Genetic and physiological autonomic nervous system factors involved in failed back surgery syndrome: A review of the literature and report of nine cases treated with pulsed radiofrequency

Main Article Content

Manuela Baronio
Mirko Baglivo
Giuseppe Natalini
Paolo Notaro
Astrit Dautaj
Stefano Paolacci
Matteo Bertelli

Keywords

Failed back surgery syndrome, sympathetic nervous system, pulsed radiofrequency, Numeric Rating Scale, Oswestry Disability Index, back pain, autonomic nervous system, genetic factors

Abstract

Background and aim: failed back surgery syndrome is one of the most important causes of chronic low back pain that involve the physiology of autonomic nervous system factors. Some genetic and molecular factor can be determinant in the development of failed back surgery syndrome and novel therapy are needed. Pulsed radiofrequency treatment could be an innovative treatment option for this syndrome. Methods: 44 patients classified with failed back surgery syndrome from the Poliambulanza Foundation Hospital of Brescia patients were treated with standard therapy for six months; 9 of these patients who showed no improvement were candidates for pulsed radiofrequency therapy for three months. Results and Conclusions: reduction of lumbar and radicular pain, disability and number of drug classes prescribed improved significantly (p <0.001) in patients treated with pulsed radiofrequency compared to whom that follow only the standard therapy. The role of the nervous system is important for understanding how pulsed radiofrequency can improve the health of patients with back pain. We suggest that some genetic and molecular studies are needed for better understand the role of this therapy in back pain.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...
Abstract 2 |

References

1. Waguespack A, Schofferman J, Slosar P, Reynolds J. Etiology of long-term failures of lumbar spine surgery. Pain Med 2002; 3: 18-22.
2. Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014; 73: 968–74.
3. Rabb CH. Failed back syndrome and epidural fibrosis. Spine J 2010; 10: 454-5.
4. Baber Z, Erdek MA. Failed back surgery syndrome: current perspectives. J Pain Res 2016; 9: 979-87.
5. Nachemson L. The lumbar spine: an orthopaedic challenge. Spine 1976; 1: 59-71.
6. Timothy MS, Carey WS, Garrett J, Jackman A. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors and orthopedic surgeons. N Engl J Med 1995; 333: 913-7.
7. Bueff HU, Van Der Reis W. Low back pain. Prim Care 1996; 23: 345-64.
8. Slipman CW, Shin CH, Patel RK, et al. Etiologies of failed back surgery syndrome. Pain Med 2002; 3: 200-14.
9. Sahin N, Müslümanoğlu L, Karataş O, Cakmak A, Ozcan E, Berker E. Evaluation of sympathetic response in cases with failed back surgery syndrome. Agri 2009; 21: 10-5.
10. El-Badawy MA, El Mikkawy DME. Sympathetic dysfunction in patients with chronic low back pain and failed back surgery syndrome. Clin J Pain 2016; 32: 226–31.
11. Bordoni B, Marelli F. Failed back surgery syndrome: review and new hypotheses. J Pain Res 2016; 9: 17-22.
12. Hallman DM, Lyskov E. Autonomic regulation in musculoskeletal pain. Pain in Perspective, 2012.
13. Djuric V. Pulsed radiofrequency treatment of complex regional pain syndrome: A case series. Pain Res Manag 2014; 19: 186-90.
14. Buchan JG, Alvarado DM, Haller GE, et al. Rare variants in FBN1 and FBN2 are associated with severe adolescent idiopathic scoliosis. Hum Mol Genet 2014; 23: 5271-82.
15. Velvin G, Bathen T, Rand-Hendriksen S, Geirdal A. Systematic review of chronic pain in persons with Marfan syndrome. Clin Genet 2016; 22: 647-58.
16. Babcock D, Gasner C, Francke U, Maslen C. A single mutation that results in an Asp to His substitution and partial exon skipping in a family with congenital contractural arachnodactyly. Hum Genet 1998; 103: 22-8.
17. Kou I, Takahashi Y, Johnson TA, et al. Genetic variants in GPR126 are associated with adolescent idiopathic scoliosis. Nat Genet 2013; 6: 676-9.
18. Baschal EE, Wethey CI, Swindle K, et al. Exome sequencing identifies a rare HSPG2 variant associated with familial idiopathic scoliosis. G3 (Bethesda) 2015; 5: 167-74.
19. Bogduk N. Pulsed radiofrequency. Pain Med 2006; 7: 396-407.
20. Harper WL, Schmidt WK, Kubat NJ, Isenberg RA. An open-label pilot study of pulsed electromagnetic field therapy in the treatment of failed back surgery syndrome pain. Int Med Case Rep J 2015; 8: 13-22.
21. Freitas TS, Fonoff ET, Neto ORM, Deusdará RM, Waihrich ES, Kessler I. Pulsed radiofrequency of sympathetic lumbar plexus versus sympathetic block in the management of lower limb complex regional pain syndrome type 1. Journal of Pain & Relief 2014; 3: 3-7.
22. Owens EF, Hosek RS, Sullivan SGB, Russell BS, Mullin LE, Dever LL. Establishing force and speed training targets for lumbar spine high-velocity, low-amplitude chiropractic adjustments. J Chiropr Educ 2016; 30: 7-13.
23. Jia Z, Ren H, Li Q, Ji N, Luo F. Pulsed radiofrequency reduced neuropathic pain behavior in rats associated with upregulation of GDNF expression. Pain Physician 2016; 19: 49–58.
24. Baronio M, Sadia H, Paolacci S, et al. Molecular aspects of regional pain syndrome. Pain Res Manag 2020; 3: 1-10.