Chronic pain is recognised as a problem worldwide. Interdisciplinary multimodal pain therapy (MMPT) is currently the gold standard of treatment.

The aim of the present prospective observational study is to research whether chronic pain patients form an intention for lifestyle change during a 4-week-long treatment at the Outpatient Clinic for Pain Therapy and Conservative Orthopedics in Heidelberg, Germany, and how sustainable this change is after 3 months. In addition, we theorized a connection between standardised survey endpoints and the number of therapy units perceived as helpful (TPAH). Finally, the effect of socio-demographic factors on patient perceptions were put into perspective.

Clinical data was collected via 3-part-questionnaires from 95 German-speaking patients at 4 checkpoints between 05/2020 and 11/2021 at admission (T1), after 2 weeks (T2), at discharge (T3) and 3 months post-treatment (T4). The questionnaires consisted of already established scores for surveying chronic pain patients, such as the von Korff Chronification Scale, ODI, HADS, PSEQ/FESS, and FABQ, a grading scale for each therapy unit, and free answers.

Patients were most likely to implement Group Walking in their everyday lives. A higher number of TPAH neither lowered nor improved significantly the change in lifestyle, but both a higher number and bigger lifestyle changes improved significantly the scores across the standardised surveys. Furthermore, no significant change in intention happened between the second and the fourth week. Physical components were perceived throughout as more helpful.

The results of this research support the efficacy of MMPT in multi-faceted improving of the patient's well-being and lowering the possibility for pain chronification. A higher number of TPAH could be translated as having more available techniques to combat chronic pain in everyday life. The number of TPAH and the amount of lifestyle change both influence positively the survey scores, yet no connection between them was found. A third factor could be the reason for this constellation. The possibility that the more mental therapies are offered, the more likely it is for those to be perceived as helpful, cannot be excluded either. Further research is required on both topics.

Introduction: Long-term treatment of chronic muscu-loskeletal pain with opioids often causes a cluster of unpleasant side effects such as constipation, dizziness and cognitive impairment and is likely to lead to tolerance and to hyperalgesia, which is clinically important but not yet well researched. In this study we investigated the development of hyperalgesia after long-term treatment with opioids in patients with chronic low back pain (cLBP). The goal of this prospective longitudinal study was to investigate the long-term (> 1.5 years) effects of opioid analgetics on thermal sensation and pain thresholds and to follow the changes in pain sensitivity for 6 months during opioid withdrawal.

Methods: Using quantitative sensory testing (QST), we compared thermal sensation and pain thresholds on the palm of the hand and the low back bilaterally among three groups: patients with cLBP and long-term treatment with opioids (group 1, n=35); opioid-naive patients with chronic low back pain (group 2, n=34) and subjects with neither pain nor opioid intake (group 3, n=27). The effects of age, sex, pain duration, duration and dose of opioid intake, comorbidity (depression) and self-reported pain intensity assessed by QST were investigated.

All patients were allocated to a 3-week multidisciplinary functional restoration programme that emphasized biopsychosocial factors and included continuous tapering of opioid dose. During the study all patients kept records of the medication they used.

Results: Group 1 patients showed significantly delayed reaction to cold and warm stimuli on the back, compared with both group 2 and group 3. Pain thresholds for cold and heat on the hand were similar in group 1 and 2 but significantly reduced in these groups compared with group 3. Age, sex, pain duration, duration and dose of opioid intake, and self-reported pain intensity, but not depression, correlated significantly with QST results.

Discussion: The present study demonstrated that long-term opioid use significantly delayed thermal QST responses but had no measureable analgesic effects in patients with chronic low back pain. While the pain thresholds in groups 1 and 2 did not differ before opioid withdrawal, both groups 1 and 2 were more sensitive to pain than group 3 (healthy controls). This finding confirms that chronic low back pain itself might cause increased pain sensitivity, which seems not to be counteracted by opioid medication. Rather, treatment in the multidisciplinary pain therapy programme had positive effects on pain thresholds in opioid-naive patients but not in patients after opioid withdrawal. The opioid-naive patients of group 2 showed normalized pain thresholds 6 months after therapy, while the former opioid-positive patients of group 1 still had significantly decreased pain thresholds despite 6 months’ abstinence.

Low back pain is the primary cause of disability in individuals younger than 50 years. Potential sources of low back pain include the intervertebral disks, facet joints, vertebrae, neural structures, muscles, ligaments, and fascia. Increasing evidence is available as to the importance of cytokines in acute and particular chronic pain. Cytokines can influence transduction, conduction, and transmission of the nociceptive signal, resulting in prolonged or permanent signalling to the brain’s cognitive centres in the absence of a painful noxious or nonnoxius stimulus.

Several cytokines, including IL-1, TNFa, IL-6, and IL-10 are thought to influence nociception or pain.

To date, there have been no studies of the production of inflammatory mediators in blood from patients with low back pain. We have therefore analysed levels of the proinflammatory mediators IL-1ß, IL-6, TNF-α in sera from patients with sciatica and low back pain, and their possible relationship to pain dimensions.

In this prospective longitudinal study with a follow-up of six months, the course of serum concentration of IL-1ß, IL-6 and TNF-α was measured by Bio-Plex cytokine assay in 31 patients with acute sciatica and 41 patients with chronic low back pain. Blood samples were taken at ten fixed times during follow-up, and cytokine values were adjusted to possible influential factors and correlated to the course of pain and clinical function to evaluate the predictive role of cytokine regarding therapy outcome.

At admission of the study and 10 days later, the proportion of TNF-α positive subjects was significant elevated among patients with low back pain compared to patients with acute sciatica. Median (SD) of serum TNF-α concentrations were significant higher in patients with chronic low back pain (n=41) than in patients with acute sciatica (n=31). In the whole period the pain of patients reduced from time to time. Elevated TNF-α serum levels are associated with a significantly improved pain in patients with chronic low back pain but not with acute sciatica. A close coherence exists between the cytokines IL-1ß, IL-6 and TNF-α together in blood of patients as with acute sciatica as with chronic low back pain. But no connection of IL-1ß, IL-6 or TNF-α and CRP in blood was observed. Neither age, sex, BMI, nicotine and alcohol consumption are not related to the serum levels of cytokines.

As far as we know, this is the first analysis of parameters predicting a major clinical connection of cytokines in blood and low back pain. Our findings indicate that elevated serum levels of the proinflammatory cytokine TNF-α are associated with a significantly improved pain in patients with chronic low back pain but not with acute sciatica. We concluded that Detection of high level of TNF-α might be a marker for more pain in patients with chronic low back pain. and TNF-α probably play an important role in the chronic process of low back pain.