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What low back pain is and why we need to pay attention
Abstract
Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide. For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause—eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect. Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public health problem.
... Low back pain (LBP) is a common condition that considerably impacts daily life activities in all ages [1]. In 2015, it was established that 540 million individuals were affected by LBP at some point [2]. ...
... Yet, MRI is not typically the first-line investigation unless there are red flag signs and symptoms indicating a potential serious underlying pathology that warrants an urgent MRI. These red flags include a previous history of cancer, chronic steroid use, history of IV drug abuse, immunosuppression, HIV, weight loss, fever, chills, night sweats, pain that worsens when supine, bowel or bladder dysfunction, 1 1 1 1 1 thoracic pain, saddle anesthesia, and radicular pain [4,6]. Nevertheless, some signs and symptoms are considered red flags in certain guidelines but not in others [7,8]. ...
... However, only 18 (28%) patients exhibited MRI findings related to LBP ( Table 5). Consistent with the current results, a previous study demonstrated that in most countries, LBP is the leading cause of disability [2], especially within the working age group [2,1]. This observation can likely be attributed to the fact that non-specific low back pain is the most prevalent form [5,13]. ...
Background:
Low back pain (LBP) is common and considerably impacts daily lives across all age groups. MRI is not frequently used as a first-line investigation for patients presenting with LBP, except in the presence of red- flag symptoms. This study aimed to use pain severity and its impact as a predictor for MRI findings to help physicians decide whether a patient needs an MRI.
Methods:
This cross-sectional study was conducted at the outpatient clinic of the neurosurgery department. The questionnaire included demographic data of the patients, red-flag symptoms, and the Dallas Pain Questionnaire (DPQ). The primary physician then determines whether the patient should have an MRI appointment.
Results:
The study included 100 patients with LBP, of which 71 had chronic LBP (CLBP). Out of these 71, an MRI was requested for 62, but only 26 had findings related to LBP. Regarding the impact of CLBP on daily activities as measured by the DPQ, there was a significant association between those whose CLBP affected their daily activities and the decision to request an MRI. However, no significant statistical association was found between the three other parameters of the DPQ and the primary physician's decision to request an MRI.
Conclusion:
Concerning the use of the DPQ questionnaire to predict MRI findings in patients with CLBP, the study indicates that significant pain impact on the DPQ does not necessarily correlate with MRI findings related to LBP. This suggests that the DPQ evaluation tool has no advantage over a physician's clinical judgment.
... The majority of people suffer from lower back pain at least once in their lifetime, although this problem is usually self-limiting and recovery is achieved within 4-6 weeks. [13][14][15][16] However, 5%-10% of cases continue for more than 12 weeks and become chronic back pain, leading to a higher disease burden. 17,18 Furthermore, back pain is one of the most common causes of disability in society, with high care and treatment costs, and in 2018 back pain was the leading cause of disability worldwide. ...
... 17,18 Furthermore, back pain is one of the most common causes of disability in society, with high care and treatment costs, and in 2018 back pain was the leading cause of disability worldwide. [13][14][15]18 Anatomically, back pain refers to pain in the L1-L5 vertebrae and the sacroiliac area, which continues from the bottom edge of the 12th rib to the iliac crest area. 1,13,14 The documented history of back pain goes back to 1500 BCE, in an Egyptian case report. ...
... [13][14][15]18 Anatomically, back pain refers to pain in the L1-L5 vertebrae and the sacroiliac area, which continues from the bottom edge of the 12th rib to the iliac crest area. 1,13,14 The documented history of back pain goes back to 1500 BCE, in an Egyptian case report. 19 Furthermore, degenerative changes have been found in Egyptian mummies, which confirm the existence of this problem in ancient times. ...
Background and aims:
Low back pain (LBP) is one of the most debilitating and prevalent disorders. The prevalence of LBP ranges from 30% to 80%, depending on the population, and increases with age. Causes of LBP are typically classified as spinal and non-spinal. The main goal of this study was to investigate the non-spinal causes of LBP, since neglecting these factors leads to increases in the financial, psychological, and physical burden of LBP on individuals as well as on society.
Methods:
The data were extracted after searching the PubMed database and Google Scholar search engine up to October 27, 2021. We included all studies that were conducted on a human population and assessed the effects of epidemiological, biological, psychological, and sociodemographic factors on the incidence or progression of LBP.
Results:
The most common causes of non-spinal LBP were diseases such as nephrolithiasis, endometriosis, tumors, fibromyalgia, and conditions like psychological disorders and pregnancy. Nevertheless, the perceived intensity of the pain can be affected by factors such as socioeconomic level, genetics, age, habits, diet, and psychological status.
Conclusion:
The epidemiology, etiologies, and risk factors associated with LBP should be more clearly recognized to better prevent, diagnose, and treat the underlying disease and to reduce the burden of LBP.
... Journals focusing on LBP treatments (pharmaceutical research in LBP-O and physical rehabilitation in LBP-W) published relatively more LBP-related papers. Although LBP is the number one cause of people living with disabilities and the number of LBPrelated publications has been growing exponentially over the last three decades, only a few papers were published in 29,33,[38][39][40][41][42][43][44][45] This observation may be ascribed to the perception that LBP is a ubiquitous, but non-lifethreatening ailment. Further, LBP research is more related to rehabilitation, which may not be considered for publications in mainstream or specialty medical journals. ...
... Despite LBP being a highly costly and debilitating health condition and the fact that primary care providers are nearly always the point of first contact for these patients, insufficient attention is paid to LBP in the general medical literature. [41][42][43] In the future, more high-quality LBP studies should be conducted to increase the awareness of medical professionals regarding the prevention and management of LBP. The highest number of publications in the LBP-O-and LBP-W-related fields over the last three decades originated from the United States because it may have more funding opportunities, and prominent research institutions, which may hire more researchers. ...
Although the number of publications focusing on low back pain in older adults (LBP-O) and working-age adults (LBP-W) has been growing for decades, comparative research trends in these two populations, which may help to guide future investigation, have not been rigorously explored. This analysis aimed to describe publication patterns and trends of research targeting LBP-O and LBP-W over the last three decades. Peer-reviewed LBP-O and LBP-W articles published between 1993 and 2023 were retrieved from the Web of Science, which provided the details of annual publication volume, and prominent journals/countries/institutions. The relationship between the annual publication volumes and years was analyzed by Spearman correlation analysis. The hot topics and emerging trends were analyzed by VOSviewer and CiteSpace, respectively. A total of 4217 LBP-O-related and 50,559 LBP-W-related documents were included. The annual publication volumes of LBP-O and LBP-W articles increased over the years (r=0.995 to 0.998, p<0.001). The United States had the highest number of prominent institutions publishing relevant articles. The most prolific journal for LBP-O (5.4%) and LBP-W-related (6.1%) papers is the journal "Spine". Cognitive behavioral therapy, intervertebral disc (IVD) degeneration, physiotherapy, physical activity, and walking were the recent hot topics and physical activity was an emerging trend in LBP-O, while surgery and IVD degeneration (also a hot topic) were emerging trends in LBP-W. This study highlights the paucity of LBP-O-related research in the past. The United States and the journal Spine stand out in LBP research. The research trend of physical activity in LBP-O is consistent with the recognized importance of physical activity for older adults in general, and for managing LBP-O in particular. Conversely, the emerging trends of surgery and intervertebral disc degeneration in LBP-W research highlight a focus on the biomedical model of LBP despite LBP being a biopsychosocial condition.
... 10 Também uma outra investigação, de 2018, verificou que os doentes utilizadores de MFR, ao nível dos CSP, eram maioritariamente do sexo feminino e que o código ICPC mais utilizado era o do capítulo L -Sistema músculo-esquelético. 11 A patologia músculo-esquelética, especificamente a da coluna vertebral, é descrita em vários estudos como um importante problema de saúde nos países desenvolvidos, sendo uma causa major de morbilidade e incapacidade na população. [12][13] Com o envelhecimento da população, a prevalência destas condições para as quais o tratamento fisiátrico é um elemento-chave aumenta de forma significativa. 14 A partir de uma amostra de mais de dois mil milhões de pessoas que necessitaram de MFR, um estudo publicado em 2020 concluiu que o grupo de patologias que mais frequentemente carecia de tratamento era o músculo-esquelético, principalmente a patologia da coluna lombar. ...
... Se, por um lado, os problemas músculo-esqueléticos são o principal motivo para uma saída prematura do mercado laboral, por outro, o baixo nível de escolaridade é identificado como um fator de risco e de agravamento deste tipo de patologias, na medida em que os trabalhadores com menor grau de escolaridade têm frequentemente trabalhos fisicamente mais desgastantes e pior regulamentados quanto a condições de segurança e saúde. 13 No que diz respeito às consultas subsequentes, a maioria das prescrições iniciais não envolveu prescrições subsequentes. Os autores foram surpreendidos por esses resultados, tendo em conta que a duração média de tratamento foi superior em estudos realizados noutros países 10 e que alguns trabalhos sugerem melhorias a longo prazo, com intervenções de reforço após a intervenção inicial. ...
Introdução: Os médicos de família assumem um papel fulcral na identificação e gestão das necessidades de medicina física e de reabilitação. Uma vez que não existe um registo centralizado de informação não é possível conhecer com rigor o universo dos utentes utilizadores. Objetivos: Caracterizar a prescrição de medicina física e de reabilitação em quatro unidades de saúde familiar da Administração Regional de Saúde do Norte, no ano de 2019. Método: Foi realizado um estudo observacional, analítico e retrospetivo numa amostra aleatória de 400 prescrições de primeira consulta de medicina física e de reabilitação, pertencentes a quatro unidades de saúde familiar, no ano de 2019. Resultados: Das prescrições analisadas mais de metade era de indivíduos do sexo feminino, que tinham em média 58 anos, um nível de escolaridade igual ou inferior ao primeiro ciclo do ensino básico e uma situação profissional não ativa. A maioria das prescrições estava relacionada com patologia do sistema músculo-esquelético (71%), seguindo-se causas gerais e inespecíficas (17%) e o sistema nervoso (5%). De entre os motivos músculo-esqueléticos, 43% relacionaram-se com patologia degenerativa, 21% com patologia inflamatória e 8% com patologia traumática. Dos pedidos analisados, 61% não foram seguidos de requisições subsequentes. Conclusões: Com este estudo foi possível definir as características de uma população de utentes utilizadores dos cuidados da medicina física e de reabilitação em quatro unidades de saúde familiar. Verificou-se que a patologia do foro músculo-esquelético foi a que mais frequentemente motivou tratamento. A maior parte da amostra estudada tinha um baixo grau de escolaridade e encontrava-se reformada/desempregada, apesar da idade ativa. Mais de metade das primeiras prescrições não foi renovada. Este estudo pode ser um ponto de partida para mais investigação e uma melhoria da qualidade dos serviços prestados neste âmbito.
... Due to the scale of the problem, it has social and economic implications, requiring significant financial investment in treatment and rehabilitation. In the long term, it leads to prolonged work absences, loss of work capacity, and even disability [3]. This results in limitations in social, professional, and personal life, ultimately reducing the quality of life [4]. ...
... Contributing factors to this situation are sedentary lifestyles and a lack of physical activity. The modern transformation of individuals, who spend a significant portion of their lives in a seated position, leads to spinal pain in various regions [3]. ...
Introduction. Degenerative spinal disease is considered one of the most prevalent chronic diseases in Poland and worldwide. Sedentary lifestyle, lack of physical activity, and spinal overload contribute to this state of affairs. The chronic nature of the disease, along with pain and functional limitations of the musculoskeletal system, impact the quality of life. Aim. To determine the level of life quality and factors influencing the quality of life in patients with degenerative spinal changes. Material and Methods. The study involved 107 individuals aged between 55 and 65 years. Standardized research tools were utilized, including the Acceptance of Illness Scale (AIS), Oswestry Disability Index (ODI), Neck Disability Index (NDI), Activities of Daily Living scale (ADL), and the World Health Organization Quality of Life-Bref (WHOQoL-BREF) questionnaire. Results. The level of illness acceptance in the study population was 26.52 points (SD=6.61). All respondents experienced pain symptoms, with an average pain intensity of 7.02 (SD=1.13). The average self-assessed quality of life among the participants was 3.5 points (SD=0.76), while the average self-assessed health rating was 2.54 points (SD=0.7). Spinal disability affected all patients in the lumbar region, whereas no disability was reported in the cervical region by 27.10% of the respondents. Conclusions. Patients with degenerative spinal changes have a relatively good quality of life and a moderate level of illness acceptance. Age, marital status, occupational activity, body mass, pain intensity, and degree of disability all influence the quality of life. (JNNN 2023;12(1):44–52)
... Many health system quality studies consider access to medical services as an indicator of the quality of care. On the other hand, there is a consensus that over-treatment of low back pain has led to worse care [7][8][9]. In light of the over-treatment paradox, it is clear that access to highend medical facilities and services cannot be the only index in assessing low back pain care. ...
... In 2017, The YLD and prevalence rate of high-income countries were 1,151.6 (816.6 to 1,538.5) and 10,261.31 (9,259.0 to 11,408.7) per 100,000 persons, respectively. In addition, upper-middleincome countries had the lowest YLD and prevalence rates in 2017 at 696.24 (491.16 to 930.20) and 6,186.76 ...
Background. Low back pain is one of the major causes of morbidity worldwide. Studies on low back pain quality of care are limited. This study aimed to evaluate the quality of care for low back pain worldwide and compare gender, age, and socioeconomic groups. Methods. This study used GBD data from 1990 to 2017 from the Institute for Health Metrics and Evaluation (IHME) website. Extracted data included low back pain incidence, prevalence, disability-adjusted life years (DALYs), and years lived with disability (YLDs). DALYs to prevalence ratio and prevalence to incidence ratio were calculated and used in the principal component analysis (PCA) to make a proxy of the quality-of-care index (QCI). Age groups, genders, and countries with different socioeconomic statuses regarding low back pain care quality from 1990 to 2017 were compared. Results The proxy of QCI showed a slight decrease from 36.44 in 1990 to 35.20 in 2017. High- and upper-middle-income countries showed a decrease in the quality of care from 43.17 to 41.57 and from 36.37 to 36.00, respectively, from 1990 to 2017. On the other hand, low and low-middle-income countries improved, from a proxy of QCI of 20.99 to 27.89 and 27.74 to 29.36, respectively. Conclusion. Despite improvements in the quality of care for low back pain in low and lower-middle-income countries between 1990 and 2017, there is still a large gap between these countries and higher-income countries. Continued steps must be taken to reduce healthcare barriers in these countries.
... The largest contributor to the global burden of disease is low back pain (LBP) [1], and in Denmark alone about 900,000 people experience LBP every year [2]. For most patients with LBP, improvement is seen within the first 6-12 weeks, regardless of the treatment received [3,4]. However, based on studies of clinical course, it has been suggested that the good prognosis might have been overestimated for patients with acute LBP and underestimated the potential for improvement in patients with persistent LBP [5]. ...
... Long-term LBP disproportionately affects individuals with a lower income and those with short or no education [4,6]. In Denmark, patients must pay 60-82% of the cost for conservative treatments recommended in the clinical guidelines, (e.g. ...
Background
The pre-referral history of patients with low back pain referred to secondary care is poorly documented, and it is unclear whether it complies with clinical guideline recommendations; specifically, whether they have received appropriate treatment in primary care. This study describes the patient population referred to a spine clinic at a Danish hospital and investigates whether they have received an adequate course of treatment in primary care before referral. Furthermore, a possible association between primary care treatment and socioeconomic factors is estimated.
Methods
We examined self-reported data from 1035 patients with low back pain of at least eight weeks duration referred to secondary care at a medical spine clinic using a cross-sectional design. As an approximation to national clinical guidelines, the definition of an adequate course of treatment in primary care was at least five visits to a physiotherapist or chiropractor prior to referral.
Results
Patients were on average 53 years old, and 56% were women. The average Oswestry Disability Index score was 36, indicating a moderate level of disability. Nearly half of the patients reported pain for over a year, and 75% reported pain below knee level.
Prior to referral, 33% of the patients had not received an adequate course of treatment in primary care. Based on multiple logistic regression with the three socioeconomic variables, age and sex in the model, those who were unemployed had an odds ratio of 2.35 (1.15–4.79) for not receiving appropriate treatment compared to employed patients. Similarly, the odds ratio for patients without vs. with health insurance was 1.71 (1.17–2.50). No significant association was observed with length of education.
Conclusions
Despite national clinical guidelines recommending management for low back pain in primary care, one third of the patients had not received an adequate course of treatment before referral to secondary care. Moreover, the high probability of not having received recommended treatment for patients who were unemployed or lacked health insurance indicates an economic obstacle to adequate care. Therefore, reconsidering the compensation structure for the treatment of back pain patients is imperative to mitigate health inequality within low back pain management.
... Patients with LBP have difficulty performing and/or sustaining everyday activities such as standing, lifting and walking [5,20,49,50]. Therefore, lower OMQ-LBP total scores were expected to associate with higher levels of perceived low back complaints. ...
... Because the item definitions clearly express MQ, they could also initiate a discussion about patients' experiences, beliefs and pain-related anxiety regarding the performance of activities. Sharing these experiences and beliefs might help individual patients make sense of pain [12,49,67,80]. It might also support specific patient education and encourage self-management in patients with LBP [81]. ...
Background
The Observable Movement Quality scale for patients with low back pain (OMQ-LBP) is a newly developed measurement instrument for use in primary care settings of physical and exercise therapists to assess movement quality (MQ) of patients with low back pain (LBP).
Objective
This study aims to determine validity, reliability and feasibility of the OMQ-LBP. The OMQ-LBP consists of a standardized movement circuit (performed twice) consisting of five daily activities problematic for LBP patients, which are scored with an 11-item observation list.
Methods
Construct validity was determined by testing seven hypotheses on associations between constructs (n = 85 patients with LBP) and four hypotheses on known group differences (n = 85 patients with LBP and n = 63 healthy controls; n = 35 matched participant-patients having VAS-pain ≥ 20 mm during and/or after both circuits and healthy controls). Internal consistency was analyzed with Cronbach’s alpha (n = 85 patients with LBP). For inter- and intra-rater reliability Intraclass Correlation Coefficient (ICC) values were examined (n = 14 therapists: seven primary care physical therapists and seven exercise therapists). Additionally, content validity and feasibility were determined using thematic analysis of a brief interview with participants, patients (n = 38) and therapists (n = 14).
Results
After Bonferroni correction 2/7 associations between constructs and 2/4 significant group differences were confirmed. Cronbach’s alpha was 0,79. The ICC-values of interrater reliability of the OMQ-LBP total score and the duration score were 0.56 and 0.99 and intra-rater reliability 0.82 and 0,93, respectively. Thematic analysis revealed five themes. Three themes elucidate that both patients and therapists perceived the content of the OMQ-LBP as valid. The fourth theme exhibits that OMQ-LBP provides a clear and unambiguous language for MQ in patients with LBP. Theme 5 depicts that the OMQ-LBP seems feasible, but video recording is time-consuming.
Conclusions
The OMQ-LBP is a promising standardized observational assessment of MQ during the five most problematic daily activities in patients with LBP. It is expected that uniform and objective description and evaluation of MQ add value to clinical reasoning and facilitate uniform communication with patients and colleagues.
... Low back pain is a major cause of disability worldwide (1). Hartvigsen J et al. found that the rate of disability caused by low back pain increased by 54% from 1990 to 2015 due to the population explosion and increased aging (2). This condition also has a high recurrence rate, and the persistent pain brings great distress and economic burden to patients. ...
... This condition also has a high recurrence rate, and the persistent pain brings great distress and economic burden to patients. Low back pain is a common public health problem, especially in low-and middle-income countries (2). Approximately 84% of people reported suffering from low back pain during their lifetime, and 23% eventually developed chronic low back pain (3). ...
Postural assessment can help doctors and therapists identify risk factors for low back pain and determine appropriate follow-up treatment.
Postural alignment is not perfectly symmetrical, and small asymmetries can instead represent norms and criteria for postural evaluation.
It is necessary to comprehensively observe patients’ posture in all directions and analyze the factors related to posture evaluation.
The results of reliability show that in general intra-rater reliability is higher than inter-rater reliability, and inclinometers are being more reliable than other instrumentations.
Some common postural problems can cause lumbar discomfort, and prolonged poor posture is a potential risk factor for lumbar spine injuries.
On the basis of previous studies on posture evaluation, a unified standardized method for posture evaluation must be established in future research.
... The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) indicated that low back pain (LBP) is one of the five causes of DALYs rate (disabilityadjusted life-years) in the 25-49-year age, being prevalent also for ages 10-24 years. In fact, LBP is a common musculoskeletal disorder present in both sexes and for all age groups, and it might be associated with sedentary occupations as well as with some sport activities [1,2]. LBP can be common in young athletes from different sports, and especially in adolescents, it might be caused by extreme hyperextension positions, and by repetitive high-velocity movements such as bending, twisting, or jumping [3,4]. ...
... However, the moderate sample size and inter-individual differences recommend caution and further studies in larger samples should be encouraged to provide additional evidence of such alterations, in particular when referring to LBP. Indeed, LBP is a clinical condition that might be characterized by heterogeneous causes, risk factors, and manifestations [1]. In addition, its diagnosis, especially in sports, can be complicated and often relies on subjective reporting [4]. ...
Background:
Trunk muscles' function and characteristics are of great importance for both static and dynamic tasks in different sports, and abnormalities of trunk flexors and extensors might be associated with low back pain (LBP). The aim of this study was to provide a comprehensive evaluation of the functional, morphological and contractile properties in trunk flexors and extensors of young gymnasts with and without LBP.
Methods:
Young gymnasts (14/25 females, 14-18 y) were screened for the presence of chronic LBP. Abdominal and lumbar muscles were tested for function (McGill's endurance tests), thickness (ultrasound), and contractile responses (tensiomyography). An 8-sessions physiotherapy intervention including postural reeducation was performed by a subsample of 10 subjects with LBP.
Results:
LBP was found to be associated to higher flexors-to-extensors endurance ratio (OR 11.250, 95% CI: 1.647-76.849, p = 0.014), reduced mean lumbar multifidus thickness (OR 16.500, 95% CI: 2.246-121.228, p = 0.006), and reduced mean erector spinae radial displacement (OR 16.500, 95% CI: 2.246-121.228, p = 0.006). The physiotherapy intervention was found to reduce LBP symptoms and it was associated with a significant improvement in the flexors-to-extensors ratio (p < 0.001).
Conclusions:
This study provides preliminary evidence of functional, morphological, and contractile trunk muscles' alterations associated with chronic LBP in young gymnasts, and presents the effects of a postural reeducation program on symptoms and muscles' functional properties.
... LBP affects people of all ages, from children to older adults, and can afflict people in high-, middle-, and low-income countries. People with physically demanding jobs, those with physical and mental illnesses, smokers, and people with obesity are more likely to have LBP [3]. From the third decade of life to 60 years of age, the frequency of chronic LBP rises linearly, with women being more affected [4]. ...
Background: Low back pain is a common health problem globally. Based on the duration of pain, it is classified as acute, subacute, or chronic low back pain. Different treatment strategies are available to reduce chronic low back pain. Virtual reality (VR) is a novel approach in back pain rehabilitation.
... Lumbar spinal stenosis (LSS) is a condition characterized by degenerative changes, including facet joint disorder, hypertrophy or calcification of the ligamentum flavum, and disc bulge. These changes lead to compression of the spinal dura mater and nerve roots due to stenosis of the spinal canal or intervertebral foramen [1], typical clinical manifestations of LSS include absence of pain while sitting, symptom improvement with flexion, extensive gait (difficulties with walking), and intermittent claudication. These findings are crucial for clinical diagnosis [2]. ...
Purpose
The purpose of the study was to evaluate the efficacy of OLIF combined with pedicle screw internal fixation in the treatment of lumbar spinal stenosis by assessing the changes in spinal canal before and after surgery.
Methods
In this retrospective study, we included sixteen patients who underwent a combination of single-segment OLIF and pedicle screw internal fixation for the treatment of lumbar spinal stenosis at the Affiliated Hospital of Jiangxi University of Chinese Medicine between February 2018 and August 2022. The patients' pre- and post-operative data were compared. Intraoperative bleeding, duration of surgery, visual analogue score (VAS), Oswestry Disability Index (ODI), disc height (DH), cross-sectional area of vertebral canal (CSAVC), cross-sectional area of dural sac (CSADS), cross-sectional area of intervertebral foramen (CSAIF), spinal canal volume (SCV), spinal canal volume expansion rate, lumbar lordosis, and sagittal vertical axis were observed and recorded. The efficacy of OLIF combined with pedicle screw internal fixation for lumbar spinal stenosis on spinal canal changes before and after surgery was summarized.
Results
The results showed that OLIF combined with pedicle screw internal fixation effectively restored disc height and increased the cross-sectional area of the spinal canal. It also had an indirect decompression effect. The intraoperative bleeding and duration of surgery were within acceptable ranges. The VAS and ODI scores significantly improved after surgery, indicating a reduction in pain and improvement in functional disability. The CSAVC, CSADS, CSAIF, SCV, and spinal canal volume expansion rate were all increased postoperatively. Additionally, there was improvement in lumbar lordosis and sagittal vertical axis. We conducted a follow-up of all patients at 1 year after the surgery. The results revealed that the parameter values at 1 year post-surgery showed varying degrees of decrease or increase compared to the immediate postoperative values. However, these values remained statistically significant when compared to the preoperative parameter values (P < 0.05).
Conclusions
OLIF combined with pedicle screw internal fixation effectively restores disc height and increases the cross-sectional area of the vertebral canal in patients with LSS, reflecting the indirect decompression effect. Measuring parameters such as DH, CSAVC, CSADS, CSAIF, SCV, and SCV expansion rate before and after surgery provides valuable information for evaluating the efficacy and functional recovery of the lumbar spine in LSS patients treated with OLIF surgery.
... According to recent studies, MTrPs are the initial indicator of muscular overload. However, in addition to affecting the musculoskeletal system, this disorder also interacts with the visceral somatic system, affects the central and peripheral neurological systems, overproduces inflammatory mediators, and alters microcirculation [11][12][13][14]. ...
Background: Chronic neck pain (CNP) may be associated with latent myofascial trigger points (MTrPs) in the levator scapulae (LS), which can be treated with ischemic compression (IC) and dry needling (DN). Variables and elastography changes are evaluated to compare the short-term efficacy of two treatments with DN. Methods: A randomized clinical trial is conducted with 80 participants in two groups: the DN group (n = 40) and IC group (n = 40). The duration is 12 weeks, and mechanical heterogeneity index, pressure pain threshold (PPT), and pain intensity are measured at baseline, immediately after, 48 h after, and one week after treatment. Results: Statistically significant changes were immediately observed between the two groups: PPT decreased in the DN group (p = 0.05), while it increased in the IC group. At 48 h and one week after treatment, these values increased in the DN group and remained higher than in the IC group. The heterogeneity index improved in both groups but more significantly in the DN group than in the IC group. Conclusions: In subjects with CNP who had latent plus hyperalgesic MTrPs in the LS muscle, DN outperformed IC in PPT, pain intensity, and mechanical heterogeneity index at 48 h and one week after initiating therapy.
... It is one of the global health problems, which adds to considerable socioeconomic burden affecting about 80% of world population at some point in their life [3][4]. It is the major cause of limited activity and absenteeism from work [5][6][7], resulting in a huge medical burden and economic cost [8][9]. According to the duration of low back pain, it can be classified as acute low back pain (ALBP) which persist for less than six weeks and chronic low back pain (CLBP) where the pain persists for more than three months duration of time [10], which is associated with histo-morphological, structural and atrophic changes and fatigability in para-spinal muscles [11][12][13]. ...
Low back pain (LBP) is a painful condition affecting 80% of word population at some point in their life. Lumbar intervertebral disc degeneration and reduced muscle force is one the major cause of LBP. Sixty-two patients with LBP undergoing discectomy were recruited after receiving consent. Lumbar muscles strength and VAS (visual analogue scale) for lumbar pain were checked, MRI scan were analysed. Histological degenerative changes were analysed. The study revealed histological degeneration at intervertebral disc has direct effect on increase in pain at lumbar region, decrease in strength of lumbar flexor and extensors muscles and degenerative changes seen on MRI scan.
... IDD is frequently asymptomatic (Matsumoto et al., 2010;Brinjikji et al., 2015), but it remains one of the leading causes of LBP (Morlion, 2013;Hartvigsen et al., 2018), a severe chronic disorder that is a significant cause of disability (Hicks et al., 2009;March et al., 2014). It affects approximately 1 billion people worldwide . ...
The intervertebral disc (IVD) is a load-bearing, avascular tissue that cushions pressure and increases flexibility in the spine. Under the influence of obesity, injury, and reduced nutrient supply, it develops pathological changes such as fibular annulus (AF) injury, disc herniation, and inflammation, eventually leading to intervertebral disc degeneration (IDD). Lower back pain (LBP) caused by IDD is a severe chronic disorder that severely affects patients’ quality of life and has a substantial socioeconomic impact. Patients may consider surgical treatment after conservative treatment has failed. However, the broken AF cannot be repaired after surgery, and the incidence of re-protrusion and reoccurring pain is high, possibly leading to a degeneration of the adjacent vertebrae. Therefore, effective treatment strategies must be explored to repair and prevent IDD. This paper systematically reviews recent advances in repairing IVD, describes its advantages and shortcomings, and explores the future direction of repair technology.
... low back, meta-analysis, Modic change, nucleus pulposus, pain, pain antibiotics, systematic review 1 | INTRODUCTION Low back pain (LBP) is the most disabling condition worldwide. 1 Many efforts have been made to manage this growing global healthcare problem and associated socioeconomic consequences. 2 Notably, chronic LBP (CLBP) and the treatment thereof have demonstrated a substantial challenge to modern healthcare providers. ...
Background: This systematic review and meta-analysis aimed to summarize evidence regarding the effectiveness and safety of oral antibiotic intervention for chronic low back pain (CLBP) patients with/without type-1 Modic changes (MC1).
Methods: AMED, CINAHL, Cochrane Library, Embase, and Medline were searched from inception to March 3, 2023. Randomized controlled trials (RCTs) or non-RCTs that investigated the effectiveness or safety of oral antibiotics in treating CLBP patients were eligible for inclusion. Two independent reviewers screened abstracts, full-text articles, and extracted data. The methodological quality of each included article were evaluated by RoB2 and NIH quality assessment tools. The quality of evidence was appraised by GRADE. Meta-analyses were performed, where applicable. A subgroup analysis was conducted to evaluate the RCTs and case series separately, and to evaluate the effect of removing a low-quality RCT.
Results: Three RCTs and four case series were included. All Amoxicillin-clavulanate/Amoxicillin treatments lasted for approximately 3 months. Moderate- and low-quality evidence suggested that antibiotic was significantly better than placebo in improving disability and quality of life in CLBP patients with MC1 at 12-month follow-up, respectively. Low-quality evidence from meta-analyses of RCTs showed that oral antibiotic was significantly better than placebo in improving pain and disability in CLBP patients with MC1 immediately post-treatment. Very low-quality evidence from the case series suggested that oral Amoxicillin-clavulanate significantly improved LBP/leg pain, and LBP-related disability. Conversely, low-quality evidence found that oral Amoxicillin alone was not significantly better than placebo in improving global perceived health in patients with CLBP at the 12-month follow-up. Additionally, oral antibiotic users had significantly more adverse effects than placebo users.
Conclusions: Although oral antibiotics were statistically superior to placebo in reducing LBP-related disability in patients with CLBP and concomitant MC1, its clinical significance remains uncertain. Future large-scale high-quality RCTs are warranted to validate the effectiveness of antibiotics in individuals with CLBP.
... This results in economic burden, reduced work productivity and affects the quality of life (QOL). 42 Yoga studies for CLBP patients conducted so far have limited data on the measures of QOL, mental health conditions (depression, anxiety, etc.), and other psychological impacts. 10,[43][44][45] Tekur et al. 15 demonstrated the usefulness of IAYT in improving QOL within the CLBP nursing populations. ...
Background
Chronic low back pain is associated with both psychological and functional limitation. Yoga therapy has been shown to improve both the aspects. The present study was planned to evaluate integrated approach of yoga therapy with usaul care.
Aims
This controlled randomized trial was done to evaluate the clinical and molecular changes resulting from integrated approach of yoga therapy (IAYT) as an adjunct regimen and compared it with usual care for the management of chronic low back pain patients.
Material and methods
We enrolled 29 adult patients with non‐specific chronic low back pain (CLBP). Patients were randomly divided into two groups. The control group received the usual care of treatment as per institutional protocol. The yoga group received IAYT as an adjunct to usual care. Primary outcomes were pain intensity assessed by verbal numerical rating scale (VNRS) and functional ability assessed by Modified Oswestry Disability Index (MODI). Secondary outcomes were pain catastrophizing, quality of life, fear of movement related to CLBP, type of pain, levels of β‐endorphin and TNF‐α, and salivary CGRP. All parameters were measured at baseline, 1 and 3 months.
Results
A Significant decrease in VNRS score at 1 and 3 months was observed in both the groups with the yoga group showing a more significant reduction in pain over time than the control group ( p = 0.036). MODI improved significantly only in the yoga group at 1 and 3 months. Intergroup comparison revealed significantly better MODI over time in the yoga group ( p < 0.001). DN4, PDQ, PCS, HADS (anxiety), and Euro QOL had a statistically significant improvement at 1 and 3 months in the yoga group compared with the control group. The HADS (depression) had a statistically significant reduction scores in the yoga group at 3 months compared with the control group ( p = 0.012). There was a significant reduction in TNF‐α values in the yoga group compared with baseline ( p = 0.004).
Conclusion
IAYT therapy helped in addressing the psychological components of pain and improved quality of life patients with chronic low back pain compared with usual care.
... Over 80% of the population worldwide will experience LBP at some point in their lives, which has a significant economic impact on individuals, healthcare systems, and local economies [2][3][4][5]. While the multifactorial biopsychosocial-environmental etiology is widely recognized [6][7][8], there remain limited options for effective conservative management programs despite nearly 30 years of data from clinical trials [9]. Imaging studies demonstrate that people with LBP are more likely to present with morphological and compositional asymmetries, including muscle fatty infiltration and paraspinal muscular atrophy, especially in the multifidus muscle as compared to healthy controls [10][11][12]. ...
Low back pain (LBP), a globally widespread and persistent musculoskeletal disorder, benefits from exercise therapy. However, it remains unclear which type leads to greater changes in paraspinal muscle health. This study aimed to (1) compare the effects of a combined motor control and isolated lumbar extension exercise (MC+ILEX) versus a general exercise (GE) intervention on paraspinal muscle morphology, composition, and function, and (2) examine whether alterations in paraspinal muscle health were correlated with improvements in pain, function, and quality of life. Fifty participants with chronic LBP were randomly assigned to each group and underwent a 12-week supervised intervention program. Magnetic resonance imaging and ultrasound assessments were acquired at baseline, 6 and 12 weeks to examine the impact of each intervention on erector spinae (ES) and multifidus (MF) muscle size (cross-sectional area, CSA), composition, and function at L4-L5 and L5-S1. Self-reported questionnaires were also acquired to assess participant-oriented outcomes. Our findings indicated that the MC+ILEX group demonstrated greater improvements in MF and ES CSA, along with MF thickness at both levels (all p < 0.01). Both groups significantly improved in pain, function, and quality of life. This study provided preliminary results suggesting that an MC+ILEX intervention may improve paraspinal morphology while decreasing pain and disability.
... These disorders cause a decline in the health status and productivity of workers, which then leads to the loss of their jobs. Furthermore, several studies stated that the number of people with the condition is expected to increase rapidly in low-and middleincome countries (Hartvigsen et al., 2018). This high prevalence of MSDs has led to the development of studies on the risk factors to provide adequate preventive measures. ...
Introduction: Musculoskeletal disorders (MSDs) are a collection of symptoms in the human skeletal and muscular systems, which are characterized by discomfort or pain. The International Labor Organization (ILO) stated that MSDs are the most common health problem among office workers in 27 countries under the European Union. Therefore, this study aims to determine the risk factors for MSDs among office workers. Method: This study used the literature review method by accessing an online database using different keywords, namely risk factors, musculoskeletal disorders, and office workers. Subsequently, 939, 1,421, and 243 articles were obtained from Google Scholar, ProQuest, and PubMed. Gov, respectively, with a total of 2,603. The inclusion criteria include papers published between 2011 and 2021, relevant titles and abstracts, primary study with a cross-sectional design, as well as full-text availability. Incomplete articles that are irrelevant to the topic were then excluded, after which a total of eight were selected for analysis. Result: Based on selected articles known that the risk factors for MSDs include age, gender, knowledge of ergonomics, work posture, work facilities, duration of work, physical activity, and psychosocial factors in the workplace. Conclusion: The significant risk factors for MSDs include increasing age, female gender, increased work duration, poor knowledge of ergonomics, wrong work posture, non-ergonomic support facilities, lack of physical activity, as well as poor psychosocial conditions in the workplace.
... Low-back pain (LBP) is a globally prevalent condition, associated with a high disease burden [1] and significant economic costs [2]. Effective treatment options remain scarce [3], largely due to the heterogeneity of the patient population and an incomplete understanding of the mechanisms that impede or facilitate recovery [4,5]. ...
Background:
Differences in variability of trunk motor behavior between people with and without low back pain (LBP) have been reported in the literature. However, the direction and consistency of these differences remain unclear. Understanding variability of trunk motor behavior between individuals with LBP and those without is crucial to better understand the impact of LBP and potentially optimize treatment outcomes. Identifying such differences may help tailor therapeutic interventions.
Objective:
This systematic review aims to answer the question: Is variability of trunk motor behavior different between people with and without LBP and if so, do people with LBP show more or less variability? Furthermore, we addressed the question whether the results are dependent on characteristics of the patient group, the task performed and the type of variability measure.
Methods:
This study was registered in PROSPERO (CRD42020180003). A comprehensive systematic literature search was performed by searching PubMed, Embase, Cinahl, Cochrane Central Register of Controlled Trials, Web of Science and Sport Discus. Studies were eligible if they (1) included a LBP group and a control group, (2) included adults with non-specific low back pain of any duration and (3) measured kinematic variability, EMG variability and/or kinetic variability. Risk of Bias was evaluated and a descriptive synthesis was performed.
Results:
Thirty-nine studies were included, thirty-one of which were included in the descriptive synthesis. In most studies and experimental conditions, variability did not significantly differ between groups. When significant differences were found, less variability in patients with LBP was more frequently reported than more variability, especially in gait-related tasks.
Conclusions:
Given the considerable risk of bias of the included studies and the clinical characteristics of the participants with low severity scores for pain, disability and psychological measures, there is insufficient evidence to draw firm conclusions.
... It represents the first cause of disability worldwide and is associated with a significant burden at both individual and societal levels. 1 Although traditionally investigated in aging populations, LBP has been increasingly reported in children and adolescents. Previous studies have shown that as many as 5% of children may be suffering from LBP at any time 2 and that LBP prevalence is higher in females and increases with age, ranging from 1 to 6% of children and 18 to 51% of adolescents. ...
Nonspecific low back pain (LBP) is one of the most common causes of disability, affecting all individuals at least once in their lifetime. Such a condition is also becoming increasingly frequent in the pediatric population, especially in children and adolescents with overweight/obesity. Furthermore, new-onset LBP during adolescence has been demonstrated to be a strong predictor of developing LBP later in life, contributing to poorer outcomes and increasing social and medical costs. Several causes and different mechanisms have been considered for the development of LBP in pediatric individuals affected by obesity. For this reason, planning adequate prevention and treatment strategies, mainly through conservative lifestyle changes, would be crucial to anticipate the negative consequences of persisting LBP in adulthood. The aim of this narrative review was to characterize the relationship between LBP and overweight/obesity in the pediatric population, highlighting epidemiological and pathophysiological aspects. In addition, prevention and treatment approaches will be reviewed considering the need to reduce the burden of LBP on this population. According to our search, LBP was more frequent in children and adolescents with overweight and obesity and has been associated with several anthropometric and lifestyle factors, including lumbar hyperlordosis, sedentary habits, physical inactivity, carrying a heavy schoolbag, low vitamin D levels, psychosocial ill-being, and premature intervertebral disc degeneration. Most of these conditions may be addressed with conservative strategies mainly consisting of dietary adjustments, physical exercise, education programs, and physical therapy.
... The prevalence of chronic LBP among individuals aged 24-39 is 4.2%, while among individuals aged 20-59, it is 19.6% [2]. In 2015, the global prevalence of LBP among adults reached 7.3% [3]. LBP has become a major cause of disability worldwide [4,5], with approximately 1% of Americans experiencing long-term disability due to LBP, and an additional 1% experiencing temporary disability [1]. ...
To further explore the pathogenic mechanism of lumbar disc herniation (LDH) pain, this study screens important imaging features that are significantly correlated with the pain score of LDH. The features with significant correlation imaging were included into a back propagation (BP) neural network model for training, including Pfirrmann classification, Michigan State University (MSU) regional localization (MSU protrusion size classification and MSU protrusion location classification), sagittal diameter index, sagittal diameter/transverse diameter index, transverse diameter index, and AN angle (angle between nerve root and protrusion). The BP neural network training model results showed that the specificity was 95 ± 2%, sensitivity was 91 ± 2%, and accuracy was 91 ± 2% of the model. The results show that the degree of intraspinal occupation of the intervertebral disc herniation and the degree of intervertebral disc degeneration are related to LDH pain. The innovation of this study is that the BP neural network model constructed in this study shows good performance in the accuracy experiment and receiver operating characteristic experiment, which completes the prediction task of lumbar Magnetic Resonance Imaging features for the pain degree of LDH for the first time, and provides a basis for subsequent clinical diagnosis.
... Low back pain has been the leading global cause of disability and absenteeism at work, associated with huge socioeconomic expenses and loss of production (Hartvigsen et al., 2018). ...
Introduction: Multidisciplinary teamwork provides a better operationalization of the principles of the SUS. The integration of the physiotherapist into the family health strategy team will enable greater results in the field of public health. Studies that identified the profile and prognosis of patients assisted by physiotherapy in basic health units are scarce. Objective: To identify the profile and prognosis of patients assisted in physiotherapy in the town of São Miguel da Boa Vista/Santa Catarina. Development: This is a cross-sectional study, delimited to the health unit of São Miguel da Boa Vista/SC. Data were collected from physiotherapeutic treatments carried out over 8 years. Data collection took place through medical records, covering socio-demographic, psychological and psychological issues. Results: 8576 individual consultations were carried out, of which 63% were female and 37% were male. The predominant age group was between 41 and 60 years (45% of attendances). Most were farmers and housewives (25% each). 34% of patients had diagnoses of spinal disorders, of which 63% had low back pain. 54% of patients had complete improvement of the clinical picture and 2% had no improvement. Final Considerations: The highest prevalence of attendances was of patients with musculoskeletal disorders of the spine (low back pain). In order to try to minimize these high incidences, a comprehensive base work is necessary, acting, mainly, in the preventive plan and not only in rehabilitation. The strategic planning based on this survey was the creation of Pilates Groups for patients with low back pain.
... Low back pain (LBP) is one of the most common disabling pathologies worldwide [1]. In the last 30 years, in low-and middle-income Western societies, disability associated with LBP has become a massive problem due to the individual, health, work, economic, and social aspects that highlight the complexity of its causes and possible solutions [2]. Although most acute LBP usually resolves within four weeks, 2-15% of cases can become chronic [3]. ...
Background
Low back pain is one of the most common disabling pathologies in humanity worldwide. Physical exercises have been used in recent decades to reduce the pain, improve the functionality of the lumbar spine and avoid relapses. The purpose of the study is to analyze the effect of a program based on re-education exercises involving preactivation of the abdominal transverse muscle compared to conventional treatment in adults with chronic nonspecific low back pain.
Methods
A two-arm, single-blind randomized control trial with 35 primary care patients with chronic nonspecific low back pain. Both groups received a 4-week intervention. Data were collected at baseline and at the end of the intervention. Sixteen patients participated in the intervention group, and 19 patients in the control group.
Results
For the experimental group, the outcomes of disability and activation of the abdominal transverse muscle decreased significantly (MD -2.9; CI 95% -5.6 to -0.35; η2 = 0.14; p = 0.028) and (MD 2.3; CI 95% 0.91 to 3.67; η2 = 0.25; p = 0.002) respectively, with a large effect size, compared to the control group. There were no differences between the groups in pain intensity, thickness, and resistance of the transverse abdominal muscle.
Conclusion
A 4-week specific program based on re-education exercises of the preactivation of the abdominal transverse muscle is more effective than conventional treatment for reducing disability and increasing the activation of the abdominal transverse muscle measured by VAS scale and PBU.
Trial registration
Clinicaltrials.gov identifier: NCT03097497. Date of registration: 31/03/2017.
... 61,75,77 The risk factors for LBP are still poorly recognized despite the significant frequency of LBP among nurses. [78][79][80][81][82][83][84] LBP is thought to be a multi-factorial illness with a variety of potential underlying causes. [85][86][87] Researchers came to the conclusion that LBP may result from a lack of awareness, comprehension, or application of ergonomics' fundamental concepts and guidelines. ...
Background:
Hospital nursing staff are particularly susceptible to low back pain (LBP) a widespread health issue worldwide. There was little available data on the prevalence of LBP and risk factors related to it in this population.
Objective:
Assessed the prevalence of LBP and risk factors in nurses working in South-East Ethiopia's Oromia region in the East Bale, Bale, and West Arsi zone government hospitals.
Methods:
A cross-sectional study was carried out within an institution in the East Bale, Bale, and West Arsi zone government hospitals; 440 nurses were chosen to use a process of systematic random sampling, and data was gathered between June 1 and July 30, 2021. Using pre-designed questionnaires, I interrogated participants. After being verified as complete, the gathered data was entered into Epi-data version 3.1 and exported to SPSS version 25 for analysis. Bi variate and multivariate logistic regressions with 95% confidence intervals and crude and adjusted odd ratios were generated and interpreted as necessary. To deem a result statistically significant, a p-value of 0.05 or lower was required.
Results:
A total of 427 nurses engaged in the interview out of the 440 participants that wanted to take part in the study, yielding a response rate of 97.1%. Low back pain was 42.6% more common over a year [95% CI: (0.384, 0.476)]. According to the multivariate analysis, females [AOR = 1.791; 95% CI: (1.121, 2.861)], age higher than forty [AOR=2.388, 95% CI: (1.315, 4.337)], age grouped 31-40 years [(AOR=2.064, 95% CI: 1.233, 3.455)], divorced [(AOR=10.288, 95% CI: (3.063, 34.553)], married [(AOR=1.676 (1.675, 16.999)].
Conclusion:
The study suggests that implementing preventive measures and offering ergonomic training can help reduce LBP among nurses in these hospitals.
... Lower back pain is the main contributor to the high prevalence of musculoskeletal conditions worldwide (570.1 million cases), followed by osteoarthritis (528 million cases), fractures (440 million cases), neck pain (222 million cases), amputation (180 million cases), gout (54 million cases), and rheumatoid arthritis (18 million cases) [1]. Disabilities caused by MSK disorders can lead to loss of productivity, work absenteeism, early retirement, and increased healthcare costs [1][2][3][4]. ...
The burden of musculoskeletal disorders (MSK) is increasing worldwide. It affects millions of people worldwide, decreases their quality of life, and can cause mortality. The treatment of such conditions is challenging and often requires surgery. Thus, it is necessary to discuss new strategies. The therapeutic potential of mesenchymal stem cells (MSC) in several diseases has been investigated with relative success. However, this potential is hindered by their limited stemness and expansion ability in vitro and their high donor variability. MSC derived from induced pluripotent stem cells (iPSC) have emerged as an alternative treatment for MSK diseases. These cells present distinct features, such as a juvenile phenotype, in addition to higher stemness, proliferation, and differentiation potential than those of MSC. Here, we review the opportunities, challenges, and applications of iPSC as relevant clinical therapeutic cell sources for MSK disorders. We discuss iPSC sources from which to derive iMSC and the advantages and disadvantages of iMSC over MSC as a therapeutic approach. We further summarize the main preclinical and clinical studies exploring the therapeutic potential of iMSC in MSK disorders.
... LBP is often followed by discomfort in one or both legs and can sometimes result in neurological symptoms in the legs. LBP can be due to a variety of causes, including poor posture and stress on muscles in the region [2]. ...
... LBP is the leading cause of disability globally and is a huge economic burden. (9) Chair sitting in the standard comfortable position for humans almost up to 55% of the working hours that is 7.7 hours. (11) Sitting contributes to the decrease in the lordotic curve and an increase in intra-disk pressure. ...
Background: Low back pain (LBP) is commonly accompanied by radiating pain in one or both legs and experienced by people of all ages. Many professionals are using laptop and computers in non-desk setting situations at the table, and on the bed and floor tend to stay in a static posture for long periods which can lead to poor spinal alignment and bad ergonomics. LBP is the leading cause of Years Lived with Disability (YLD) being one of the major public health problems globally that requires attention and may also to take physiotherapy intervention. Aim: To evaluate prevalence of LBP in work from home IT professionals. Materials and Methods: A cross-sectional study was conducted among 892 work from home IT professionals of Anand city, aged between 20-45 years fulfilling the inclusion criteria. Subjects were selected by a convenient random sampling method and general assessment was taken. Oswestry Disability Index (ODI) was used as the outcome measure. Data were analysed using SPSS software for descriptive and analytical statistics. Results and Discussion: Total 892 subjects (582 males, 310 females) selected based on inclusion criteria. The mean age was found to be 26.25 + 5.21 and the mean ODI score of all the subjects was 7.16 + 8.61 belonging to the minimal disability. Result shown that 91.31% subjects had minimal disability, 7.61% had moderate and 1.09% had severe disability, while 0% were crippled and bed bound. Out of total subjects, 69.05% reported LBP and 30.95% had no LBP. Conclusions: There was significant amount of prevalence of LBP among IT professionals while doing work from home. This study showed that the majority of IT professionals doing work from home experienced minimal disability due to low back pain according to the ODI scale.
... Chronic low back pain (CLBP), typically defned as pain below the costal margin and above the inferior gluteal folds, with or without leg pain, has been recognized as the leading cause of disability; it has a mean point prevalence of approximately 12% in the general adult population and imposes a substantial socioeconomic burden [1][2][3][4]. Trunk postural control impairment has been suggested to contribute to 90% of CLBP that has no known pathoanatomical causes and no indication for spine surgery [2,5]. Te multifdus (MF) and transversus abdominis (TrA) are among the strongest stabilizing muscles of the lumbar spine and play an essential role in postural control [5]. ...
Purpose:
Deficits in voluntary activation of the core stabilizing muscles are consistently observed in patients with chronic low back pain (CLBP); however, the underlying neural mechanism remains unclear. This cross-sectional study aimed at testing the hypothesis that the impaired voluntary activation of core stabilizing muscles is associated with structural and functional alterations in the basal ganglia, thalamus, and cortex in patients with CLBP.
Methods:
We obtained structural and resting-state functional magnetic resonance imaging (rs-fMRI) data from 53 patients with CLBP and 67 healthy controls and estimated the alterations in grey matter volume (GMV) and functional and effective connectivity (EC) of regions with altered GMV via whole brain analysis. The voluntary activation of the multifidus (MF) and transversus abdominis (TrA) was evaluated by ultrasound imaging in these patients.
Results:
Compared with the HCs, they displayed a significant decrease in GMV in the bilateral thalamus and caudate nucleus, a significant increase in GMV in the left middle frontal gyrus, and increased resting-state functional connectivity between the right caudate nucleus and the bilateral precuneus (voxel-level p < 0.005, Gaussian random field-corrected p < 0.05). The patients also showed increased EC from the right caudate nucleus to the bilateral precuneus, which was significantly correlated with voluntary activation of the bilateral MF and TrA (all p < 0.050).
Conclusions:
Grey matter alterations may be confined to regions responsible for perception, motor control, and emotion regulation in patients with CLBP. The interrupted EC from the basal ganglia to the default mode network might be involved in the impairment of voluntary activation of the core stabilizing muscles.
... LBP is one of the most common causes of emergency departments visits [4] and is the dominant cause of disability worldwide [5]. The pathophysiology of LBP is complex and is influenced by biological, social, and psychological factors [6]. Having increased body mass index (BMI) increases the risk of developing LBP-a finding which has been replicated in several studies [7][8][9][10]. ...
Background and objective: The COVID-19 pandemic had a profound impact on medical practice worldwide. In this study, we aimed to investigate the trends of elective spine surgery in our department before and during the pandemic. Materials and methods: Total number of spine procedures due to disc herniation (DH) or spinal stenosis (SS) was collected during 2019–2021 in the Department of Neurosurgery, University Hospital Center Osijek, Croatia. In order to elucidate potential risk factors in the post-pandemic period, demographic data were collected for patients who underwent surgery during 2021. Results: In 2020, there was a 22.1% decrease in the number of surgeries compared to 2019 (205 vs. 263), but during 2021 we observed an increase of 36.1% compared to 2020 (279 vs. 205). The mean age of patients in 2021 was 53.14 years (53.14 ± 13.05) with body mass index of 28.31 kg/m2 (28.31 ± 4.89). There were 179 overweight patients (74%) and 103 smokers (42.6%). Although male and female patients were equally represented (121 each), there was a significant interaction of weight class and sex (p = 0.013). Patients younger than 65 were more likely to undergo surgery due to DH (p < 0.001), whereas older patients were more likely to suffer from SS (p < 0.001). Conclusions: The volume of elective spine surgeries decreased in the first year of the pandemic and increased the following year. Our results suggest that public health policies in the early pandemic period reduced elective surgical procedures, which was followed by a compensatory increase in the following period.
... Low back pain (LBP) is a global challenge for individuals and healthcare systems due to years lived with disability. 1 It is common across age groups, and over any 2 weeks, almost one in six people in Denmark report very bothersome LBP. 2 LBP is, in most cases, a non-specific condition 3 with a variable course 4 5 that is dependent on multifactorial biopsychosocial contributors. 6 Consequently, patient-centred approaches to care are generally recommended. 7 In practice, this often entails a combination of different elements of care tailored to the individual patient's needs. ...
Objectives
To explore the elements and composition of care provided by general practitioners (GPs), physiotherapists (PTs) and chiropractors (DCs) to patients with low back pain (LBP).
Design
Observational study.
Setting
Primary care setting, Denmark.
Participants
Primary care clinicians (GPs, PTs and DCs) in the Region of Southern Denmark were invited to register consecutive adult patient visits with LBP as the primary complaint.
Primary outcome measures
Clinicians reported care elements provided to patients with LBP. Elements varied due to professional differences (eg, prescriptive rights). Data were descriptively analysed, on group and individual levels, for frequency and combination of care elements, and practice patterns were explored with latent class analysis.
Results
The clinicians (33 GPs, 67 PTs and 43 DCs with a median experience of 15 years and 59% were females) registered 3500 patient visits. On average, the visits involved patients aged 51 years, and 51% were with females. The frequencies of common care elements across professions were information (42%–56% of visits between professions) and advice (56%–81%), while other common elements for GPs were pain medication (40%) and referrals to PTs (36%), for PTs, use of exercises (81%) and for DCs, use of manual therapy (96%). Substantial variation was observed within professions and distinct practice patterns, with different focuses of attention to information and advice versus exercise and manual therapy, were identified for PTs and DCs.
Conclusions
These data indicate substantial variation in the care elements provided by GPs, PTs and DCs to LBP patients. The compositions of care and practice patterns identified challenge the understanding of usual care as a uniform concept and professions as homogeneous groups. Strategic use of particular care elements in different parts of treatment courses is indicated. Longitudinal data and qualitative enquiry are needed to assess if or how care is tailored to individual patients.
Background
Lumbar disc degeneration (DD) is widely regarded as a likely contributor to low back pain (LBP), but the association between DD and LBP is relatively weak. No known studies have normalized quantitative measures of DD severity relative to multiple variables such as age, height, and disc level. This study developed normalized quantitative measures (z‐scores) of disc signal intensity (DSI) and disc height (DH) to rate relative severity of DD.
Methods
Raw (unnormalized) quantitative measures of DSI and DH alongside potential normalization variables were acquired from MRI scans and clinical data of 76 patients. The associations between the raw quantitative measures and potential normalization variables were investigated to develop the normalized quantitative measures (z‐scores) of DSI and DH. Construct validity was assessed by comparing the normalized measures to an experienced radiologist's subjective measures of relative severity of DSI and DH loss.
Results
CSF signal intensity, age, and disc level were significantly associated with raw DSI ( R ² = 0.06, 0.25, and 0.09, respectively). Lumbar height and disc level were significantly associated with raw DH ( R ² = 0.13 and 0.31). Normalizing DSI and DH by these variables resulted in stronger relationships ( R ² = 0.39 and 0.37) than raw DSI and DH ( R ² = 0.24 and 0.31) with the radiologist's subjective measures. Normalized DSI and DH were both normally distributed ( p = 0.32 and 0.12).
Conclusions
Construct validity and the distributions suggested that normalized quantitative measures of DSI and DH are better than existing measures of DSI and DH at rating relative DD severity. Determining whether normalized quantitative measures are more predictive of clinical outcomes is important future research.
Evidence indicates that patients with chronic low back pain (CLBP) have lumbar multifidus muscle (LM) activation deficit which might be caused by changes in cortical excitability. Anodal transcranial direct current stimulation (a-tDCS) can be used to restore cortical excitability. This study aimed to (1) determine the immediate effects of a-tDCS on the cortical excitability and LM activation and (2) explore the relationship between cortical excitability and LM activation. Thirteen participants with CLBP during remission and 11 healthy participants were recruited. Cortical excitability (peak-to-peak motor evoked potential amplitude; P2P and cortical silent period; CSP) and LM activation were measured at pre- and post-intervention. We found significant difference (P < 0.05) in P2P between groups. However, no significant differences (P > 0.05) in P2P, CSP and LM activation were found between pre- and post-intervention in CLBP. The CLBP group demonstrated significant correlation (P = 0.05) between P2P and LM activation. Although our finding demonstrates change in P2P in the CLBP group, one-session of a-tDCS cannot induce changes in cortical excitability and LM activation. However, moderate to strong correlation between P2P and LM activation suggests the involvement of cortical level in LM activation deficit. Therefore, non-significant changes could have been due to inadequate dose of a-tDCS.
Bu çalışmanın amacı yük taşıyan işçilerde ergonomi eğitimin vücut farkındalığı, postür ve yaşam kalitesi üzerine etkisini araştırmaktır. Çalışmaya katılan kişiler basit randomizasyon yöntemi ile deney (n=10) ve kontrol grubu (n=10) olarak ayrıldı. Deney grubuna doğru pozisyonda yük kaldırma eğitimi 1 sefer olmak üzere seminer şeklinde verildi. Kontrol grubuna ise eğitim verilmedi. Çalışmaya alınan bireylere vücut farkındalığı için Vücut Farkındalık Anketi (VFA), postür değerlendirmesi için New York Postür Analizi Yöntemi (NYPAY) ve yaşam kalitesi değerlendirmesi için SF-36 Yaşam Kalitesi Ölçeği uygulandı. Cornell Kas iskelet sistemi rahatsızlığı taraması anketi (CKİSRA) ile kas iskelet sistemi rahatsızlıklarını değerlendirildi. Değerlendirmeler eğitim öncesi ve eğitimden 45 gün geçtikten sonra tekrar edildi. Her iki grupta da vücut farkındalığında anlamlı bir değişiklik görülmedi (p>0,05). Postür analizi bulgularına göre eğitim öncesi ile eğitim sonrası deney grubunda anlamlı düzeyde farklılık görüldü (p
Intervertebral disc degeneration (IVDD) is a complex age-related physiological change involving mainly cellular senescence (CS), inflammation, impaired tissue biomechanical function, and degradation of the extracellular matrix, and is a major cause of lumbar disc herniation and low back pain. Nonetheless, the specific role of CS and its associated genes in IVDD remains unclear. In this study, we first obtained 53 differentially expressed CS-related genes (CSRGs) by differential analyses of IVDD patients and non-IVDD patients from the GSE124272 and GSE150408 microarray expression datasets of the GEO database. We then performed GO and KEGG pathway enrichment analysis on these 53 CSRGs to explore their functions and pathways. To find the key genes from these 53 CSRGs, we first built a protein-protein interaction (PPI) network to recognize hub genes, and then on top of that we also applied the support vector machine recursive feature elimination (SVM-RFE) algorithm, random forest (RF) algorithm, and least absolute shrinkage and selection operator (LASSO) analysis. We finally obtained 4 hub CSRGs (DUSP3, MAPKAPK5, SP1 and VEGFA) to forecast the risk of IVDD. Based on the four hub genes we previously obtained, we built a nomogram model and performed a decision curve analysis, which ultimately suggested that the model was beneficial to patients. Based on the selected 4 hub CSRGs, we classified IVDD patients into two Hub gene patterns (hub gene clusters A and B) by the consensus clustering method, while the 297 DEGs obtained by screening based on the two hub gene clusters were classified into two gene patterns using the same method. We then applied a PCA algorithm to determine Hub gene scores for each sample to measure Hub gene patterns and found that patients in cluster A had higher Hub gene scores than those in cluster B. We also showed the correlation of two Hub gene patterns and Gene patterns with immune cell infiltration and the differential expression levels of four Hub genes by constructing heat maps and histograms. We performed GO enrichment analysis on these 297 DEGs to explore their role in IVDD. Finally, we used qPCR analysis and western blot to verify the expression levels of mRNA and protein in normal and IVDD cells of 4 hub CSRGs. In summary, CSRGs play an important role in the pathogenesis of IVDD, and our study of the hub gene cluster may guide future therapeutic strategies for IVDD.
Introduction: The prognosis of back pain (BP) in the elderly is less favorable than in younger adults and progress to adverse outcomes and consequent worsening of health-related quality of life (HRQoL).
Objective: To verify the association between BP intensity, disability and HRQoL in elderly residents in Brazil and Netherlands, and to evaluate whether the country of residence influences the associations.
Methods: Data were collected from 602 Brazilian and 675 Dutch participants with a new episode of BP from the Back Complaints in Elders (BACE) consortium. For the present study, a cross section was used. Pain intensity and disability were assessed using the Numerical Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. HRQoL was assessed using the Short Form Health Survey (SF-36) quality of life questionnaire. Age, sex, and education were descriptive variables. Pain intensity (NPS score) and country were the independent variables and quality of life assessed by each SF domain - 36 was the dependent variable. Analysis of models at the individual level was performed to verify the association between pain and disability, also HRQoL in Netherlands and Brazil in the total sample. The multilevel model was used to verify whether the elderly person's country of residence influenced this relationship. Results: The average age of the participants was 67.00 (7.33) years. In the total sample, linear regression analysis adjusted for sex and age showed a significant association between BP intensity scores and HRQoL, for all domains. There was no association between disability and HRQoL. In the multilevel analysis, there was an association between BP intensity and HRQoL in all domains and an association between the country of residence and HRQoL, influencing the effect of pain, in all domains, except for the physical functioning.
Conclusion: Socioeconomic and cultural aspects of different countries can affect the perception of the elderly about their HRQoL in the presence of BP. Pain and disability in Brazilian and Dutch elderly ones are experienced differently in relation to their HRQoL.
Low back pain is a very common problem that can affect a variety of ages. The symptoms of low back pain can be caused by lumbar spine problems such as root pain, radiculopathy, and spinal tract stenosis. The intervertebral disk and the joint facet are two lumbar structures that can cause pain. One element that contributes to low back discomfort is physical activity. The study design used correlation analysis with a cross-sectional approach. The sampling technique used in this study is consecutive sampling. The sample is 37 teachers with an age range of 35 – 60 years. To indentify physical activity is used Short-Form International Physical Activity Questionnaire and for identifying low back pain complaints is used Pain and Distress Scale (William J.K. Zunga) in the Primala study was analyzed using the Chi-Square test. The teachers and perform moderate activities, don’t have complaints of low back pain of 15 (40,5%), heavy activity, did have a complaint of low back pain of 22 (59,5%). The results of the Chi-square test showed that there was a significant relationship between physical activity and low back pain complaints (p value=0,000;α<0,05). Appropriate and consistent activity that is adapted to the body's capacities and age will have a positive influence on the building of stronger muscles and bones. Adequate and regular physical activity can help prevent low back pain complaints
BACKGROUND: A range of studies concerning the effects of breathing exercises on chronic low back pain (CLBP) have been proven inconclusive. OBJECTIVE: The study aimed to evaluate the effectiveness of breathing exercises for the treatment of CLBP. METHODS: We considered randomized controlled trials in English or Chinese that used breathing exercises for the treatment of CLBP. An electronic search was performed in the MEDLINE, EMBASE, Web of Science, Cochrane Library, CNKI, Wan Fang, and CBM databases for articles published up to November 2022. Two reviewers independently screened the articles, assessed the risk of bias using the Cochrane risk of bias tool, and extracted the data. The outcomes included pain, lumbar function and pulmonary function post-intervention. RESULTS: A total of thirteen studies (n= 677) satisfied the inclusion criteria. The meta-analysis results demonstrated a significant effect of breathing exercises on the Visual Analog Scale (VAS) score (SMD =-0.84, 95% CI: -1.24 to -0.45, P< 0.0001), the Oswestry Disability Index (ODI) score (SMD =-0.74, 95% CI: -0.95 to -0.54, P< 0.00001), Forced Vital Capacity (FVC) score (MD = 0.24, 95% CI: 0.10 to 0.37, P= 0.0006), Forced Expiratory Volume in 1 second /Forced Vital Capacity (FEV1/FVC) (MD = 1.90, 95% CI: 0.73 to 3.07, P= 0.001), although there was no significant difference between the breathing exercises and control interventions for Forced Expiratory Volume in the first second (FEV1) score (MD = 0.22, 95% CI = [0.00, 0.43], P= 0.05), and Maximal Voluntary Ventilation (MVV) score (MD = 8.22, 95% CI = [-4.02, 20.45], P= 0.19). CONCLUSION: Breathing exercises can reduce pain, assist people with lumbar disabilities, and improve pulmonary function, and could be considered as a potential alternative treatment for CLBP.
Introduction
Musculoskeletal pain disorders continue to be one of the leading causes of disability worldwide. Best practice care recommends patient‐centred biopsychosocial models of care. Little is known about the chronic musculoskeletal pain management in low‐ and middle‐income countries.
Objectives
To explore the management of chronic musculoskeletal pain by healthcare professionals in Bhutan.
Methods
This study employed a qualitative design involving 19 Bhutanese healthcare professionals managing chronic musculoskeletal pain in Bhutan. We collected data using a semi‐structured interview guide. Thematic analysis was done manually.
Results
Healthcare professionals reported that patients rely on a combination of home remedies and seek help from local healers and hospitals for chronic musculoskeletal pain management. While healthcare professionals understand chronic musculoskeletal pain as multi‐dimensional phenomenon, the primary focus was on identifying and treating structural anomalies. Time constraints, inadequate knowledge and skills, lack of confidence, facilities and expertise were reported as barriers to the effective management of chronic musculoskeletal pain. They proposed a need for clinical guidelines, relevant skills training and creating awareness of chronic musculoskeletal pain.
Conclusion
The management of chronic musculoskeletal pain in Bhutan is focused on identifying and treating physical abnormalities. Healthcare professionals consider psychosocial dimensions important but lack any form of actionable interventions in this domain.
Purpose
To validate the comprehensive ICF core set for post-acute musculoskeletal conditions from the perspective of patients in a primary care physiotherapy setting.
Materials and methods
A qualitative study was conducted with patients suffering from musculoskeletal problems. A phenomenological approach based on focus groups was used to identify the most relevant aspects related to physical therapy care in their condition. The data were analyzed using a meaning condensation procedure, identifying relevant themes and concepts. The identified concepts were linked to the ICF and compared to the ICF core set for post-acute musculoskeletal conditions.
Results
Forty-three patients were included in eight focus groups. A total of 1281 relevant concepts were extracted and related to 156 ICF second-level entities. Entities in the ICF core set for post-acute musculoskeletal conditions were 95.7% confirmed. Eighty-nine additional second-level ICF entities were identified.
Conclusions
Entities in the ICF core set for post-acute musculoskeletal conditions are relevant to patients seen in primary care physical therapy units. However, there are areas of functioning related to community health care not covered by this ICF-based tool.
IMPLICATIONS OF REHABILITATION
An ICF-based framework is feasible for the assessment of musculoskeletal conditions.
Post-acute musculoskeletal ICF core set was confirmed in patient focus groups.
Additional ICF categories emerged for a primary care physical therapy setting.
Community features of functioning could be addressed by a tailored ICF core set.
Study design:
Retrospective study of prospective collected data.
Objective:
To analyze the association between intervertebral vacuum phenomenon (IVP) and clinical parameters in patients with degenerative spondylolisthesis.
Summary of background data:
IVP is a sign of advanced disc degeneration. The correlation between IVP severity and low back pain in patients with degenerative spondylolisthesis has not been previously analyzed.
Methods:
We retrospectively analyzed patients with degenerative spondylolisthesis who underwent surgery. Vacuum phenomenon was measured on computed tomography scan and classified into mild, moderate, and severe. A lumbar vacuum severity (LVS) scale was developed based on vacuum severity. The associations between IVP at L4/5 and the LVS scale, preoperative and postoperative low back pain, as well as the Oswestry Disability Index was assessed. The association of IVP at L4/5 and the LVS scale and surgical decision-making, defined as decompression alone or decompression and fusion, was assessed through univariable logistic regression analysis.
Results:
A total of 167 patients (52.7% female) were included in the study. The median age was 69 years (interquartile range 62-72). Overall, 100 (59.9%) patients underwent decompression and fusion and 67 (40.1%) underwent decompression alone. The univariable regression demonstrated a significantly increased odds ratio (OR) for back pain in patients with more severe IVP at L4/5 [OR=1.69 (95% CI 1.12-2.60), P=0.01]. The univariable regressions demonstrated a significantly increased OR for increased disability with more severe L4/L5 IVP [OR=1.90 (95% CI 1.04-3.76), P=0.04] and with an increased LVS scale [OR=1.17 (95% CI 1.02-1.35), P=0.02]. IVP severity of the L4/L5 were associated with higher indication for fusion surgery.
Conclusion:
Our study showed that in patients with degenerative spondylolisthesis undergoing surgery, the severity of vacuum phenomenon at L4/L5 was associated with greater preoperative back pain and worse Oswestry Disability Index. Patients with severe IVP were more likely to undergo fusion.
Introduction:
Although there is growth in the approach to telerehabilitation (TLRH) in different pathologies, research on TLRH for the management of low back pain is scarce and controversial. Thus, the purpose of this study was to analyze whether a TLRH program is as effective as a clinical exercise program in improving pain and different functional variables in patients with nonspecific low back pain (NLBP).
Method:
A single-blind, two-armed randomized controlled trial was carried out with 68 individuals with chronic NLBP. Participants were randomly allocated to either the TLRH group (TG) (n = 34) or the clinic group (CG) (n = 34). The TG received an exercise-based TLRH video and an educational program on the neurophysiology of pain. The CG received the same pain education and exercise program at the clinic facility supervised by a clinician. Both groups performed 2 weekly sessions for 8 weeks. Active movements of the lumbar spine, pain and range of motion, and kinesiophobia were assessed at baseline, at the end of 8 weeks of treatment, and at 3 months.
Results:
Statistically significant differences for time-by-group interaction were identified in range of motion of right (F = 11.668; p = 0.001) and left (F = 4.219; p = 0.042) legs when knee extended test is performed; as well as in pain intensity when the same test (F = 5.176; p = 0.043). Moreover, higher pain level during flexion (F = 5.133; p = 0.009) and extension movements (F = 6.335; p = 0.003) in patients with bilateral pain location than those with unilateral or central pain location has been appreciated.
Conclusion:
A TLRH rehabilitation program via mobile app is as effective as the same exercise program supervised in a clinic.
This study was conducted to investigate body mass index (BMI), levels of cholesterol and triglycerides in prison inmates at the Institution for Reform and Rehabilitation in Southern Libya to be considered as an indication about their health and the provided foods. The results of this study showed that 26.5% of BMI of the prison inmates were found to be higher than the normal levels. Generally, the average level of cholesterol and triglycerides concentrations were found to be within normal range 142.6 mg/dl and 135.4 mg/dl, respectively. The findings also established that there were a significant relationship and direct correlation between BMI levels and age and concentration of cholesterol and triglycerides levels. The results of this showed that the served foods for these prison inmates are well balanced as indicated by their cholesterol and triglycerides levels.
BACKGROUND:
Radiofrequency (RF) denervation, an invasive treatment for chronic low back pain (CLBP), is used most often for pain suspected to arise from facet joints, sacroiliac (SI) joints or discs. Many (uncontrolled) studies have shown substantial variation in its use between countries and continued uncertainty regarding its effectiveness.
OBJECTIVES:
The objective of this review is to assess the effectiveness of RF denervation procedures for the treatment of patients with CLBP. The current review is an update of the review conducted in 2003.
SEARCH METHODS:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, three other databases, two clinical trials registries and the reference lists of included studies from inception to May 2014 for randomised controlled trials (RCTs) fulfilling the inclusion criteria. We updated this search in June 2015, but we have not yet incorporated these results.
SELECTION CRITERIA:
We included RCTs of RF denervation for patients with CLBP who had a positive response to a diagnostic block or discography. We applied no language or date restrictions.
DATA COLLECTION AND ANALYSIS:
Pairs of review authors independently selected RCTs, extracted data and assessed risk of bias (RoB) and clinical relevance using standardised forms. We performed meta-analyses with clinically homogeneous studies and assessed the quality of evidence for each outcome using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.
MAIN RESULTS:
In total, we included 23 RCTs (N = 1309), 13 of which (56%) had low RoB. We included both men and women with a mean age of 50.6 years. We assessed the overall quality of the evidence as very low to moderate. Twelve studies examined suspected facet joint pain, five studies disc pain, two studies SI joint pain, two studies radicular CLBP, one study suspected radiating low back pain and one study CLBP with or without suspected radiation. Overall, moderate evidence suggests that facet joint RF denervation has a greater effect on pain compared with placebo over the short term (mean difference (MD) -1.47, 95% confidence interval (CI) -2.28 to -0.67). Low-quality evidence indicates that facet joint RF denervation is more effective than placebo for function over the short term (MD -5.53, 95% CI -8.66 to -2.40) and over the long term (MD -3.70, 95% CI -6.94 to -0.47). Evidence of very low to low quality shows that facet joint RF denervation is more effective for pain than steroid injections over the short (MD -2.23, 95% CI -2.38 to -2.08), intermediate (MD -2.13, 95% CI -3.45 to -0.81), and long term (MD -2.65, 95% CI -3.43 to -1.88). RF denervation used for disc pain produces conflicting results, with no effects for RF denervation compared with placebo over the short and intermediate term, and small effects for RF denervation over the long term for pain relief (MD -1.63, 95% CI -2.58 to -0.68) and improved function (MD -6.75, 95% CI -13.42 to -0.09). Lack of evidence of short-term effectiveness undermines the clinical plausibility of intermediate-term or long-term effectiveness. When RF denervation is used for SI joint pain, low-quality evidence reveals no differences from placebo in effects on pain (MD -2.12, 95% CI -5.45 to 1.21) and function (MD -14.06, 95% CI -30.42 to 2.30) over the short term, and one study shows a small effect on both pain and function over the intermediate term. RF denervation is an invasive procedure that can cause a variety of complications. The quality and size of original studies were inadequate to permit assessment of how often complications occur.
AUTHORS' CONCLUSIONS:
The review authors found no high-quality evidence suggesting that RF denervation provides pain relief for patients with CLBP. Similarly, we identified no convincing evidence to show that this treatment improves function. Overall, the current evidence for RF denervation for CLBP is very low to moderate in quality; high-quality evidence is lacking. High-quality RCTs with larger patient samples are needed, as are data on long-term effects.
Background: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).
Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.
Findings: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9–78·6) for females and 72·0 years (68·8–75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0–49·5]) and for males was in Lesotho (41·5 years [39·0–44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97–6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74–6·27) for males and 6·49 years (6·08–6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61–1·93) for males and 1·96 years (1·69–2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (–2·3% [–5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally.
Interpretation: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.
Background
There are plausible mechanisms whereby leisure time physical activity may protect against low back pain (LBP) but there have been no quality systematic reviews and meta-analyses of the subject.
Objective
This review aims to assess the effect of leisure time physical activity on non-specific LBP.
Methods
Literature searches were conducted in PubMed, Embase, Web of Science, Scopus and Google Scholar databases from their inception through July 2016. Methodological quality of included studies was evaluated. A random-effects meta-analysis was performed, and heterogeneity and publication bias were assessed.
Results
Thirty-six prospective cohort studies (n=158 475 participants) qualified for meta-analyses. Participation in sport or other leisure physical activity reduced the risk of frequent or chronic LBP, but not LBP for >1 day in the past month or past 6–12 months. Risk of frequent/chronic LBP was 11% lower (adjusted risk ratio (RR)=0.89, CI 0.82 to 0.97, I²=31%, n=48 520) in moderately/highly active individuals, 14% lower (RR=0.86, CI 0.79 to 0.94, I²=0%, n=33 032) in moderately active individuals and 16% lower (RR=0.84, CI 0.75 to 0.93, I²=0%, n=33 032) in highly active individuals in comparison with individuals without regular physical activity. For LBP in the past 1–12 months, adjusted RR was 0.98 (CI 0.93 to 1.03, I²=50%, n=32 654) for moderate/high level of activity, 0.94 (CI 0.84 to 1.05, I²=3%, n=8549) for moderate level of activity and 1.06 (CI 0.89 to 1.25, I²=53%, n=8554) for high level of activity.
Conclusions
Leisure time physical activity may reduce the risk of chronic LBP by 11%–16%. The finding, however, should be interpreted cautiously due to limitations of the original studies. If this effect size is proven in future research, the public health implications would be substantial.
Purpose:
To summarise recommendations about 20 non-surgical interventions for recent onset (<12 weeks) non-specific low back pain (LBP) and lumbar radiculopathy (LR) based on two guidelines from the Danish Health Authority.
Methods:
Two multidisciplinary working groups formulated recommendations based on the GRADE approach.
Results:
Sixteen recommendations were based on evidence, and four on consensus. Management of LBP and LR should include information about prognosis, warning signs, and advise to remain active. If treatment is needed, the guidelines suggest using patient education, different types of supervised exercise, and manual therapy. The guidelines recommend against acupuncture, routine use of imaging, targeted treatment, extraforaminal glucocorticoid injection, paracetamol, NSAIDs, and opioids.
Conclusion:
Recommendations are based on low to moderate quality evidence or on consensus, but are well aligned with recommendations from international guidelines. The guideline working groups recommend that research efforts in relation to all aspects of management of LBP and LR be intensified.
A full-text view-only version is available at:
http://rdcu.be/rus8
Study Design Systematic review. Background While most people with acute low back pain (LBP) recover quickly, recurrences are believed to be common. No high quality systematic review has been published on the risk of recurrences of LBP, or of factors which predict LBP recurrence. Objectives The aim of this study was to investigate the risk of and prognostic factors for a recurrence of LBP, in patients who have recovered from a previous episode of LBP within the last year. Methods Systematic searches were conducted of MEDLINE, EMBASE and CINAHL databases. We included longitudinal studies of adults who had recovered from a previous episode of LBP within 12 months. The primary outcome was a new episode of LBP. Secondary outcomes were other types of recurrence (e.g. episodes causing care seeking). Results Eight studies were included in the review: seven observational studies and one randomized trial (two publications). Six studies reported recurrence proportions for the primary outcome of an episode of LBP. Meta-analysis was not conducted due to the low quality and heterogeneity of studies. Only one study was considered an inception cohort study; it reported a one year recurrence proportion of 33%. A history of previous episodes of LBP prior to the most recent episode was the only factor that consistently predicted recurrence of LBP. Conclusion The available research does not provide robust estimates of the risk of LBP recurrence and provides little information about factors that predict recurrence in people recently recovered from an episode of LBP. Level of Evidence Prognosis, 1a-. Prospectively registered in PROSPERO 9 February, 2016 (CRD42016030220).J Orthop Sports Phys Ther, Epub 29 Mar 2017. doi:10.2519/jospt.2017.7415.
Patient history and physical examination are frequently used procedures to diagnose chronic low back pain (CLBP) originating from the facet joints, although the diagnostic accuracy is controversial. The aim of this systematic review is to determine the diagnostic accuracy of patient history and/or physical examination to identify CLBP originating from the facet joints using diagnostic blocks as reference standard. We searched MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Collaboration database from inception until June 2016. Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias. We calculated sensitivity and specificity values, with 95% confidence intervals (95% CI). Twelve studies were included, in which 129 combinations of index tests and reference standards were presented. Most of these index tests have only been evaluated in single studies with a high risk of bias. Four studies evaluated the diagnostic accuracy of the Revel's criteria combination. Because of the clinical heterogeneity, results were not pooled. The published sensitivities ranged from 0.11 (95% CI 0.02-0.29) to 1.00 (95% CI 0.75-1.00), and the specificities ranged from 0.66 (95% CI 0.46-0.82) to 0.91 (95% CI 0.83-0.96). Due to clinical heterogeneity, the evidence for the diagnostic accuracy of patient history and/or physical examination to identify facet joint pain is inconclusive. Patient history and physical examination cannot be used to limit the need of a diagnostic block. The validity of the diagnostic facet joint block should be studied, and high quality studies are required to confirm the results of single studies.
Significance:
Patient history and physical examination cannot be used to limit the need of a diagnostic block. The validity of the diagnostic facet joint block should be studied, and high quality studies are required to confirm the results of single studies.
We conducted a systematic review of guidelines on the management of low back pain (LBP) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, DARE, National Health Services Economic Evaluation Database, Health Technology Assessment Database, Index to Chiropractic Literature and grey literature. Independent reviewers critically appraised eligible guidelines using AGREE II criteria. We screened 2504 citations; 13 guidelines were eligible for critical appraisal, and 10 had a low risk of bias. According to high-quality guidelines: (1) all patients with acute or chronic LBP should receive education, reassurance and instruction on self-management options; (2) patients with acute LBP should be encouraged to return to activity and may benefit from paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or spinal manipulation; (3) the management of chronic LBP may include exercise, paracetamol or NSAIDs, manual therapy, acupuncture, and multimodal rehabilitation (combined physical and psychological treatment); and (4) patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation. Ten guidelines were of high methodological quality, but updating and some methodological improvements are needed. Overall, most guidelines target nonspecific LBP and recommend education, staying active/exercise, manual therapy, and paracetamol or NSAIDs as first-line treatments. The recommendation to use paracetamol for acute LBP is challenged by recent evidence and needs to be revisited.
Significance:
Most high-quality guidelines recommend education, staying active/exercise, manual therapy and paracetamol/NSAIDs as first-line treatments for LBP. Recommendation of paracetamol for acute LBP is challenged by recent evidence and needs updating.
Background: Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015.
Methods: We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores.
Findings: We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4–19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30–2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35–2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20–30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo.
Interpretation: Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available.
Background: Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development.
Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate.
Findings: Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9–3·0) for men and 3·5 years (3·4–3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78–0·92) and 1·2 years (1·1–1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs.
Interpretation: Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum.
Background:
Lumbar muscle dysfunction due to pain might be related to altered lumbar muscle structure. Macroscopically, muscle degeneration in low back pain (LBP) is characterized by a decrease in cross-sectional area and an increase in fat infiltration in the lumbar paraspinal muscles. In addition microscopic changes, such as changes in fiber distribution, might occur. Inconsistencies in results from different studies make it difficult to draw firm conclusions on which structural changes are present in the different types of non-specific LBP. Insights regarding structural muscle alterations in LBP are, however, important for prevention and treatment of non-specific LBP.
Objective:
The goal of this article is to review which macro- and/or microscopic structural alterations of the lumbar muscles occur in case of non-specific chronic low back pain (CLBP), recurrent low back pain (RLBP), and acute low back pain (ALBP).
Study design:
Systematic review.
Setting:
All selected studies were case-control studies.
Methods:
A systematic literature search was conducted in the databases PubMed and Web of Science. Only full texts of original studies regarding structural alterations (atrophy, fat infiltration, and fiber type distribution) in lumbar muscles of patients with non-specific LBP compared to healthy controls were included. All included articles were scored on methodological quality.
Results:
Fifteen studies were found eligible after screening title, abstract, and full text for inclusion and exclusion criteria. In CLBP, moderate evidence of atrophy was found in the multifidus; whereas, results in the paraspinal and the erector spinae muscle remain inconclusive. Also moderate evidence occurred in RLBP and ALBP, where no atrophy was shown in any lumbar muscle. Conflicting results were seen in undefined LBP groups. Results concerning fat infiltration were inconsistent in CLBP. On the other hand, there is moderate evidence in RLBP that fat infiltration does not occur, although a larger muscle fat index was found in the erector spinae, multifidus, and paraspinal muscles, reflecting an increased relative amount of intramuscular lipids in RLBP. However, no studies were found investigating fat infiltration in ALBP. Restricted evidence indicates no abnormalities in fiber type in the paraspinal muscles in CLBP. No studies have examined fiber type in ALBP and RLBP.
Limitations:
Lack of clarity concerning patient definitions, exact LBP symptoms, and applied methods.
Conclusions:
The results indicate atrophy in CLBP in the multifidus and paraspinal muscles but not in the erector spinae. No atrophy was shown in RLBP and ALBP. Fat infiltration did not occur in RLBP, but results in CLBP were inconsistent. No abnormalities in fiber type in the paraspinal muscles were found in CLBP.
Key words:
Low back pain, non-specific, chronic, recurrent, acute, muscle structure, fat infiltration, cross-sectional area, fiber type, review.
Low back pain (LBP) is the world's most disabling condition. Modic changes (MC) are vertebral bone marrow changes adjacent to the endplates as noted on magnetic resonance imaging. The associations of specific MC types and patterns with prolonged, severe LBP and disability remain speculative. This study assessed the relationship of prolonged, severe LBP and back-related disability, with the presence and morphology of lumbar MC in a large cross-sectional population-based study of Southern Chinese.
We addressed the topographical and morphological dimensions of MC along with other magnetic resonance imaging phenotypes (eg, disc degeneration and displacement) on the basis of axial T1 and sagittal T2-weighted imaging of L1-S1. Prolonged severe LBP was defined as LBP lasting ≥30 days during the past year, and a visual analog scale severest pain intensity of at least 6/10. An Oswestry Disability Index score of 15% was regarded as significant disability. We also assessed subject demographics, occupation, and lifestyle factors.
In total, 1142 subjects (63% females, mean age 53 years) were assessed. Of these, 282 (24.7%) had MC (7.1% type I, 17.6% type II). MC subjects were older (P = 0.003), had more frequent disc displacements (P < 0.001) and greater degree of disc degeneration (P < 0.001) than non-MC subjects. In adjusted models, any MC (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.01–2.18), MC affecting whole anterior-posterior length (OR 1.62, 95% CI 1.04–2.51), and MC affecting 2/3 posterior length (OR 2.79, 95% CI 1.17–6.65) were associated with prolonged severe LBP. Type I MC tended to associate with pain more strongly than type II MC (OR 1.80, 95% CI 0.94–3.44 vs OR 1.36, 95% CI 0.88–2.09, respectively). Any MC (OR 1.47, 95% CI 1.04–2.10), type II MC (OR 1.56, 95% CI 1.06–2.31), MC affecting 2/3 posterior length (OR 2.96, 95% CI 1.27–6.89), and extensive MC (OR 1.95, 95% CI 1.21–3.15) were associated with disability. The strength of the associations increased with the number of MC.
This large-scale study is the first to definitively note MC types and specific morphologies to be independently associated with prolonged severe LBP and back-related disability. This proposed refined MC phenotype may have direct implications in clinical decision-making as to the development and management of LBP. Understanding of these imaging biomarkers can lead to new preventative and personalized therapeutics related to LBP.
BACKGROUND:
Non-specific low back pain (LBP) is often categorised as acute, subacute or chronic by focusing on the duration of the current episode. However, more than twenty years ago this concept was challenged by a recognition that LBP is often an episodic condition. This episodic nature also means that the course of LBP is not well described by an overall population mean. Therefore, studies have investigated if specific LBP trajectories could be identified which better reflect individuals' course patterns. Following a pioneering study into LBP trajectories published by Dunn et al. in 2006, a number of subsequent studies have also identified LBP trajectories and it is timely to provide an overview of their findings and discuss how insights into these trajectories may be helpful for improving our understanding of LBP and its clinical management.
DISCUSSION:
LBP trajectories in adults have been identified by data driven approaches in ten cohorts, and these have consistently demonstrated that different trajectory patterns exist. Despite some differences between studies, common trajectories have been identified across settings and countries, which have associations with a number of patient characteristics from different health domains. One study has demonstrated that in many people such trajectories are stable over several years. LBP trajectories seem to be recognisable by patients, and appealing to clinicians, and we discuss their potential usefulness as prognostic factors, effect moderators, and as a tool to support communication with patients.
CONCLUSIONS:
Investigations of trajectories underpin the notion that differentiation between acute and chronic LBP is overly simplistic, and we believe it is time to shift from this paradigm to one that focuses on trajectories over time. We suggest that trajectory patterns may represent practical phenotypes of LBP that could improve the clinical dialogue with patients, and might have a potential for supporting clinical decision making, but their usefulness is still underexplored.
Modic type I change (MC1) are vertebral bone marrow lesions adjacent to degenerated discs that are specific for discogenic low back pain. The etiopathogenesis is unknown, but occult discitis, in particular with Propionibacteria acnes (P.acnes), has been suggested as a possible etiology. If true, antibiotic therapy should be considered for patients with MC1. However, this hypothesis is controversial. While some studies report up to 40% infection rate in herniated discs, others fail to detect infected discs and attribute reports of positive cultures to contamination during sampling procedure. Irrespective of the clinical controversy, whether it is biologically plausible for P.acnes to cause MC1 has never been investigated. Therefore, the objective of this study was to test if P.acnes can proliferate within discs and cause reactive changes in the adjacent bone marrow. P.acnes was aseptically isolated from a symptomatic human L4/5 disc with MC1 and injected into rat tail discs. We demonstrate proliferation of P.acnes and up-regulation of IL-1 and IL-6 within three days of inoculation. At day-7, disc degeneration was apparent along with fibrotic endplate erosion. TNF-α immunoreactivity was enhanced within the effected endplates along with cellular infiltrates. The bone marrow appeared normal. At day-14, endplates and trabecular bone close to the disc were almost completely resorbed and fibrotic tissue extended into the bone marrow. T-cells and TNF-α immunoreactivity were identified at the disc/marrow junction. On MRI, bone marrow showed MC1-like changes. In conclusion, P.acnes proliferate within the disc, induce degeneration, and cause MC1-like changes in the adjacent bone marrow. This article is protected by copyright. All rights reserved.
OBJECTIVE: To examine the perspectives of villagers in rural Botswana about the everyday life burden and impact of their musculoskeletal disorders.
METHODS: Ethnographic fieldwork for 8 months included 55 in-depth interviews with 34 villagers. Interviews were typically conducted in Setswana with an interpreter. Audio recordings were transcribed verbatim, with Setswana contextually translated into English. The theoretical lens included Bury’s biographical disruption, in which he distinguishes between “meaning as consequence” and “meaning as significance”.
RESULTS: Interviews revealed co-existing accounts for the consequences and significance of musculoskeletal burden related to 3 themes: (i) hard work for traditional lives; (ii) bearing the load of a rugged landscape; and, (iii) caring for others with disrupted lives. Physical labour with musculoskeletal symptoms had economic and subsistence consequences. The loss of independence and social identity to fulfil traditional roles held meaning as significance. Outmigration for wage labour and other shifts in family structure compounded everyday musculoskeletal burden.
CONCLUSION: Uncovering burden is an important first step to address musculoskeletal care needs in developing country settings. Community-engaged partnerships are needed to develop rehabilitation programmes to ease the burden of musculoskeletal disorders in rural Botswana.
Purpose:
Low back pain (LBP) is the most disabling condition worldwide. Although LBP relates to different spinal pathologies, vertebral bone marrow lesions visualized as Modic changes on MRI have a high specificity for discogenic LBP. This review summarizes the pathobiology of Modic changes and suggests a disease model.
Methods:
Non-systematic literature review.
Results:
Chemical and mechanical stimulation of nociceptors adjacent to damaged endplates are likely a source of pain. Modic changes are adjacent to a degenerated intervertebral disc and have three generally interconvertible types suggesting that the different Modic change types represent different stages of the same pathological process, which is characterized by inflammation, high bone turnover, and fibrosis. A disease model is suggested where disc/endplate damage and the persistence of an inflammatory stimulus (i.e., occult discitis or autoimmune response against disc material) create predisposing conditions. The risk to develop Modic changes likely depends on the inflammatory potential of the disc and the capacity of the bone marrow to respond to it. Bone marrow lesions in osteoarthritic knee joints share many characteristics with Modic changes adjacent to degenerated discs and suggest that damage-associated molecular patterns and marrow fat metabolism are important pathogenetic factors. There is no consensus on the ideal therapy. Non-surgical treatment approaches including intradiscal steroid injections, anti-TNF-α antibody, antibiotics, and bisphosphonates have some demonstrated efficacy in mostly non-replicated clinical studies in reducing Modic changes in the short term, but with unknown long-term benefits. New diagnostic tools and animal models are required to improve painful Modic change identification and classification, and to clarify the pathogenesis.
Conclusion:
Modic changes are likely to be more than just a coincidental imaging finding in LBP patients and rather represent an underlying pathology that should be a target for therapy.
Introduction
Musculoskeletal (MSK) pain in children and adolescents is responsible for substantial personal impacts and societal costs, but it has not been intensively or systematically researched. This means our understanding of these conditions is limited, and healthcare professionals have little empirical evidence to underpin their clinical practice. In this article we summarise the state of the evidence concerning MSK pain in children and adolescents, and offer suggestions for future research.
Results
Rates of self-reported MSK pain in adolescents are similar to those in adult populations and they are typically higher in teenage girls than boys. Epidemiological research has identified conditions such as back and neck pain as major causes of disability in adolescents, and in up to a quarter of cases there are impacts on school or physical activities. A range of physical, psychological and social factors have been shown to be associated with MSK pain report, but the strength and direction of these relationships are unclear. There are few validated instruments available to quantify the nature and severity of MSK pain in children, but some show promise. Several national surveys have shown that adolescents with MSK pain commonly seek care and use medications for their condition. Some studies have revealed a link between MSK pain in adolescents and chronic pain in adults.
Conclusion
Musculoskeletal pain conditions are often recurrent in nature, occurring throughout the life-course. Attempts to understand these conditions at a time close to their initial onset may offer a better chance of developing effective prevention and treatment strategies.
Study design:
Delphi.
Objective:
Obtain an expert consensus on which history factors are most important in the clinical diagnosis of LSS.
Summary of background data:
Lumbar spinal stenosis (LSS) is a poorly defined clinical syndrome. Criteria for defining LSS are needed and should be informed by the experience of expert clinicians.
Methods:
Phase 1 (Delphi Items): 20 members of the International Taskforce on the Diagnosis and Management of LSS confirmed a list of 14 history items. An on-line survey was developed that permits specialists to express the logical order in which they consider the items, and the level of certainty ascertained from the questions. Phase 2 (Delphi Study) Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine. Round 2: Meeting of 9 members of Taskforce where consensus was reached on a final list of 10 items. Round 3: Final survey was distributed internationally. Phase 3: Final Taskforce consensus meeting.
Results:
279 clinicians from 29 different countries, with a mean of 19 (±SD: 12) years in practice participated. The six top items were "leg or buttock pain while walking", "flex forward to relieve symptoms", "feel relief when using a shopping cart or bicycle", "motor or sensory disturbance while walking", "normal and symmetric foot pulses", "lower extremity weakness" and "low back pain". Significant change in certainty ceased after 6 questions at 80% (p < .05).
Conclusions:
This is the first study to reach an international consensus on the clinical diagnosis of LSS, and suggests that within six questions clinicians are 80% certain of diagnosis. We propose a consensus-based set of "7 history items" that can act as a pragmatic criterion for defining LSS in both clinical and research settings, which in the long-term may lead to more cost-effective treatment, improved health-care utilization and enhanced patient outcomes.
Level of evidence:
2.
Purpose
To test whether the localization of worsening of pain during coughing, sneezing and straining matters in the assessment of lumbosacral nerve root compression or disc herniation on MRI.
Methods
Recently the diagnostic accuracy of history items to assess disc herniation or nerve root compression on magnetic resonance imaging (MRI) was investigated. A total of 395 adult patients with severe sciatica of 6–12 weeks duration were included in this study. The question regarding the influence of coughing, sneezing and straining on the intensity of pain could be answered on a 4 point scale: no worsening of pain, worsening of back pain, worsening of leg pain, worsening of back and leg pain. Diagnostic odds ratio’s (DORs) were calculated for the various dichotomization options.
Results
The DOR changed into significant values when the answer option was more narrowed to worsening of leg pain. The highest DOR was observed for the answer option ‘worsening of leg pain’ with a DOR of 2.28 (95 % CI 1.28–4.04) for the presence of nerve root compression and a DOR of 2.50 (95 % CI 1.27–4.90) for the presence of a herniated disc on MRI.
Conclusions
Worsening of leg pain during coughing, sneezing or straining has a significant diagnostic value for the presence of nerve root compression and disc herniation on MRI in patients with sciatica. This study also highlights the importance of the formulation of answer options in history taking.
Background: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development.
Methods: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time.
Results: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries.
Conclusions: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition-in which increasing sociodemographic status brings structured change in disease burden-is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.
Funding: Bill & Melinda Gates Foundation.
In contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes.
To compare function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy.
Prospective cohort of 5239 patients 65 years or older with a new primary care visit for back pain (2011-2013) in 3 US health care systems. We matched controls 1:1 using propensity score matching of demographic and clinical characteristics, including diagnosis, pain severity, pain duration, functional status, and prior resource use.
Diagnostic imaging (plain films, computed tomography [CT], magnetic resonance imaging [MRI]) of the lumbar or thoracic spine within 6 weeks of the index visit.
Primary outcome: back or leg pain-related disability measured by the modified Roland-Morris Disability Questionnaire (score range, 0-24; higher scores indicate greater disability) 12 months after enrollment.
Among the 5239 patients, 1174 had early radiographs and 349 had early MRI/CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on the disability questionnaire. The mean score for patients who underwent early radiography was 8.54 vs 8.74 among the control group (difference, -0.10 [95% CI, -0.71 to 0.50]; mixed model, P = .36). The mean score for the early MRI/CT group was 9.81 vs 10.50 for the control group (difference,-0.51 [-1.62 to 0.60]; mixed model, P = .18).
Among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain.
Chronic low back pain (CLBP) is associated with a number of costly disability-related outcomes. It has received increasing attention from qualitative researchers studying its consequences for personal, social, and health care experiences. As research questions and methods diversify, there is a growing need to integrate findings emerging from these studies. A meta-ethnography was carried out to synthesise the findings of 38 separate qualitative articles published on the subjective experience of CLBP between 1994 and 2011. Studies were identified following a literature search and quality appraisal. Four themes were proposed after a process of translating the meaning of text extracts from the findings sections across all the articles. The themes referred to the undermining influence of pain, its disempowering impact on all levels, unsatisfying relationships with health care professionals, and learning to live with the pain. The findings are dominated by wide-ranging distress and loss but also acknowledge self-determination and resilience. Implications of the meta-ethnography for clinicians and future qualitative research are outlined, including the need to study relatively unexamined facets of subjective experience such as illness trajectory and social identity.
