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1. Long-Term Opioid Therapy in Spine Center Outpatients: Protocol for the Spinal Pain Opioid Cohort (SPOC) Study

Author

Manniche, Claus, Stokholm, Lonny, Ravn, Sophie L, Andersen, Tonny E, Brandt, Lars PA, Rubin, Katrine H, Schiøttz-Christensen, Berit, Andersen, Lars L, and Skousgaard, Søren G

Subjects
Medicine, Computer applications to medicine. Medical informatics, R858-859.7
Abstract

BackgroundSpinal pain is the leading cause of patient-years lived with chronic pain and disability worldwide. Although opioids are well documented as an effective short-term pain-relieving medication, more than a few weeks of treatment may result in a diminishing clinical effect as well as the development of addictive behavior. Despite recognition of opioid addiction in pain patients as a major problem commonly experienced in the clinic, no reference material exists on the scope of long-term problems in novel opioid users and the link to clinical outcomes. ObjectiveThe main aims of this study are to describe baseline and follow-up characteristics of the Spinal Pain Opioid Cohort (SPOC), to evaluate the general use of opioids in spinal pain when an acute pain episode occurs, and to demonstrate the prevalence of long-term opioid therapy (LTOT). MethodsProspective clinical registry data were collected from an outpatient spine center setting during 2012-2013 including patients with a new spinal pain episode lasting for more than 2 months, aged between 18 and 65 years who had their first outpatient visit in the center. Variables include demographics, clinical data collected in SpineData, the Danish National Patient Register, and The Danish National Prescription Registry. The primary outcome parameter is long-term prescription opioid use registered from 4 years before the first spine center visit to 5 years after. ResultsThis is an ongoing survey. It is estimated that more than 8000 patients fulfill the SPOC inclusion criteria. In 2019, we began the intellectual process of identifying the most relevant supplementary data available from the wide range of existing national registries available in Denmark. We have now begun merging SpineData with relevant opioid data from Danish national registers and will continue to extract data up to 2021-2022. We will also be looking at data regarding somatic or psychiatric hospitalization patterns, patient usage of health care resources, as well as their working status and disability pensions. ConclusionsTo our knowledge, this survey will be the first to document the scope of long-term problems regarding LTOT and opioid addiction following new spinal pain episodes and comparing descriptive follow-up data between substance users and nonusers. Trial RegistrationISRCTN Registry ISRCTN69685117; http://www.isrctn.com/ISRCTN69685117 International Registered Report Identifier (IRRID)DERR1-10.2196/21380

Published
2020
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3. Prognostic value of the clinical and imaging arm of the ASAS criteria for progression of structural sacroiliac joint lesions

Author

Arnbak, Bodil, Jensen, Tue Secher, Hendricks, Oliver, Ostergaard, Mikkel, Zejden, Anna, Jurik, Anne Grethe, Manniche, Claus, Arnbak, Bodil, Jensen, Tue Secher, Hendricks, Oliver, Ostergaard, Mikkel, Zejden, Anna, Jurik, Anne Grethe, and Manniche, Claus

Abstract

Objective To investigate the prognostic value of the two arms of the Assessment of SpondyloArthritis international Society (ASAS) criteria regarding the progression of structural lesions in the sacroiliac joints (SIJs). Methods Information on baseline fulfilment of the ASAS criteria and baseline and follow-up magnetic resonance imaging of the SIJ in 603 patients aged 18–40 years referred with low back pain to an outpatient spine were collected. Magnetic resonance imaging positivity was defined as bone marrow oedema (BMO) in two or more consecutive slices or two or more lesions in one slice, as described in the ASAS definition of sacroiliitis. Results Of 71 participants fulfilling the ASAS criteria at baseline, 66 (93%) fulfilled the ‘imaging arm’ and 14 (20%) fulfilled the ‘clinical arm’. The ‘clinical arm’ predicted the progression of erosions with an odds ratio of 55 (compared with not fulfilling the ASAS criteria), while the ‘imaging arm’ predicted the progression of erosions with an odds ratio of 8. Moreover, in 24% of the patients in the ‘imaging arm’, all having BMO at the SIJ at baseline, the BMO disappeared without neither erosions nor ankylosis emerging. Conclusion We found that the ‘clinical arm’ was a strong predictor for the progression of SIJ erosion, while the ‘imaging arm’ had a more modest prognostic value for structural progression., Objective To investigate the prognostic value of the two arms of the Assessment of SpondyloArthritis international Society (ASAS) criteria regarding the progression of structural lesions in the sacroiliac joints (SIJs). Methods Information on baseline fulfilment of the ASAS criteria and baseline and follow-up magnetic resonance imaging of the SIJ in 603 patients aged 18-40 years referred with low back pain to an outpatient spine were collected. Magnetic resonance imaging positivity was defined as bone marrow oedema (BMO) in two or more consecutive slices or two or more lesions in one slice, as described in the ASAS definition of sacroiliitis. Results Of 71 participants fulfilling the ASAS criteria at baseline, 66 (93%) fulfilled the 'imaging arm' and 14 (20%) fulfilled the 'clinical arm'. The 'clinical arm' predicted the progression of erosions with an odds ratio of 55 (compared with not fulfilling the ASAS criteria), while the 'imaging arm' predicted the progression of erosions with an odds ratio of 8. Moreover, in 24% of the patients in the 'imaging arm', all having BMO at the SIJ at baseline, the BMO disappeared without neither erosions nor ankylosis emerging. Conclusion We found that the 'clinical arm' was a strong predictor for the progression of SIJ erosion, while the 'imaging arm' had a more modest prognostic value for structural progression.

Published
2024

10. Analgesics and ASH medications in workers increase the risk of disability pension and mortality:prospective cohort

Author

Andersen, Lars Louis, Vinstrup, Jonas, Calatayud, Joaquín, López-Bueno, Rubén, Clausen, Thomas, and Manniche, Claus

Abstract

BACKGROUND: Relying on medication for musculoskeletal and mental disorders are common, but may have long-term consequences. This study investigates whether use of analgesics and anxiolytic/sedative/hypnotic (ASH) medication increases the risk of disability pension and mortality.METHODS: After completing a survey in 2005, 7773 female eldercare workers were followed for 11 years in a national register. We estimated hazard ratios (HRs) for disability pension and mortality from using analgesics and ASH.RESULTS: During follow-up, 10.3% obtained disability pension and 2.4% died. For use of analgesics, a frequency-response association for the risk of disability pension existed with HR's (95% confidence interval) of 1.30 (1.07-1.57), 2.00 (1.62-2.46) and 3.47 (2.69-4.47) for monthly, weekly and daily use, respectively. For ASH, an increased risk of disability pension also existed (HR's between 1.51 and 1.64). For mortality risk, only daily use of analgesics and ASH remained significant. Population attributable fractions of analgesics and ASH, respectively, were 30% and 3% for disability pension and 5% and 3% for mortality.CONCLUSIONS: Frequent use of analgesics and ASH medication in workers increase the risk of disability pension and early death. Better management of musculoskeletal and mental health conditions, without excessive medication use, is necessary.

Published
2023

11. Analgesics and ASH medications in workers increase the risk of disability pension and mortality: prospective cohort.

Author

Andersen, Lars Louis, Vinstrup, Jonas, Calatayud, Joaquín, López-Bueno, Rubén, Clausen, Thomas, and Manniche, Claus

Subjects
MORTALITY risk factors, MUSCULOSKELETAL system diseases, CONFIDENCE intervals, ANALGESICS, RISK assessment, SURVEYS, COMPARATIVE studies, PENSIONS, DESCRIPTIVE statistics, RESEARCH funding, PEOPLE with disabilities, TRANQUILIZING drugs, ELDER care, MENTAL illness, LONGITUDINAL method
Abstract

Background Relying on medication for musculoskeletal and mental disorders are common, but may have long-term consequences. This study investigates whether use of analgesics and anxiolytic/sedative/hypnotic (ASH) medication increases the risk of disability pension and mortality. Methods After completing a survey in 2005, 7773 female eldercare workers were followed for 11 years in a national register. We estimated hazard ratios (HRs) for disability pension and mortality from using analgesics and ASH. Results During follow-up, 10.3% obtained disability pension and 2.4% died. For use of analgesics, a frequency-response association for the risk of disability pension existed with HR's (95% confidence interval) of 1.30 (1.07–1.57), 2.00 (1.62–2.46) and 3.47 (2.69–4.47) for monthly, weekly and daily use, respectively. For ASH, an increased risk of disability pension also existed (HR's between 1.51 and 1.64). For mortality risk, only daily use of analgesics and ASH remained significant. Population attributable fractions of analgesics and ASH, respectively, were 30% and 3% for disability pension and 5% and 3% for mortality. Conclusions Frequent use of analgesics and ASH medication in workers increase the risk of disability pension and early death. Better management of musculoskeletal and mental health conditions, without excessive medication use, is necessary. [ABSTRACT FROM AUTHOR]

Published
2023
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19. Trajectories of disability in low back pain

Author

Andersen, Tonny E, Karstoft, Karen-Inge, Lauridsen, Henrik H, Manniche, Claus, Andersen, Tonny E, Karstoft, Karen-Inge, Lauridsen, Henrik H, and Manniche, Claus

Abstract

Introduction: Low back pain (LBP) is the leading course of years lived with disability. Unfortunately, not much knowledge exists about distinct trajectories of recovery from disability after LBP and their potential psychological predictors.Objectives: Hence, the aim of the present study was to identify trajectories of functional disability in LBP and their potential baseline psychological predictors.Methods: A 1-year consecutive cohort (N = 1048) of patients with LBP referred to the Spine Centre if they have not improved satisfactorily from a course of treatment in primary care after 1 to 2 months were assessed by self-report questionnaires at their first visit and at 6- and 12-month follow-up. Data from patients who responded to the Roland Morris Disability Questionnaire at least twice (N = 747) were used to assess trajectories of functional disability by Latent Growth Mixture Modeling. The following measures were used as baseline predictors of the trajectories: Pain Intensity Numerical Rating Scales, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Hospital Anxiety and Depression Scale.Results: Four distinct trajectories were identified: high-stable (22.0%), high-decreasing (20.4%), medium-stable (29.7%), and low-decreasing (27.9%). Using the low-decreasing trajectory as reference, baseline pain intensity, depressive symptoms, and pain-catastrophizing predicted membership of all 3 symptomatic trajectories. However, using the high-decreasing trajectory as reference, age, baseline pain intensity, and depression were predictors of the high-stable trajectory.Conclusion: In particular, the finding of a high-stable trajectory characterized by high levels of baseline psychological distress is of potential clinical importance because psychological distress may be targeted by cognitive behavioral therapeutic approaches.

Published
2022

39. Antibiotics should not be used for back/leg pain

Author

Manniche Claus, Peter Fritzell, Olle Hägg, Tomas Bergström, Bodil Jönsson, Siv G E Andersson, Mikael Skorpil, Peter Muhareb Udby, and Mikkel Andersen

Subjects
medicine.medical_specialty, medicine.drug_class, Antibiotics, MEDLINE, Orthopaedics, 03 medical and health sciences, 0302 clinical medicine, Musculoskeletal Pain, Internal medicine, medicine, Back pain, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, Orthopedic surgery, Leg, 030222 orthopedics, business.industry, Leg pain, Modic changes, General Medicine, Anti-Bacterial Agents, Back Pain, Ortopedi, Surgery, sense organs, medicine.symptom, business, RD701-811, Research Article
Abstract

Antibiotics have been suggested as treatment for selected patients with chronic back pain, with or without leg pain, and in association with Modic changes type 1 (MC1) on MRI (Modic et al. 1988, Albert et al. 2013a). The hypothesis is that various bacteria, but above all the common skin bacterium Cutibacterium acnes (formerly Propionibacterium acnes), would spread hematogenously to degenerated discs, where a “low-grade subclinical infection” would trigger an inflammatory reaction and cause MC1 (Albert et al. 2013a), irritate nociceptive nerve endings, and induce pain. Other studies have not found this connection, or have been cautious in their conclusions (Birkenmaier 2013, Urquhart et al. 2015) but have not had the same public impact. Since back/leg pain is common, and Modic changes occur in people with or without back/leg pain (Wang et al. 2012), and as antibiotic resistance is a major health threat (Carlsson et al. 2019), the suggestion of treating chronic back/leg pain with antibiotics must be thoroughly investigated. Research groups in Sweden, Denmark, and Norway have independently conducted studies from 3 different perspectives, but with a focus on the same basic questions: is there a causative link between Modic changes, back pain, and bacteria. The studies, all published during 2019, conclude that antibiotics should not be used for back/leg pain, unless there is a clinically relevant infection in the disc/vertebra (discitis/spondylitis).

Published
2020

48. What Level of Inflammation Leads to Structural Damage in the Sacroiliac Joints? A Four‐Year Magnetic Resonance Imaging Follow‐Up Study of Low Back Pain Patients

Author

Arnbak, Bodil, primary, Jensen, Tue S., additional, Schiøttz‐Christensen, Berit, additional, Pedersen, Susanne J., additional, Østergaard, Mikkel, additional, Weber, Ulrich, additional, Hendricks, Oliver, additional, Zejden, Anna, additional, Manniche, Claus, additional, and Jurik, Anne G., additional

Published
2019
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