Rheum Round-up: 10 Facts and Myths About Back Pain, Cannabis Use in Pain, and more

Here are the top stories recently covered by DocWire News in the Rheumatology section. In this edition, read about 10 truths and 10 falsehoods pertaining to back pain, the risk of cannabis use disorder in adults with pain, whether beliefs about activity improve functional back pain outcomes, and the importance of alignment in distal radius fracture restoration.

Misinformation about low back pain (LBP) is common, and the spread of falsehoods may adversely affect those who suffer from it by increasing levels of pain, disability, missed work, and medication and healthcare utilization, researchers say in a recent editorial. Here are five common misconceptions about LBP:

  1. LBP is usually a serious medical condition.
  2. LBP will become persistent and deteriorate later in life.
  3. Persistent LBP is always related to tissue damage.
  4. Scans are always needed to detect the cause of LBP.
  5. Pain related to exercise and movement is always a warning that harm is being done to the spine and a signal to stop or modify activity.

Here are five “helpful facts” according to the authors:

  1. LBP is not a serious life-threatening medical condition.
  2. Most episodes of LBP improve and LBP does not get worse as we age.
  3. A negative mindset, fear-avoidance [behavior], negative recovery expectations, and poor pain coping [behaviors] are more strongly associated with persistent pain than is tissue damage.
  4. Scans do not determine prognosis of the current episode of LBP, the likelihood of future LBP disability, and do not improve LBP clinical outcomes.
  5. Graduated exercise and movement in all directions is safe and healthy for the spine.

Click here for the complete lists.

U.S. adults living with pain have a greater risk of adverse cannabis use outcomes, nonmedical cannabis use, and cannabis use disorder. The researchers examined data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) spanning 2001-2002 (n=43,093) and the NESARC-III spanning 2012-2013. During both time periods, patients with pain were more likely than those without pain to report any nonmedical cannabis use (2001-2002: 5.15% vs. 3.74%; 2012-2013: 12.42% vs. 9.02%). In the earlier survey, there were no significant pain-based differences in the prevalence of frequent nonmedical cannabis use, but in the later survey, the prevalence was significantly higher in the pain group than the non-pain group (5.03% vs. 3.45%). Patients with pain were more likely than those without pain to have cannabis use disorder at both timepoints (2001-20012: 1.77% vs. 1.35%; 2012-2013: 4.18% vs. 2.74%).

A new study questioned whether patients with LBP who believe staying active despite having pain have a better functional outcome compared to those who believe pain is a warning sign to cease activity. Final analysis included 816 patients, of whom 596 (73.0%) said that they believe pain is a warning sign to stop being active. The main outcome of 30% Roland Morris Disability Questionnairescore after 52 weeks did not largely differ between patients who did and did not consider pain a warning signal (n=80, 43.2% vs. n=201, 41.2%; adjusted P=0.542 and unadjusted P=0.629).). Functional outcomes were poorer among STarT Back Tool high-risk patients (adjusted P=0.003 and unadjusted P=0.002). Chronic pain was a risk factor for less favorable functional outcome (adjusted P<0.001 and unadjusted P<0.001), but beliefs regarding finding the cause, diagnostic imaging, perceiving to have received advice to stay active, and pain intensity did not largely impact outcome.

A new study examined whether precise anatomic restoration for distal radius fractures (DRFs) is associated with improved functional and patient-reported outcomes and found they may not be related. Final analysis included 166 patients (mean [SD] age, 70.9 [8.9] years; 144 [86.7%] were female). According to the study authors, “only 2 of the 84 correlation coefficients calculated were statistically significant.” Among patients aged 70 years and older, every degree increase in radial inclination away from a normal grip strength of 22 degrees in the fracture hand was 1.1 kg weaker compared to the contralateral hand (95% confidence interval [CI], 0.38–1.76; P=0.004). for every millimeter increase toward a normal ulnar variance of 0 mm, a 10.4-point improvement was observed in Michigan Hand Outcomes Questionnaire (MHQ) activities of daily living score (95% CI, –16.84 to –3.86). Still, neither measurement was correlated with MHQ total or function scores.