BACKGROUND: Chronic low back pain (CLBP) is the leading cause of disability in the United States. People suffering from CLBP often have multiple comorbidities including depression, anxiety, and substance use disorder (SUD). Although the opioid epidemic has intensified the search for new treatment options, both pharmacological and other, opioids still remain the most common treatment for chronic pain. Long-term opioid therapy (LTOT) has been shown to lead to opioid-induced hyperalgesia (OIH), an increased sensitivity to painful stimuli. It remains unclear, however, the extent to which reductions in opioid dose impact OIH. METHODS: This is a longitudinal cohort study whose primary aim is to determine how changes in opioid doses are associated with changes in psychosocial and quantitative sensory testing (QST) variables. Participants were 24 adults with CLBP being treated with LTOT and visits were conducted on a monthly basis for six months. All 24 participants were included in the analysis of demographic and psychosocial variables (disability, anxiety, depression, opioid misuse, pain severity, pain interference, and catastrophizing). A subset of 13 participants were included in the analysis of QST variables. RESULTS: We found that pressure pain thresholds at the thumb and the trapezius, and heat pain threshold significantly (p < 0.05) improved between visit 1 and visit 6. We also found that a decrease in morphine equivalent doses (MED) is correlated (coefficient > 0.2) with improvements in punctuate probe rating, pain pressure at the thumb, and maximum cold ratings. DISCUSSION: Our results show that reductions in opioid dose are associated with reduced pain sensitivity, even while the psychosocial variables studied (including subjective pain score, depression, and anxiety) remain stable.

Chronic low back pain (CLBP) is a nonspecific and persistent ailment that entails many physiological, psychological, social, and economic consequences for individuals and societies. Although there is a plethora of treatments available to treat CLBP, each treatment has varying efficacy for different patients, and it is currently unknown how to best link patients to their ideal treatment. However, it is known that biopsychosocial influences associated with CLBP affect the way that we move. It has been hypothesized that identifying phenotypes of spinal motion could facilitate an objective and repeatable method of determining the optimal treatment for each patient. The objective of this research was to develop an array of high deflection strain gauges to monitor spinal motion, and use that information to identify spinal-motion phenotypes. The high deflection strain gauges used in this endeavor exhibit highly nonlinear electrical signal due to their viscoelastic material properties. Two sub-models were developed to account for these nonlinearities: the first characterizes the relationship between quasistatic strain and resistance, and the second accounts for transient electrical phenomena due to the viscoelastic response to dynamic loads. These sub-models are superimposed to predict and interpret the electrical signal under a wide range of applications. The combined model accurately predicts sensor strain with a mean absolute error (MAE) of 1.4% strain and strain rate with an MAE of 0.036 mm/s. Additionally, a multilayered architecture was developed for the strain gauges to provide mechanical support during high strain, cyclic loads. The architecture significantly mitigates sensor creep and viscoplastic deformation, thereby reducing electrical signal drift by 74%. This research also evaluates the effects of CLBP on patient-reported outcomes. An exploratory factor analysis revealed that there are five primary components of well-being: Pain and Physical Limitations, Psychological Distress, Physical Activity, Sleep Deprivation, and Pain Catastrophizing. The presence of CLBP has adverse effects on all these components. It was also observed that different patient reported outcomes are highly correlated with each other, and the presence of CLBP is a significant moderating factor in many of these relationships. Arrays of high-deflection strain gauges were used to collect spinal kinematic data from 274 subjects. Seven phenotypes of spinal motion were identified among study participants. Statistical analyses revealed significant differences in the patient-reported outcomes of subjects who exhibited different phenotypes. This is a promising indication that the phenotypes may also provide important information to clinicians who treat patients suffering from CLBP. Future research will be conducted to develop and identify the optimal treatments for patients according to their phenotypes, which has the potential to reduce medical costs, expedite recovery, and improve the lives of millions of patients worldwide.

BACKGROUND AND AIMS: Globally, chronic low back pain (CLBP) affects 70-80% of adults at some point in their lives and current treatments are widely unsuccessful in relieving pain. Understanding the underlying neurophysiological (e.g., descending pain inhibition) and biobehavioral (e.g., stress) processes contributing to chronic pain in patients with CLBP is needed for the development of novel treatments. Previous studies have shown that acute stress can impact pain sensitivity and that childhood trauma may predispose a person to CLBP, but the mechanisms underlying this impact are unknown. Conditioned Pain Modulation (CPM) is a psychophysical paradigm used in research to assess descending pain modulatory pathways, which are thought to be impaired in patients with CLBP as well as in those with childhood trauma. The overlap of conditions has not been explored. The current study explored the impact of childhood trauma on the CPM response within a sample of patients with CLBP being treated at a tertiary pain clinic. CLBP patients exposed to an acute stress paradigm were expected to shower higher pain sensitivity, with acute stress significantly interacting with a history of childhood trauma as a factor leading to the higher pain sensitivity. METHODS: 46 Participants with CLBP (n=46, mean age=49 years, 55.3% female) recruited from a pain treatment service completed a Quantitative Sensory Testing (QST) and CPM before and after an acute psychological stressor. Participants were randomized to a control (n=25) or an acute-stress (n=21) condition. The acute-stress condition included the Stroop Color Word Task (SCWT) and a mental arithmetic task prior to completing the QST protocol a second time. The control participants did not undergo any additional stressors and completed the QST protocol a second time after a 20-minute break. Participants’ CPM response was measured by the average change in pressure pain threshold (PPT) from baseline to the conditioning stimulus (non-dominant hand in ice-water bath). A “Good CPM response” was defined as a CPM effect above 100, indicating that the pain threshold increased when exposed to the conditioning stimulus. To examine the impact of childhood trauma on pain sensitivity, participants completed a Childhood Traumatic Events Scale (CTES) to assess the presence and severity of six types of trauma (death, parental upheaval, sexual, violence, illness or injury, other upheaval) during childhood. The CTES was scored as a continuous variable by calculating the sum the trauma severity for all six trauma types. RESULTS: A large majority of the sample (94% of participants) showed an increase in pain threshold during hand immersion in ice water, which was contrary to our hypothesis based on prior research done on other chronic pain conditions and CLBP. Participants exposed to an acute stressor had an impaired CPM effect compared to those that were not exposed to an acute stressor, however there was no difference between groups (p=0.277). A history of childhood traumatic events did not correlate significantly with an impaired baseline CPM or a change in CPM effect when exposed to an acute stressor. CONCLUSION: The current study used novel QST modalities, including CPM, to analyze the interaction between acute and chronic stress on pain sensitivity. Ultimately, this study found that exposure to an acute stressor had a negative effect on CPM, indicating that when under experimental stress participants were more sensitive to pain compared to when they were not under stress, although the findings were not statistically significant. These findings should be further investigated to expand the understanding of the neurophysiological mechanisms underlying CLBP and to potentially provide novel treatment modalities for patients with CLBP.

In this study, the use of hypnosis in the treatment of chronic low back pain is described in terms of Ecosystemic thinking, as opposed to traditional conceptualisations of hypnosis. Six case studies were used. Each is described in detail, as well as the therapeutic rationale behind each case, in order to present the reader with an understanding of the thinking behind using Ecosystemic hypnotherapy. / Psychology / M.A. (Psychology)

Syfte: Syftet med denna studie var att undersöka hur statisk muskelkontraktion och cold pressor test påverkar kroppsegna smärtreglerande system (”Exercise induced analgesia” (EIA) och ”Conditioned pain modulation” (CPM)) hos patienter med kronisk ländryggssmärta kännetecknad av lumbal myalgi (LM) jämfört med friska kontroller. Försökspersoner och metod: Tjugosex friska köns- och åldersmatchade personer och tjugosex LM-patienter deltog. De utförde standardiserad statisk muskelkontraktion med m. Erector spinae (ME) i form av rygglyft och kontraktion av m. Quadriceps femoris (MQ) i form av knäledsextension. För att bedöma CPM användes sk cold pressor test. Smärttrösklar för tryck (PPTs) mättes över m. Deltoideus (MD), m. Erector spinae (ME) samt över m. Quadriceps (MQ) i vila och under resp. efter kontraktionen/cold pressor test. Under kontraktion mättes PPTs över den arbetande muskeln respektive över de två vilande musklerna. Dessutom undersöktes PPTs och känsligheten för övertrösklig trycksmärta (P7) i vila på 8 olika punkter på kroppen. Resultat: Kvinnliga LM-patienter hade ökad känslighet för trycksmärta (PPT) och övertrösklig trycksmärta (P7) jämfört med köns- och åldermatchade friska kontroller, medan manliga LM-patienter paradoxalt nog hade minskad känslighet för övertrösklig trycksmärta. Beträffande EIA fann vi att LM-patienter och kontroller kunde aktivera lokal EIA under kontraktion med ME. Vi fann dessutom en minskad förmåga hos LM-patienter att rekrytera generaliserad EIA under kontraktion med MQ. Slutligen hade LM-patienterna en normal funktion av CPM. Slutsats: LM-patienter kunde aktivera lokal EIA under kontraktion av ME, men hade mindre effektiv generaliserad EIA jämfört med kontrollerna, trots normal funktion av CPM. Våra resultat tyder på att muskelarbete med smärtande ryggmuskler skulle kunna användas för att minska smärtkänslighet i det drabbade området.

No description available.

Bakgrund: Ospecifik ländryggssmärta är en av de vanligaste orsakerna till att man söker hjälp inom primärvården. För långvarig, ospecifik ländryggssmärta är träning ett förstahandsval och fokus har under det senaste årtiondet legat på bålstabiliserande träning. Psykosociala faktorer som self-efficacy och rörelserädsla kan vara viktiga att beakta vid behandlingen då de spelar en roll i hur ländryggssmärtan utvecklas. Syfte: Att undersöka hur skattad smärta, self-efficacy och rörelserädsla samt funktionsnivå förändrades hos enskilda patienter med långvarig, ospecifik ländryggssmärta under och efter en intervention i grupp med bålstabiliserande träning. Metod: Designen var en A-B-A single-subject design (SSED). Smärtnivå, self-efficacy och rörelserädsla mättes med självskattningsformulär en gång per vecka under fas A-B-A och funktionsnivå före och efter avslutad intervention. Interventionen pågick under åtta veckor, en gång per vecka. Data presenterades visuellt och analys gjordes även av statistisk (2-SD band metod) och klinisk signifikans. Resultat: Analysen visade att skattad smärta, self-efficacy, rörelserädsla och funktionsnivå förändrades i positiv riktning hos flera patienter. Statistisk och klinisk signifikans varierade. Slutsats: Graderad bålstabiliserande träning i grupp under handledning av sjukgymnast verkar för flera av deltagarna ha en positiv effekt på såväl smärtnivå, self-efficacy, rörelserädsla som funktionsnivå. Eftersom SSED har en begränsad generaliserbarhet bör resultaten replikeras i ytterligare studier. / Background: Non-specific low back pain is one of the most common reasons for seeking help in primary care. For chronic, non-specific low back pain exercise rehabilitation is a first choice and focus in the last decade has been on motor control exercises. Psychosocial factors such as self-efficacy and fear of movement may be important to consider in the treatment as they play a role in how low back pain develops. Aim: To investigate how rated pain, self-efficacy and fear of movement as well as level of function changed in individual patients with chronic, nonspecific low back pain during and after an intervention group with motor control exercises. Method: The design was an A-B-A single-subject design (SSED). Pain level, self-efficacy and fear of movement were measured by self-assessment questionnaires once a week during phase A-B-A and level of function before and after the intervention. The intervention lasted for eight weeks, once a week. Data were presented visually and analysis was done to prove statistical (2-SD band method) and clinical significance. Results: The analysis showed that rated pain, self-efficacy, fear of movement and level of function changed in a positive direction for several of the patients. Statistical and clinical significance varied. Conclusion: Graded motor control exercises in a group under the supervision of a physiotherapist seem to have a positive effect for several of the participants with regards to level of pain, self-efficacy, fear of movement as well as level of function. Since SSED has a limited generalizability, results should be replicated in further studies.

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Submitted by ISABELA MAIA DA CRUZ FERNANDES null (isabelamaia.cf@gmail.com) on 2017-09-06T19:07:55Z No. of bitstreams: 1 Defesa_Isabela_final_com certificado.pdf: 1267984 bytes, checksum: ad309a61c522002d4498d84f2bb8f0fc (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-09-11T19:23:50Z (GMT) No. of bitstreams: 1 fernandes_imc_me_prud.pdf: 1267984 bytes, checksum: ad309a61c522002d4498d84f2bb8f0fc (MD5) / Made available in DSpace on 2017-09-11T19:23:50Z (GMT). No. of bitstreams: 1 fernandes_imc_me_prud.pdf: 1267984 bytes, checksum: ad309a61c522002d4498d84f2bb8f0fc (MD5) Previous issue date: 2017-07-24 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Introduction: The non-specific chronic low back pain (NSCLBP) is the most commonly found in clinical practice as well as being one of the most discussed problems in the world. Individuals with non-specific chronic low back pain (NSCLBP) have a lower level of physical activity when compared with individuals without NSCLBP, and therefore a decrease in aerobic power (V̇O2max). The guidelines of NSCLBP recommend as treatment the practice of physical exercise, as they claim to be effective in reducing the intensity of pain and functional disability. However, studies that use exercise as a treatment for LBP fail to prescribe exercise in a specific way. Objective: Evaluate and compare the effectiveness of different treadmill protocols for aerobic fitness determination in individuals with and without NSCLBP. Materials and Methods: Twenty individuals (10 with NSCLBP and 10 without NSCLBP) underwent two tests (modified Bruce and incremental) on treadmill. The following were collected during the tests: oxygen consumption (V̇O2), heart rate (HR), rate perceived exertion (RPE 6-20), blood lactate concentration ([Lac]), respiratory quotient (RQ) and pain intensity. Independent t-test was used to evaluate the difference between groups. Differences in physiological responses within groups (with and without NSCLBP) and between groups (Group vs. Test Interaction) were analyzed using two-way ANOVA. Statistical significance was set at p < 0.05. Results: When the groups were compared, no differences were observed on age (p-value = 0.839) or HRrest (p-value = 0.730), however the group with NSCLBP was overweight (p-value = 0.031). Only for the respiratory quotient (RQ) variable was observed a main effect of the test (p-value = 0.015) with higher RQ values in the modified Bruce test than in the incremental test. Conclusion: Both tests are good methods for assessing aerobic fitness. However, it can be speculated that using incremental test is a better method for prescribing treatment for this population.

In this study, the use of hypnosis in the treatment of chronic low back pain is described in terms of Ecosystemic thinking, as opposed to traditional conceptualisations of hypnosis. Six case studies were used. Each is described in detail, as well as the therapeutic rationale behind each case, in order to present the reader with an understanding of the thinking behind using Ecosystemic hypnotherapy. / Psychology / M.A. (Psychology)