Dataset Information

Tapentadol treatment results in long-term pain relief in patients with chronic low back pain and associates with reduced segmental sensitization.

ABSTRACT:

Introduction

Chronic low back pain (CLBP) is one of the most common chronic pain conditions in pain practice.

Objectives

In the current study, we describe phenotypes of patients with CLBP based on the status of their endogenous pain modulatory system.

Methods

Conditioned pain modulation (a measure of central pain inhibition), temporal summation (TS, a measure of pain facilitation), and offset analgesia (a measure of temporal filtering of nociception) were evaluated in 53 patients with CLBP at painful and nonpainful sites. Next, in a double-blind, randomized, placebo-controlled trial, 40 patients with defective conditioned pain modulation responses received treatment with tapentadol prolonged-release or placebo for 3 months.

Results

The majority of patients (87%) demonstrated loss of central pain inhibition combined with segmentally increased TS and reduced offset analgesia at the lower back region. During treatment, tapentadol reduced pain intensity more than placebo (tapentadol -19.5 ± 2.1 mm versus placebo -7.1 ± 1.8 mm, P = 0.025). Furthermore, tapentadol significantly decreased pain facilitation by reduction of TS responses at the lower back (tapentadol -0.94 ± 1.9 versus placebo 0.01 ± 1.5, P = 0.020), which correlated with pain reduction (P < 0.001).

Conclusion

Patients with CLBP demonstrated different phenotypes of endogenous pain modulation. In patients with reduced conditioned pain modulation, tapentadol produced long-term pain relief that coincided with reduction of signs of pain facilitation. These data indicate that the endogenous pain system may be used as a biomarker in the pharmacological treatment of CLBP, enabling an individualized, mechanism-based treatment approach.

SUBMITTER: van de Donk T

PROVIDER: S-EPMC7752667 | biostudies-literature | 2020 Nov-Dec

REPOSITORIES: biostudies-literature

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Publications

Tapentadol treatment results in long-term pain relief in patients with chronic low back pain and associates with reduced segmental sensitization.

van de Donk Tine T van Cosburgh Jurjan J van Dasselaar Tom T van Velzen Monique M Drewes Asbjørn Mohr AM Dahan Albert A Niesters Marieke M

Pain reports 20201101 6

<h4>Introduction</h4>Chronic low back pain (CLBP) is one of the most common chronic pain conditions in pain practice.<h4>Objectives</h4>In the current study, we describe phenotypes of patients with CLBP based on the status of their endogenous pain modulatory system.<h4>Methods</h4>Conditioned pain modulation (a measure of central pain inhibition), temporal summation (TS, a measure of pain facilitation), and offset analgesia (a measure of temporal filtering of nociception) were evaluated in 53 pa ...[more]

PMID: 33364540

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Project description:BackgroundLittle information is available on vertebral motion in patients with discogenic low back pain under physiological conditions. We previously validated a combined dual fluoroscopic and magnetic resonance imaging system to investigate in vivo lumbar kinematics. The purpose of the present study was to characterize mechanical dysfunction among patients with confirmed discogenic low back pain, relative to asymptomatic controls without degenerative disc disease, by quantifying abnormal vertebral motion.MethodsTen subjects were recruited for the present study. All patients had discogenic low back pain confirmed clinically and radiographically at L4-L5 and L5-S1. Motions were reproduced with use of the combined imaging technique during flexion-extension, left-to-right bending, and left-to-right twisting movements. From local coordinate systems at the end plates, relative motions of the cephalad vertebrae with respect to caudad vertebrae were calculated at each of the segments from L2 to S1. Range of motion of the primary rotations and coupled translations and rotations were determined.ResultsDuring all three movements, the greatest range of motion was observed at L3-L4. L3-L4 had significantly greater motion than L2-L3 with left-right bending and left-right twisting movements (p < 0.05). The least motion occurred at L5-S1 for all movements; the motion at this level was significantly smaller than that at L3-L4 (p < 0.05). Range of motion during left-right bending and left-right twisting at L3-L4 was significantly larger in the degenerative disc disease group than in the normal group. The range of motion at L4-L5 was significantly larger in the degenerative group than in the normal group during flexion; however, the ranges of motion in both groups were similar during left-to-right bending and left-to-right twisting.ConclusionsThe greatest range of motion in patients with discogenic back pain was observed at L3-L4; this motion was greater than that in normal subjects, suggesting that superior adjacent levels developed segmental hypermobility prior to undergoing fusion. L5-S1 had the least motion, suggesting that segmental hypomobility ensues at this level in patients with discogenic low back pain.

Dataset Information

Tapentadol treatment results in long-term pain relief in patients with chronic low back pain and associates with reduced segmental sensitization.

Introduction

Objectives

Methods

Results

Conclusion

Publications

Tapentadol treatment results in long-term pain relief in patients with chronic low back pain and associates with reduced segmental sensitization.

Similar Datasets

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