Net Guide: Chronic Back Pain

Pain Management, July 2010, Volume 3, Issue 5

A collection of links and resources from across the web focused on one specific condition. These resource range from useful websites to clinical trials.

(Type the link codes into our search function) //THE EDUCATED PATIENT™

This site features information on a variety of back pain conditions, distinguishing neuropathic from nocicpetive pain, and chronic from acute back pain. The site explains the possible causes of the conditions and how the diagnoses are made. Treatment options discussed range from non-surgical—such as acupuncture, exercise, medications, and physical therapy—to surgical

treatments, including minimally invasive discectomy, spinal fusion surgery, and laminectomy. Each is described through a step-by-step process, with some descriptions including diagrams and illustrations. Articles like “What Treatment Is Right for You?” or “Chicken Noodle Soup for Low Back Pain,” review the latest research and provide lifestyle tips for those suffering from

chronic back pain. Additionally, offers tools, such as the “Back Pain Tracker,” which serves as a 7-day journal that can be used to track pain.

Link Code: pm3525

Acute Back Pain vs. Chronic Back Pain Video

The video housed at this site describes, in detail, the differences between acute and chronic back pain. Dr. Peter F. Ullrich, Jr.,

reviews “the causes of chronic pain and the different ways it can be treated.” Although the site focuses mainly on spine issues, much information is dedicated to chronic back pain. Featured in the “Managing Chronic Back Pain” article are a number of tips and coping techniques, covering such topics as eating right and getting enough sleep.

Link Code: pm3526

Back Pain Exercise Video: Pelvic Tilt

Learning some simple exercise techniques can help those who suffer from chronic back pain. This video highlights the pelvic tilt, which “strengthens the lower abdominal muscles and stretches your low ack (lumbar spine).” The exercise requires the patient to lay on their back with knees bent and feet fl at on the fl oor. Next, he or she must “contract their abdominal muscles,

pushing their belly button towards the fl oor and fl attening their lower back.” This should be held for five seconds and repeated 10 times. The site recommends receiving permission from a qualifi ed spine specialist before attempting the exercise.

Link Code: pm3527



“The mission of the OrthoGate Project is to improve orthopedic care, education and research using Internet technologies.” In doing so, the site provides physicians with access to numerous peer-validated Internet resources, as well as news on the industry, recent literature, new products, and articles.

Link Code: pm3511


Based on the popular Wikipedia model, this site allows users to view and submit pages on relevant orthopedic topics in an encyclopedic manner. As with Wikipedia, much of the information found here can be trusted, but users should be wary of the accuracy of it all, as content is user-generated. Topics range from musculoskeletal medicine to joint reconstruction. The site claims to be a “knowledge sharing portal for orthopedics and musculoskeletal health.” Physicians can also share videos, power points, talks, and more.

Link Code: pm3512


Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back

Pain: A Randomized, Double-blind, Controlled Trial with a 2-year Follow-up

Journal: International Journal of Medical Sciences (May 28, 2010)

Authors: Manchikanti L, Singh V, Falco F, et al.

Purpose: To “determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks with or without steroids in managing chronic low back pain of facet joint origin.”

Results: Researchers concluded that “therapeutic lumbar facet joint nerve blocks, with or without steroids, may provide a management option for chronic function-limiting low back pain of facet joint origin.”

Link Code: pm3556

Importance of Fear-avoidance Behavior in Chronic Non-specifi c Low Back Pain

Journal: Back and Musculoskeletal Rehabilitation (June 16, 2010)

Authors: Nagarajan M, Nair M

Purpose: “The aim of this article is to describe the importance of fear avoidance behavior and to evaluate the immediate effect of cognitive behavioral therapy (CBT) during evaluation of patients with CLBP.”

Results: A physical examination of a 24-year-old female patient with CLBP, was performed. The patient exhibited “painful guarded movements over the lumbo-pelvic region, but the outcomes of her Fear-Avoidance Belief Questionnaire (FABQ) showed strong cues for psychological illness.” The patient was educated on cognitive reconstruction and “after some CBT sessions, her spine guarding pattern disappeared.” The researchers concluded that by “using biopsychosocial training, positive results in fear avoidance behavior can be achieved.”

Link Code: pm3557

painACTION-Back Pain: A Self-Management Website for People with Chronic Back Pain

Journal: Pain Medicine (June 8, 2010)

Authors: Chiauzzi E, Pujol L, Wood M, et al.

Purpose: “To determine whether an interactive self-management Website for people with chronic back pain would signifi cantly improve emotional management, coping, self-efficacy to manage pain, pain levels, and physical functioning compared with standard text-based materials.”

Results: The team concluded that an “online self-management program for people with chronic back pain can lead to improvements in stress, coping, and social support, and produce clinically significant differences in pain, depression, anxiety, and global rates of improvement.”

Link Code: pm3558

Acupuncture Therapy for Chronic Lower Back Pain: a Systematic Review

Journal: Annals of the Royal College of Surgeons of England (June 7, 2010)

Authors: Trigkilidas D

Purpose: “The aim of this systematic review was to evaluate if this treatment option is justified in view of recent evidence available on the efficacy of acupuncture.”

Results: The researcher concluded that “NICE guidelines of a course of acupuncture, offered according to patient preference as a treatment option for chronic low back pain, are justified.”

Link Code: pm3559

Patients’ Experiences of the Impact of Chronic Back Pain on Family Life and Work Journal: Disability and Rehabilitation (June 4, 2010)

Author: De Souza L, Frank A

Purpose: “This study investigates how individuals experience pain and its consequences for family life and work.”

Results: The results demonstrated that there were emergent themes, such as relationships with spouses and partners (n=7), children/parents (n=6), other family and friends (n=7), and with work-related issues (n=11). “Patients expressed anxiety about how their pain affected and other family members, regret at losing full work capacity and worry about fi nancial consequences.”

Link Code: pm35591


Telehealth Outreach for Chronic Back Pain

Study Type: Interventional

Age/Gender Requirements: 18-75 years (male/female)

Sponsor: Department of Veterans Affairs

Purpose: This double blind, randomized, six- month clinical trial will evaluate the effectiveness of using telephone-delivered therapy on patients with chronic low back pain of non-neoplastic origin.

Link Code: pm3566

Efficacy of Antidepressants in Chronic Back Pain

Study Type: Interventional

Age/Gender Requirements: 18-70 years (male/female)

Sponsor: Department of Veterans Affairs

Purpose: “This 12 week placebo controlled clinical trial tests the individual and combined effects of an antidepressant medication and cognitive behavioral therapy for chronic

back pain.”

Link Code: pm3567

P H A R M A F O C U S Cobroxin (cobratoxin)

The Educated Patient™

Cobroxin for Chronic Pain

Developed from the venom of cobra snakes, this over-the-counter medicine releases its fangs on low back pain, shoulder pain, cramps, migraine, and more. Direct your patients to the offi cial site to learn about potential side effects, directions on how to properly use the medication, history of the creation of the product, and more. Visitors can also watch a video featuring an interview on the product featured on the TV show, “The Balancing Act.” appearing on Lifetime. The product is sold as a topical gel or an oral spray.

LINK CODE: pm3528


Cobratoxin Inhibits Pain-evoked Discharge of Neurons in Thalamic Parafascicular Nucleus in Rats: Involvement of Cholinergic and Serotonergic Systems

JOURNAL: Toxican (September 2009)

AUTHORS: Cheng B, Zhou X, Zhu Q, et al.

PURPOSE: To “investigate the inhibitory effect of cobratoxin (CTX) on pain-evoked discharge of neurons in thalamic parafascicular nucleus (Pf) of rats.” It also “analyzed some of the mechanisms involved in this effect.”

RESULTS: Researchers concluded that CTX “has a dose-dependent inhibitory effect on pain-evoked discharges of Pf neurons.” The results confi rmed “electrophysiologically the antinocicpetive actions of CTX.” They also found that CTX “has a longer duration compared to morphine.”

LINK CODE: pm35592