HPE Chronic pain – part one | Page 10

evidence-based and standardised recommendation for such a promising approach. Economic impact The total costs per year associated with low back pain, including loss of wages, have been estimated to be 100 billion dollars in the US and range from 2 to 17 billion Euros in European countries. 5 In the UK, low back pain is the most common cause of disability among young adults, representing more than 100 million work days lost per year, whereas in the US this amounts to 149 million days of work per year lost. 1 A study conducted in Europe identified poor physical health, high functional disability and low health-related quality of life as predictive factors of high costs among patients with chronic low back pain. 19 Another study involving patients admitted to a multidisciplinary spine centre revealed healthcare costs twice as high compared with patients in primary care. 20 Unfortunately, most of the recommended therapeutic avenues have not been evaluated for cost-effectiveness, but exercise therapy seems to be cost-effective for the treatment of subacute and chronic low back pain, although not superior to other interventions for neck and low back pain. 21 References 1 Duthey B. Priority medicines for Europe and the world. A public health approach to innovation. World Health Organization. 2013. www.who.int/medicines/areas/ priority_medicines/BP6_24LBP. pdf (accessed October 2019). 2 Freynhagen R, Baron R. The evaluation of neuropathic components in low back pain. Curr Pain Headache Rep 2009;13(3):185–90. 3 Fatoye F et al. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int 2019;39(4):619–26. 4 GBD 2015 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and health life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet radiculopathy, it is difficult to summarise treatment recommendations in this way because too few studies provide information on homogeneous patient populations. In most cases the causes of low back pain are not known/identified and, therefore, are not addressed. 1 Recently, regenerative approaches have sought to use autologous biologic molecules and components to repair and replace the damaged tissue. Platelet- rich plasma and mesenchymal stem cells, which show high proliferation rates and potential for multilineage differentiation, have been evaluated in several studies, alone or in combination with exercise, physical therapy or behavioural therapy. They have been shown to be a relatively safe alternative for patients with degenerative disc disease who do not respond to conventional treatment, but often only provide short-term relief. 17,18 However, large-scale double-blind randomised studies will be required to establish an Conclusions The pathophysiology of low back pain is undoubtedly complex and further complicated by the absence of non-standardised approaches to clinical decision making. For this reason, low back pain is not considered to be a single pathological entity but a cluster of heterogeneous symptoms (mixed pain). Currently, management of the disease offers merely symptomatic treatment, helping attenuating symptoms of pain and mobility, and no treatment alone can actually prevent, suspend or reverse the progression of the disease. 1 The economic impact of chronic low back pain on individuals, societies, and health systems is significantly high, and it will only increase as the population ages. The identification of specific and effective biomarkers and anthropometric factors for diagnosing and monitoring improvements, in addition to the development of biomaterials for replacement surgical procedures and regenerative therapy, are important areas for future research to narrow the gap between evidence and practice, considering the long-term nature of the management of the condition. 1 2016;388(10053):1603–58. 5 Oliveira CB et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 2018;27(11):2791–803. 6 Freynhagen R et al. Current understanding of the mixed pain concept: a brief narrative review. Curr Med Res Opin 2019;35(6):1011–18. 7 Freynhagen R et al. Pseudoradicular and radicular low-back pain – a disease continuum rather than different entities? Answers from quantitative sensory testing. Pain 2008;135(1-2):65–74. 8 Gudala K et al. High prevalence of neuropathic pain component in patients with low back pain: evidence from meta-analysis. Pain Physician 2017;20(5): 343–52. 9 Schmidt CO et al. Modeling the prevalence and cost of back pain 2010;150(3):420–7. 15 Qaseem A et al. Noninvasive treatments for acute, subacute, and chronic low back pain: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med 2017;166(7):514–30. 16 Kapural L et al. Clinical evidence for spinal cord stimulation for failed back surgery syndrome (FBSS): Systematic review. Spine (Phila Pa 1976) 2017;42(Suppl 14): S61–S66. 17 Navani A et al. Responsible, safe, and effective use of biologics in the management of low back pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician 2019;22(1S):S1–174. 18 Urits I et al. Platelet-rich plasma for the treatment of low back pain: a comprehensive review. Curr Pain Headache Rep 2019;23(7):52. 10 | 2019 | hospitalpharmacyeurope.com with neuropathic components in the general population. Eur J Pain 2009;13(10):1030–5. 10 Last AR, Hulbert K. Chronic low back pain: Evaluation and management. Am Fam Physician 2009;79(12):1067–74. 11 Mulvey MR et al. The role of screening tools in diagnosing neuropathic pain. Pain Manag 2014;4(3):233–43. 12 Freynhagen R et al. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 2006;22(10):1911–20. 13 Coluzzi F et al. Tapentadol: an effective option for the treatment of back pain. J Pain Res 2019;12: 1521–8. 14 Baron R et al ; A0081007 Investigators. The efficacy and safety of pregabalin in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy. Pain 19 Mutubuki EN et al. Predictive factors of high societal costs among chronic low back pain patients. Eur J Pain 2019;Sep 30 [Epub ahead of print]. 20 Dutmer AL et al. Personal and societal impact of low back pain: The Groningen Spine Cohort. Spine 2019;Jul 31 [Epub ahead of print]. 21 Miyamoto GC et al. Cost- effectiveness of exercise therapy in the treatment of non-specific neck pain and low back pain: a systematic review with meta-analysis. Br J Sports Med 2019;53(3):172–81. 22 Atlas SJ, Deyo RA. Evaluating and managing acute low back pain in the primary care setting. J Gen Intern Med 2001;16: 120–31. 23 Chenot J-F et al. Non-specific low back pain. Dtsch Arztebl Int 2017;114(51-52):883–90.