Pathophysiological Mechanisms Underlying the Transition From Acute to Chronic Low Back Pain: Are NSAIDs to Blame?

Learning Objective

As a result of participating in this activity, learners will be better able to:

• Apply an improved understanding as to the roles of inflammation, neurogenic inflammation, and neuroinflammation to manage acute and chronic pain

Overview

• How acute LBP is becoming chronic
• How Low Back Pain (LBP) Can be a societal and clinical problem
• Risk factors for the chronification of LBP
• The importance of prostaglandins and cytokines as targets of therapeutic intervention
• The Effectiveness of epidural steroid injections after new injury

Accreditation & Designation

Release date: This activity was released 8/20/2022.

Termination date: The content of this activity remains eligible for CME Credit until 8/19/2025, unless reviewed or amended prior to this date.

Claiming Credit: Watch the entire presentation and complete the Improvement Plan/Evaluation.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this other activity (blended learning) for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Financial Relationships & Measures to Resolve of Conflicts of Interest

[Presenter] Massimo Allegri discloses the following financial relationships within the past 24 months: Consulting: Clover Orthopedics, Health & RCB

No other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships have been mitigated. Materials were reviewed in advance of the activity by person(s) that do not have conflicts of interest related to the content. In some cases, content may have been modified as part of the review and mitigation process. All clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering to evidence-based practice guidelines).

Additional Reading

• Parisien, M., Lima, L. V., Dagostino, C., El-Hachem, N., Drury, G. L., Grant, A. V., ... & Diatchenko, L. (2022). Acute inflammatory response via neutrophil activation protects against the development of chronic pain. Science Translational Medicine, 14(644), eabj9954.
• Stevans, J. M., Delitto, A., Khoja, S. S., Patterson, C. G., Smith, C. N., Schneider, M. J., ... & Saper, R. B. (2021). Risk factors associated with transition from acute to chronic low back pain in US patients seeking primary care. JAMA network open, 4(2), e2037371-e2037371.
• Manchikanti, L., Nampiaparampil, D. E., Manchikanti, K. N., Falco, F. J., Singh, V., Benyamin, R. M., ... & Hirsch, J. A. (2015). Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials. Surgical neurology international, 6(Suppl 4), S194.
• Curatolo, M., Rundell, S. D., Gold, L. S., Suri, P., Friedly, J. L., Nedeljkovic, S. S., ... & Jarvik, J. G. Long‐term effectiveness of epidural steroid injections after new episodes of low back pain in older adults. European Journal of Pain.
• Freidin, M. B., Lauc, G., Allegri, M., Primorac, D., & Williams, F. M. (2016). Using omics in chronic pain conditions to delineate mechanisms and provide new therapeutic strategies. Pain Management, 6(3), 211-215.
• Buchheit, T., Huh, Y., Maixner, W., Cheng, J., & Ji, R. R. (2020). Neuroimmune modulation of pain and regenerative pain medicine. The Journal of Clinical Investigation, 130(5), 2164-2176.
• Matsuda, M., Huh, Y., & Ji, R. R. (2019). Roles of inflammation, neurogenic inflammation, and neuroinflammation in pain. Journal of anesthesia, 33(1), 131-139.