Cohort profile: why do people keep hurting their back?

Klyne, David M.; Hoorn, Wolbert van den; Barbe, Mary F.; Cholewicki, Jacek; Hall, Leanne; Khan, Asaduzzaman; Meroni, Roberto; Moseley, G. Lorimer; Nicholas, Michael K.; O’Sullivan, Lee; Park, Rachel; Russell, Glen; Sterling, Michele; Hodges, Paul W.

doi:10.1186/s13104-020-05356-z

Cited by 13 publications

(8 citation statements)

References 37 publications

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“…As sex is an important factor in the modulation of pain, and sex differences in pain behaviors have been reported in other disc puncture studies ( 21 , 116 ), sex differences should be considered in future animal studies. This limitation is somewhat mitigated by findings that women bear the burden of chronic LBP ( 1 , 2 ), sex has been found to inconsistently predict outcomes over 12 months in a human study ( 117 ), and no sex differences in disc height and histopathology changes have been reported ( 21 ). Our design also makes our findings directly relatable to those of Lillyman et al ( 17 ) who studied the effects of disc injury in female rats across 18 weeks.…”

Section: Discussionmentioning

confidence: 99%

Characterization of pain-related behaviors in a rat model of acute-to-chronic low back pain: single vs. multi-level disc injury

Barbe,

Chen,

Loomis

et al. 2024

Front. Pain Res.

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IntroductionLow back pain is the most common type of chronic pain. We examined pain-related behaviors across 18 weeks in rats that received injury to one or two lumbar intervertebral discs (IVD) to determine if multi-level disc injuries enhance/prolong pain.MethodsTwenty-three Sprague-Dawley adult female rats were used: 8 received disc puncture (DP) of one lumbar IVD (L5/6, DP-1); 8 received DP of two lumbar IVDs (L4/5 & L5/6, DP-2); 8 underwent sham surgery.ResultsDP-2 rats showed local (low back) sensitivity to pressure at 6- and 12-weeks post-injury, and remote sensitivity to pressure (upper thighs) at 12- and 18-weeks and touch (hind paws) at 6, 12 and 18-weeks. DP-1 rats showed local and remote pressure sensitivity at 12-weeks only (and no tactile sensitivity), relative to Sham DP rats. Both DP groups showed reduced distance traveled during gait testing over multiple weeks, compared to pre-injury; only DP-2 rats showed reduced distance relative to Sham DP rats at 12-weeks. DP-2 rats displayed reduced positive interactions with a novel adult female rat at 3-weeks and hesitation and freezing during gait assays from 6-weeks onwards. At study end (18-weeks), radiological and histological analyses revealed reduced disc height and degeneration of punctured IVDs. Serum BDNF and TNFα levels were higher at 18-weeks in DP-2 rats, relative to Sham DP rats, and levels correlated positively with remote sensitivity in hind paws (tactile) and thighs (pressure).DiscussionThus, multi-level disc injuries resulted in earlier, prolonged and greater discomfort locally and remotely, than single-level disc injury. BDNF and TNFα may have contributing roles.

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Section: Discussionmentioning

confidence: 99%

Characterization of pain-related behaviors in a rat model of acute-to-chronic low back pain: single vs. multi-level disc injury

Barbe,

Chen,

Loomis

et al. 2024

Front. Pain Res.

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“…This study analysed data from a data‐intensive cohort study that included extensive collection of biological, behavioural, psychological and social data from individuals who were recruited within 2 weeks of onset of an acute episode of LBP and followed for 12 months (Klyne et al, 2020 ). This analysis involved data from the entire cohort of 133 participants.…”

Section: Methodsmentioning

confidence: 99%

“…Participants were recruited and assessed within 2 weeks of onset of an acute episode of LBP that was preceded by at least 1 month without pain. To ensure participants had experienced an acute LBP episode of sufficient duration and intensity, we employed a two‐phase screening process with respect to pain and disability (Klyne et al, 2020 ). Initially, participants were screened by an automated online screening questionnaire that included participants if their LBP (1) occurred within the last 2 weeks and lasted for at least 24 hours, (2) caused functional limitation and (3) caused them to seek/seriously consider health intervention.…”

Section: Methodsmentioning

confidence: 99%

Risk factors for low back pain outcome: Does it matter when they are measured?

Klyne

Hall

Nicholas

et al. 2022

European Journal of Pain

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Background:The early identification of factors that increase risk of poor recovery from acute low back pain (LBP) is critical to prevent the transition to chronicity. Although most studies of risk factors for poor outcome in LBP tend to investigate the condition once it is already persistent, there is evidence to suggest that this differs from risk factors measured during the early-acute stage. This study aimed to identify early risk factors for poor outcome in the short-and longterm in individuals with acute LBP, and to compare this with factors identified at 3 months in the same cohort.Methods: One hundred and thirty-three individuals were recruited within 2 weeks of an acute LBP episode and completed questionnaires related to their sociodemographic, psychological, clinical and history/treatment status at baseline and 3 months later, and their pain-level fortnightly for 12 months.Results: Of the 133 participants recruited, follow-up data were provided by 120 at 3 months, 97 at 6 months, 85 at 9 months and 94 at 12 months. Linear regression identified various factors at baseline (acute phase) and 3 months later that predicted short-and long-term outcome (pain level, change in pain). Key findings were that: (1) depressive symptoms at baseline most consistently predicted worse outcome; (2) psychological factors in general at 3 months were more predictive of outcome than when measured at baseline; (3) early health care utilization predicted better outcome, whereas use of pain medication later (3 months) predicted worse outcome; and (4) sex and BMI predicted outcome inconsistently over 12-months. Conclusions:The results highlight the multidimensional nature of risk factors for poor outcome in LBP and the need to consider time variation in these factors.Significance: This study attempts to consider the impact of time variation of candidate risk factors on long-term outcome from the very early onset of acute low back pain. Risk factors across domains (sociodemographic, psychological, clinical, history/treatment) were identified, but their relationship with outcome often depended on when (acute phase vs. 3 months later) they were measured after back pain onset. Findings highlight the need to consider both a diverse range of factors and their potential time variance when assessing risk of poor outcome.

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“…Indeed, positive relationships between pain-related fear, LBP intensity and disability have been found in systematic reviews and meta-analyses ( 39 , 42 ), and fear avoidance beliefs have been shown to be associated with poor treatment outcome in patients suffering from LBP within a time period of <6 months ( 43 ). However, the predictive value of pain-related fear regarding the development of LBP is limited ( 39 ) and psychological factors in general (when considered in isolation) explain only a small proportion in outcomes such as pain intensity ( 44 , 45 ). Yet, recent research has shown an association between pain-related fear and dysfunctional motor behavior in LBP patients and healthy individuals ( 46 – 48 ), indicating significant interactions between psychological factors and motor control (psychomotor interactions), which can promote potential clinically relevant consequences such as limited motor variability, increased paraspinal muscle co-contraction and loading on spinal tissues ( 15 ).…”

Section: Psychological Factorsmentioning

confidence: 99%

Identifying Motor Control Strategies and Their Role in Low Back Pain: A Cross-Disciplinary Approach Bridging Neurosciences With Movement Biomechanics

et al. 2021

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Persistent low back pain (LBP) is a major health issue, and its treatment remains challenging due to a lack of pathophysiological understanding. A better understanding of LBP pathophysiology has been recognized as a research priority, however research on contributing mechanisms to LBP is often limited by siloed research within different disciplines. Novel cross-disciplinary approaches are necessary to fill important knowledge gaps in LBP research. This becomes particularly apparent when considering new theories about a potential role of changes in movement behavior (motor control) in the development and persistence of LBP. First evidence points toward the existence of different motor control strategy phenotypes, which are suggested to have pain-provoking effects in some individuals driven by interactions between neuroplastic, psychological and biomechanical factors. Yet, these phenotypes and their role in LBP need further validation, which can be systematically tested using an appropriate cross-disciplinary approach. Therefore, we propose a novel approach, connecting methods from neuroscience and biomechanics research including state-of-the-art optical motion capture, musculoskeletal modeling, functional magnetic resonance imaging and assessments of psychological factors. Ultimately, this cross-disciplinary approach might lead to the identification of different motor control strategy phenotypes with the potential to translate into clinical research for better treatment options.

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Cohort profile: why do people keep hurting their back?

Cited by 13 publications

References 37 publications

Characterization of pain-related behaviors in a rat model of acute-to-chronic low back pain: single vs. multi-level disc injury

Characterization of pain-related behaviors in a rat model of acute-to-chronic low back pain: single vs. multi-level disc injury

Risk factors for low back pain outcome: Does it matter when they are measured?

Identifying Motor Control Strategies and Their Role in Low Back Pain: A Cross-Disciplinary Approach Bridging Neurosciences With Movement Biomechanics

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