Abstract Objectives The purpose of this systematic review is to analyze the available literature on structural and functional brain abnormalities in chronic low back pain (CLBP) using several brain ...magnetic resonance imaging (MRI) techniques. Methods PubMed and Web of Science were systematically screened for relevant literature using different combinations of keywords regarding structural and functional brain imaging techniques in patients with CLBP. Reference lists of included articles were hand-searched for additional literature. Eligible articles were assessed on risk of bias and reviewed by two independent researchers. Results The search query returned 27 articles meeting the inclusion criteria. Methodological quality varied from poor to good. A total of 10 studies evaluated structural gray matter changes. There is conflicting evidence in global gray matter changes, with both increases and decreases shown in different studies. Gray matter changes were demonstrated in specific brain regions. Structural white matter changes were reported in five studies. There is conflicting evidence in total white matter volume due to both increases and unchanged white matter. Several regional differences were identified in which white matter changes were shown. Functional organization during rest was evaluated in 10 studies. CLBP patients showed increased activation in specific regions, together with a disrupted default mode network. A total of six studies evaluated brain activity in response to a nociceptive stimulus. Findings suggest that patients demonstrated increased activity in pain-related regions, and decreased activity in analgesic regions. Conclusions Overall, there is moderate evidence for regional changes in gray and white matter, together with an altered functional connectivity during rest and increased activity in pain-related areas following painful stimulation, evidencing an upregulated pain matrix. More longitudinal research is needed to clarify the temporal relationship regarding pain and neuroplastic changes, and integration of different brain imaging techniques is warranted.
Recently, the International Association for the Study of Pain (IASP) released clinical criteria and a grading system for nociplastic pain affecting the musculoskeletal system. These criteria replaced ...the 2014 clinical criteria for predominant central sensitization (CS) pain and accounted for clinicians' need to identify (early) and correctly classify patients having chronic pain according to the pain phenotype. Still, clinicians and researchers can become confused by the multitude of terms and the variety of clinical criteria available. Therefore, this paper aims at (1) providing an overview of what preceded the IASP criteria for nociplastic pain ('the past'); (2) explaining the new IASP criteria for nociplastic pain in comparison with the 2014 clinical criteria for predominant CS pain ('the present'); and (3) highlighting key areas for future implementation and research work in this area ('the future'). It is explained that the 2021 IASP clinical criteria for nociplastic pain are in line with the 2014 clinical criteria for predominant CS pain but are more robust, comprehensive, better developed and hold more potential. Therefore, the 2021 IASP clinical criteria for nociplastic pain are important steps towards precision pain medicine, yet studies examining the clinimetric and psychometric properties of the criteria are urgently needed.
Chronic pain has a tremendous personal and socioeconomic impact and remains difficult to treat. Therefore, it is important to provide an update on the current understanding regarding lifestyle ...factors in people with chronic pain across the lifespan. Lifestyle factors such as physical (in)activity, sedentary behavior, stress, poor sleep, unhealthy diet, and smoking are associated with chronic pain severity and sustainment. This applies to all age categories, that is, chronic pain across the lifespan. Yet current treatment options often do not or only partly address the many lifestyle factors associated with chronic pain or attempt to address them in a standard format rather than providing an individually tailored multimodal lifestyle intervention. The evidence regarding lifestyle factors is available in adults, but limited in children and older adults having chronic pain, providing important avenues for future research. In conclusion, it is proposed that treatment approaches for people with chronic pain should address all relevant lifestyle factors concomitantly in an individually‐tailored multimodal intervention. Ultimately, this should lead to improved outcomes and decrease the psychological and socioeconomic burden of chronic pain. Level of Evidence: IV.
Dietary patterns may play an important role in musculoskeletal well-being. However, the link between dietary patterns, the components of patients' diet, and chronic musculoskeletal pain remains ...unclear. Therefore, the purpose of this review was to systematically review the literature on the link between dietary patterns, the components of patients' diet and chronic musculoskeletal pain. This review was conducted following the "Preferred Reporting Items for Systematic reviews and Meta-Analyses" (PRISMA) guidelines and was registered in PROSPERO with the registration number CRD42018110782. PubMed, Web of Science, and Embase online databases were searched. After screening titles and abstracts of 20,316 articles and full texts of 347 articles, 12 eligible articles were included in this review, consisting of nine experimental and three observational studies. Seven out of nine experimental studies reported a pain-relieving effect of dietary changes. Additionally, protein, fat, and sugar intake were found to be associated with pain intensity and pain threshold. In conclusion, plant-based diets might have pain relieving effects on chronic musculoskeletal pain. Patients with chronic rheumatoid arthritis pain can show inadequate intake of calcium, folate, zinc, magnesium, and vitamin B6, whilst patients with fibromyalgia can show a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Chronic pain severity also shows a positive relation with fat and sugar intake in osteoarthritis, and pain threshold shows a positive association with protein intake in fibromyalgia.
Chronic Low Back Pain (CLBP) is a major and highly prevalent health problem. Given the high number of papers available, clinicians might be overwhelmed by the evidence on CLBP management. Taking into ...account the scale and costs of CLBP, it is imperative that healthcare professionals have access to up-to-date, evidence-based information to assist them in treatment decision-making. Therefore, this paper provides a state-of-the-art overview of the best evidence non-invasive rehabilitation for CLBP. Taking together up-to-date evidence from systematic reviews, meta-analysis and available treatment guidelines, most physically inactive therapies should not be considered for CLBP management, except for pain neuroscience education and spinal manipulative therapy if combined with exercise therapy, with or without psychological therapy. Regarding active therapy, back schools, sensory discrimination training, proprioceptive exercises, and sling exercises should not be considered due to low-quality and/or conflicting evidence. Exercise interventions on the other hand are recommended, but while all exercise modalities appear effective compared to minimal/passive/conservative/no intervention, there is no evidence that some specific types of exercises are superior to others. Therefore, we recommend choosing exercises in line with the patient's preferences and abilities. When exercise interventions are combined with a psychological component, effects are better and maintain longer over time.
Nutrition plays an important role in pain management. Healthy eating patterns are associated with reduced systemic inflammation, as well as lower risk and severity of chronic non-cancer pain and ...associated comorbidities. The role of nutrition in chronic non-cancer pain management is an emerging field with increasing interest from clinicians and patients. Evidence from a number of recent systematic reviews shows that optimising diet quality and incorporating foods containing anti-inflammatory nutrients such as fruits, vegetables, long chain and monounsaturated fats, antioxidants, and fibre leads to reduction in pain severity and interference. This review describes the current state of the art and highlights why nutrition is critical within a person-centred approach to pain management. Recommendations are made to guide clinicians and highlight areas for future research.
Chronic spinal pain, including both neck and low back pain, is a common disabling disorder in which sleep problems are frequently reported as a comorbidity. The complex processes of both sleep and ...chronic pain seem to have overlapping mechanisms, which may explain their often established bidirectional relationship. This systematic review aims to investigate the assumed association between sleep and chronic spinal pain by providing an overview of the literature from the last decade. Eligible studies were obtained by searching four databases (PubMed, Embase, Web of Science, and PsycARTICLES). Articles were found relevant if they included a human adult population and investigated the possible association between sleep parameters and chronic spinal pain. Only studies published after January 2009 were included, as this review aimed to provide an update of a previous literature overview on this topic. The quality of the studies was assessed by risk of bias and level of evidence. A total of twenty-seven studies (6 cohort, 5 case-control, and 16 cross-sectional studies) were included in this systematic review. The methodological quality of these studies was low to moderate. The majority of studies reported weak to moderate evidence for an association between sleep parameters and chronic spinal pain, with more severe pain accompanied by more disturbed sleep. Addressing frequently reported sleep problems in chronic spinal pain patients therefore appears to be a necessary complement to pain management to achieve optimal treatment outcomes.
Background: Although the association of gray matter morphology alterations and pain-related
psychosocial characteristics with pain intensity and chronification in people with chronic spinal
pain is ...evident, research on their mutual interaction is scarce and does not account for possible
gender differences. Gender-based differences are, however, of utmost importance to consider
when examining pain neurobiology.
Objectives: To look for gender differences in the association between magnetic resonance
imaging- (MRI) derived brain gray matter morphology and self-reported psychosocial characteristics.
Study Design: An explorative, observational study.
Setting: University Hospitals Ghent and Brussels, Belgium.
Methods: Brain gray matter morphology (using MRI) and self-reported psychosocial characteristics
were examined in women and men with nonspecific chronic spinal pain. Statistical analyses were
performed in SPSS and R to identify differences between men and women regarding brain gray
matter, self-reported psychosocial characteristics, as well as gender differences in the association
between those outcome measures.
Results: A total of 94 people with chronic spinal pain were studied, including 32 men (15 suffering
from neck pain, 17 suffering from low back pain; demographics mean ± SD age: 45.00 ± 12.02
years; pain duration: 128.37 ± 110.45 months), and 62 women (36 suffering from neck pain, 26
suffering from low back pain; demographics mean ± SD age: 38.78 ± 12.69 years; pain duration:
114.27 ± 92.45 months). Woman showed larger (positive) associations of several central brain areas
(paracentral, precentral, postcentral, etc.) with perceived consequences (P < 0.001), emotional
representations (P < 0.001), chronicity (P < 0.001), and pain catastrophizing (P< 0.001). Men showed
larger (both positive and negative) associations of the precuneus cortex, the precentral gyrus, and the
insula with perceived personal control (P < 0.001) and kinesiophobia (P < 0.001).
Limitations: Other factors, such as menstrual cycle and medication can have a certain influence,
and were only partly taken into consideration in the present investigation to obtain sufficient
power. Another limitation is the observational study design, which hampers the possibility to look
for causal or temporal interactions.
Conclusions: Gray matter morphology relates differently to psychosocial characteristics in
women and men. These explorative findings provide ideas for further research to investigate if
targeting perceived negative consequences of the illness, perceived emotional representations,
perceived chronicity, and pain catastrophizing in women, and perceived personal control of the
illness and kinesiophobia in men, could contribute to the normalization of brain alterations in
people with nonspecific chronic spinal pain.
Key words: Gray matter, brain morphology, central nervous system, illness perceptions, central
sensitization
Insomnia is a major problem in the chronic spinal pain (CSP) population and has a negative impact on health and well-being. While insomnia is commonly reported, underlying mechanisms explaining the ...relation between sleep and pain are still not fully understood. Additionally, no reviews regarding the prevention of insomnia and/or associated factors in people with CSP are currently available. To gain a better understanding of the occurrence of insomnia and associated factors in this population, we conducted a systematic review of the literature exploring associates for insomnia in people with CSP in PubMed, Web of Science and Embase. Three independent reviewers extracted the data and performed the quality assessment. A meta-analysis was conducted for every potential associate presented in at least two studies. A total of 13 studies were found eligible, which together identified 25 different potential associates of insomnia in 24,817 people with CSP. Twelve studies had a cross-sectional design. Moderate-quality evidence showed a significantly higher rate for insomnia when one of the following factors was present: high pain intensity, anxiety and depression. Low-quality evidence showed increased odds for insomnia when one of the following factors was present: female sex, performing no professional activities and physical/musculoskeletal comorbidities. Higher healthcare use was also significantly related to the presence of insomnia. One study showed a strong association between high levels of pain catastrophizing and insomnia in people with chronic neck pain. Last, reduced odds for insomnia were found in physically active people with chronic low back pain compared to inactive people with chronic low back pain. This review provides an overview of the available literature regarding potential associates of insomnia in people with CSP. Several significant associates of insomnia were identified. These findings can be helpful to gain a better understanding of the characteristics and potential origin of insomnia in people witch CSP, to identify people with CSP who are (less) likely to have insomnia and to determine directions of future research in this area.
Impaired glucose regulation is suggested to be related to chronic low back pain (CLBP), although it is not clear how they interact with each other. Thus, the primary aim of this study was to ...investigate differences in postprandial glycemic responses (PPGRs) (the first sign of impaired glucose metabolism) to high- (sucrose) and low-glycemic index (GI) (isomaltulose) beverages in normoglycemic women with CLBP and healthy controls (HCs) and explore whether any group that showed greater PPGRs to high-GI beverage intake would benefit when the high-GI beverage was replaced with a low-GI beverage. Secondly, this study aimed to explore the association between PPGR and pain in patients with CLBP.
This study was registered at clinicaltrials.org (NCT04459104) before the start of the study. In this study, 53 CLBP patients and 53 HCs were recruited. After 11-12 h of fasting, each participant randomly received isomaltulose or sucrose. Blood glucose levels were measured during the fasting state and 15, 30, 45, 60, 90, and 120 min after the beverage intake, and each participant underwent experimental pain measures.
Compared to the HCs, the CLBP group showed significantly higher PPGRs to sucrose (
< 0.021). Additionally, the CLBP group showed a significantly higher decrease in PPGR (
= 0.045) when comparing PPGR to sucrose with PPGR to isomaltulose. Correlation analysis revealed a positive association between self-reported pain sensitivity and PPGR to sucrose, while there was no association found between any experimental pain measures and glycemic responses.
Overall, these findings suggest that normoglycemic CLBP patients might have a higher risk of developing impaired glucose tolerance than the HCs and might benefit more when high-GI foods are replaced with low-GI ones.
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