The medial temporal lobe in nociception: a meta-analytic and functional connectivity study
Recent neuroimaging studies implicate the medial temporal lobe (MTL) in nociception and pain modulation. Here, we aim to identify which subregions of the MTL are involved in human pain and to test its connectivity in a cohort of chronic low-back pain patients (CBP). We conducted 2 coordinate-based meta-analyses to determine which regions within the MTL showed consistent spatial patterns of functional activation (1) in response to experimental pain in healthy participants and (2) in chronic pain compared with healthy participants. We followed PRISMA guidelines and performed activation likelihood estimate (ALE) meta-analyses. The first meta-analysis revealed consistent activation in the right anterior hippocampus (right antHC), parahippocampal gyrus, and amygdala. The second meta-analysis revealed consistently less activation in patients' right antHC, compared with healthy participants. We then conducted a seed-to-voxel resting state functional connectivity of the right antHC seed with the rest of the brain in 77 CBP and 79 age-matched healthy participants. We found that CBP had significantly weaker antHC functional connectivity to the medial prefrontal cortex compared with healthy participants. Taken together, these data indicate that the antHC has abnormally lower activity in chronic pain and reduced connectivity to the medial prefrontal cortex in CBP. Future studies should investigate the specific role of the antHC in the development and management of chronic pain.
AbstractPurpose of ReviewThe purpose of this study is to evaluate the effectiveness of a multimodal approach to treating chronic low back pain.Recent FindingsChronic non-cancer-related back pain is often a frustrating and poorly managed problem for patients. It poses a significant public health issue worsened by the widespread use of narcotics. In 2016, the CDC released guidelines with noticeably more strict recommendations on prescription of narcotics for pain.SummaryVeterans at an interventional pain clinic presenting with chronic back pain refractory to medical and to surgical care were enrolled in an 8-week interdiscip...
Discussion: The current case series describes the use of a targeted exercise approach consisting mostly of hip abductor strengthening in a group of patients with CLBP and hip abductor weakness. The results indicated that this approach may be effective in reducing pain and improving function, particularly for older patients.
Conclusion: Trustworthy information regarding RFs and triggers of LBP is rare in the current literature. Future research needs to use precise definitions of LBP (onset of the "disease" vs. episodes) and nominate the timing of the associated factors in relation to the types of LBP as these are two critical factors when studying causes of LBP. PMID: 31214272 [PubMed - in process]
This article is protected by copyright. All rights reserved.
This is a long…… readooops, sorry, not. Low back pain is, we know, the greatest contributor to days lived with disability (Rice, Smith &Blyth, 2016). And no-one anywhere in the world has found a good mix of services to reduce the number of days lived with disability as a result of this problem. And yet billions of dollars are used to fund research into the many contributors to a shift from acute low back pain to ongoing disability associated with low back pain. At the same time, treatments that directly target disability, rather than pain (a target considered the most important outcome by Sullivan a...
Discussion: Sleep disturbance was related significantly with chronic pain intensity and function by both direct and indirect pathways. These results are consistent with an emerging literature highlighting the potential significance of sleep disturbance in chronic pain patients, and provide further support for addressing sleep disturbance in the assessment and management of chronic pain.
Low back pain is the leading cause of global disability24,9,45 and urgently requires better management.9 80% of the adult population experiences a significant episode of disabling low back pain over their life. Most people recover, however 10-15% go on to develop chronic low back pain (CLBP), defined as pain lasting over 12 weeks.12 90% of people with CLBP have a non-specific problem with no clearly identifiable cause for their pain.17 CLBP is increasing in prevalence and is globally the second most frequent reason for time off work.
ConclusionUsing wireless SCS devices that allow for an extended trial period and evaluation of various waveforms, we observed a high rate trial success rate with both HFS and LFS waveforms, with minimal incidence of infection. Long ‐term follow‐up will address the cost‐effectiveness and morbidity associated with this technology, which facilitates single‐stage treatment.
Conclusions: Use of RF neurotomy as an intervention for chronic lumbar and sacroiliac joint pain led to improved function; however, larger, more directly comparable studies are needed to confirm this study's findings.
We describe the presence of RCF lasting for at least 9 months or longer without secondary axonal degeneration in a case of chronic sensorimotor and autonomic polyneuropathy. A 63-year-old woman presented with lower back pain, limb pain, paresthesia, and weakness after a sinus infection. She was diagnosed with mild Guillain–Barre syndrome and treated symptomatically. Four months later, she developed symptoms of dysautonomia and worsening neuropathic pain, and treatment with intravenous immunoglobulin led to significant clinical improvement. Electrodiagnostic study revealed significant improvement, manifesting as incre...