Does Duration of Pain at Baseline Influence Longer-term Clinical Outcomes of Low Back Pain Patients Managed on an Evidence-Based Pathway?

Jess, Mary-Anne; Ryan, Cormac; Hamilton, Sharon; Wellburn, Shaun; Atkinson, Greg; Greenough, C G; Peat, Glynis; Coxon, Andrew; Fatoye, Francis; Ferguson, Diarmaid; Dickson, Alastair; Ridley, Helen; Martin, Denis

doi:10.1097/brs.0000000000003760

Cited by 13 publications

(11 citation statements)

References 34 publications

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“…The latter has recently been shown to affect other LBP treatment modalities. 21 Furthermore, the iron sucrose labeling used might have affected the MSCs' performance, since in a previous in vitro study, 18 this labeling somewhat delayed the onset of glycosaminoglycan synthesis. However, for all reported disc cell injection studies, pain relief has been reported to be between 50% and 90%, so the present study is overall relatively well in line with those.…”

Section: Discussionmentioning

confidence: 99%

Intradiscal Injection of Iron-Labeled Autologous Mesenchymal Stromal Cells in Patients With Chronic Low Back Pain: A Feasibility Study With 2 Years Follow-Up

et al. 2021

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Purpose: Degeneration of the intervertebral disc is considered to be central in pain pathogenesis in patients suffering from chronic low back pain (LBP). In recent years, the injection of mesenchymal stromal cells (MSCs) into the disc to arrest or reverse the degenerative process has been proposed as an alternative therapy. The aim of the present study was to investigate the feasibility of using iron-labeled MSCs for intradiscal injection in patients with long-standing LBP.Methods: Ten patients (7 men, 3 women, mean age 40 years, range 26-53) with chronic LBP and confirmed disc degeneration on magnetic resonance imaging (MRI) were recruited from the waiting list for planned surgery. Injection of autologous, expanded, and iron-labeled bone marrow-derived MSCs (BM-MSCs) into 1 or 2 disc levels was undertaken. Follow-up consisted of monitoring of adverse events, regular MRI examinations, and collection of patient-reported outcome measures (PROMs) for a minimum of 2 years.Results: No complications could be detected, neither clinically nor on MRI. No statistically significant improvement was seen for PROMs on a group level up to 2 years postinjection. Three of 10 patients opted to proceed with the initially planned surgery within the first year and 2 more within 3 years postinjection.Conclusion: Results from this pilot cohort study show that injection of autologous expanded iron-labeled BM-MSCs is a safe procedure, in accordance with the existing body of evidence. The clinical result warrants further larger studies.Level of Evidence: 4 for therapeutic studies.

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Section: Discussionmentioning

confidence: 99%

Intradiscal Injection of Iron-Labeled Autologous Mesenchymal Stromal Cells in Patients With Chronic Low Back Pain: A Feasibility Study With 2 Years Follow-Up

et al. 2021

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“…All studies were from six western, high-income countries (Table 1). Of the 11 studies and service evaluation report from the UK, five studies were local manifestations of the NHS England National Low Back and Radicular Pain Pathway (NELBPP) [19][20][21][22][23], with three from the same regional implementation site, the North East of England (NERP) [19][20][21]. Seven Canadian studies related to three separate pathways [24][25][26][27][28][29][30].…”

Section: Overview Of Studiesmentioning

confidence: 99%

“…Four American studies included two from one centre regarding a telehealth-assisted pathway [31,32]. Four pathways were described as regional, namely the Integrated Spine Assessment and Education Clinics (ISAEC) [30], the Saskatchewan Spine Pathway (SSP) [27][28][29], the NERP [19][20][21] and that of Fleuren et al [33]. Eleven papers considered lumbar related conditions [19-21, 24-26, 30, 34-37], eight were specific to radicular leg pain [17,18,22,23,[27][28][29]33], and eight studies included more general spine conditions [31,32,[38][39][40][41][42][43], although half of these stated that most participants had lumbar complaints [38,40,41,43].…”

Section: Overview Of Studiesmentioning

confidence: 99%

Clinical pathways for the management of low back pain from primary to specialised care: a systematic review

et al. 2022

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Purpose Clinical pathways for low back pain (LBP) have potential to improve clinical outcomes and health service efficiency. This systematic review aimed to synthesise the evidence for clinical pathways for LBP and/or radicular leg pain from primary to specialised care and to describe key pathway components. Methods Electronic database searches (CINAHL, MEDLINE, Cochrane Library, EMBASE) from 2006 onwards were conducted with further manual and citation searching. Two independent reviewers conducted eligibility assessment, data extraction and quality appraisal. A narrative synthesis of findings is presented. Results From 18,443 identified studies, 28 papers met inclusion criteria. Pathways were developed primarily to address over-burdened secondary care services in high-income countries and almost universally used interface services with a triage remit at the primary-secondary care boundary. Accordingly, evaluation of healthcare resource use and patient flow predominated, with interface services associated with enhanced service efficiency through decreased wait times and appropriate use of consultant appointments. Low quality study designs, heterogeneous outcomes and insufficient comparative data precluded definitive conclusions regarding clinical- and cost-effectiveness. Pathways demonstrated basic levels of care integration across the primary-secondary care boundary. Conclusions The limited volume of research evaluating clinical pathways for LBP/radicular leg pain and spanning primary and specialised care predominantly used interface services to ensure appropriate specialised care referrals with associated increased efficiency of care delivery. Pathways demonstrated basic levels of care integration across healthcare boundaries. Well-designed randomised controlled trials to explore the potential of clinical pathways to improve clinical outcomes, deliver cost-effective, guideline-concordant care and enhance care integration are required.

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“…Therapeutic interventions for FJ pain include intra-articular steroid injections, extracorporeal shockwave therapy, surgical treatment, medial branch nerve blocks and medial branch nerve radiofrequency ablation (RFA) [ 5 , 6 ]. RFA is an injection procedure that is used to treat several conditions, including chronic spinal pain.…”

Section: Introductionmentioning

confidence: 99%

Effect of radiofrequency denervation on pain severity among patients with cervical, thoracic or lumbar spinal pain: A clinical retrospective study

Akgül

Akgün

2022

Heliyon

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Does Duration of Pain at Baseline Influence Longer-term Clinical Outcomes of Low Back Pain Patients Managed on an Evidence-Based Pathway?

Abstract: and Martin, D (2021) Does duration of pain at baseline influence longer-term clinical outcomes of low back pain patients managed on an evidence-based pathway? Spine, 46 (3). pp. 191-197.

Cited by 13 publications

References 34 publications

Intradiscal Injection of Iron-Labeled Autologous Mesenchymal Stromal Cells in Patients With Chronic Low Back Pain: A Feasibility Study With 2 Years Follow-Up

Intradiscal Injection of Iron-Labeled Autologous Mesenchymal Stromal Cells in Patients With Chronic Low Back Pain: A Feasibility Study With 2 Years Follow-Up

Clinical pathways for the management of low back pain from primary to specialised care: a systematic review

Effect of radiofrequency denervation on pain severity among patients with cervical, thoracic or lumbar spinal pain: A clinical retrospective study

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