Our patient education dynamic spine models help low back pain sufferers better understanding of their pain sources.

[caption id="attachment_16501" align="aligncenter" width="300"]patient educational tools Dynamic models for effective patient education tools[/caption]

A dynamic spine model can empower a patient to help him or her get to know the motions postures and loads related to pain. Once the specific movements are identified, a patient can learn what exercises and movement strategies that will reduce their symptoms. A disc bulge is often an MRI finding but it can also tells a story about hypermobility. For lumbar spinal stenosis, it is also common for a person to have symptoms while their spine is in relative extension. The Lumbar Spinal Stenosis Model helps a practitioner deliver this important message to engage with accurate patient education.

arthritic changes, lumbar models, cervical models

Arthritic changes are very common. They are often related to a person’s pain with neck pain as one of the highest ranked common causes of disability. In this specific research article 1, the authors looked at the micro-details of neck synovial joints. With osteoarthritis known to be related to neck pain, they were looking to reveal higher anatomical detail and they were also curious about whether men or women have more of these problems.

With both neck and back pain being multifactorial (which may include both psychological and social aspects) degenerative changes within the synovial joints play a significant structural role with the development of spondylosis. This is a general term to describe a disorder of the musculoskeletal system with an emphasis on joint space narrowing, intervertebral disc height loss and frequent formation of bony spurs.

The architecture of the cervical facet joints is quite well known with most of the current knowledge around the smooth (or lack of smoothness) hyaline cartilage to allow the joint to receive and distribute loads in an efficient manner. However, there has not been much quantitative data revealing the anatomy under the hyaline cartilage designated as the subchondral bone. This bone under the cartilage (sub, meaning below and chondral, meaning cartilage) has been of recent interest as there exist nerves in this area that can cause pain. This is thought to be similar to the basivertebral nerve of the vertebral body. The innervation of the facet, however, has ascending fibres travelling through the posterior primary division which can be seen in this Medial Branch Dynamic Disc Model.

 

modeling hyaline cartilage, models

Hyaline Cartilage Modeling in our Professional and Academic LxH Dynamic Disc Models

basivertebral nerve lumbar model

Basivertebral nerve of a lumbar vertebra.

Previous research has shown that the thickness of the hyaline cartilage is .4mm in women and .5mm in men with the subchondral bone making up approximately 5% of the total cartilage thickness. It is also known that with increasing age the cartilage starts to flake off (called fibrillation) and researchers also coin the stripping of cartilage from the bone, denudation. This means being nude. A joint surface within a covering. Other terms used to describe the break down of the hyaline cartilage is erosion, fissuring and deformation. All in all, the terminology all mean that the hyaline is thinning.

arthritic changes, subchondral, joint, model

Subchondral thickening – arthritic changes

How did they do it?

These researchers looked at 72 recently deceased people and examined their joints. They used microscopes to look closely at the facet joints to help understand the pathogenesis of the arthritic changes.

When they observed the osteocartilaginous junction, the morphological changes included: flaking, splitting, eburnation, fissuring, blood vessel invasion and osteophytes. They looked at the length of the cartilage, the hyaline cartilage thickness, the calcified cartilage thickness and the subchondral bone thickness.

They found that males tended to have more severe degenerative changes described by flaking and severe fissures in the facet cartilage. Click To Tweet

Points of Key Interest

  • this was a study that looked at 1132 unique cervical spine facets from 72 humans
  • males were found to have more degenerative changes of the osteocartilaginous junction
  • the thickness of the calcified cartilage and subchondral bone increased with age whereas the hyaline cartilage decreased
  • the osteocartilaginous junction is particularly important in the pathogenesis of osteoarthritis in the cervical spine facet joints

 

At Dynamic Disc Designs, we work to bring research to the practitioner so when there is a teaching moment, Professionals are ready to explain pain triggers as they relate to a patients symptoms and movements. Empowering people about their own anatomy helps in the crafting of customized treatment plans for each unique pain patient. Explore our dynamic models and help a patient understand their arthritic changes and what that means to them.

spine pain, models

Ed Cambridge: “Our colleague Jerome Fryer created some models for us, and this is some of the work that has come out of our lab with you and Christian Balkovec about the dynamic changes we see after herniation. Where we have disc height loss at one level, creating hypermobility at the adjacent level. So here you can see, when you move the spine around there is a stiffening effect down in the lower joint and in the upper joint hypermobility. That’s what we see when an injury propagates from one joint to the next. The patient says, “Well, the pain used to be lower but now its starting to creep up my back a little bit.” “

Stuart McGill: “Fabulous. Another little take on that … By the way, these are all cast from real human specimens. So this is the real deal. Once again, Dynamic Disc Designs has been so clever in representing the biofidelity. We start to see how this disc has been damaged, and it’s quite lax as we move it around. So those micro-movements now are triggering pain just at that level. And this joint has normal stiffness, but then look what happens. Over time, the join changes because of the change in mechanics. The lax disc now cases a bit more arthritis in those facet joints, because they are now responsible for much more motion. So then, look what happens to the cascade. As the person now extends, look what happens. The joint that was hypermobile has now bound up, has no mobility because the facets have bound up and all the motion is now left at the previously stiffened joint. The polar opposite. And then you need some kind of mobility to pop those facet joints open again after they’ve been jammed.”

inflammatory mediators

The changing spine and the anatomy. Professional LxH Dynamic Disc Model

Stuart McGill:  “So, when you understand the cascade of change that happens at a joint, it might be kicked off with a little bit of a flattened disc, which puts more load in the facet joints, which causes a little bit of arthritic growth. In two years, the joint has changed and so have the pain patterns and the mechanics. So, it really does lend insight to allow us to understand the cascade of how the patient reports those changes and their pain changes over the years. And it better allows us to show them what to do to wind down the pain sensitivity. “

 

patient educational tools

Recent studies12 on the effects of patient education in reducing stress and promoting long-term positive patient outcomes indicate that providing literature and visual aids that clearly describe or demonstrate the patient’s condition can help relieve anxiety and encourage a positive psychological state that fosters better health outcomes. Examples of patient educational tools include illustrated pamphlets, photographs, radiograph images, charts, and finely detailed dynamic design models to provide an overall contextual effect in framing treatment and health expectations.

Reframe Treatment Expectations by Providing Context

Clinicians, chiropractors, and physical therapists who are prepared with effective aids to answer their patients’ questions about disc herniation, bulging discs, disc degeneration, annular fissure, osteoarthritis, stability, hypermobility, nerve pain, sheer instability, neutral loading, recumbency, facet or disc pain, disc height changes with static loads, diurnal changes, and other spinal conditions can look forward to a better patient-practitioner experience, more patient cooperation,  and a better long-term treatment outcome for their patients than those who rely on simple diagnosis and treatment procedures without effective patient education.

Empower Patients with Biopsychosocial Approach

By providing patients with a better understanding of their condition through the use of dynamic models or other visual devices, practitioners improve patient-clinician treatment collaboration and empower patients to take a more active role in their own healing agenda. This biopsychosocial approach to treatment has been shown in studies to generate more positive, long-lasting treatment outcomes and improve relationships between patients and practitioners, fostering trust, communication, and respect.

When practitioners take the time to help patients understand their condition, the patient feels more supported and engaged in the healing process and report being generally happier with their treatment plan. Using a person-centered approach to healing, the practitioner is concerned not only with a patient’s diagnosis and treatment, but is also concerned about the patient’s perception of his diagnosis and treatment experience. This perception, according to studies, is more positive and empowering when the practitioner takes the time to fully address the patient’s concerns and questions and uses visual aids, images, charts, literature, dynamic designs, and other tools to demonstrate what the patient is experiencing and how the treatment will work.

Keywords: dynamic models and other tools in patient education, use of dynamic models or other visual devices, finely detailed dynamic design models, patient educational tools, biopsychosocial approach to treatment, disc herniation, bulging discs, disc degeneration, annular fissure, osteoarthritis, stability, hypermobility, nerve pain, sheer instability, neutral loading, recumbency, facet or disc pain, disc height changes with static loads, diurnal changes

lower back pain

A data review of how education of patients suffering from lower back pain (LBP) in a primary care setting affects their psychological state found moderate-to-high evidence that when primary care physicians provided information on the condition, their patients were reassured and experienced long-term healthy and psychological benefits.

patient education

Although it has been long-established that reassurance from a medical practitioner improves patient outcomes, it is also true that reassuring non-specific illness patients without educating them about their condition can contribute to stress, which can precipitate chronic pain and expensive, recurring health care costs.

Because LBP patients are often discouraged from receiving costly diagnostic imaging tests, they may not experience the reassurance that comes from understanding the source of their pain. Though only 25 percent of physicians in the UK currently order imaging as a matter of course, the number is increasing as the benefits of patient reassurance become more evident.

Another means of patient reassurance involves preplanned educational materials that explain the condition in understandable language. Booklets, diagrams, and dynamic devices that clearly demonstrate the health problem and how it can be treated may have beneficial health and psychological effects on LBP in a clinical setting, but there have been few studies to validate the effectiveness of these intervention methods. The purpose of this systematic review was to examine how patient education would increase reassurance in LBP patients and to determine which method of intervention was most effective.

Methods

A literature review of identified, eligible studies was conducted in November of 2013 and repeated in June of 2014. The studies reviewed involved LBP patient education, advice, reassurance, information, counselling, and consultation in clinical trial settings. Eligibility included LBP adult patients with acute or subacute conditions in clinical trials where more than 70 percent of the patients reported symptoms and where the interventions were conducted in a primary care setting, with at least one patient education element, either written or verbal, that provided reassurance.

Results

The data analysis of the review suggested, with moderate-to-high quality evidence, that patients with LBP are reassured when they receive education about their condition from their primary care provider and that the positive effects of the intervention are still evident at a one-year follow-up consultation. The evidence also showed that receiving education about their LBP during their initial primary care visit reduced the amount of LBP health-care visits over a one-year period. A sub-group review also determined that patients were more reassured when they received education about their condition directly from their physician, rather than from a nurse of a physiotherapist.

Discussion

The results of this review indicate that physicians who can provide their LBP patients with structured, understandable educational materials about their condition are more successful in reassuring their patients, who continue to have lasting health and psychological benefits for up to a year after their initial consultation. Because patients with LBP typically endure numerous costly treatments and may suffer from chronic pain and stress, it would be beneficial for primary care physicians to prepare educational materials that could lead to a more successful treatment outcome and reduced financial burden for their patients.

spine models, patient education, anatomy models

Dynamic spine models – Patient Education for Spine

KEYWORDS: educating lower back pain patients, patients suffering from lower back pain, patient reassurance, patient education, diagnostic imaging tests, psychological effects of LBP

somatosensory changes, LBP

A four-month study 1 of acute lower back pain (LBP) patients and a pain-free control group found a correlation between persistent LBP and somatosensory changes over time that appeared to increase pain and other types of neurological sensitivity in chronic LBP patients. Because even baseline pain awareness was elevated in the subjects that later developed chronic LBP, the authors of the study suggest further studies that would examine the evident link between heightened pain sensitivity and its possible role in the development of chronic LBP.

initial LBP diagnosis also be evaluated for potential psychological issues. Click To Tweet

They also suggest patients undergoing initial LBP diagnosis also be evaluated for potential psychological issues that might be contributing factors to their pain.

The Study

Quantitative sensory responses (QSR) were collected and analyzed at less than three weeks prior to the onset of an acute LBP episode (baseline), a two-month follow-up, and at four months for 25 LBP patients and a pain-free control group of 48 subjects.  LBP patients were recruited from a variety of treatment facilities, physicians, and practitioners. Excluding criteria included any history of serious spinal injury or back surgery, pregnancy, or any painful condition requiring at least a month of treatment in the past year or one that affected the subject’s ability to function in any way on a regular basis or required the use of long-term pain medications. Demographics including sex, age, race, work status, and body mass index (BMI) were collected from the LBP and pain-free control participants at the beginning of the study.

Collecting Initial and Follow-Up Data

Patients with LBP answered questions about their pain’s onset, duration, intensity, and how well they were able to function while in pain. The participants then answered questions about their levels of depression, anxiety, and scale of stress. Back pain patients also answered questions that would indicate how much they catastrophized their pain and how self-sufficient they were at dealing with their pain, as well as questions designed to measure the sensory and emotional or affective connection to their pain. They were screened by questionnaires to determine possible neuropathic features of their LBP. All participants involved in the study were given the questionnaires to complete at each of their three assessments, and they were then classified into blind groups according to their answers.

Sensory Testing

All patients were tested for their cold-pain threshold (CPT), followed by a test for their heat-pain threshold (HPT), mechanical wind-up ratio (WUR), pressure-pain threshold (PPT), two-point discrimination (TPD), and conditioned pain modulation (CPM). The testing was conducted at the same three body sites on the backs and hands of all patients. The LBP patients’ back testing was conducted at the location of their greatest pain. Thermal pain thresholds were measured using three consecutive measurements. Pain from the stimulus of a single pin-prick, followed by that of a 10-pin prick, was used to measure the WUR of all subjects and then compared using analysis of a numerical calculation. Three measurements of pressure-pain were used to calculate the PPT. A ruler was used to calculate the TPD of all subjects.

A series of 30-second contacts with a thermally-heated device was used to measure heat pain, and a cold foot bath was used to determine the subjects’ sensitivity to cold, as they were asked to withdraw their foot when they were no longer capable of tolerating the cold water. They were then asked to rate their discomfort at 30, 60, and 90 seconds on a pain scale, and their score was given a negative or positive inhibitory response value. Data and statistics were computed and analyzed by the researchers using statistical software.

Results

The data collected in this study showed that the chronic LBP group had a significantly increased pain sensitivity during early and later pressure and mechanical tests and were more cognizant of pain responses at baseline than their pain-free and recovered acute LPB study counterparts. The psychological effects of their pain were also measured higher at the two and four-month follow-up than their recovered LBP counterparts. This could mean that those patients were neurologically and/or psychologically more prone to pain, even prior to the development of their LBP symptoms. The study authors suggest better standardization of a CPM protocol in future studies to take psychological factors of the patients into account and improve the reliability of future test results.

 

KEYWORDS: correlation between persistent LBP and somatosensory changes, link between heightened pain sensitivity and its possible role in the development of chronic LBP. patients undergoing initial LBP diagnosis also be evaluated for potential psychological issues, cold-pain threshold, heat-pain threshold, conditioned pain modulation

Physician-Patient Communication

A qualitative phenomenological study of 15 musculoskeletal patients and their physiotherapists found that patients were better able to express their concerns and outcome expectations when their practitioners utilized a patient-centric, communicative approach during their initial healthcare consultation. When practitioners were well-versed in contemporary pain and pathology theories, they were better able to anticipate and elicit feedback about their patients’ concerns, leading to a more positive dialogue and better patient satisfaction. Practitioners who have developed systems and approaches to encourage proactive communication from their patients about their health concerns were more likely to have positive patient outcomes than those who relied only upon their prior medical expertise in diagnosing and treating their patients.

Purpose of the Study

Recent healthcare approaches have trended away from the strictly traditional biomedical paradigm to include the biopsychosocial approach to patient consultation and treatment. The newer model recognizes the importance of communication in empowering patients to take an active role in their own treatment and encourages them to consider and express their own health agendas, allowing their clinicians to more fully understand and attend to their specific healthcare needs. To develop a true partnership with their patients, healthcare practitioners must be willing to abandon the “doctor knows best” attitude and develop better communication skills that will allow for a patient-clinician treatment collaboration. This study proposed to investigate the relationship between a clinician’s communication technique and skills and how well the patient was able to express healthcare concerns during an initial consultation.

Methods

15 musculoskeletal patients and their physiotherapists were interviewed after an initial consultation encounter of between 15 and 20 minutes, which was recorded and later analyzed, utilizing predetermined topic guides, including: presenting problems and symptoms; understanding diagnosis theories, how the patients reacted to referrals, the behavior of the clinician during the consultation, desirable and undesirable treatment activities, fears, concerns, and emotional or social issues related to the patient’s treatment or diagnosis.

Findings

Each of the patients involved in the study presented with a range of two to five topics they wanted to discuss with their clinician. The data determined three main themes when it came to important topics of patient-clinician communication during consultations:

Clarity of the patient’s agenda

The first theme identified was how clear or unstructured a patient’s agenda was during their consultation. Some patients had very clear health agendas and were able to communicate their expectations and needs effectively to their clinician. Others were more passive and had more difficulty in communicating their expectations. These patients would have likely benefitted from a practitioner who was better able to create an atmosphere of trust and confidence, which would encourage the patient to discuss their needs.

The need for information and understanding

Patients who had more information about and better understood their health concerns were better at identifying and expressing their expectations and needs during their consultation. The subjects reported being more satisfied with and reassured by their consultation when their clinician took the time to explain and discuss the healthcare issue with them, rather than simply offering a diagnosis and treatment plan. When the clinicians offered evidence-based information regarding their diagnosis and reassurance that their health problem was not due to a serious underlying condition or likely to create too much disruption in their lives, they felt more satisfied with their experience. They were also happier about their consultation when their clinician was able to illicit further information regarding their symptoms and concerns, especially when the patients had neglected to mention these concerns, either through forgetfulness or reluctance to communicate their fears.

Developing Collaboration

Patients in the study reported feeling more supported and engaged when their healthcare provider used a person-centered approach during the interview at their initial consultation. They were better able to trust and have confidence in providers that projected a sense of partnership and were concerned with the social, emotional and physical condition of their patients, rather than treating their dysfunction as a stand-alone concern.

The results of this study emphasize the need for clinicians to create an atmosphere of trust, collaboration, and communication in their patient consultations, rather than relying exclusively on their medical expertise during diagnosis and treatment. By encouraging their patients to more effectively communicate their healthcare concerns, and by creating an atmosphere of collaboration between themselves and their patients, healthcare providers can empower and reassure their patients, which may improve diagnosis, treatment, and healthcare outcomes.

 

KEYWORDS: Importance of Physician-to-Patient Communication, patient-centric, communicative approach, clinician’s communication technique and skills, desirable and undesirable treatment activities, fears, concerns, emotional or social issues related to the patient’s treatment or diagnosis

degenerative spondylolisthesis model

An in vivo dynamic radiographic imaging study of two sets of subjects (symptomatic and asymptomatic) revealed that some degenerative spondylolisthesis (DS) patients showed a greater range of aberrant motion, creating occult instability, in their mid-range kinematic images than previously exhibited on static imaging studies. The new data could have important clinical and diagnostic implications, as practitioners learn to distinguish between DS patients who might benefit from non-surgical interventions and those who require fusion to treat their condition.

Degenerative Spondylolisthesis model

A degenerated lumbar disc model with a grade 1 spondylolisthesis.

Background

Surgical spinal fusion and decompression with laminectomy are the remedies most often prescribed to patients suffering from lumbar DS, but some patients may be treated with decompression alone and avoid costly and potentially risky surgical procedures. Understanding how lumbar spinal instability contributes to DS can help predict which patients may be at risk of destabilization after laminectomy and thus require surgical fusion. The authors of this study sought to compare static and dynamic clinical radiographs to see if the full spectrum of rotational and translational kinematics were evident in MRI’s of subjects utilizing flexion/extension poses.

The Study

Seven Degenerative Spondylolisthesis patients and seven asymptomatic control subjects were imaged during torso flexion as a tracking system measured and calculated the movement of each vertebra and AP slip. Static, and dynamic radiograph images were obtained and compared. The results showed that the static radiographs did not detect the full spectrum of aberrant motion and underestimated AP slip. In contrast, the continuous dynamic imaging showed that DS patients demonstrated a wide range of aberrant motion with high kinematic heterogeneity that was not visible on the static radiographs.





Implications

The results of this ISSLS bioengineering prize-winning study suggest that the presence or absence of lumbar instability in DS patients should be considered and evaluated prior to prescribing treatment. Mid-range kinematics and AP translation may play an important role in determining the relative effectiveness of decompression and laminectomy with—or without—surgical fusion and might spare a subgroup of lumbar DS patients unnecessary expense, risk, and recovery from procedures that are potentially superfluous (or harmful) to their recovery.

KEYWORDS: Some DS Patients May Not Require Fusion Surgery to Improve, some degenerative spondylolisthesis (DS) patients showed a greater range of aberrant motion, creating occult instability, in their mid-range kinematic images, from non-surgical interventions and those who require fusion, static radiographs did not detect the full spectrum of aberrant motion and underestimated AP slip, kinematics and AP translation may play an important role in determining the relative effectiveness of decompression and laminectomy