Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Commentary
8 (
4
); 627-628
doi:
10.4103/jnrp.jnrp_282_17

Commentary

Division of Neurosurgery, University of Toronto, Toronto, USA
Address for correspondence: Dr. Manish Ranjan, Division of Neurosurgery, University of Toronto, Toronto, Canada. E-mail: manish.ranjan@gmail.com

Read COMMENTARY-ARTICLE associated with this -

Licence

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

“Pain is a more terrible lord of mankind than even death itself.”- Dr. Albert Schweitzer

“Pain” the most common presenting symptoms to physician, yet many a times ignored and often leading to a chronic pain syndrome. Chronic pain is increasing in prevalence though epidemiological estimate varies largely depending on the study sample and study settings. With a more stringent definition (pain for 6 months, experiencing pain in the last month, and several times during the last week), a pan-European study reported chronic pain prevalence of 19%.[1] In contemporary society, chronic pain is the most common cause of long-term disability. As per the Global Burden of Disease Study 2010, low back pain is among the top 10 diseases and injuries that account for the highest number of DALYs worldwide.[2] However, having specific focus on chronic pain, its often masked with other diseases especially diseases with “so called” higher morbidity and diseases with higher mortality and more so in settings with limited medical resources. In fact, the chronic pain and especially low back pain is one of the major causes of poor quality of life and life dissatisfaction.

Despite growing concern for chronic pain evaluation and treatment, up to two-thirds of sufferer's report dissatisfaction with current treatment and most chronic pain persists for many years.[3] Among neurosurgeons, the low back pain is often seen with the prism of discogenic, neurogenic, or spinal degenerative diseases. Patients with no clear compressive pathology are often poorly managed or worked up. In fact, sacroiliac joint (SIJ) pain is one of the common conditions under “umbrella” back pain syndrome. In one of the retrospective studies,[4] SIJ pain was the common condition in outpatient evaluation at surgical spine clinic and in patients with residual low back pain following spinal fusion, ranging up to 40%.[56]

It is important to understand that the nature of pain from SIJ may be different from preoperative pain; however, it may be overlapping the area of pain in low back coming to the attention of a neurosurgeon and could also be contributory, especially in cases with poor or unsatisfactory response. Moscote-Salazar et al.[7] in the paper, “A clinical approach for the neurosurgeon” explored the SIJ pain and presented a nice overview of a common pain syndrome, though often ignored or missed in consideration of neurosurgical evaluation and differential diagnosis of low back pain. When medicine is evolving from therapeutic to preventive and holistic medicine, low back pain, and chronic pain should be assessed and treated appropriately. Whatever be our specialty of practice or expertise, we should always remember that pain is the “5th vital sign” and that access to pain management is a fundamental human right (Declaration of Montréal).[8]

REFERENCES

  1. , , , , , . Survey of chronic pain in europe: Prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10:287-333.
    [Google Scholar]
  2. , , , , , , . Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2163-96.
    [Google Scholar]
  3. , , , , , . The course of chronic pain in the community: Results of a 4-year follow-up study. Pain. 2002;99:299-307.
    [Google Scholar]
  4. , , . How often is low back pain not coming from the back? Spine (Phila Pa 1976). 2009;34:E27-32.
    [Google Scholar]
  5. , , , . Etiology of chronic low back pain in patients having undergone lumbar fusion. Pain Med. 2011;12:732-9.
    [Google Scholar]
  6. , , , , , , . Sacroiliac joint pain after lumbar and lumbosacral fusion: Findings using dual sacroiliac joint blocks. Pain Med. 2011;12:565-70.
    [Google Scholar]
  7. , , , , , . Sacroiliac pain: A clinical approach for the neurosurgeon. J Neurosci Rural Practi. 2017;8.:622-7.
    [Google Scholar]
  8. International Pain Summit Of The International Association For The Study Of Pain. Declaration of montréal: declaration that access to pain management is a fundamental human right. J Pain Palliat Care Pharmacother. 2011;25:29-31.
    [Google Scholar]

    Fulltext Views
    697

    PDF downloads
    265
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections