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What have we learned about the evidence-informed management of chronic low back pain?
... In this scoring system, the word in each subclass implying the least pain is given a value of 1, the next word is given a value of 2, etc. The rank values of words chosen by a patient are summed to obtain a score separately for the sensory (subclass 1-10), affective (subclasses 11-15), evaluative (subclass 18) and miscellaneous (subclasses [17][18][19][20] words, in addition to provide a total score (subclasses [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].The PPI is recorded as a number and is associated with the following words 1-mild, 2discomforting, 3-distrcession, 4-horrible, and 5-excruciating. Data Analysis:All Data was analyzed using statistical test-pair t test. ...
... In this scoring system, the word in each subclass implying the least pain is given a value of 1, the next word is given a value of 2, etc. The rank values of words chosen by a patient are summed to obtain a score separately for the sensory (subclass 1-10), affective (subclasses 11-15), evaluative (subclass 18) and miscellaneous (subclasses [17][18][19][20] words, in addition to provide a total score (subclasses [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].The PPI is recorded as a number and is associated with the following words 1-mild, 2discomforting, 3-distrcession, 4-horrible, and 5-excruciating. Data Analysis:All Data was analyzed using statistical test-pair t test. ...
... The fact that there are more than 20 types of treatment for chronic LBP, each of which has multiple subcategories, is a testament that no single approach has yet been able to demonstrate its definitive superiority 17 . For example, exercise therapy is one promising treatment option, but there is still no consensus upon which kind is the most effective 18 . ...
Study Objective: Effect of Ultrasound and Exercise together and TENS alone in the managementof Chronic back pain. Design: Pre & post test control group design. Method and Measurements: 40 patients from Raj Nursing Home [Age group 25-55 yrs] who werediagnosed with Low back pain, with onset ˃1-3 months (chronic) were randomly assigned to either group A receiving US and Exercise together or group B receiving TENS alone. Treatment was given for 10 sessions for the period of 5week. Before treatment and after 5 weeks of treatment pain was assessed on VAS and MPQ. Results:Subjects in-group A that received Ultrasound and exercise showed greaterImprovement in pain compared with the TENS groupon 5thweek compared with pre treatment. (p˂0.050) Conclusion: The result of study suggests that both Ultrasound and TENSimproves the symptoms of chronic back pain. TENS alone improved the pain symptoms but was too small to reach satisfactory outcome for patients. Based on these results Ultrasound and Exercise should be the treatment of choice for chronic back pain rather than TENS alone.
... that cannot be informed by typical clinical trials. [16][17][18] To a large degree, variability in the selection of treatment methods among doctors of chiropractic (DCs) continues to exist, even though the large body of research on low back pain (LBP) has focused on the most commonly used manipulative methods. 17,19,20 Although the weight of the evidence may favor the evidence referenced in a guideline for particular clinical methods, an individual patient may be best served in subsequent trials of care by treatment that is highly personalized to their own mechanical disorder, experience of pain and disability, as well as preference for a specific treatment approach. ...
... The original guidelines had been developed based on the evidence, including guidelines and research available at the time. 16,53-63 The steering committee, composed of authors on these previous guidelines, developed 51 seed statements based on the background documents, revising the previous statements if it seemed advisable based on the literature. The steering committee did not conduct a formal consensus process; however, the seed statement development was a team effort, with changes only made if all members of the steering committee were in agreement. ...
... 9,10,12 This set in motion an effort to improve clinical methods by reducing variation in chiropractic treatment patterns that has long been unaddressed by any other evidence-informed and consensus-driven official guideline. 16,54,55,62,63,72 The approach to the development of these recommendations has been evolutionary so as to guide the profession toward the utilization of more evidence-informed clinical methods intended to improve patient outcomes. Historically, this also explains why the initial low back guideline, published in 2008, required 2 subsequent additional guidelines to expand on acute and chronic conditions. ...
Objective:
The purpose of this article is to provide an update of a previously published evidence-based practice guideline on chiropractic management of low back pain.
Methods:
This project updated and combined 3 previous guidelines. A systematic review of articles published between October 2009 through February 2014 was conducted to update the literature published since the previous Council on Chiropractic Guidelines and Practice Parameters (CCGPP) guideline was developed. Articles with new relevant information were summarized and provided to the Delphi panel as background information along with the previous CCGPP guidelines. Delphi panelists who served on previous consensus projects and represented a broad sampling of jurisdictions and practice experience related to low back pain management were invited to participate. Thirty-seven panelists participated; 33 were doctors of chiropractic (DCs). In addition, public comment was sought by posting the consensus statements on the CCGPP Web site. The RAND-UCLA methodology was used to reach formal consensus.
Results:
Consensus was reached after 1 round of revisions, with an additional round conducted to reach consensus on the changes that resulted from the public comment period. Most recommendations made in the original guidelines were unchanged after going through the consensus process.
Conclusions:
The evidence supports that doctors of chiropractic are well suited to diagnose, treat, co-manage, and manage the treatment of patients with low back pain disorders.
... Amazingly, there are more than 200 treatments for LBP and IVD degeneration [7]. However, the average effects of conservative treatments for LBP are not much better than those of placebos [7]. ...
... Amazingly, there are more than 200 treatments for LBP and IVD degeneration [7]. However, the average effects of conservative treatments for LBP are not much better than those of placebos [7]. Moreover, as a last resort, invasive surgical procedure (spine fusion or arthroplasty) is not an ultimate treatment option. ...
Intervertebral disc (IVD) degeneration is the primary cause for low back pain that has a high prevalence in modern society and poses enormous economic burden on patients. Few effective therapeutic strategies are available for IVD degeneration treatment. To understand the biological effects of dental pulp stem cells (DPSCs) on nucleus pulposus (NP) cells, we carried out RNA sequencing, bioinformatic analysis which unveiled gene expression differences, and pathway variation in primarily isolated patients’ NP cells after treatment with DPSCs supernatant. Western blot and immunofluorescence were used to verify these molecular alterations. Besides, to evaluate the therapeutic effect of DPSCs in IVD degeneration treatment, DPSCs were injected into a degeneration rat model in situ, with treatment outcome measured by micro-CT and histological analysis. RNA sequencing and in vitro experiments demonstrated that DPSCs supernatant could downregulate NP cells’ inflammation-related NF-κB and JAK-STAT pathways, reduce IL-6 production, increase collagen II expression, and mitigate apoptosis. In vivo results showed that DPSCs treatment protected the integrity of the disc structure, alleviated extracellular matrix degradation, and increased collagen fiber expression. In this study, we verified the therapeutic effect of DPSCs in an IVD degeneration rat model and elucidated the underlying molecular mechanism of DPSCs treatment, which provides a foundation for the application of DPSCs in IVD degeneration treatment.
... In this scoring system, the word in each subclass implying the least pain is given a value of 1, the next word is given a value of 2, etc. The rank values of words chosen by a patient are summed to obtain a score separately for the sensory (subclass 1-10), affective (subclasses 11-15), evaluative (subclass 18) and miscellaneous (subclasses [17][18][19][20] words, in addition to provide a total score (subclasses [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].The PPI is recorded as a number and is associated with the following words 1-mild, 2-discomforting, 3distrcession, 4-horrible, and 5-excruciating. ...
... The fact that there are more than 20 types of treatment for chronic LBP, each of which has multiple subcategories, is a testament that no single approach has yet been able to demonstrate its definitive superiority. [14] For example, exercise therapy is one promising treatment option, but there is still no consensus upon which kind is the most effective. [15] This situation makes it very challenging for Clinicians, policy makers, insurers, and patients to make decisions regarding which treatment is the most appropriate for chronic LBP. ...
Study Objective: Comparative Study of Short Wave Diathermy (SWD) and Exercise together and Exercise alone in the Management of Chronic back pain. Design: Pre & post test control group design. Method and Measurements: 40 patients from Raj Nursing Home and shifa Hospital [Age group 25-65 yrs] who were diagnosed with Low back pain, with onset ˃1-3 months (chronic) were randomly assigned to either group A receiving SWD and Exercise combined or group B receiving Exercise alone. Treatment was given for 3 times in a week for the period of 6 week. Before treatment and after 6 weeks of treatment pain was assessed on VAS and MPQ. Results: Subjects in-group A that received SWD and exercise showed greater Improvement in pain compared with the exercise group on 6th week compared with pre treatment. (p˂0.050) Conclusion: The result of study suggests that both SWD and exercise improves the symptoms of chronic back pain. Exercise alone improved the pain symptoms but was too small to reach satisfactory outcome for patients. Based on these results SWD and Exercise should be the treatment of choice for chronic back pain rather than Exercise alone.
... Prevalence studies for low back pain are variable, and it is determined as 33% in point prevalence, 65% in one-year prevalence, and reaches up to 84% in life-long prevalence (3). The main aim of lower back pain treatment is to enable the patient to reach desired activity and participation levels as well as to protect the patient from disease recurrence and chronic complaints (4). The treatment of low back pain includes life-style changes, rehabilitation applications, and surgery. ...
... The treatment of low back pain includes life-style changes, rehabilitation applications, and surgery. Although there are many different treatment subcategories for low back pain, there is no single application with proven superiority (4). While there is evidence to support the efficacy of some treatments for low back pain (i.e. ...
... Bunların %30-60'ı bir hafta içerisinde, %60-90'ı altı hafta içerisinde, %95'i ise on iki hafta içerisinde gerilemekte ve fonksiyonel iyileşme sağlanmaktadır. [7,15,16,47,51] Hastaların %68-86'sı ilk bir ay, %90'ı ise iki ay içerisinde işe geri dönmektedir. [52] Rekürrens sıklığı ise, ilk altı ay içerisinde %40, bir yıl içerisinde %73, üç yıl içerisinde ise %84 olarak bildirilmektedir. ...
... [45,46] Söz konusu tedavi, hasta eğitimi ve egzersiz programlarından oluşan bel okullarını, psikoterapiyi, bilişsel ve davranışsal tedaviyi, sosyal ve mesleki danışmanlık hizmetlerini ve daha önce sözü edilen biyo-yararlanım tekniklerini kapsar. [7,42,47] Uzman gözetiminde yapılan tedavi planlamasının, başarı oranlarını arttırdığı bilinmelidir. [44] Cerrahi tedavi bahsinde de belirtileceği üzere, bu hastaların tedavisinde uygulanabilecek olan füzyon girişimlerinin, multidisipliner rehabilitasyon yaklaşımından daha etkin olmadığı akılda tutulmalıdır. ...
... In this scoring system, the word in each subclass implying the least pain is given a value of 1, the next word is given a value of 2, etc. The rank values of words chosen by a patient are summed to obtain a score separately for the sensory (subclass 1-10), affective (subclasses 11-15), evaluative (subclass 18) and miscellaneous (subclasses [17][18][19][20] words, in addition to provide a total score (subclasses [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].The PPI is recorded as a number and is associated with the following words 1-mild, 2discomforting, 3-distrcession, 4-horrible, and 5excruciating. ...
... The fact that there are more than 20 types of treatment for chronic LBP, each of which has multiple subcategories, is a testament that no single approach has yet been able to demonstrate its definitive superiority 14 . For example, exercise therapy is one promising treatment option, but there is still no consensus upon which kind is the most effective 15 . ...
Study Objective: Effect of Ultrasound and Exercise combined and Exercise alone in the Treatment of Chronic back pain. Design: Pre & post test control group design. Method and Measurements: 30 patients from Raj Nursing Home [Age group 25-65 yrs] who were diagnosed with Low back pain, with onset >1-3 months (chronic) were randomly assigned to either group A receiving US and Exercise combined or group B receiving Exercise alone. Treatment was given for 10 session for the period of 4 week. Before treatment and after 4 weeks of treatment pain was assessed on VAS and MPQ. Results: Subjects in-group A that received Ultrasound and exercise showed greater Improvement in pain compared with the exercise group on 4th week compared with pre treatment. (p Conclusion: The result of study suggests that both Ultrasound and exercise improves the symptoms of chronic back pain. Exercise alone improved the pain symptoms but was too small to reach satisfactory outcome for patients. Based on these results Ultrasound and Exercise should be the treatment of choice for chronic back pain rather than Exercise alone.
... Additionally, CLBP imposes a significant societal and economic burden on the U.S. healthcare system [4][5][6]. Multidisciplinary approaches (i.e., education, exercise, analgesics, spinal manipulation, and behavior) have suggested protocols, techniques, or guidelines for acute and chronic back pain [7], but these treatments have limited efficacy [8]. Moreover, older adults are less likely to receive adjunctive care for their pain such as spinal manipulation, massage therapy, or electrical stimulation [8,9]. ...
... Multidisciplinary approaches (i.e., education, exercise, analgesics, spinal manipulation, and behavior) have suggested protocols, techniques, or guidelines for acute and chronic back pain [7], but these treatments have limited efficacy [8]. Moreover, older adults are less likely to receive adjunctive care for their pain such as spinal manipulation, massage therapy, or electrical stimulation [8,9]. The continued high prevalence of CLBP highlights the need for better pain management strategies. ...
This prospective, randomized clinical trial (RCT) pilot study was designed to (1) assess the feasibility and tolerability of an easily administered, auricular point acupressure (APA) intervention and (2) provide an initial assessment of effect size as compared to a sham treatment. Thirty-seven subjects were randomized to receive either the real or sham APA treatment. All participants were treated once a week for 4 weeks. Self-report measures were obtained at baseline, weekly during treatment, at end-of-intervention (EOI), and at a 1-month follow-up. A dropout rate of 26% in the real APA group and 50% in the sham group was observed. The reduction in worst pain from baseline to EOI was 41% for the real and 5% for the sham group with a Cohen's effect size of 1.22 (P < 0.00). Disability scores on the Roland Morris Disability Questionnaire (RMDQ) decreased in the real group by 29% and were unchanged in the sham group (+3%) (P < 0.00). Given the high dropout rate, results must be interpreted with caution; nevertheless, our results suggest that APA may provide an inexpensive and effective complementary approach for the management of back pain in older adults, and further study is warranted.
... At present, no universally recognized treatment provides long-term relief from symptomatic IDD [27]. Common conservative therapies, often prescribed to temporize symptoms during acute episodes of back pain, have not proven effective for IDD. ...
... 26. History of, or current psychiatric condition, substance or alcohol abuse that would potentially interfere with the subject's participation in the study. 27. Ongoing or previous participation in another drug or device clinical study within the previous 2 months. ...
Assess the safety and efficacy of intradiscal fibrin sealant in adults with chronic discogenic low back pain.
Prospective, nonrandomized Food and Drug Administration approved pilot study.
Three centers in the United States.
Fifteen adults with chronic, single, or contiguous two-level lumbar discogenic pain confirmed through meticulous provocation discography.
Volume- and pressure-controlled intradiscal delivery of BIOSTAT BIOLOGX(®) Fibrin Sealant with the Biostat(®) Delivery Device into symptomatic lumbar disc(s).
Assessments were performed at baseline, 72 hours, and 1, 4, 13, 26, 52, and 104 weeks following intervention. Potential adverse events were evaluated with serial assessment of neurological status, radiographic, and magnetic resonance imaging (MRI). Efficacy measures included serial assessments of low back pain visual analog scale (VAS) measurements and the Roland-Morris Disability Questionnaire (RMDQ).
Safety neurological assessments, X-ray, and MRI showed no significant changes. Adverse events were reported in nine subjects. Two instances of low back muscle spasm and one case of discitis were the only events considered related to the procedure or product.
Mean low back pain VAS scores (mm) decreased from 72.4 (95% confidence interval 64.6-80.3) at baseline to 31.7 (17.4-46.1), 35.4 (17.7-53.1), and 33.0 (16.3-49.6); mean RMDQ score improved from 15.2 (12.7-17.7) at baseline to 8.9 (5.3-12.5), 6.2 (3.4-9.1), and 5.6 (2.9-8.4) at 26, 52, and 104 weeks, respectively.
Intradiscal injection of BIOSTAT BIOLOGX Fibrin Sealant with the Biostat Delivery Device appears safe and may improve pain and function in selected patients with discogenic pain.
... Many researchers of spine surgery have discussed the importance of evaluating costs as well as clinical outcomes. 16 This study is important because it could provide surgeons, hospitals, and patients another way to evaluate surgical options and costs. Better medical care decisions may then be made, ensuring advanced technology and quality of care while limiting high costs of spine surgery. ...
... Thus post-approval evaluations would serve well to also include measures of costs in addition to standard outcomes. 16 Estimated healthcare direct costs typically include cost to per- form the surgical procedure, cost of the instrumentation or technology, length of hospitalization, and length-of-stay days in the hospital. Also of interest are the indirect costs to payers that may include production losses such as the length of recumbency and time off work. ...
Background
We sought to evaluate the difference between hospital service costs of 2 treatment options for patients diagnosed with 3-level degenerative disc disease (DDD) in the lumbar spine. In this retrospective analysis, itemized billing records of hospital stay for patients with 3-level DDD treated with artificial disc replacement (ADR) were compared with those treated with circumferential fusion (standard of care).
... However, its usefulness in reducing symptoms related to chronic low back pain and improving functions was limited to a few months. In an American study, although there are numerous privatized yoga exercises for chronic low back pain for people with chronic low back and neck pain, none of them have been proven to be fully effective for chronic low back pain (Haldeman and Dagenais, 2008). Yoga and stretching exercises can be considered as a suitable activity to reduce moderate low back pain and to enable patients to participate in physical activity. ...
Low back pain, one of the skeletal and muscular system problems, is one of the most common chronic diseases in the world. Chronic low back pain is an important disorder that affects the daily, social, and work-life of individuals. The majority of people experience low back pain at least once in their life. In this sense, it affects both social and economic life. Low back pain can be acute or chronic, depending on the duration of the syndrome. Interventional, medication, rehabilitation, and exercise methods can be used in the treatment of chronic low back pain. In this study, it was investigated which exercise among the exercise models was more effective in the treatment of non-specific chronic low back pain. “Exercise” and “Chronic low back pain” were used as keywords in database searches. As treatment approaches, the effects of Abdominal Hypopressive exercise, Pilates, Yoga, Tai Chi, McKenzie, Gait, Dynamic and Static Stabilization Exercises, Motor Control and Gradual Activity Exercises in patients with low back pain were investigated. It has been determined that all the exercise models investigated reduce non-specific chronic low back pain and positively affect the mental state and quality of life of the patients. The fact remains that, it can be said that Pilates exercises come into prominence more than other exercises in terms of the stated effects.
... The clinical effects of diathermy are well documented, however there is a lack of clinical evidence from high-quality studies; Tecar therapy represents the technological evolution of diathermy [26][27][28]. Although Tecar has been widely used in physical therapy practise as a physical therapy agent for almost 20 years, there are only a few studies that have investigated its clinical efficacy [11,29]. ...
Background
Over the last 20 years, both diathermy and ultrasound have been popular choices for many clinicians in treating musculoskeletal disorders. However, there is a lack of clinical evidence of deep heating modalities to treat tendon pathology, There is no study to investigate the effects of such as physical modalities on morphological and elastic properties on the human tendons.
Objective
the objective of the present study was to compare the effects of diathermy and ultrasound therapies on cross sectional area, transversal height and hardness percentage of the non-insertional region of the Achilles tendon in able-bodied subjects.
Methods
healthy volunteers were divided in diathermy and ultrasound group received six 15-min treatment sessions. Before and after treatment a sonographic assessment was conducted by mean of ultrasonography and the following parameters were recorded: cross sectional area, transversal height and hardness percentage.
Results
thirty-two subjects were enrolled. Between-group comparisons showed a significant change on hardness percentage (p = 0.004) after treatment in diathermy therapy group. Within-group comparison showed a significant improvement in the hardness percentage for the diathermy (p = 0.001) and ultrasound (p = 0.046) after two weeks of treatment.
Conclusion
this pilot study demonstrated larger effects on morphological and elastic properties of the non-insertional region of the Achilles tendon after diathermy than ultrasound therapy in normal tendons. Diathermy may be a useful deep heat modality for treating non-insertional Achilles tendinopathy.
... Consequently, the evidence reported by previous research indicates that there is a large number of treatments for CLP because it is a serious problem for global public health (Katz, 2006). However, no single approach has been placed above the rest of the treatments since it has not yet been possible to determine which strategy is optimal (Haldeman & Dagenais, 2008;Henchoz & Kai-Lik, 2008). This situation makes it very difficult for doctors, physiotherapists, physical trainers, politicians, insurers, and the patients themselves to make decisions regarding which treatment or intervention is the most appropriate for the treatment of CLP and even more so in OAs (Searle et al., 2015). ...
The combined effect of a muscle strength training program with the previous application of a topical menthol gel on the intensity of chronic low back pain (CLP) and the functional capacity of overweight/obese older women was evaluated. A randomized controlled clinical trial with parallel group comparison was conducted. In Phase 1 (12-weeks), 31 women were randomly assigned: (i) a control group that did not change their habits (CG; n = 11); (ii) group of strength training prior to application of a gel with menthol (RTM; n = 10) and (iii) group that performed the same training prior to application of a placebo gel (RTP; n = 10). After 12 weeks of no training, phase 2 of the study (32-week duration) was run, where the RTM and RTP women were randomly reassigned. It was evaluated before and after each phase: body composition, functional capacity, pain perception and Oswestry disability index. The significance level established for the study was p ≤ .05. Both training groups significantly improved all variables after stages 1 and 2, with significant post-intervention differences but no significant intergroup differences, although RTM obtained better results. The percentage of improvement in pain perception and functional parameters were related to the intervention time without positive effects for CG. In conclusion, the use of menthol gel prior to a muscle strength program reduced pain and enhanced the functional improvements achieved as a result of moderate-high intensity training in older adult women with CLP and overweight or obesity.
... The disease is observed among to 80% of the population but is less prevalent than that in the lumbar area of the spinal column (Romanoff et al, 2004). When monitoring patients with CNP over a period of one to five years, we find out that at least half of them report for constant or repeated problems in this area (Haldeman, Dagenais, 2008). A number of anatomic-physiological and topo gra phic peculiarities of the neck area of the spinal column lead to its loading, proneness to damage, and compensatory possibilities (Grant, et al.,2002). ...
... Current evidence does not provide guidance in selecting an appropriate treatment approach or when specific treatments are warranted. There is no clarity about the best treatments, while many treatments are expensive and of unclear efficacy (9). The poor control of the pattern of activation of the deep muscles and an alteration of the trunk musculature, stability and control of altered vertebral column have been proposed as factors that contribute to the appearance of low back pain and its persistence (10)(11)(12). ...
Objective: To evaluate the impact of two therapeutic interventions in patients with non-specific low back pain. Materials and methods: Prospective study, in which in 20 subjects from both genders assigned through consecutive sampling of the two interventions: Group 1: 10 sessions of conventional physiotherapy treatment (CPT) (Ultrasound, TENS: Transcutaneous Electrical Nervous Stimulation y HWC: Hot Wet Compresses) and Group 2: 10 sessions of Motor Control Exercises (MCE). A numerical Pain Scale (NPS) was applied before and after each intervention. Results: In the first group, it was found a 20% decrease the pain scores after 10 sessions compared with the baseline measurements (before the intervention) (p=0.03). Similarly, in the second group, pain score dimished 42% respect to baseline values at the end of the 10 therapeutic sessions (p = 0.03). When comparing the two interventions, the MCE were more effective than the CPT, even from the first treatment session (p <0.05). Discussion: a significant reduction of pain was found in both groups, although this reduction was significantly in the group treated with MCE.
... Pain, reduced physical functioning and poor quality of life are the most common symptoms. However, effective treatment options are still lacking (Haldeman and Dagenais, 2008;The Pain Proposal Steering Committee 2010;Hoy et al., 2012), and effect sizes are relatively low for most available treatments including physical, pharmacological and surgical interventions (Van Middelkoop et al., 2011). Further evidence suggests that patients who seek medical attention attributed to the frequency or intensity of chronic back pain do not show substantial improvement compared with those who do not (Balagu e et al., 2012). ...
... 20 In alleviating disability, low velocity-variable amplitude spinal manipulation was superior to minimally conservative medical care at all end points (3, 6, 12, and 24 weeks), with high velocity-low amplitude spinal manipulation being superior to mini-mally conservative medical care at week 3. 20 The finding of this study concurs with those of 2 of the included studies in this review and further supports a mild treatment effect of spinal manipulation compared with other available therapies. 27,28 Two studies compared different forms of manual therapy, and no significant between-group differences in pain or disability were reported in both. 19,21 The study by Learman et al 21 had an intervention design in which clinicians used either a thrust technique or a nonthrust technique to best benefit the patient. ...
Objectives:
The aim of this study was to perform a systematic review of the literature of the effectiveness and safety of manual therapy interventions on pain and disability in older persons with chronic low back pain (LBP).
Methods:
A literature search of 4 electronic databases was performed (PubMed, EMBASE, OVID, and CINAHL). Inclusion criteria included randomized controlled trials of manual therapy interventions on older persons who had chronic LBP. Effectiveness was determined by extracting and examining outcomes for pain and disability, with safety determined by the report of adverse events. The PEDro scale was used for quality assessment of eligible studies.
Results:
The search identified 405 articles, and 38 full-text articles were assessed. Four studies met the inclusion criteria. All trials were of good methodologic quality and had a low risk of bias. The included studies provided moderate evidence supporting the use of manual therapy to reduce pain levels and alleviate disability.
Conclusions:
A limited number of studies have investigated the effectiveness and safety of manual therapy in the management of older people with chronic LBP. The current evidence to make firm clinical recommendations is limited. Research with appropriately designed trials to investigate the effectiveness and safety of manual therapy interventions in older persons with chronic LBP is required.
... Деякі з них повідомляють про ефективність методу [10][11][12][13][14], інші -заперечують цю ефективність [15], що зумовлює різні клінічні рекомендації. Так, в рекомендаціях щодо ведення пацієнтів при хронічному болю в спині, створених для системи охорони здоров'я Великої Британії (NICE -National Institute for Health and Clinical Excellence) є положення не направляти пацієнтів для лікування з застосуванням РЧД; тоді як американські автори з позицій доказової медицини рекомендують використання методу [16]. У наших спостереженнях тривалість лікування пацієнтів з застосуванням методу РЧД ДВС становила один день, контрольної групи -у середньому 28 днів. ...
Вступ. Висока частота дегенеративно-дистрофічного ураження хребта за недостатньої ефективності терапії спондилоартрозу зумовлює актуальність застосування при нижньопоперековому болю, спричиненому переважно спондилоартрозом, інноваційного мініінвазивного методу радіочастотної денервації (РЧД) дуговідросткових суглобів (ДВС).Мета. Визначити ефективність РЧД ДВС на підставі аналізу ранніх і віддалених результатів лікування хворих з приводу нижньопоперекового больового синдрому (НПБС) з переважанням ознак спондилоартрозу.Матеріали і методи. Проведений аналіз ранніх і віддалених результатів лікування з використанням методу РЧД за допомогою апарата RFG-1A/RFG-1B (фірми Radionics) 136 пацієнтів (73 чоловіків, 63 жінок, віком від 44 до 81 року) з приводу НПБС, у яких провідним клінічним проявом був артроз ДВС (основна група). Виразність больового синдрому оцінювали до операції, через 1 тиж після неї, через 3 міс і 1 рік після лікування. Використовували візуальну аналогову шкалу (ВАШ) болю та опитувальник індексу непрацездатності Освестрі.В контрольну групу включений 31 пацієнт (15 жінок, 16 чоловіків, віком від 42 до 83 років), яких з приводу НПБС з переважанням ознак спондилоартрозу лікували консервативно.Результати. Відразу після лікування статистично значущий ефект досягнутий як в основній, так і контрольній групі при всіх структурно-морфологічних змінах хребта (крім хворих контрольної групи, у яких спондилоартроз поєднувався з стенозом хребтового каналу, спондилолістезом та великими грижами міжхребцевих дисків) як за індексом непрацездатності Освестрі, так і за ВАШ болю. Через 3 міс та 1 рік після лікування статистично значущий ефект спостерігали лише в основній групі, що свідчило про високу ефективність методу РЧД ДВС.Висновок. Аналіз ранніх та віддалених результатів лікування хворих з приводу НПБС з переважанням ознак спондилоартрозу свідчить про ефективність та безпечність РЧД ДВС. Метод доцільно включити в алгоритм лікування фасеткового синдрому за неефективності консервативного лікування.
... Forty-eight systematic reviews, meta-analyses and guidelines on non-pharmacological CLBP treatments, plus a special issue of Spine Journal [67], revealed no treatment that consistently provides superior results for the treatment of CLBP. Overall positive recommendations exist for exercise therapy, massage, various forms of physiotherapy, cognitive behavioural therapy and, in particular, a multi-disciplinary approach. ...
Background
Low back pain causes more global disability than any other condition. Once the acute pain becomes chronic, about two-thirds of sufferers will not fully recover after 1–2 years. There is a paucity of effective treatments for non-specific, chronic low back pain.
It has been noted that low back pain is associated with changes in the connective tissue in the affected area, and a very low-impact treatment, Esoteric Connective Tissue Therapy (ECTT), has been developed to restore flexibility in connective tissue. ECTT uses patterns of very small, circular movements, to the legs, arms, spine, sacrum and head, which anecdotally are effective in pain relief. In an unpublished single-arm phase I/II trial with chronic pain patients, ECTT showed a 56% reduction in pain after five treatments and 45% and 54% improvements at 6 months and 7–9 years of follow-up respectively.
Methods
The aim of this randomised controlled trial is to compare ECTT with physiotherapy for reducing pain and improving physical function and physical and mental well-being in patients with chronic low back pain.
The trial will be held at two hospitals in Vietnam. One hundred participants with chronic low back pain greater than or equal to 40/100 on the visual analogue scale will be recruited and randomised to either ECTT or physiotherapy. Four weekly treatments will be provided by two experienced ECTT practitioners (Treatment Group, 40 minutes each) and hospital-employed physiotherapy nurses (Control Group, 50 minutes).
The primary outcomes will be changes in pain, physical function per the Quebec Pain Functionality Questionnaire and physical and mental well-being recorded by the Short Form Health Survey (SF-36), with mixed modelling used as the primary statistical tool because the data are longitudinal. Initial follow-up will be at either 4 or 8 months, with a second follow-up after 12 months.
Discussion
The trial design has important strengths, because it is to be conducted in hospitals under medical supervision, because ECTT is to be compared with a standard therapy and because the assessor and analyst are to be blinded. The findings from this trial will provide evidence of the efficacy of ECTT for chronic low back pain compared with standard physiotherapy treatment.
Trial registration
Australian New Zealand Clinical Trials Registry, ACTRN12616001196437. Registered on 30 August 2016.
Electronic supplementary material
The online version of this article (doi:10.1186/s13063-017-2055-8) contains supplementary material, which is available to authorized users.
... Providers often demonstrate limited knowledge of LBP diagnoses and treatment (Buchbinder, Staples, & Jolley, 2009;Cayea, Perera, & Weiner, 2006). Hundreds of treatments for LBP exist (Haldeman & Dagenais, 2008), with guidelines endorsing self-care, medication, physical therapy, exercise, spinal manipulation, and other treatments (Chou et al., 2007). Providers may not understand how to select or integrate musculoskeletal treatments from other clinicians with the services they offer (Frenkel & Borkan, 2003;Penney et al., 2016). ...
Purpose
Older adults seek health care for low back pain from multiple providers who may not coordinate their treatments. This study evaluated the perceived feasibility of a patient-centered practice model for back pain, including facilitators for interprofessional collaboration between family medicine physicians and doctors of chiropractic.
Design and Methods
This qualitative evaluation was a component of a randomized controlled trial of 3 interdisciplinary models for back pain management: usual medical care; concurrent medical and chiropractic care; and collaborative medical and chiropractic care with interprofessional education, clinical record exchange, and team-based case management. Data collection included clinician interviews, chart abstractions, and fieldnotes analyzed with qualitative content analysis. An organizational-level framework for dissemination of health care interventions identified norms/attitudes, organizational structures and processes, resources, networks–linkages, and change agents that supported model implementation.
Results
Clinicians interviewed included 13 family medicine residents and 6 chiropractors. Clinicians were receptive to interprofessional education, noting the experience introduced them to new colleagues and the treatment approaches of the cooperating profession. Clinicians exchanged high volumes of clinical records, but found the logistics cumbersome. Team-based case management enhanced information flow, social support, and interaction between individual patients and the collaborating providers. Older patients were viewed positively as change agents for interprofessional collaboration between these provider groups.
Implications
Family medicine residents and doctors of chiropractic viewed collaborative care as a useful practice model for older adults with back pain. Health care organizations adopting medical and chiropractic collaboration can tailor this general model to their specific setting to support implementation.
... For example, massage, needle acupuncture, yoga, and herbal medicines are widely prescribed for the management of chronic LBP, and their use is supported by a large body of evidence. [2][3][4][5] In Japan, Kampo medicine is a traditional therapeutic method that is widely practiced. Moreover, along with Western medicines, it is available as a medical service under the national health insurance scheme. ...
Objectives:
Low back pain (LBP) is a chronic condition. Although Western treatments are available, Kampo (traditional Japanese) medicine is widely prescribed and covered by health insurance in Japan. Goshajinkigan (GJG), a Kampo formula, is commonly used to treat LBP. However, cases we have occasionally been encountered in which GJG did not show the expected effects. Hence, the purpose of this retrospective study was to investigate patient factors important in developing the effects of GJG.
Methods:
This was a retrospective observational study based at the Center for Kampo Medicine, Keio University Hospital. Data were retrieved from the medical records of 28 patients who visited our hospital between May 2008 and March 2013 and who received GJG for LBP. The patients were divided into responders and non-responders based on whether their LBP improved post treatment. The groups were compared with respect to daily GJG dose, incidence of spine disease, and side effects.
Results:
Ten patients (responders) reported an improvement in LBP within 6 months. One patient experienced decreased appetite as a side effect. Nine patients reported no improvement (non-responders). The number of patients prescribed the usual daily dose of GJG (7.5 g) was significantly higher among responders than it was among non-responders (p = 0.023), and the number of patients with spine disease was significantly greater among non-responders than it was among responders (p = 0.020). The number of patients with spinal stenosis was significantly higher among non-responders than it was among responders (p = 0.011). Therefore, the usual daily dose of GJG provided significant relief of LBP, particularly in patients without any spine disease.
Conclusions:
Routine daily administration of GJG in patients without spine disease seems to lead to the effects of the product. However, further investigations using the above-mentioned parameters are needed to confirm these findings.
... 16,17 Guiding principles behind evidence-informed practice are the use of research evidence when available and personal recommendations that are based on clinical experience, but practitioners retain transparency about the process used to reach their clinical decisions. 15 While this decisionmaking process is used and promoted by all professionals to improve the care of patients, this approach should also include some form of critical appraisal that may not always be available for clinicians. A challenge of this approach is the type of methodology used to build the evidence, especially when treatment deals with complex interventions, such as osteopathy, that were evaluated within a pharmacological paradigm in the past. ...
... In 2005, the third edition of the Principles and Practice text was published and was now more than 1200 pages, twice the size of the second edition. 28 In 2006, Simon Dagenais, DC, PhD, and I proposed to the NASS that a supplement in The Spine Journal be considered for a group of articles on "Evidence Informed Management of Chronic Low Back Pain." 29,30 The NASS did not flinch at the fact that 2 editors of this supplement had chiropractic degrees, and it was rapidly approved and published in 2008. The success of this supplement, which remains one of the most cited set of articles ever published in that journal, was followed by an invitation to edit a textbook on "Evidence Based Management of Low Back Pain." 31 We have been told that this book has become a principal reference text in a number of orthopedic surgical residency programs. ...
The McAndrews Leadership Lecture was developed by the American Chiropractic Association to honor the legacy of Jerome F. McAndrews, DC, and George P. McAndrews, JD, and their contributions to the chiropractic profession. This article is a transcription of the presentation made by Dr Scott Haldeman on February 28, 2015, in Washington, DC, at the National Chiropractic Leadership Conference.
... Chronic low back pain (CLBP) is a major health problem worldwide and is associated with high medical costs, lost productivity, and long-term disability [1][2][3]. Although various standard pharmacologic and nonpharmacologic treatments have been proposed to alleviate CLBP, their effectiveness is limited [4]. The growing prevalence of CLBP and the limited treatments available underscore an increasing need for complementary therapies, which is reflected by more than one-third of adults with low back pain in the United States who have been treated by an integrative medicine provider over the past decade [5][6][7]. ...
Background. Auricular point acupressure (APA) is a promising treatment for pain management. Few studies have investigated the physiological mechanisms of APA analgesics. Method. In this pilot randomized clinical trial (RCT), a 4-week APA treatment was used to manage chronic low back pain (CLBP). Sixty-one participants were randomized into a real APA group () or a sham APA group (). Blood samples, pain intensity, and physical function were collected at baseline and after 4 weeks of treatment. Results. Subjects in the real APA group reported a 56% reduction of pain intensity and a 26% improvement in physical function. Serum blood samples showed (1) a decrease in IL-1β, IL-2, IL-6, and calcitonin gene-related peptide [CGRP] and (2) an increase in IL-4. In contrast, subjects in the sham APA group (1) reported a 9% reduction in pain and a 2% improvement in physical function and (2) exhibited minimal changes of inflammatory cytokines and neuropeptides. Statistically significant differences in IL-4 and CGRP expression between the real and sham APA groups were verified. Conclusion. These findings suggest that APA treatment affects pain intensity through modulation of the immune system, as reflected by APA-induced changes in serum inflammatory cytokine and neuropeptide levels.
... The effects of CLBP place an enormous burden on society and healthcare systems in the United States, as reflected by medical care costs and disability-related loss of productivity and wages [6][7][8]. A variety of approaches (i.e., analgesics, education, exercise, spinal manipulation, massage, or acupuncture) have been suggested as reasonable modalities for management of CLBP, but these treatments have had limited efficacy [9]. Analgesics are the most common methods used to treat CLBP but are associated with a variety of adverse side effects [10,11]. ...
Objective
The purpose of this study was to determine the effects of a 4-week auricular point acupressure (APA) treatment on chronic low back pain (CLBP) outcomes and examine the day-to-day variability of CLBP in individuals receiving APA for CLBP over 29 days.DesignThis was a prospective, randomized controlled trial (RCT). Data were collected at baseline, during each of the four office visits for APA treatment, after the completion of the 4-week intervention, and 1 month after the last treatment. A daily diary was given to each participant to record his or her APA practices, analgesic use, and pain intensity.InterventionsAPA was used to manage CLBP. The participants received one APA treatment per week for 4 weeks.Patients and Setting. Sixty-one participants with CLBP were randomized into either a real APA or sham APA treatment group. Participants were recruited from primary care offices and clinics or through the Research Participant Registry at the University of Pittsburgh.ResultsAmong participants in the real APA group, a 30% reduction of worst pain was exhibited after the first day of APA treatment, and continuous reduction in pain (44%) was reported by the completion of the 4-week APA. This magnitude of pain reduction reached the clinically significant level of improvement reported in other clinical trials of chronic pain therapies. Analgesic use by participants in the real APA group also was reduced compared with use by participants in the sham group.Conclusion
This study shows that APA is a promising pain management strategy that is not invasive and can be self-managed by participants for CLBP. Given the day-to-day fluctuation in ratings, the tighter ecologic assessment of pain scores and other treatment parameters are an important pragmatic aspect of the design of chronic pain studies.
... Many types of treatment for low back pain have been recommended [2,6,7]. Exercise therapy is widely used and recommended as a conservative therapy for chronic nonspecific but not for acute LBP. ...
The vertical orientation of the body in the upright standing position is maintained by keeping the body's centre of gravity (COG) upright, above the base of support, by a dynamic interplay of visual, vestibular, and somatosensory control systems. The objectives of this study were: to compare the postural control strategy between people with and without low back pain (LBP), to estimate the influence of the stretching therapy on the postural control strategy, and to discover the relationship between the restriction of spine mobility and occurrence of some ergonomic factors.
The study consisted of 32 patients with LBP and 25 healthy controls. Postural characteristics of the subjects were measured with the use of a computerized force platform. The software programme filters and measures COG sway velocity in different conditions. Additional measurements and tests were conducted in patients after stretching therapy. Based on survey research, all individuals were selected and evaluated from the aspect of ergonomics.
The results of the COG sway velocity vary under the testing conditions. From the aspect of ergonomic attitude and influence of the rehabilitation, results varied in the groups.
Ergonomic factors are often accompanied by the appearance of LBP. The restrictions within the musculoskeletal system cause disorders in muscle synergies, which is expressed by an increase in the angular velocity of the COG. In patients with chronic back pain syndrome, selected stretching therapy techniques improves the range of motion of the spine and reduces pain.
... Последние публикации относительно тактики ведения пациентов с хронической болью в спине допускают (однако без четкого указания на уровень доказательности) применение РЧД фасеточных суставов у пациентов с положительным эффектом в виде полного или почти полного регресса боли после проведения блокады медиальной ветви с местным анестетиком под контролем визуализации. Минимально инвазивные внутридисковые воздействия рекомендуются при протрузии дисков менее 4-6 мм или невыраженном стенозе перед решением вопроса о проведении спондилодеза или артропластики [40]. С точки зрения оптимизации подходов к лечению пациентов с хронической болью в спине заслуживают внимания данные критического анализа эффективности отдельных методов лечения хронической «неспецифической» боли в спине. ...
The paper gives an account of approaches to treating patients with acute and chronic back pain in the context of evidence-based medicine and current clinical guidelines. In the vast majority, acute back pain is a benign self-limiting condition (nonspecific musculoskeletal pain) and most patients need additional instrumental examinations. An active approach to treatment is considered to be optimal. It is expedient to apply a more differential approach involving the refinement of mechanisms for development of the pain syndrome and the elaboration of treatment strategy in relation to the leading pathophysiological mechanism when examining the patients with chronic back pain.
... Yoga is a mind-body practice originating from ancient India which has also become popular in the West over the last century (Saper 2004). There are many branches and styles of yoga practice, with varying philosophies and practices, but all may be characterized by the integration of physical poses (asanas) and controlled breathing (pranayama), and frequently also the incorporation of meditation (dhyana) (Hewitt 2001;Hayes 2010) Therapeutic yoga is the use of yoga to help people with health problems manage their condition and reduce their symptoms (International Association of Yoga Therapists 2016). Yoga has been suggested as being useful in managing pain and associated disability across a range of conditions, including back pain (McCall 2007;. ...
This is the protocol for a review and there is no abstract. The objectives are as follows:To assess the effects of yoga for treating chronic non-specific low-back pain, compared to no specific treatment, a minimal intervention (e.g., education), or another active treatment, with a focus on both pain and function.
... N eck pain is a common condition, with a 12-month prevalence of 30% to 50% and rates of activity-limiting pain of 1.7% to 11.5%, 1 and it accounts for more than 10 million ambulatory medical care visits per year in the United States. 2 At least one-half of persons with neck pain report persistent or recurrent neck problems at 1 to 5 years of follow-up. 3,4 Neck pain is the eighth leading cause of disability in the United States 5 and fourth worldwide. 6 It is the second leading reason for use of complementary and alternative medicine (CAM), 7 with chiropractic and massage most commonly used. ...
Purpose:
This trial was designed to evaluate the optimal dose of massage for individuals with chronic neck pain.
Methods:
We recruited 228 individuals with chronic nonspecific neck pain from an integrated health care system and the general population, and randomized them to 5 groups receiving various doses of massage (a 4-week course consisting of 30-minute visits 2 or 3 times weekly or 60-minute visits 1, 2, or 3 times weekly) or to a single control group (a 4-week period on a wait list). We assessed neck-related dysfunction with the Neck Disability Index (range, 0-50 points) and pain intensity with a numerical rating scale (range, 0-10 points) at baseline and 5 weeks. We used log-linear regression to assess the likelihood of clinically meaningful improvement in neck-related dysfunction (≥5 points on Neck Disability Index) or pain intensity (≥30% improvement) by treatment group.
Results:
After adjustment for baseline age, outcome measures, and imbalanced covariates, 30-minute treatments were not significantly better than the wait list control condition in terms of achieving a clinically meaningful improvement in neck dysfunction or pain, regardless of the frequency of treatments. In contrast, 60-minute treatments 2 and 3 times weekly significantly increased the likelihood of such improvement compared with the control condition in terms of both neck dysfunction (relative risk = 3.41 and 4.98, P = .04 and .005, respectively) and pain intensity (relative risk = 2.30 and 2.73; P = .007 and .001, respectively).
Conclusions:
After 4 weeks of treatment, we found multiple 60-minute massages per week more effective than fewer or shorter sessions for individuals with chronic neck pain. Clinicians recommending massage and researchers studying this therapy should ensure that patients receive a likely effective dose of treatment.
... The therapeutic and restorative benefit of chiropractic on functional abilities has been wellestablished in clinical efficacy studies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). However, what is not known is the comparative effectiveness of chiropractic vs. other common medical treatments for similar clinical conditions over time, especially among Medicare beneficiaries receiving their care in everyday practice settings. ...
Objectives
The comparative effect of chiropractic vs medical care on health, as used in everyday practice settings by older adults, is not well understood. The purpose of this study is to examine how chiropractic compares to medical treatment in episodes of care for uncomplicated back conditions. Episodes of care patterns between treatment groups are described, and effects on health outcomes among an older group of Medicare beneficiaries over a 2-year period are estimated.
Methods
Survey data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old were linked to participants' Medicare Part B claims under a restricted Data Use Agreement with the Centers for Medicare and Medicaid Services. Logistic regression was used to model the effect of chiropractic use in an episode of care relative to medical treatment on declines in function and well-being among a clinically homogenous older adult population. Two analytic approaches were used, the first assumed no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.
Results
Episodes of care between treatment groups varied in duration and provider visit pattern. Among the unadjusted models, there was no significant difference between chiropractic and medical episodes of care. The propensity score results indicate a significant protective effect of chiropractic against declines in activities of daily living (ADLs), instrumental ADLs, and self-rated health (adjusted odds ratio [AOR], 0.49; AOR, 0.62; and AOR, 0.59, respectively). There was no difference between treatment types on declines in lower body function or depressive symptoms.
Conclusion
The findings from this study suggest that chiropractic use in episodes of care for uncomplicated back conditions has protective effects against declines in ADLs, instrumental ADLs, and self-rated health for older Medicare beneficiaries over a 2-year period.
... These functional deficits can have adverse psychological and emotional consequences as well [4]. Despite a wide variety of treatment options, chronic low back pain can be difficult and costly to treat, and 17% of U.S. adults turn to some form of complementary and alternative medicine to address their back pain [5][6][7][8]. ...
An estimated 70% of people will experience low back pain at some point in their lives, and recurrence rates can be as high as 85%. Recent studies suggest that yoga – a widely practiced physical/mental discipline – may relieve back pain and reduce functional disability. The objective of this study was to conduct a systematic review and meta-analysis of the existing research on the effects of yoga on chronic low back pain and function. Our literature search began April 2011 and continued through October 2011. Cochrane, PubMed, CINAHL, Embase, ProQuest Dissertations and Theses, Google Scholar, and Clinicaltrials.gov databases were searched electronically. The search terms used were: yoga AND back pain. A total of 58 relevant studies were originally identified through the database searches. Of those, 45 were excluded on the basis of the title and/or review of the abstract. The 13 remaining studies were fully evaluated via a careful review of the full text. On the basis of the inclusion and exclusion criteria, 6 studies were excluded, leaving a total of 7 studies to be included in the meta-analyses of the impact of yoga on low back pain and function. Effect sizes were calculated as the standardized mean difference and meta-analyses were completed using a random-effects model. Overall, yoga was found to result in a medium, beneficial effect on chronic low back pain [overall effect size (ES) = 0.58, p<0.001], indicating that subjects practicing yoga reported significantly less pain than control subjects. Yoga subjects also reported significantly less functional disability after the intervention (overall ES = 0.53, p<0.001). Moreover, the improvements in pain and function for yoga subjects remained statistically significant 12-24 weeks after the end of the intervention (overall ES = 0.44-0.54, p≤0.002). In conclusion, yoga practice can significantly reduce pain and increase functional ability in chronic low back pain patients.
Objectives
Low back pain (LBP) is the number one cause of disability world-wide. It is also the most expensive area in healthcare. Patient-centered innovations are needed. This paper uses medical storytelling to illustrate the common problems that often lead to unnecessary suffering for patients, and costs to society. We present innovative solutions, including narrative interventions.
Methods
We use medical storytelling to present a scenario in which hypothetical twin patients with identical LBP episodes enter the healthcare system, with one twin managed in an appropriate manner, and the other inappropriately.
Results
One twin becomes a chronic LBP sufferer, while the other experiences quick resolution, despite identical conditions. Recommendations are made to de-implement inappropriate action and to implement a more productive approach.
Conclusions
Many patients with LBP descend into chronic pain. This is rarely inevitable based on clinical factors. Much of chronic LBP results from how the condition is handled within the healthcare system. Medical narrative may be one innovation to illustrate the problem of current LBP management, recommend solutions and foster changes in clinical behavior.
Practical implications
The starkly different outcomes for each identical twin are illustrated. Recommendations are made for reframing the situation to de-implement the inappropriate and to implement a more appropriate approach.
Objective
The purpose of this study was to describe changes in opioid-therapy prescription rates after a family medicine practice included on-site chiropractic services.
Methods
The study design was a retrospective analysis of opioid prescription data. The database included opioid prescriptions written for patients seeking care at the family medicine practice from April 2015 to September 2018. In June 2016, the practice reviewed and changed its opioid medication practices. In April 2017, the practice included on-site chiropractic services. Opiod-therapy use was defined as the average rate of opioid prescriptions over all medical providers at the practice.
Results
There was a significant decrease of 22% in the average monthly rate of opioid prescriptions after the inclusion of chiropractic services (F1,40 = 10.69; P < .05). There was a significant decrease of 32% in the prescribing rate of schedule II opioids after the inclusion of chiropractic services (F2,80 = 6.07 for the Group × Schedule interaction; P < .05). The likelihood of writing schedule II opioid prescriptions decreased by 27% after the inclusion of chiropractic services (odds ratio, 0.73; 95% confidence interval, 0.59-0.90). Changes in opioid medication practices by the medical providers included prescribing a schedule III or IV opioid rather than a schedule II opioid (F6,76 = 29.81; P < .05) and a 30% decrease in the daily doses of opioid prescriptions (odds ratio, 0.70; 95% confidence interval, 0.50-0.98).
Conclusion
This study demonstrates that there were decreases in opioid-therapy prescribing rates after a family medicine practice included on-site chiropractic services. This suggests that inclusion of chiropractic services may have had a positive effect on prescribing behaviors of medical physicians, as they may have been able to offer their patients additional nonpharmaceutical options for pain management.
Background:
This is an update of a Cochrane Review published in 2014. Chronic non-specific low back pain (LBP) has become one of the main causes of disability in the adult population around the world. Although therapeutic ultrasound is not recommended in recent clinical guidelines, it is frequently used by physiotherapists in the treatment of chronic LBP.
Objectives:
The objective of this review was to determine the effectiveness of therapeutic ultrasound in the management of chronic non-specific LBP. A secondary objective was to determine the most effective dosage and intensity of therapeutic ultrasound for chronic LBP.
Search methods:
We performed electronic searches in CENTRAL, MEDLINE, Embase, CINAHL, PEDro, Index to Chiropractic Literature, and two trials registers to 7 January 2020. We checked the reference lists of eligible studies and relevant systematic reviews and performed forward citation searching.
Selection criteria:
We included randomised controlled trials (RCTs) on therapeutic ultrasound for chronic non-specific LBP. We compared ultrasound (either alone or in combination with another treatment) with placebo or other interventions for chronic LBP.
Data collection and analysis:
Two review authors independently assessed the risk of bias of each trial and extracted the data. We performed a meta-analysis when sufficient clinical and statistical homogeneity existed. We determined the certainty of the evidence for each comparison using the GRADE approach.
Main results:
We included 10 RCTs involving a total of 1025 participants with chronic LBP. The included studies were carried out in secondary care settings in Turkey, Iran, Saudi Arabia, Croatia, the UK, and the USA, and most applied therapeutic ultrasound in addition to another treatment, for six to 18 treatment sessions. The risk of bias was unclear in most studies. Eight studies (80%) had unclear or high risk of selection bias; no studies blinded care providers to the intervention; and only five studies (50%) blinded participants. There was a risk of selective reporting in eight studies (80%), and no studies adequately assessed compliance with the intervention. There was very low-certainty evidence (downgraded for imprecision, inconsistency, and limitations in design) of little to no difference between therapeutic ultrasound and placebo for short-term pain improvement (mean difference (MD) -7.12, 95% confidence interval (CI) -17.99 to 3.75; n = 121, 3 RCTs; 0-to-100-point visual analogue scale (VAS)). There was also moderate-certainty evidence (downgraded for imprecision) of little to no difference in the number of participants achieving a 30% reduction in pain in the short term (risk ratio 1.08, 95% CI 0.81 to 1.44; n = 225, 1 RCT). There was low-certainty evidence (downgraded for imprecision and limitations in design) that therapeutic ultrasound has a small effect on back-specific function compared with placebo in the short term (standardised mean difference -0.29, 95% CI -0.51 to -0.07 (MD -1.07, 95% CI -1.89 to -0.26; Roland Morris Disability Questionnaire); n = 325; 4 RCTs), but this effect does not appear to be clinically important. There was moderate-certainty evidence (downgraded for imprecision) of little to no difference between therapeutic ultrasound and placebo on well-being (MD -2.71, 95% CI -9.85 to 4.44; n = 267, 2 RCTs; general health subscale of the 36-item Short Form Health Survey (SF-36)). Two studies (n = 486) reported on overall improvement and satisfaction between groups, and both reported little to no difference between groups (low-certainty evidence, downgraded for serious imprecision). One study (n = 225) reported on adverse events and did not identify any adverse events related to the intervention (low-certainty evidence, downgraded for serious imprecision). No study reported on disability for this comparison. We do not know whether therapeutic ultrasound in addition to exercise results in better outcomes than exercise alone because the certainty of the evidence for all outcomes was very low (downgraded for imprecision and serious limitations in design). The estimate effect for pain was in favour of the ultrasound plus exercise group (MD -21.1, 95% CI -27.6 to -14.5; n = 70, 2 RCTs; 0-to-100-point VAS) at short term. Regarding back-specific function (MD - 0.41, 95% CI -3.14 to 2.32; n = 79, 2 RCTs; Oswestry Disability Questionnaire) and well-being (MD -2.50, 95% CI -9.53 to 4.53; n = 79, 2 RCTs; general health subscale of the SF-36), there was little to no difference between groups at short term. No studies reported on the number of participants achieving a 30% reduction in pain, patient satisfaction, disability, or adverse events for this comparison.
Authors' conclusions:
The evidence from this systematic review is uncertain regarding the effect of therapeutic ultrasound on pain in individuals with chronic non-specific LBP. Whilst there is some evidence that therapeutic ultrasound may have a small effect on improving low back function in the short term compared to placebo, the certainty of evidence is very low. The true effect is likely to be substantially different. There are few high-quality randomised trials, and the available trials were very small. The current evidence does not support the use of therapeutic ultrasound in the management of chronic LBP.
Висока розповсюдженість дегенеративно-дистрофічного ураження хребта та мала ефектив ність терапії спондилоартрозу робить актуальним дослідження підходів до лікування пацієн тів із нижньопоперековим болем, зумовленим переважно спондилоартрозом.
Мета дослідження – визначити ефективність радіочастотної денервації дуговідросткових (фасеткових) суглобів (РЧД ДВС) у вигляді монотерапії та в поєднані з періартикулярним введенням місцевих анестетиків і стероїдних препаратів у лікуванні хворих із нижньопопере ковим больовим синдромом (НПБС), в яких переважають явища спондилоартрозу.
Матеріал і методи. З використанням методу РЧД ДВС за допомогою апарата RFG-1A/RFG- 1B (Radionics) прооперовано 136 пацієнтів (73 чоловіки та 63 жінки, віком від 44 до 81 року) з приводу НПБС, у яких провідним клінічним проявом був артроз дуговідросткових суглобів (основна група). Для 31 пацієнта (15 жінок і 16 чоловіків, віком від 42 до 83 років), включених до контрольної групи, використовували консервативні методи лікування: нестероїдні проти запальні препарати, судинну, відновну та дегідратаційну терапію, фізіотерапію, ЛФК, масаж, голкотерапію. Також проаналізовано ранні та віддалені результати лікування 78 пацієнтів (37 чоловіків і 41 жінка, віком від 51 до 79 років) з НПБС, в яких провідним клінічним проявом був артроз дуговідросткових суглобів (друга основна група), та яким було проведено РЧД ДВС у поєднанні з періартикулярним введенням місцевого анестетика та стероїдного препа рату. У цьому фрагменті дослідження контрольну групу склали 136 пацієнтів (73 чоловіків і 63 жінки, віком від 44 до 81 років) з нижньопоперековим болем, в яких домінували явища спондилоартрозу та які лікувалися виключно за допомогою методу РЧД ДВС. Оцінку больо вого синдрому проводили чотири рази – в передопераційний, поопераційний період (протя гом тижня), через три місяці та через один рік після лікування за візуальною аналоговою шкалою (ВАШ) болю та опитувальником індексу непрацездатності Освестрі.
Результати. Вірогідно ліпші результати в ранній період отримано в групі пацієнтів, яким поєднували РЧД ДВС із періартикулярним введення місцевого анестетика та стероїдного пре парату. Натомість у віддалений період (через 1 рік після лікування) в основній і контрольній групі результати не різнились.
Висновки. Отримані результати лікування в ранній і віддалений поопераційний період свід чать про ефективність і безпечність як самої РЧД ДВС, так і її поєднання з періартикулярним введенням місцевого анестетика та стероїдного препарату в хворих із НПБС, в яких доміну ють явища спондилоартрозу. Обидві методики можуть бути рекомендованими до включення в алгоритм лікування фасеткового синдрому за неефективності консервативної терапії.
Background: Although regional socioeconomic (SE) factors have been associated with worse health outcomes, prior studies have not addressed important confounders or work disability.
Methods: A national sample of 59 360 workers’ compensation (WC) cases to evaluate impact of regional SE factors on medical costs and length of disability (LOD) in occupational low back pain (LBP).
Results: Lower neighborhood median household incomes (MHI) and higher state unemployment rates were associated with longer LOD. Medical costs were lower in states with more workers receiving Social Security Disability, and in areas with lower MHI, but this varied in magnitude and direction among neighborhoods. Medical costs were higher in more urban, more racially diverse, and lower education neighborhoods.
Conclusions: Regional SE disparities in medical costs and LOD occur even when health insurance,
health care availability, and indemnity benefits are similar. Results suggest opportunities to
improve care and disability outcomes through targeted health care and disability interventions.
Background:
Non-specific low back pain is a common, potentially disabling condition usually treated with self-care and non-prescription medication. For chronic low back pain, current guidelines state that exercise therapy may be beneficial. Yoga is a mind-body exercise sometimes used for non-specific low back pain.
Objectives:
To assess the effects of yoga for treating chronic non-specific low back pain, compared to no specific treatment, a minimal intervention (e.g. education), or another active treatment, with a focus on pain, function, and adverse events.
Search methods:
We searched CENTRAL, MEDLINE, Embase, five other databases and four trials registers to 11 March 2016 without restriction of language or publication status. We screened reference lists and contacted experts in the field to identify additional studies.
Selection criteria:
We included randomized controlled trials of yoga treatment in people with chronic non-specific low back pain. We included studies comparing yoga to any other intervention or to no intervention. We also included studies comparing yoga as an adjunct to other therapies, versus those other therapies alone.
Data collection and analysis:
Two authors independently screened and selected studies, extracted outcome data, and assessed risk of bias. We contacted study authors to obtain missing or unclear information. We evaluated the overall certainty of evidence using the GRADE approach.
Main results:
We included 12 trials (1080 participants) carried out in the USA (seven trials), India (three trials), and the UK (two trials). Studies were unfunded (one trial), funded by a yoga institution (one trial), funded by non-profit or government sources (seven trials), or did not report on funding (three trials). Most trials used Iyengar, Hatha, or Viniyoga forms of yoga. The trials compared yoga to no intervention or a non-exercise intervention such as education (seven trials), an exercise intervention (three trials), or both exercise and non-exercise interventions (two trials). All trials were at high risk of performance and detection bias because participants and providers were not blinded to treatment assignment, and outcomes were self-assessed. Therefore, we downgraded all outcomes to 'moderate' certainty evidence because of risk of bias, and when there was additional serious risk of bias, unexplained heterogeneity between studies, or the analyses were imprecise, we downgraded the certainty of the evidence further.For yoga compared to non-exercise controls (9 trials; 810 participants), there was low-certainty evidence that yoga produced small to moderate improvements in back-related function at three to four months (standardized mean difference (SMD) -0.40, 95% confidence interval (CI) -0.66 to -0.14; corresponding to a change in the Roland-Morris Disability Questionnaire of mean difference (MD) -2.18, 95% -3.60 to -0.76), moderate-certainty evidence for small to moderate improvements at six months (SMD -0.44, 95% CI -0.66 to -0.22; corresponding to a change in the Roland-Morris Disability Questionnaire of MD -2.15, 95% -3.23 to -1.08), and low-certainty evidence for small improvements at 12 months (SMD -0.26, 95% CI -0.46 to -0.05; corresponding to a change in the Roland-Morris Disability Questionnaire of MD -1.36, 95% -2.41 to -0.26). On a 0-100 scale there was very low- to moderate-certainty evidence that yoga was slightly better for pain at three to four months (MD -4.55, 95% CI -7.04 to -2.06), six months (MD -7.81, 95% CI -13.37 to -2.25), and 12 months (MD -5.40, 95% CI -14.50 to -3.70), however we pre-defined clinically significant changes in pain as 15 points or greater and this threshold was not met. Based on information from six trials, there was moderate-certainty evidence that the risk of adverse events, primarily increased back pain, was higher in yoga than in non-exercise controls (risk difference (RD) 5%, 95% CI 2% to 8%).For yoga compared to non-yoga exercise controls (4 trials; 394 participants), there was very-low-certainty evidence for little or no difference in back-related function at three months (SMD -0.22, 95% CI -0.65 to 0.20; corresponding to a change in the Roland-Morris Disability Questionnaire of MD -0.99, 95% -2.87 to 0.90) and six months (SMD -0.20, 95% CI -0.59 to 0.19; corresponding to a change in the Roland-Morris Disability Questionnaire of MD -0.90, 95% -2.61 to 0.81), and no information on back-related function after six months. There was very low-certainty evidence for lower pain on a 0-100 scale at seven months (MD -20.40, 95% CI -25.48 to -15.32), and no information on pain at three months or after seven months. Based on information from three trials, there was low-certainty evidence for no difference in the risk of adverse events between yoga and non-yoga exercise controls (RD 1%, 95% CI -4% to 6%).For yoga added to exercise compared to exercise alone (1 trial; 24 participants), there was very-low-certainty evidence for little or no difference at 10 weeks in back-related function (SMD -0.60, 95% CI -1.42 to 0.22; corresponding to a change in the Oswestry Disability Index of MD -17.05, 95% -22.96 to 11.14) or pain on a 0-100 scale (MD -3.20, 95% CI -13.76 to 7.36). There was no information on outcomes at other time points. There was no information on adverse events.Studies provided limited evidence on risk of clinical improvement, measures of quality of life, and depression. There was no evidence on work-related disability.
Authors' conclusions:
There is low- to moderate-certainty evidence that yoga compared to non-exercise controls results in small to moderate improvements in back-related function at three and six months. Yoga may also be slightly more effective for pain at three and six months, however the effect size did not meet predefined levels of minimum clinical importance. It is uncertain whether there is any difference between yoga and other exercise for back-related function or pain, or whether yoga added to exercise is more effective than exercise alone. Yoga is associated with more adverse events than non-exercise controls, but may have the same risk of adverse events as other back-focused exercise. Yoga is not associated with serious adverse events. There is a need for additional high-quality research to improve confidence in estimates of effect, to evaluate long-term outcomes, and to provide additional information on comparisons between yoga and other exercise for chronic non-specific low back pain.
This is the protocol for a review and there is no abstract. The objectives are as follows:
The objectives of this systematic review are to determine the effects of acupuncture for (sub)acute non-specific low-back pain compared to no treatment, placebo/sham acupuncture or other sham procedures, other therapies, the addition of acupuncture to other therapies, and between various techniques of acupuncture.
Background: Auricular therapy is a promising treatment for pain. However, the physiologic mechanisms of analgesic effects are not well-understood, which limits the scientific credibility of auricular therapy for pain management. Objectives: This prospective, randomized clinical trial (RCT) was conducted to determine whether or not the levels of pro- and anti-inflammatory cytokines change in response to auricular point acupressure (APA) for chronic low-back pain (CLBP). Methods: Blood samples (10 mL) were collected in a vacutainer, based on standard phlebotomy procedures. Blood was drawn at the following timepoints: before APA treatment to measure the baseline; 30 minutes after the first APA treatment; weekly for 4 weeks; and within 1 month of a follow-up visit (a total of seven timepoints) for each subject). Results: Participants with CLBP reported a mean 70% reduction of pain intensity at the completion of the 4-week APA regimen. The participants also had changes in serum pro- and anti-inflammatory cytokines. In particular, interleukin (IL)-1β, IL-4, and IL-10 were decreased. IL-2, IL-6, and tumor necrosis factor (TNF)-α were increased. In contrast, the participants who were in the sham APA group, with a 29% pain reduction, had a different profile. In particular, I-L2, IL-4, and TNF-α were decreased. IL-1β, IL-6, and IL-10 were increased. IL-1β, IL-2, IL-6, and IL-10 levels were associated with the worst pain intensity score, suggesting that these cytokines had an important role in mediating the APA effect on CLBP. Conclusions: The changes in cytokine levels in response to APA treatment suggested that APA could influence the level of circulating cytokines in patients with CLBP.
Study design:
Systematic review of randomized controlled trials (RCTs).
Objectives:
To determine the effectiveness of herbal medicine for nonspecific low back pain (LBP).
Summary of background data:
Many people with chronic LBP use complementary and alternative medicine (CAM), visit CAM practitioners, or both. Several herbal medicines have been purported for use in treating people with LBP. This is an update of a Cochrane Review first published in 2006.
Methods:
We searched numerous electronic databases up to September 2014; checked reference lists in review articles, guidelines and retrieved trials; and personally contacted individuals with expertise in this area. We included RCTs examining adults (over 18 years of age) suffering from acute, sub-acute, or chronic nonspecific LBP. The interventions were herbal medicines that we defined as plants used for medicinal purposes in any form. Primary outcome measures were pain and function. Two review authors assessed risk of bias, GRADE criteria (GRADE 2004), and CONSORT compliance and a random subset were compared with assessments by a third individual. Two review authors assessed clinical relevance and resolved any disagreements by consensus.
Results:
Fourteen RCTs (2050 participants) were included. Capsicum frutescens (cayenne) reduces pain more than placebo. Although Harpagophytum procumbens (devil's claw), Salix alba (white willow bark), Symphytum officinale L. (comfrey), Solidago chilensis (Brazilian arnica), and lavender essential oil also seem to reduce pain more than placebo, evidence for these substances was of moderate quality at best. No significant adverse events were noted within the included trials.
Conclusions:
Additional well-designed large trials are needed to test these herbal medicines against standard treatments. In general, the completeness of reporting in these trials was poor. Trialists should refer to the CONSORT statement extension for reporting trials of herbal medicine interventions.
Level of evidence:
N/A.
Back pain is a topical problem for both a general practitioner and a neurologist because of not only the high rate of this syndrome, but also its differential diagnosis problems. As any clinical syndrome, back pain should be differentiated from very many other diseases. This is primarily determined by the tactics of the management and treatment of a patient with neck-and-chest or low back pain. Today the diagnosis of spinal osteochondrosis may be rather common as that of exclusion. A meticulous neurological examination is of importance when diagnosing back pain. A premium is also placed upon X-ray and neuroimaging studies. When back pain is treated, it is necessary to take into account the intensity of pain syndrome, its proneness to chronicity, the individual personality traits, and concomitant visceral involvement and to use both drug and non-drug treatments, among which remedial exercises and psychotherapy are considered most effective.
BACKGROUND:
Low-back pain (LBP) is a common condition and imposes a substantial economic burden upon people living in industrialized societies. A large proportion of people with chronic LBP use complementary and alternative medicine (CAM), visit CAM practitioners, or both. Several herbal medicines have been purported for use in treating people with LBP. This is an update of a Cochrane Review first published in 2006.
OBJECTIVES:
To determine the effectiveness of herbal medicine for non-specific LBP.
SEARCH METHODS:
We searched the following electronic databases up to September 2014: MEDLINE, EMBASE, CENTRAL, CINAHL, Clinical Trials.gov, World Health Organization International Clinical Trials Registry Portal and PubMed; checked reference lists in review articles, guidelines and retrieved trials; and personally contacted individuals with expertise in this area.
SELECTION CRITERIA:
We included randomized controlled trials (RCTs) examining adults (over 18 years of age) suffering from acute, sub-acute, or chronic non-specific LBP. The interventions were herbal medicines which we defined as plants used for medicinal purposes in any form. Primary outcome measures were pain and function.
DATA COLLECTION AND ANALYSIS:
A library scientist with the Cochrane Back Review Group conducted the database searches. One review author contacted content experts and acquired relevant citations. We downloaded full references and abstracts of the identified studies and retrieved a hard copy of each study for final inclusion decisions. Two review authors assessed risk of bias, GRADE criteria (GRADE 2004), and CONSORT compliance and a random subset were compared to assessments by a third individual. Two review authors assessed clinical relevance and resolved any disagreements by consensus.
MAIN RESULTS:
We included 14 RCTs (2050 participants) in this review. One trial on Solidago chilensis M. (Brazilian arnica) (20 participants) found very low quality evidence of reduction in perception of pain and improved flexibility with application of Brazilian arnica-containing gel twice daily as compared to placebo gel. Capsicum frutescens cream or plaster probably produces more favourable results than placebo in people with chronic LBP (three trials, 755 participants, moderate quality evidence). Based on current evidence, it is not clear whether topical capsicum cream is more beneficial for treating people with acute LBP compared to placebo (one trial, 40 participants, low quality evidence). Another trial found equivalence of C. frutescens cream to a homeopathic ointment (one trial, 161 participants, very low quality evidence). Daily doses of Harpagophytum procumbens (devil's claw), standardized to 50 mg or 100 mg harpagoside, may be better than placebo for short-term improvements in pain and may reduce use of rescue medication (two trials, 315 participants, low quality evidence). Another H. procumbens trial demonstrated relative equivalence to 12.5 mg per day of rofecoxib (Vioxx®) but was of very low quality (one trial, 88 participants, very low quality). Daily doses of Salix alba (white willow bark), standardized to 120 mg or 240 mg salicin, are probably better than placebo for short-term improvements in pain and rescue medication (two trials, 261 participants, moderate quality evidence). An additional trial demonstrated relative equivalence to 12.5 mg per day of rofecoxib (one trial, 228 participants) but was graded as very low quality evidence. S. alba minimally affected platelet thrombosis versus a cardioprotective dose of acetylsalicylate (one trial, 51 participants). One trial (120 participants) examining Symphytum officinale L. (comfrey root extract) found low quality evidence that a Kytta-Salbe comfrey extract ointment is better than placebo ointment for short-term improvements in pain as assessed by VAS. Aromatic lavender essential oil applied by acupressure may reduce subjective pain intensity and improve lateral spine flexion and walking time compared to untreated participants (one trial, 61 participants,very low quality evidence). No significant adverse events were noted within the included trials.
AUTHORS' CONCLUSIONS:
C. frutescens (Cayenne) reduces pain more than placebo. Although H. procumbens, S. alba, S. officinale L., S. chilensis, and lavender essential oil also seem to reduce pain more than placebo, evidence for these substances was of moderate quality at best. Additional well-designed large trials are needed to test these herbal medicines against standard treatments. In general, the completeness of reporting in these trials was poor. Trialists should refer to the CONSORT statement extension for reporting trials of herbal medicine interventions.
Objective: to study the association of the DRD4, DAT genes with vital exhaustion in an open 25—64-old-year male population. A random representative sample of 657 men aged 25—64 years, living in one of the Novosibirsk districts was examined within the WHO MONICA project in 1994. The MONICA-MOPSY test was used to estimate the level of vital exhaustion. The examined DRD4, DAT gene Polymorphisms were genotypes in the Laboratory of Molecular Genetic Studies, Therapy Research Institute, Siberian Branch, Russian Academy of Medical Sciences (Novosibirsk). Results. The genotype containing allele 7 in the dopamine receptor subtype 4 (DRD4) gene, as well as genotype 9/9 in the dopamine-transporter protein (DAT) gene are significantly associated with the high level of vital exhaustion. Conclusion. The vital exhaustion is significantly associated with certain DRD4, DAT gene polymorphisms in the open 25—64-year-old male population of Novosibirsk.
Background:
Chronic lower back pain (CLBP) is a significant public health problem in the USA. The complexity of CLBP necessitates an assessment tool that can objectively evaluate the aspects of CLBP that lead to disability. Here we present a novel means by which to provide pressure stimuli to the lumbar spine through the use of an electro-pneumatic circuit that can be used in conjunction with functional magnetic resonance imaging (fMRI) technology to assess the cortical activity changes associated with CLBP.
Methods:
A test-retest experimental design was used to objectively quantify pressure pain sensitivity of the lumbar spine. Sensitivity was investigated through the identification of pressure pain thresholds of the lumbar spine using a multiple random staircase method (5-s stimuli) and continuous pain intensity rating (25-s stimuli).
Results:
Data presented here were consistent and reliable from day to day with an interclass-correlation coefficient (ICC) value of 0.913 for threshold values overall and individual ICC values of 0.652, 0.818, and 0.851 for mild, moderate, and intense thresholds, respectively. Linear regression analysis for longer trials indicated a large variation on day 1, R(2) values ranged from 0.222 to 0.882, however, the number of low correlation values decreased with only three subjects having R(2) < 0.6 for trial 2 on day 2.
Conclusion:
This project has successfully developed a device that can deliver a reliable and reproducible stimulus over the lumbar spine that mimics the palpatory technique used in clinical practice, and can be used in conjunction with fMRI to assess cortical response.
Chronic non-specific low-back pain (LBP) has become one of the main causes of disability in the adult population around the world. Therapeutic ultrasound is frequently used by physiotherapists in the treatment of LBP and is one of the most widely used electro-physical agents in clinical practice.
The objective of this review is to determine the effectiveness of therapeutic ultrasound in the management of chronic non-specific LBP.
Electronic searches were performed using CENTRAL, MEDLINE, EMBASE, PEDro, and PsycLIT databases in October 2013. Reference lists of eligible studies and relevant systematic reviews were checked and forward citation searching was also performed.
Randomised controlled trials on therapeutic ultrasound for non-specific chronic LBP were included.
Two review authors independently assessed the risk of bias of each trial and extracted the data. When sufficient clinical and statistical homogeneity existed, a meta-analysis was performed. The quality of the evidence for each comparison was determined using the GRADE approach.
Seven small randomised controlled trials involving a total of 362 participants with chronic LBP were included. Two of the studies had a low risk of bias, meeting six or more of the 12 criteria used for assessing risk of bias. All studies were carried out in secondary care settings and most applied therapeutic ultrasound in addition to exercise therapy, at various intensities for six to 18 treatment sessions. There was moderate quality evidence that therapeutic ultrasound improves back-specific function (standardised mean difference (SMD) [95%CI] -0.45 [-0.84 to -0.05]) compared with placebo in the short term. There was low quality evidence that therapeutic ultrasound is no better than placebo for short-term pain improvement (mean difference (MD) [95%CI] -7.12 [-17.99 to 3.75]; zero to100-point scale). There was low quality evidence that therapeutic ultrasound plus exercise is no better than exercise alone for short-term pain improvement (MD [95%CI] -2.16 [-4.66 to 0.34]; zero to 50-point scale), or functional disability (MD [95%CI] -0.41 [-3.14 to 2.32]; per cent). The studies comparing therapeutic ultrasound versus placebo or versus exercise alone did not report on overall satisfaction with treatment, or quality of life. There was low quality evidence that spinal manipulation reduces pain and functional disability more than ultrasound over the short to medium term. There is also very low quality evidence that there is no clear benefit on any outcome measure between electrical stimulation and therapeutic ultrasound; and that phonophoresis results in improved SF-36 scores compared to therapeutic ultrasound. None of the included studies reported on adverse events related to the application of therapeutic ultrasound.
No high quality evidence was found to support the use of ultrasound for improving pain or quality of life in patients with non-specific chronic LBP. There is some evidence that therapeutic ultrasound has a small effect on improving low-back function in the short term, but this benefit is unlikely to be clinically important. Evidence from comparisons between other treatments and therapeutic ultrasound for chronic LBP were indeterminate and generally of low quality. Since there are few high quality randomised trials and the available trials are very small, future large trials with valid methodology are likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Descriptive method guidelines.
To help reviewers design, conduct, and report reviews of trials in the field of back and neck pain.
In 1997, the Cochrane Collaboration Back Review Group published method guidelines for systematic reviews. Since its publication, new methodologic evidence emerged and more experience was acquired in conducting reviews.
All reviews and protocols of the Back Review Group were assessed for compliance with the 1997 method guidelines. Also, the most recent version of the Cochrane Handbook (4.1) was checked for new recommendations. In addition, some important topics that were not addressed in the 1997 method guidelines were included (e.g., methods for qualitative analysis, reporting of conclusions, and discussion of clinical relevance of the results). In May 2002, preliminary results were presented and discussed in a workshop. In two rounds, a list of all possible recommendations and the final draft were circulated for comments among the editors of the Back Review Group.
The recommendations are divided in five categories: literature search, inclusion criteria, methodologic quality assessment, data extraction, and data analysis. Each recommendation is classified in minimum criteria and further guidance. Additional recommendations are included regarding assessment of clinical relevance, and reporting of results and conclusions.
Systematic reviews need to be conducted as carefully as the trials they report and, to achieve full impact, systematic reviews need to meet high methodologic standards.
Findings and recommendations on the assessment and treatment of adults with acute low
back problems-activity limitations due to symptoms in the low back and/or back-related
leg symptoms of less than 3 months' duration-are presented in this clinical practice
guideline. The following are the principal conclusions of this guideline:
The initial assessment of patients with acute low back problems focuses on the
detection of "red flags" (indicators of potentially serious spinal pathology or
other nonspinal pathology).In the absence of red flags, imaging studies and further testing of patients
are not usually helpful during the first 4 weeks of low back symptoms.Relief of discomfort can be accomplished most safely with nonprescription
medication and/or spinal manipulation.While some activity modification may be necessary during the acute phase, bed
rest >4 days is not helpful and may further debilitate the patient.Low-stress aerobic activities can be safely started in the first 2 weeks of
symptoms to help avoid debilitation; exercises to condition trunk muscles are
commonly delayed at least 2 weeks.Patients recovering from acute low back problems are encouraged to return to
work or their normal daily activities as soon as possible.If low back symptoms persist, further evaluation may be indicated.Patients with sciatica may recover more slowly, but further evaluation can also
be safely delayed.Within the first 3 months of low back symptoms, only patients with evidence of
serious spinal pathology or severe, debilitating symptoms of sciatica, and
physiologic evidence of specific nerve root compromise corroborated on imaging
studies can be expected to benefit from surgery.With or without surgery, 80 percent of patients with sciatica recover
eventually. Nonphysical factors (such as psychological or socioeconomic problems) may be
addressed in the context of discussing reasonable expectations for
recovery.
Acute low back problems in adults. [AHCPR Publication No. 95-0642], . Clinical Practice Guideline No
- Bigos S O Bowyer
- Braen
Bigos S, Bowyer O, Braen G. Acute low back problems in adults. [AHCPR Publication No. 95-0642],. Clinical Practice Guideline No.
Agency for Health Care Policy and Research. Pub-lic Health Service, US Department of Health and Human Services
- Rockville
- Md
Rockville, MD: Agency for Health Care Policy and Research. Pub-lic Health Service, US Department of Health and Human Services; 1994. 160.
Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane collaboration back review group
- van Tulder