor de Cuello/fisiopatología , Dolor de Cuello/psicología , Neurociencias/educación , Educación del Paciente como Asunto , Lesiones por Latigazo Cervical/diagnóstico por imagen , Lesiones por Latigazo Cervical/fisiopatología , Lesiones por Latigazo Cervical/psicología , Lesiones por Latigazo Cervical/rehabilitaciónRESUMEN
Back disorders are very common phenomena in modern society. One of the methods of spinal pain treatment is performing surgery. Unfortunately, this method is not one hundred percent effective. Some patients show no improvement after surgery, the pain persists and even increases. In these cases, it is reasonable to use the term Failed Back Surgery Syndrome (FBSS), i.e. back pain syndrome after unsuccessful spine surgery. AIM: The aim of the study is to assess the impact of rehabilitation on the pain intensity level in patients with FBSS. MATERIALS AND METHODS: The study was conducted in a group of 38 patients aged from 32 to 87 (mean age 61 years), including 20 women and 18 men. All patients were operated for spinal pain syndrome. Afterwards, they underwent rehabilitation because of persisting pain after the surgery. For the pain assessment was used The Visual- Analogue Scale and The Laitinen Modified Questionnaire Indicators of Pain. The results were statistically analyzed. RESULTS: The study showed the high efficacy of specialized rehabilitation in patients with FBSS. CONCLUSIONS: The rehabilitation in patients with FBSS has a significant analgesic effect. Rehabilitation should be a gold standard in patients with FBSS.
Asunto(s)
Síndrome de Fracaso de la Cirugía Espinal Lumbar/rehabilitación , Desplazamiento del Disco Intervertebral/cirugía , Núcleo Pulposo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: Chronic low back and leg pain is a disabling condition, affecting, in most cases, older patients with congenital or acquired spinal stenosis or patients with failed back surgery syndrome. Spinal cord stimulation has been introduced as an effective therapeutic option for those patients who have previously been operated without significant clinical benefits, or for all those patients who are ineligible for traditional surgery. METHODS: We report our experience with ten patients treated with spinal cord stimulation plus medication and physical therapy between November 2014 and September 2015. Inclusion criteria were: previous surgical treatments for lumbar stenosis and metameric instability and persistent or ingravescent disabling low back and leg pain, with a mean duration of symptoms of at least 18 months. A visual analog scale (VAS) was employed for back and leg pain, and the Oswestry Disability Index (ODI) score was determined, and findings were analyzed after 6 months. FINDINGS: No intra- or postoperative complication was recorded. The mean VAS score for back pain decreased from 7.5 to 2.9, while leg VAS decreased from 8.2 to 3.0. Analysis of ODI values showed evident improvement in daily life activities, ranging from a median value of 75.7% to 32.7 % after the stimulation. CONCLUSION: Spinal cord stimulation has a recognized impact on the pain and on the quality of life of patients with failed back surgery syndrome.
Asunto(s)
Síndrome de Fracaso de la Cirugía Espinal Lumbar/rehabilitación , Estimulación de la Médula Espinal/métodos , Estenosis Espinal/rehabilitación , Anciano , Artrodesis , Dolor de Espalda/rehabilitación , Descompresión Quirúrgica , Femenino , Humanos , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Modalidades de Fisioterapia , Estenosis Espinal/cirugíaRESUMEN
INTRODUCTION: Failed back surgery syndrome (FBSS) constitutes a constellation of symptoms grouped together and attributed to prior surgical intervention. Clinicians often poorly understand the heterogeneity of this condition combined with the etiological factors responsible for its development. Therefore, it would follow that an algorithmic treatment approach to patients diagnosed with this syndrome might pose challenges. The clinical work-up of the patient involves history, examination and appropriate diagnostic imaging as well as behavioral assessment. MATERIALS AND METHODS: We sought to conduct a narrative review of the available literature focused on the medical, rehabilitative and behavioral treatment of FBSS. To that end, we conducted a literature search using PubMed (through March 2013). We focused on studies published over the last 20years. Only English language articles were included. Search terms included "failed back surgery syndrome", "FBSS", "failed back syndrome", and "post-laminectomy syndrome". Studies included in our review focused on randomized controlled trials (RCTs), prospective cohort studies, and case series (retrospective and prospective). Studies were organized by intervention (e.g. medical management, physical therapy and rehabilitation, and psychosocial) and presented to emphasize the quality of evidence (e.g. RCTs, prospective studies, etc.). CONCLUSION: Overall, the literature provides very limited guidance on the comprehensive management of patients suffering from FBSS. There are rehabilitative interventions and behavioral protocols that demonstrate promise. Pathways based on medication management remain difficult to clearly define.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Síndrome de Fracaso de la Cirugía Espinal Lumbar/psicología , Síndrome de Fracaso de la Cirugía Espinal Lumbar/rehabilitación , Algoritmos , Terapia por Estimulación Eléctrica , Síndrome de Fracaso de la Cirugía Espinal Lumbar/tratamiento farmacológico , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Chronic pain is one of the most prevalent and costly health care problems in the United States today. Two conditions, failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS), in particular have been difficult to manage, resulting in increased disability and poorer quality of life measures for patients as well as increased treatments cost for payers. Given the cost of chronic pain management and overall subjectivity of analog pain scores, many payers are emphasizing the importance of functional outcomes as a means of assessing efficacy of treatment. Neuromodulation devices such as spinal cord stimulators are shown to be cost effective and able to improve functional outcomes and quality of life. Specific rehabilitation therapies also demonstrate improved functional outcomes. This article aims to discuss the role of rehabilitation in the patient with a neuromodulatory device. From the available data and our clinical experience, we recommend incorporating rehabilitation after placement of a neuromodulation device in order to optimize functional outcomes.
Asunto(s)
Dolor Crónico/rehabilitación , Síndromes de Dolor Regional Complejo/rehabilitación , Terapia por Estimulación Eléctrica , Síndrome de Fracaso de la Cirugía Espinal Lumbar/rehabilitación , Modalidades de Fisioterapia , Dolor Crónico/economía , Dolor Crónico/fisiopatología , Dolor Crónico/terapia , Terapia Combinada/economía , Síndromes de Dolor Regional Complejo/economía , Síndromes de Dolor Regional Complejo/fisiopatología , Síndromes de Dolor Regional Complejo/terapia , Análisis Costo-Beneficio , Terapia por Estimulación Eléctrica/economía , Diseño de Equipo , Síndrome de Fracaso de la Cirugía Espinal Lumbar/economía , Síndrome de Fracaso de la Cirugía Espinal Lumbar/fisiopatología , Síndrome de Fracaso de la Cirugía Espinal Lumbar/terapia , Femenino , Humanos , Masculino , Dimensión del Dolor , Satisfacción del Paciente , Modalidades de Fisioterapia/economía , Prótesis e Implantes/economía , Calidad de Vida , Resultado del TratamientoRESUMEN
CONTEXT: Previous studies on the effect of mindfulness-based stress reduction (MBSR) therapy on chronic pain syndromes have been hampered by study design. OBJECTIVE: To evaluate short-term efficacy of MBSR therapy for improving quality of life in adults with failed back surgery syndrome (FBSS). DESIGN: A single-center, prospective, randomized, single-blind, parallel-group clinical trial. PATIENTS AND SETTING: Participants were recruited from a multidisciplinary spine and rehabilitation center in the greater Portland, Maine, area. INTERVENTIONS AND MAIN OUTCOME MEASURES: Patients were randomly assigned at baseline to receive either MBSR therapy plus traditional therapy or traditional therapy alone for an 8-week period. Those receiving MBSR therapy completed weekly group sessions, and the control group continued with their traditional care as prescribed by their medical care providers. At study enrollment and at 12-week follow-up, all participants completed questionnaires on pain, quality of life, functionality, analgesic use, and sleep quality. Patients in the intervention group also completed questionnaires at 40-week follow-up. RESULTS: The final analysis included 25 patients with FBSS; 15 patients were in the MBSR intervention arm, and 10 in the control group. At 12-week follow-up, patients in the intervention arm had a mean 7.0-point increase (on an 108-point [corrected] scale) in pain acceptance and quality of life on the Chronic Pain Assessment Questionnaire, a mean 3.6-point [corrected] decrease (on a 24-point scale) in functional limitation on the Roland-Morris Disability Questionnaire, a mean 6.9-point [corrected] reduction (on a 30-point scale) in pain level on the Summary Visual Analog Scale for Pain, a mean 1.5-point [corrected] reduction (on a 4-point scale) in frequency of use and potency of analgesics used for pain and recorded on logs, and a mean 2.0-point [corrected] increase (on a 5-point scale) in sleep quality on the abridged Pittsburgh Sleep Quality Inventory. These results were statistically and clinically significant compared to outcomes for the control group. CONCLUSION: The results suggest that MBSR can be a useful clinical intervention for patients with FBSS.
Asunto(s)
Síndrome de Fracaso de la Cirugía Espinal Lumbar/psicología , Dolor de la Región Lumbar/psicología , Estrés Psicológico/prevención & control , Adaptación Psicológica , Síndrome de Fracaso de la Cirugía Espinal Lumbar/prevención & control , Síndrome de Fracaso de la Cirugía Espinal Lumbar/rehabilitación , Femenino , Indicadores de Salud , Humanos , Dolor de la Región Lumbar/rehabilitación , Dolor de la Región Lumbar/cirugía , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Método Simple Ciego , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
The study was carried out to evaluate the efficacy of hydrotherapy on ?failed back surgery syndrome?. Eight participants were assigned to an aquatic exercise group. The analgesic medication was withdrawn during the study. Evaluation parameters included the results of the Visual Analogue Scale (VAS) score and spine mobility. The patients were assessed at baseline and at the end of the 6-week follow-up period. The results showed that hydrotherapy had a positive impact on the outcome of chronic post-surgical low back pain. After 6 weeks of hydrotherapy, without analgesic medication, the overall mobility of the spine improved and back pain decreased. We conclude that aquatic exercises may positively impact the outcome of ?failed back surgery syndrome?, probably remaining one of the few successful measures in the management of this kind of patient.
O presente estudo foi realizado para avaliar a eficácia da hidroterapia na ?síndrome pós-laminectomia?. Oito participantes foram designados para um grupo de exercícios aquáticos. A medicação analgésica foi descontinuada durante o estudo. Os parâmetros de avaliação incluíram o escore da Escala Visual Analógica (EVA) e a mobilidade da coluna vertebral. Os pacientes foram avaliados em condições basais e ao final do período de seguimento de seis semanas. Os resultados mostraram que a hidroterapia teve um impacto positivo nos resultados da dor lombar crônica pós-cirúrgica. Após seis semanas de hidroterapia, sem medicação analgésica, a mobilidade geral da coluna melhorou e a dor lombar diminuiu. Concluímos que exercícios na água podem ter um impacto positivo no resultado da síndrome da falência da cirurgia lombar, provavelmente sendo uma das poucas medidas bem sucedidas no tratamento desse tipo de paciente.