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The Low Back Pain Group of the Bone and Joint Health Strategies for Europe Project. Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific)
Abstract
Low back pain (LBP) is defined as pain localised between the 12th rib and the inferior gluteal folds, with or without leg pain. Most cases are non-specific, but in about 10% of cases a specific cause is identified. Red flags are typical signs or symptoms that are frequently associated with specific LBP. Yellow flags are prognostic factors associated with a more unfavourable and often chronic disabling course of the disease. LBP has a lifetime prevalence of 60-85%. At any one time, about 15% of adults have LBP. LBP poses an economic burden to society, mainly in terms of the large number of work days lost (indirect costs) and less so by direct treatment costs. A substantial proportion of individuals with chronic LBP has been found to have chronic widespread pain. LBP is often associated with other pain manifestations such as headache, abdominal pain and pain in different locations of the extremities. Widespread pain is associated with a worse prognosis compared to localised LBP. Treatment targets are reduction of pain and better activity/participation, including prevention of disability as well as maintainance of work capacity. The evidence from selected and appraised guidelines, systematic reviews and major clinical studies was classified into four levels, level Ia being the best level with evidence from meta-analysis of randomised controlled trials. Key recommendations (level Ia): fitness programmes and advice to stay active can reduce pain, improve function and can prevent LBP becoming chronic. Simple analgesics, NSAIDs and muscle relaxants can reduce pain and can improve and maintain function. Maintaining physical activity, avoiding rest and manual therapy can reduce pain and maintain and restore function in acute LBP. Behavioural treatment can prevent LBP becoming chronic. Aerobic fitness and endurance training, behavioural treatment and multi-disciplinary treatment programmes can reduce pain and can improve/maintain function in chronic LBP.
... Nonspecifc low back pain (NLBP) refers to acute and chronic pain in lumbosacral region localized between costal margin and inferior gluteal folds, with or without leg pain, excluding specifc pathogenic factors [1,2]. It accounts for 90% of cases in low back pain [1]. ...
... Nonspecifc low back pain (NLBP) refers to acute and chronic pain in lumbosacral region localized between costal margin and inferior gluteal folds, with or without leg pain, excluding specifc pathogenic factors [1,2]. It accounts for 90% of cases in low back pain [1]. Pathological mechanism of NLBP is complex, which includes neurological, muscular, joint, and psychological factors. ...
... Tere are many kinds of therapeutic applications towards NLBP including bed rest, pain medication, physical/ rehabilitation therapy, and cognitive behavioral therapy [1,2]. Nevertheless, each method has its own limitation or side efect. ...
Background:
High morbidity of nonspecific low back pain (NLBP) and large consumption of medical resources caused by it have become a heavy social burden. There are many factors inducing NLBP, among which the damage and atrophy of multifidus (MF) are most closely related to NLBP. Scraping therapy can have significant treatment effects on NLBP with fewer adverse reactions and less medical fund input than other modalities or medications. However, the mechanism of scraping therapy treating NLBP remains unclarified. Here, we wanted to investigate the effects of scraping therapy on promoting MF regeneration and the underlying mechanisms.
Methods:
A total of 54 male rats (SD, 6-7 weeks old) were randomly divided into nine groups, namely, K, M6h, M1d, M2d, M3d, G6h, G1d, G2d, and G3d, with six rats in each group. They were injected with bupivacaine (BPVC) to intentionally induce MF injury. We then performed scraping therapy on the rats that had been randomly chosen and compared treatment effects at different time points. In vitro data including skin temperature and tactile allodynia threshold were collected and histological sections were analyzed. mRNA sequencing was applied to distinguish the genes or signaling pathways that had been altered due to scraping therapy, and the results were further verified through reverse transcription polymerase chain reaction and Western blot analysis.
Results:
Transitory petechiae and ecchymosis both on and beneath the rats' skin raised by scraping therapy gradually faded in about 3 d. Cross-sectional area (CSA) of MF was significantly smaller 30 h, 2 d, and 4 d after modeling (P=0.007, P=0.001, and P=0.015, respectively, vs. the blank group) and was significantly larger in the scraping group 1 d after treatment (P=0.002 vs. the model 1d group). Skin temperature significantly increased immediately after scraping (P < 0.001) and hindlimb pain threshold increased on the 2nd day after scraping (P=0.046 and P=0.028, respectively). 391 differentially expressed genes and 8 signaling pathways were characterized 6 h after scraping; only 3 differentially expressed genes and 3 signaling pathways were screened out 2 d after treatment. The amounts of mRNAs or proteins for GLUT4, HK2, PFKM, PKM, LDHA (which belong to the GLUT4/glycolytic pathway), p-mTOR, p-4EBP1 (which belong to the AMPK/mTOR/4EBP1 pathway), and BDH1 were enhanced, and p-AMPKα was decreased after scraping therapy.
Conclusions:
Scraping therapy has therapeutic effects on rats with multifidus injury by promoting muscle regeneration via regulating GLUT4/glycolytic and AMPK/mTOR/4EBP1 signaling pathways.
... [1,3] The lifetime prevalence of LBP has been estimated to be approximately 60%-90% and is commonly considered a biopsychosocial phenomenon. [11][12][13] On the other hand, Krismer and van Tulder indicated that approximately 90% of workers return to work within 2 months of LBP episode. [12] Preventing new episodes or recurrences of LBP and also predicting workers who develop chronic LBP seems to be a logical approach to potentially reducing the impact of long-term disability. ...
... [11][12][13] On the other hand, Krismer and van Tulder indicated that approximately 90% of workers return to work within 2 months of LBP episode. [12] Preventing new episodes or recurrences of LBP and also predicting workers who develop chronic LBP seems to be a logical approach to potentially reducing the impact of long-term disability. [1,3,[11][12][13] Medical history of recent trauma, red flags, chronic development, and the underlining conditions of constant LBP should be considered while examining the patient. ...
... [12] Preventing new episodes or recurrences of LBP and also predicting workers who develop chronic LBP seems to be a logical approach to potentially reducing the impact of long-term disability. [1,3,[11][12][13] Medical history of recent trauma, red flags, chronic development, and the underlining conditions of constant LBP should be considered while examining the patient. [11][12][13] Furthermore, workplace and workload that involve heavy lifting, bending, long sitting hours, heavy work, and long-distance driving may cause LBP. ...
Background: Low back pain (LBP) is a complex condition with several determinants contributing to its occurrence. LBP is defined as pain that persists for 12 weeks or longer. The prevalence of work-related LBP among health-care personnel in Saudi Arabia affects both the healthcare personnel and the quality of patient care. Aim: The aim of this study was to review the epidemiology of LBP among the healthcare personnel in Saudi Arabia and wellness programs aimed at decreasing the rate of LBP. Methods: A systematic literature search was conducted using relevant keywords to search for studies conducted in Saudi Arabia regarding LBP among healthcare personnel. After selecting the inclusion criteria and epidemiological measures of LBP for the current research as well as obtaining full texts for the study, a total of 13 articles were used. Results: Thirteen studies were included in the current systematic review. Nurses and dentists were among the most vulnerable groups, constantly experiencing LBP due to long working hours, standing, as well as stress. Physical and occupational therapists and surgeons were experiencing LBP and generalized myalgia due to the work stress caused by the overcommitment at work and a high number of treated patients. Emergency medical services personnel reported a very high prevalence of musculoskeletal disorders. Based on the results of the reviewed studies, most of the participants experienced the prevalence of the LBP within the last 12 months. Conclusion: LBP has multifactorial risks, etiology, and increased evidence and prevalence among healthcare personnel in Saudi Arabia. The results show that there is good reason to conduct an in-depth study of available best practice interventions aimed at preventing LBP among healthcare personnel. Future studies in Saudi Arabia should focus on creating workplace wellness programs and on assessing risk factors as well as preventing LBP.
... 2,3 Moreover, chronic LBP is associated with a high recurrence rate, with a 1-year recurrence rate of 20-44% and a lifetime recurrence rate of 85%. 4 Pharmacological treatment is only recommended for patients with chronic back pain if nonpharmacological therapy is ineffective, while nonpharmacological therapies, such as exercise, multidisciplinary rehabilitation, and acupuncture, are strongly recommended in most cases. 5 Patients with chronic LBP have concerns, such as frequent recurrence and chronic productivity loss, 4,6 which increases the demand for more effective treatment options. ...
... 2,3 Moreover, chronic LBP is associated with a high recurrence rate, with a 1-year recurrence rate of 20-44% and a lifetime recurrence rate of 85%. 4 Pharmacological treatment is only recommended for patients with chronic back pain if nonpharmacological therapy is ineffective, while nonpharmacological therapies, such as exercise, multidisciplinary rehabilitation, and acupuncture, are strongly recommended in most cases. 5 Patients with chronic LBP have concerns, such as frequent recurrence and chronic productivity loss, 4,6 which increases the demand for more effective treatment options. A growing interest exists involving complementary and alternative medical treatments. ...
Purpose:
Chronic lower back pain (LBP) is a major global health concern. Pharmacopuncture has been widely used to treat LBP in Korea; however, randomized clinical trials (RCT) or active control have not been conducted to evaluate its effectiveness. Therefore, this RCT aimed to compare the effectiveness of pharmacopuncture and physical therapy (PT) for the treatment of chronic LBP.
Patients and methods:
A two-arm, parallel, and multicenter RCT was conducted at four hospitals of Korean medicine. Participants with chronic LBP were randomly assigned at a 1:1 ratio using block randomization to undergo 10 sessions of pharmacopuncture or PT over 5 weeks and followed up for 25 weeks. The numerical rating scale (NRS) and visual analog scale scores of LBP and radiating leg pain and the Oswestry disability index (ODI), 5-level EuroQol-5 dimension (EQ-5D-5L), and the patient global impression of change were recorded at baseline and at 6, 13, and 25 weeks. An intention-to-treat analysis was conducted as the primary analysis using a linear mixed model.
Results:
One-hundred patients (mean age, 49.27 years; 58 women) were recruited. At 6 weeks after randomization, pharmacopuncture showed statistically superior results compared with PT in LBP (difference in NRS, 1.54; 95% CI, 0.94-2.13), function (difference in ODI, 4.52%; 95% CI, 0.93-8.11%), and quality of life (difference in EQ-5D-5L) scores (-0.05; 95% CI, -0.08 to -0.01). This effect persisted for 25 weeks. In the survival analysis for participants with at least a 50% reduction in the NRS scores of LBP during the 182-day follow-up, the pharmacopuncture group showed significantly faster recovery than the PT group (P<0.001, Log rank test).
Conclusion:
Pharmacopuncture significantly reduced pain and improved functional outcomes and quality of life in patients with low back pain compared with physical therapy. Based on the findings of this study, pharmacopuncture could be recommended as a treatment for patients with chronic low back pain.
... [7] Benjamin et al. discussed the evidence linking diastasis of the rectus abdominis muscle (DRAM) presence to pelvic organ prolapse (POP) and DRAM severity to poor mental well-being satisfaction with lifestyle, decreased abdominal muscle strength, and LBP intensity. [8,9] Although DRA is not a primary cause of either suffering or discomfort, it may assist toward growth and lumbar pain or PFD. ...
... The eligibility guidelines were used to ascertain inclusion: women who have had a C-section or an episiotomy give birth, [2] postpartum time of more than 6 months/<3 years, [9] gravida 2, parity 1, maximum of 2, [10] and age between 25 and 35 years old. [2] Exclusion criteria were as follows: over 35, prolapsed intervertebral disc, spondylitis/spondylosis, prenatal exercise regime, polycystic ovarian syndrome, acute discogenic pain, and low back ache. ...
... Chronic non-specific low back pain is defined as low back pain which is not related to specific pathology like bone disorder, prolapsed intervertebral disk, radiculopathy, stenosis in lumbar spine, cauda equine syndrome, inflammatory disease like ankylosing spondylitis, tumor in lumbar area, osteoporosis, meningitis etc 1,2 . The prevalence of low back pain is reported to be as high as 84% 12 whereas for chronic nonspecific low back pain it is about 23%, 11-12% of the population being disabled by chronic nonspecific low back pain 11,12 . Kinesio taping is the most advanced technique that is considered to be an effectiveness in the musculoskeletal disorders 1,2 . ...
... Chronic non-specific low back pain is defined as low back pain which is not related to specific pathology like bone disorder, prolapsed intervertebral disk, radiculopathy, stenosis in lumbar spine, cauda equine syndrome, inflammatory disease like ankylosing spondylitis, tumor in lumbar area, osteoporosis, meningitis etc 1,2 . The prevalence of low back pain is reported to be as high as 84% 12 whereas for chronic nonspecific low back pain it is about 23%, 11-12% of the population being disabled by chronic nonspecific low back pain 11,12 . Kinesio taping is the most advanced technique that is considered to be an effectiveness in the musculoskeletal disorders 1,2 . ...
The Aim of the study was to compare the effectiveness of kinesio taping (KT) with and without neuromuscular training (NMT) versus conventional treatment in patients with chronic nonspecific low back pain. 60 subjects who fulfilled the inclusive and exclusive criteria were randomly allocated in 3 groups. Group A: 20 patients were received KT, NMT and conventional treatment in chronic nonspecific low back pain. Group B: 20 patients were received KT and conventional treatment in chronic nonspecific low back pain. Group C: 20 patients were received conventional therapy only in chronic nonspecific low back pain. To determine the effect of intervention the patients were assessed on the measures of oswestry disability index (ODI) and visual analog scale (VAS) on pre and 4-week post treatment of the study. Paired t test showed significant (P<0.001) decrease in ODI and VAS score in group A as compared to both Group B and Group C. The ANOVA showed significantly different mean change in ODI and VAS score among the groups. Tukey test showed significantly (P<0.001) different and higher mean change in ODI and VAS score of Group A as compared to both Group B and Group C. The study suggests that pain and disability was clinically and statistically significant improved in kinesio taping with neuromuscular training of patients with chronic nonspecific low back pain.
... Low back pain (LBP) is a recurrent or sometimes persistent disorder defined as the pain localized between the 12th rib and the inferior gluteal folds, which has been one of the most common musculoskeletal diseases worldwide (Krismer and van Tulder, 2007;Wu et al., 2020). For helicopter pilots, due to prolonged exposure to whole-body vibration of high-intensity and confined sitting posture, they complain about LBP frequently (Posch et al., 2019;da Silva, 2020). ...
... Total score summarizes the scores in all sections and is normalized according to Eq. 1. Total score = [(total score)/(number of items completed by subjects × 5)] × 100 (Krismer and van Tulder, 2007). ...
Low back pain (LBP) is known to pose a serious threat to helicopter pilots. This study aimed to explore the potential of electrical bio-impedance (EBI) technique with the advantages of no radiation, non-invasiveness and low cost, which is intended to be used as a daily detection tool to assess LBP in primary aviation medical units. The LBP scales (severity) in 72 helicopter pilots were assessed using a pain questionnaire, while the bilateral impedance measurements of the lumbar muscle were carried out with a high precision EBI measurement system. Results showed that the modulus of lumbar muscle impedance increased with LBP scale whereas the phase angle decreased. For different LBP scales, significant differences were found in the modulus of lumbar muscle impedance sum on both sides (Zsum), as well as in the modulus and phase angle of lumbar muscle impedance difference between both sides (Zdiff and ϕdiff), respectively (P < 0.05). Moreover, Spearman’s correlation analysis manifested a strong correlation between Zsum and LBP scale (R = 0.692, P < 0.01), an excellent correlation between Zdiff and LBP scale (R = 0.86, P < 0.01), and a desirable correlation between ϕdiff and LBP scale (R = −0.858, P < 0.01). In addition, receiver operator characteristic analysis showed that for LBP prediction, the area under receiver operator characteristic curve of Zsum, Zdiff, and ϕdiff were 0.931, 0.992, and 0.965, respectively. These findings demonstrated that EBI could sensitively and accurately detect the state of lumbar muscle associated with LBP, which might be the potential tool for daily detection of LBP in primary aviation medical units.
... 3 A lombalgia, além de limitar diversas atividades diárias e prejudicar a qualidade de vida, também é um dos principais fatores responsáveis por absenteísmo laboral e diminuição da produtividade no ambiente de trabalho. 4 Na literatura são descritos vários fatores de risco que podem desempenhar um papel crucial na etiologia da lombalgia, como ser do gênero feminino, ter sobrepeso, história prévia de problemas de coluna, histórico familiar de problemas de coluna, tempo sentado prolongado e estilo de vida sedentário, 5-8 ou mesmo fatores psicológicos, como ansiedade e estresse. 8,9 Devido à grande carga horária dos cursos de medicina, alunos e professores frequentemente estão expostos a vários desses fatores de risco, como estresse e sedentarismo, e longas jornadas em hospitais e clínicas, que podem contribuir para uma maior prevalência de lombalgia quando comparados para a população em geral. ...
Resumo
Objetivo Este estudo teve como objetivo determinar a prevalência de lombalgia antes e durante a pandemia, comparando os dois períodos.
Métodos Foi aplicado um questionário contendo questões sobre a presença de lombalgia, características sociodemográficas e hábitos que poderiam estar relacionados à essa dor.
Resultados Entre as 978 respostas obtidas, a prevalência de lombalgia durante a pandemia foi de 69,94%, o que representou um aumento significativo em relação aos valores do período pré-pandêmico (57,37%). Foi encontrada alta prevalência de lombalgia entre todos os grupos, principalmente entre as mulheres. Alguns fatores foram associados à incidência de lombalgia, como ter problemas de coluna previamente diagnosticados e sedentarismo.
Conclusões A prevalência de lombalgia aumentou significativamente durante a pandemia nos grupos estudados.
... [3] In Indian population, the prevalence of lower back pain is 60%-85%. [4] Men have a higher occurrence of lumbar radiculopathy in their 4 th decade of life, while women are more likely in their 5 th and 6 th decade of life, with an overall incidence of 23.09% in India. [2,5] The common cause of radicular pain is degenerative changes in the lumbar spine, intervertebral disc prolapse (IVDP), and hypertrophy of facet joint. ...
... The most prevalent musculoskeletal condition globally is LBP. 2 Epidemiological studies show that LBP is the most common type of chronic pain, affecting 70-80% of people experience life's events at some point. 3 Back pain (BP) may be divided into three primary categories. An acute case of pain is one that lasts less than six weeks, a subacute case is one that lasts between six weeks and three months, and a chronic case is one that lasts more than three months. ...
Low back pain is the most common chronic pain disease, affecting 70–80% of people at some time in their life, according to epidemiological research. LBP is described as discomfort in the region of the back of the body that stretches from the lower border of the 12th rib to the lower gluteal folds that lasts for at least one day. Back pain (BP) may be divided into three primary categories. Subacute pain is described as lasting between six weeks and three months, acute pain as lasting less than six weeks, and chronic pain as lasting longer than three months. The two primary forms of low back pain are specific low back pain and nonspecific low back pain (NSLBP). NSLBP, on the other hand, is a kind of low back pain where the relationship between the symptoms, physical findings, and imaging data is unclear. The most frequent musculoskeletal disorder worldwide is low back pain (LBP). Outlined here is what we propose by carrying out research aimed to evaluate and compare the Effect of William Flexion exercise and Movement Control exercise in two arm parallel superiority randomized clinical study on decreasing Pain, Range of Motion, Muscle Strength and Functionality in Non-Specific Low Back Pain. In this study the total of 74 patients of non-specific low back pain in people between the ages of 18 and 40 will be divided into two group one group received William flexion exercise and other group received Movement control exercises followed by conventional physiotherapy. The treatment will be given for 6 session a week for 4 weeks. The assessment will be done at day one of treatment and at the end of week. The implementation of this physiotherapy technique in treatment could occur if the study's hypothesis is productive in non-specific low back pain.
... It is characterized by pain or discomfort below the costal margin and above the lower gluteal folds, with or without pain in either leg [2] and whose pathoanatomical origin cannot be determined [3][4][5]. This pain is considered chronic if it lasts more than 12 weeks [6]. ...
Chronic Non-Specific Low Back Pain (cNSLBP) has been identified as one of the leading global causes of disability and is characterized by symptoms without clear patho-anatomical
origin. The majority of clinical trials assess cNSLBP using scales or questionnaires, reporting an influence of cognitive, emotional and behavioral factors. However, few studies have explored the effect of chronic pain in daily life tasks such as walking and avoiding obstacles, which involves perceptual-motor processes to interact with the environment.
Are action strategies in a horizontal aperture crossing paradigm affected by cNSLBP and which factors influence these decisions ?
... Low back pain (LBP) is considered as one of the most widespread musculoskeletal disorders, impacting over 80% of the world's population, resulting in work absence, medical consultation, a decline in quality of life, and financial burden. Moreover, 10%-40% of subjects with LBP progress to chronic LBP (CLBP) [1,2]. LBP is classified into specific and non-specific types [3]. ...
... Low back pain, more commonly referred to as "LBP," is a feeling of discomfort and pain between the inferior gluteal folds and the 12th rib; it may or may not accompany leg pain. 1 Almost 84% of the populace experience LBP at some point in their lives, 23% experience persistent LBP, and around 11%-12% become disabled due to this pain. 2 Among many other musculoskeletal issues, LBP is one of the issues associated with employment status and condition. ...
Objective
Our goal was to deduce the prevalence of low back pain among medical doctors in the teaching hospitals of Karachi, Pakistan, along with its associated variables and the functional disability accompanying it.
Methods
This cross-sectional study was conducted among medical doctors from Creek General Hospital and United Hospital, affiliated with United Medical and Dental College, Karachi, Pakistan. A sample of 80 participants was included in this study, and a non-probability convenient sampling with randomization was utilized. Using a three-part questionnaire that included the Oswestry Disability Index, all participants were scrutinized for low back pain with its characteristics, associated risk factors, and functional disability.
Results
Seventy percent of medical doctors included in this study suffered from the problem of low back pain, with 68% experiencing it over the last 3 months to 1 year. Furthermore, 89% and 11% suffered from minimal and moderate disability, respectively, affecting day-to-day and work life. Moreover, this study also found a significantly positive association ( p value < 0.05*) of low back pain with age and work-related characteristics and was more common in those with work experience between 1 and 10 years, >8 working hours, >4 standing hours, and belonging to the surgery and medicine specialties. The association was significantly positive according to the chi-square/Fischer exact test.
Conclusion
Our study addressed the evidence that low back pain is prevalent among medical doctors in teaching hospitals in Karachi, Pakistan, potentially affecting patient treatment and student education and accentuating the need for further intervention and research among doctors worldwide.
... 4 Many studies have suggested that sociodemographic (age, sex, marital and employment status, educational background), lifestyle (excess body mass, lack of physical activity) and psychological factors, notably depression, anxiety and somatization or somatic symptom disorder (SSD), are risk factors of LBP and predictors of poor outcomes, thus shaping the concept of a "biopsychosocial pain syndrome". [5][6][7][8][9][10][11][12][13][14] In particular, older age, high values of Body Mass Index (BMI) and less frequent physical exercise have been linked with lower quality of life, pain and disability severity in patients with chronic low back pain (CLBP). 11,[15][16][17][18][19][20] Additionally, the potential importance of the aforementioned psychological factors is supported by a systematic review of LBP (25 cohort studies) that found depression, anxiety and somatization to be consistently correlated with persisting pain and disability. ...
Literature findings have suggested that psychological factors, including anxiety, depression and somatic symptom disorder (SSD), are predictors of poor outcomes in individuals with chronic low back pain (CLBP). The aim of this study was to examine the correlations between anxiety, depression and SSD with pain, disability and health-related quality of life (HRQoL) in Greek CLBP patients. Ninety-two participants with CLBP recruited using random systematic sampling from an outpatient physiotherapy department, who completed a battery of paper-and-pencil questionnaires included items on demographic characteristics, as well the Numerical Pain Rating Scale (NPRS) for pain, the Rolland-Morris Disability Questionnaire for disability (RMDQ), the EuroQoL 5-dimension 5-level (EQ-5D-5L) for health status, the Somatic Symptom Scale-8 (SSS-8) for SSD, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression. A Mann-Whitney test and a Kruskall-Wallis test were used for the comparison of continuous variables between two groups and among more than two groups, respectively. Moreover, Spearman correlations coefficients were used to explore the association between subjects' demographics, SSS-8, HADS-Anxiety, HADS-Depression, NPS, RMDQ and EQ-5D-5L indices. Predictors of health status, pain and disability were assessed using multiple regression analyses, whereas the level of statistical significance was set at p<0.05. The response rate was 94.6% (87 participants, 55 of whom were women) and the mean age of the sample was 59.6 years (SD=15.1). A tendency of weak negative associations was noted between scores of SSD, anxiety and depression with EQ-5D-5L indices, whereas only a weak positive correlation was found between levels of SSD with pain and disability. After examining in a multiple regression analysis, only SSD emerged as prognostic factor of poor HRQoL, greater levels of pain and disability. In conclusion, the elevated scores of SSD significantly predict worse HRQoL, intense pain and severe disability in Greek CLBP patients. Further research is needed to test our findings in larger and more representative samples of the Greek general population.
... The anatomy, nerve innervation, and function of the canine multifidus and longissimus muscles are not significantly different from that in humans (15,18,19,23,24). Despite the apparent differences in gait posture between bipeds and quadrupeds, humans and dogs share several spinal biomechanical features, including similarities in axial compressive loads and the pathogenesis of disc degeneration in non-chondrodystrophic breeds (3,7). ...
... This is solidified by the fact that no single diagnostic test is effective [12] at identifying the pathophysiology underlying low back pain. Only 10-15% of cases of cLBP are attributable to a specific pathophysiological diagnosis, and therefore, most cases of low back pain are non-specific [13,14]. Unfortunately, early MRI, which is the diagnostic gold-standard, has led to increased back surgeries, greater use of prescription opioids and increase in healthcare costs in the United States [15] without improvement in outcomes. ...
Purpose
Chronic low back pain (cLBP) is a common health condition worldwide and a leading cause of disability with an estimated lifetime prevalence of 80–90% in industrialized countries. However, we have had limited success in treating cLBP likely due to its non-specific heterogeneous nature that goes beyond detectable anatomical changes. We propose that omics technologies as precision medicine tools are well suited to provide insight into its pathophysiology and provide diagnostic markers and therapeutic targets. Therefore, in this review, we explore the current state of omics technologies in the diagnosis and classification of cLBP. We identify factors that may serve as markers to differentiate between acute and chronic cases of low back pain (LBP). Finally, we also discuss some challenges that must be overcome to successfully apply precision medicine to the diagnosis and treatment of cLBP.
Methods
A literature search for the current applications of omics technologies to chronic low back pain was performed using the following search terms— “back pain,” “low back pain,” “proteomics,” “transcriptomics”, “epigenomics,” “genomics,” “omics.” We reviewed molecular markers identified from 35 studies which hold promise in providing information regarding molecular insights into cLBP.
Results
GWAS studies have found evidence for the role of single nucleotide polymorphisms (SNPs) associated with pain pathways in individuals with cLBP. Epigenomic modifications in patients with cLBP have been found to be enriched among genes involved in immune signaling and inflammation. Transcriptomics profiles of patients with cLBP show multiple lines of evidence for the role of inflammation in cLBP. The glycomics profiles of patients with cLBP are similar to those of patients with inflammatory conditions. Proteomics and microbiomics show promise but have limited studies currently.
Conclusion
Omics technologies have identified associations between inflammatory and pain pathways in the pathophysiology of cLBP. However, in order to integrate information across the range of studies, it is important for the field to identify and adopt standardized definitions of cLBP and control patients. Additionally, most papers have applied a single omics method to a sampling of cLBP patients which have yielded limited insight into the pathophysiology of cLBP. Therefore, we recommend a multi-omics approach applied to large global consortia for advancing subphenotyping and better management of cLBP, via improved identification of diagnostic markers and therapeutic targets.
... It has a prevalence of 60-85% during an individual lifetime and it may vary according to age, gender, education and occupation. Women's have higher rate of developing low back pain [4] [5]. The lifetime prevalence of low back pain is reported to be as higher as 84% and best estimated suggest that the prevalence of chronic low back pain is about 23% with 11-12% of population disabled by it [6]. ...
Non-specific back pain in general refers to any type of back pain that is caused by placing abnormal stress and strain on muscles of the vertebral column. The current study was based on the evaluation of the effect of Mckenzie exercises with theraband for reducing pain, disability and improves the strength in patients with subacute non-specific low backpain. It also evaluated the effect of Mckenzie exercises alone for reducing pain, disability and improves the strength in patients with subacute non-specific low backpain and compared the pain effectiveness of McKenzie exercises with theraband versus Mckenzie exercises alone in reducing pain, disability and improves the strength in patients with subacute non- specific low backpain. he participants for the study were recruited from the population of Integral University at Physiotherapy OPD, Lucknow (UP). On the basis of dependent variables NPRS, ODI, MMT and all the measurements were checked on first day (pretreatment) and last day (post treatment) i.e., after 4 weeks. The subjects were selected according to the inclusion and exclusion criteria and were divided into 2 groups-Group A and Group B. tables showed average difference of ODI, NPRS, MMT showed at 1st to 28th respectively and showed that average difference in pre to post ODI, NPRS, MMT scores was significant in both groups but Group A showed statistically significant difference of pre to post ODI, NPRS, and MMT score in order to decrease pain, disability and in improving muscle strength. Mckenzie exercises with theraband showed statistically more significant difference in ODI, NPRS and MMT score in order to decrease pain, disability and in improving muscle strength. Key words: Mckenzie Exercise, Theraband, low back pain, ODI, MMT .
... Back pain is a common debilitating condition and an important clinical and epidemic social and economic problem in most industrialized and non-industrialized countries, which imposes direct and indirect costs on society (1). Non-specific chronic back pain is one of the subgroups of back pain, which affects about 85% of patients and has no pathoanatomical symptoms that can be detected by radiography (2). Back pain can be caused by ergonomic and mechanical factors, personal and social factors. ...
Background: Low back pain is one of the most common health problems worldwide, but there is no agreement on the most appropriate treatment intervention. Objectives: The aim of this study was to evaluate the effect of Swiss ball training and ear acupuncture on pain and central muscle endurance in women with chronic non-specific low back pain. Methods: In this quasi-experimental study, 45 patients with non-specific chronic low back pain participated voluntarily. They were divided into three equal groups (Swiss ball, ear acupuncture, and control) based on random sampling, g each group consisted of 15 people. The Swiss ball and ear acupuncture groups underwent treatment for six weeks. The control group was asked to continue their daily activities before and after six weeks of the intervention. Pain and central muscle endurance were measured using visual analog scale (VAS) and McGill tests, respectively. Analysis of variance (ANOVA) and paired t-tests were used to analyze the data of inter-group and intra-group, respectively. Results: The results of the present study showed that pain intensity and disability were significantly reduced in both groups of ear acupuncture, Swiss ball, and central muscle endurance increased (P = 0.001); however, no significant difference was observed between the two post-tests (P > 0.05). Conclusions: According to the results of the present study, it seems that both interventions, including ear acupuncture and Swiss ball, can reduce the severity of pain and also increase central muscle endurance in women with non-specific chronic low back pain.
... In these cases, in addition to back pain of unknown cause, the specialist should also consider the presence of muscle pain originating in the spine. This type of pain may be nonmechanical or mechanical (increase in pain with movement or physical pressure), and the pain may be constant at rest [1,4]. ...
There is evidence in the literature to suggest that low back pain may change spine–pelvis coordination during activities of daily living. This study aimed to compare the variability of the spine–pelvis coordination during sit-to-stand in people with and without LBP. Ten healthy individuals with a history of LBP and ten individuals without history of LBP participated in this study. Three-dimensional kinematic data of the upper trunk (UT), lower trunk (LT), lower back (LB), and pelvis segments during sit-to-stand and stand-to-sit were recorded using a multi-segmental spine and pelvis models using a motion capture system. The coordination patterns and the variability of the adjacent segments (UT, LT, LB, and pelvis) were calculated using the modified vector coding method that was implemented through a custom MATLAB code. An independent sample t-test was utilized to assess the differences in the coordination pattern, and a statistical parametric mapping method was used to quantify the differences in coordination variability between the two groups. The results indicate that there are some differences in coordination patterns between groups during sit-to-stand and stand-to-sit. However, a significant difference in coordination variability was only observed during sit-to-stand. The results showed that LBP can alter the kinematics coordination even in the upper (pain-free) parts of the spine during sit-to-stand by changing the coordination between UT and LT in a way that can lead to an increase in the loading on these segments. Additionally, people with LBP showed more coordination variability during sit-to-stand, which can be associated with a coordination strategy that facilitates an optimal and possibly pain-free coordination pattern.
... There is a lifetime prevalence of 60-85%. The majority of cases (90%), which affect people of all ages, are nonspecific [3]. Occupational ergonomic influences, such as heavy physical activity, repetitive activities as a result of occupational demands [4]; sports activities or sports-concerned injuries [5]; a sedentary lifestyle, extensive sitting or immobilization, and absence of exercises [6]; after an operation or surgery [7]; bad trunk control as well as postural problems [8]; and psychological and behavior-concerned factors, such as smoking, alcohol addiction, obesity, depression, stress [9] socio-economic problems [10]; as well as aging [11] all contribute to LBP. ...
... There is a lifetime prevalence of 60-85%. The majority of cases (90%), which affect people of all ages, are nonspecific [3]. Occupational ergonomic influences, such as heavy physical activity, repetitive activities as a result of occupational demands [4]; sports activities or sports-concerned injuries [5]; a sedentary lifestyle, extensive sitting or immobilization, and absence of exercises [6]; after an operation or surgery [7]; bad trunk control as well as postural problems [8]; and psychological and behavior-concerned factors, such as smoking, alcohol addiction, obesity, depression, stress [9] socio-economic problems [10]; as well as aging [11] all contribute to LBP. ...
Key Words: Validity, Reliability, Arabic version of MedRisk questionnaire, Patient satisfaction, Physical therapy services, Low back pain. Background: One measure of care quality is a patient's level of satisfaction with their treatment. Maintaining a focus on patient satisfaction as a way to evaluate the effectiveness of physiotherapy is important. Providers of healthcare and researchers in the field of health services continue to place an emphasis on learning more about how to improve the quality of care they offer for their patients. Patients' expectations of receiving good value for their time, money, and effort while receiving medical care are equally essential. Aim: The purpose of this study is to evaluate the Arabic translation of the MedRisk questionnaire with regard to its face & content validity, factor analysis, feasibility, internal consistency reproducibility, as well as test-retest reliability. Subjects: 300 individuals, from both genders, aged from 18 to 60, all having LBP (mechanical or discogenic) were enrolled. Methods: In a cross-sectional study, investigators used an Arabic translation of the MedRisk Questionnaire to evaluate patient satisfaction. Results: The first expert panel found a value of 74.17% for face validity, whereas the second found a value of 97.50%. Experts agreed that the content validity was very high (97.5%). It was determined that 61.1% of the total variance in the questionnaire can be accounted for by a single factorial structure. Cronbach's was used to evaluate the internal consistency. Since then, the Cronbach has reduced from 0.939 to 0.937. The Arabic translation of the MedRisk questionnaire took an average of 5.33 minutes (SD 1.04) to complete and has excellent test-retest reliability. There were no substantial changes in either the floor or the ceiling. Conclusion: The Arabic translation of the MRPS is simplified, easy to apply, fast, as well as comprehensive scale. Consequently, it might be an appropriate scale for clinical evaluation of Arabic-speaking patients suffering from low back pain.
... nonspecific LBP is defined as back pain with no known underlying pathology. [28] NLBP is defined as LBP not attributable to a recognizable, known specific pathology (e.g., infection, tumor, osteoporosis, fracture, structural deformity, inflammatory disorder, radicular syndrome, or cauda equina syndrome). [29] CR was defined as systematic multidisciplinary treatment given by physicians and health professionals. ...
Objective:
To determine pain and functional changes during comprehensive rehabilitation (CR) in adolescents with nonspecific low back pain (NLBP), and to determine the optimal CR duration.
Methods:
The study included 106 adolescents (39 boys [36.8%], 67 girls [63.2%]), 14 to17 years old, with the following inclusion criteria: duration of NLBP for at least 12 weeks; conservative NLBP treatment was effectless; pain intensity using the visual analogue pain scale (VAS) ≤ 7 points; disrupted daily activities; ability to understand and answer the questions; written consent to participate voluntarily in the study. The pain was assessed using the VAS scale, functional changes were assessed using the Oswestry Disability Index (ODI), 12-Item Short Form Survey, Hospital Anxiety and Depression Scale (HAD), and physical functional capacity and proprioception (Proprio) were assessed using an isokinetic dynamometer. The participants performed a comprehensive pain rehabilitation program consisting of physiotherapy, TENS, magnetotherapy, lumbar massage, and relaxing vibroacoustic therapy. The active CR cycle lasted for 22 sessions (with intermediate measurements after 5 and 16 sessions), after which we performed passive observation for another half a year. Five measurements were performed.
Results:
Pain, functional assessment, and physical capacity were improved with CR. Statistically significant improvement became apparent after 5 CR sessions, but statistical and clinical significance became apparent after 16 CR sessions. In the distant period, after the completion of CR, neither statistical nor clinical changes occurred.
Conclusions:
CR is effective in reducing pain, and improving functional state and physical capacity quickly and reliably in 16 CR sessions, which is sufficient to obtain clinically satisfactory CR results. Good results were achieved during CR and neither improved nor deteriorated spontaneously in the distant period. This study shows a possible mismatch between NLBP intensity and impaired functional state in adolescents.
... For instance, patients were often uncertain about the pathoanatomical causes of their symptoms or what triggered them (Costa et al., 2022). Likewise, some clinicians raised the uncertainties surrounding the causal relationship between imaging findings and clinical presentations, which are reported in the literature: pathoanatomical causes have been argued to be identifiable in only 5-10% of individuals who experience LBP (Deyo et al., 1992;Krismer and van Tulder, 2007;Koes et al., 2006) and conversely, structural changes can be found in the spine of asymptomatic populations (Brinjikji et al., 2015). Regardless of the source, uncertainty was often accompanied by emotions such as frustration and anger. ...
Despite clinicians being important actors in the context of uncertainty, their experiences navigating uncertainty remain largely unexplored. Drawing on a theory-driven post-qualitative approach, we used Mol's logic of choice/care as a lens through which we made sense of interviews with 22 clinicians who work with patients who experience low back pain (LBP). Our analysis suggests that uncertainty is ubiquitous in LBP care and not limited to particular domains. Clinicians navigated uncertainty when considering patients' personal and social contexts; making therapeutic decisions; navigating emotions and mental health; communicating with, and educating, patients, among others. These uncertainties are intertwined with clinical aspects such as treatment choices and evidence-based education about LBP. At times, clinicians resolved these uncertainties by producing certainty at the cost of attending to human aspects of care. We argue that epistemic shifts, theorisation and practical engagement with theory in training, research and clinical practice may prompt clinicians to embrace uncertainty and enact the logic of care.
In the logic of care uncertainty is chronic, and additional arguments cannot hope to alter this. You do what you can, you try and try again.…ultimately the result is not glorious: stories about life with a disease do not end with everybody ‘living happily ever after’ (Mol, 2008, p. 78, p. 78).
... Low back pain (LBP) is a persistent disorder, which has been a common musculoskeletal disease worldwide (Krismer and van Tulder. 2007;Wu et al. 2020). For helicopter pilots, due to prolonged exposure to vibration of high-intensity and confined sitting posture, LBP occurs frequently (Posch et al. 2019;da Silva 2020). LBP poses a serious threat to pilots by causing flight safety issues, such as attention, motion control and postural stability (Gaydos 2012;Harrison et al. ...
Proceedings of the International Conference on
Bioelectromagnetism, Electrical Bioimpedance, and
Electrical Impedance Tomography,
ICBEM-ICEBI-EIT 2022.
June 29 – July 1, 2022
Virtual / Kyung Hee University
... 2 Further, chronic LBP has a high recurrence rate, with a one-year and lifetime recurrence rates of 20-44% and 85%, respectively. 3 Based on the health claims data published by the Health Insurance Review and Assessment Service (HIRA), LBP is the most frequently claimed condition in Korean medicine outpatient care in 2017, with more than four million patients receiving outpatient care at a Korean medicine clinic or hospital annually. Additionally, LBP was ranked first among the diagnoses that caused hospitalization in a Korean medicine treatment facility for the previous four years, with more than 70,000 patients receiving inpatient care for LBP in 2017. ...
Purpose:
Chronic low back pain (LBP) is a common musculoskeletal disorder that affects everyday life; moreover, it occasionally causes disability and increases medical expenditure. This pragmatic randomized clinical trial aims to investigate the effects of pharmacopuncture on chronic LBP by comparing the effectiveness of pharmacopuncture and physiotherapy strategies.
Patients and methods:
In this two-armed, parallel, multi-center randomized controlled study, the participants will randomly undergo 10 sessions of pharmacopuncture therapy or physiotherapy over five weeks based on the randomization outcomes. The primary outcome will be the numeric rating scale (NRS) score of LBP. The secondary outcomes will include the NRS score of radiating leg pain, visual analog scale (VAS) score of LBP and radiating leg pain, Oswestry disability index, the Korean version of the Roland-Morris disability questionnaire, patient global impression of change (PGIC), short Form-12 health survey version 2, and 5-level EuroQol-5 dimension (EQ-5D-5L).
Conclusion:
This protocol aims to examine the comparative effectiveness of pharmacopuncture, which is a widely used therapy in Korean medicine, with respect to the standard therapy through a pragmatic randomized controlled trial to present useful data to facilitate clinical or policy decision making.
Trial registration:
Clinicaltrials.gov (NCT04833309); Clinical Research Information Service (KCT0006088).
... Low back pain (LBP) is defined as pain, muscle tension, and stiffness, with or without leg pain, in the area between the lower edge of the 12th rib and the lower gluteal fold at the proximal thigh [1]. ...
Background/Aim: Chronic low back pain (LBP) is a common health problem that negatively affects quality of life. A multidisciplinary approach is recommended in treating chronic LBP. In the literature, we could not find any study examining the relationship between clinical status, activities of daily living, angular measurements in the lumbar region, and spondylosis level in patients with LBP. We aimed to reveal whether there is a relationship between the severity of the clinical condition and these angular measurements. In addition, there are opposing views in the literature about the relationship between obesity and LBP, and we planned to investigate this issue in our study. We aimed to investigate the correlation between clinical, functional evaluations, and radiographic findings in patients with chronic LBP and examine the relationship between these variables and gender and educational level. We also determine the effects of age, body mass index (BMI), and waist circumference on these variables. Methods: The research was designed as a cross-sectional, uncontrolled study. Seventy patients aged 18–65 years with chronic LBP and VAS (Visual Analog Scale) values ≥ 3 were included. Patients were grouped by gender and educational level. Lumbar lordosis angle (LLA), sacral inclination angle (SIA), and Kellgren-Lawrence (K-L) grade were recorded. VAS, Oswestry Disability Index (ODI), Back Pain Functional Scale (BPFS), and Katz Activities of Daily Living (Katz-ADL) scores were calculated. Pearson correlation analysis determined the normal distribution status of the variables. Spearman’s correlation analysis evaluated the linear relationship between ODI and BPFS and LLA and SIA continuous variables. A p-value of < 0.05 was considered statistically significant. Results: A total of 70 patients (47 females and 23 males) with chronic LBP were included in the study. Mean BMI (28.2 [6.1] kg/m2) and waist circumference (95.7 [12.7] cm) of the patients were above normal ranges (normal BMI: 18.5–24.99 kg/m², normal waist circumference: < 80 cm for women, < 90 cm for men). Katz-ADL (P = 0.006) and BPFS scores (P = 0.027) were lower, and LLA (P = 0.042) was higher in women than men. The BPFS score was lower in the low-level education group than in the high-level education group (P = 0.004). There was a positive correlation between age and SIA (P = 0.028, r = 0.262), and between age and K-L grade (P < 0.001, r = 0.633). A positive correlation was also observed between BMI and K-L grade (P = 0.001, r = 0.395) and waist circumference and K-L grade (P < 0.001, r = 0.442). Conclusion: No correlation was found between functional clinical scales and radiographic findings in patients with chronic LBP. Increasing age, BMI, and waist circumference were associated with more severe radiographic osteoarthritis of the lumbar spine, whereas female gender and low educational level were related to lower functional levels. Further extensive studies, including a larger number of patients, are needed to clarify our results.
... Low back pain (LBP) is defined as pain localized between the twelfth rib and the inferior gluteal folds, with or without leg 1 pain, and is defined as acute when pain persists for less than 2 12 weeks. ...
Background: Over 70% of people in resource-rich countries will experience LBP at some time in their lives. Back pain and the resulting disability constitute a major public health problem in Western as well as Indian societies. Objective: To study the short-term effect of Maitland's Mobilization on pain and functional ROM in patients with acute mechanical LBP. Methods: 30 participants were divided into 2 groups. Group A underwent Maitland's mobilization with therapeutic exercises and Group B underwent therapeutic exercises. Outcome measures taken were VAS, Pain-Pressure threshold AND functional rating index. Pre and Post treatment and 24-hour post treatment measurements were taken. Results: Results showed that there was significant improvement in VAS, PPT and FRS in group A. Conclusion: It has been concluded that Maitland's Mobilization along with conventional therapy is effective than Conventional exercise therapy alone in improving pain and functional disability in Acute Mechanical LBP.
... The KOLs discussed this item and agreed that heat therapy is more effective as a rescue therapy in case of recurrence of pain than as a preventive treatment. This is mostly secondary to the fact that low back pain is most frequently non-specific, in which case, to prevent the recurrence of pain, exercises and education are the main interventions indicated [23,41]. ...
Introduction:
Musculoskeletal pain (MP) is prevalent in our society, having a strong negative impact on physical and psychosocial quality of life. Heat therapy (HT) has been frequently described as a treatment strategy for musculoskeletal pain, but scientific evidence is still poor. The aim of the present Delphi method study is to gather a consensus among European experts on the role of HT in MP.
Methods:
To address this topic, a list of 54 statements was developed, concerning mechanism of action of heat on muscle, types of MP eligible for heat treatment, efficacy of HT, time and modalities of treatment, maximizing compliance to HT, safety (based on heat wraps), wrong beliefs and common errors in the prescription of HT and the role of HT in preventing muscular damage in athletes. The survey was distributed to 116 European experts, using a 5-point Likert scale to express agreement or disagreement with the statements; 66% concordance with the statements was needed to define a consensus.
Results:
Consensus was reached on 78% of statements. There was a strong consensus on the mechanism of action of heat on muscle, the indication in chronic MP, its effectiveness as part of a multimodal approach to MP and the safety and tolerability of superficial heat therapy. A low-level of consensus was obtained on the role of heat in preventing muscular damage and in acute MP.
Conclusion:
This Delphi consensus recognizes the role of HT mostly in chronic MP and highlights the need for stronger scientific evidence to regulate the use of this therapy in clinical practice.
... Low back pain (LBP) is one of the most common musculoskeletal conditions in the general population. The burden of LBP is enormous in terms of quality of life, productivity, and employee absenteeism, making these common conditions the single largest contributor to musculoskeletal disability worldwide.LBP is defined as pain localized between the 12th rib and the inferior gluteal folds, with or without leg pain (1,2).Diagnosis of LBP based on self-reported questionnaire has been used to estimate the prevalence of LBP in epidemiological study of community setting (3).Low back pain can be acute, subacute or chronic. It affects children to elderly and is a very common reason for medical consultations (4). ...
Back ground: Low back pain (LBP) is one of the most common work-related health problems among hospital workers. Work-related activities such as twisting, bending, sustained posture, repeated movements are regarded as associated risk factors for low back pain. The aim of this study is to assess the prevalence and associated risk factors of Low Back Pain among hospital workers. Methodology: An institution based cross sectional survey design was conducted among employees in Adama Hospital Medical College (AHMC), Adama Ethiopia. Descriptive statistics, bivariate, and multiple regression analyses were performed. p<0.1 in univariate is considered for multivariate analysis and p<0.05 was used to define statistical significance. Result: Of 263, 137(52.1%) were males and 126(47.9%) were females. The result indicated that the mean and median age of the respondents were 33.5 and 33 years respectively. The life time prevalence of LBP was found to be 50.6% and the 12 month LBP prevalence was 41.4%. Staff not participating in any physical activity (exercise) were more likely to report presence of low back pain (AOR (Adjusted Odd Ratio)=1.75, CI, 1.02-3.02). On the other hand, staff who worked sitting more than 6 hours were associated with increased risk of low back pain(AOR=2.78, CI, 1.09-7.07). Perceived stress often increased risk of low back pain (AOR=2.60, CI, 1.06-6.36). Conclusion: LBP was significantly associated with the obesity, stressed often, those worked in seated position more than six hours and those with long year experience; but doing physical exercise has rather a preventive effect. The findings of this study suggest that primary prevention of LBP should be considered.
... We defined low back pain as pain located in the back between the 12th rib 78 and buttock crease, with or without leg pain. 30 We defined neck pain as pain located in the 79 cervical region of the spine. 16, 26 We excluded trials with participants who had pain as a result Intervention 86 We included trials that assessed the effect of any intervention with a stated intention of reducing 87 weight, regardless of the content, delivery methods, providers, intensity or duration. ...
Objective:
To assess the effectiveness of weight loss interventions on pain and disability in people with knee and hip osteoarthritis (OA) and spinal pain.
Design:
Intervention systematic review.
Literature search:
Eight online databases and clinical trial registries.
Study selection criteria:
Randomised controlled trials of any weight loss intervention (e.g. diet, physical activity, surgical, pharmaceutical) that reported pain or disability outcomes of people with knee or hip OA, or spinal pain.
Data synthesis:
We calculated mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (CI). We used the Cochrane risk of bias tool to assess Risk of Bias and GRADE to judge credibility of evidence.
Results:
22 trials with 3602 participants. There was very low to low credibility evidence for a moderate effect of weight loss interventions on pain intensity (10 trials, n=1806, SMD -0.54, 95%CI -0.86, -0.22, I2= 87%, p<0.001) and a small effect on disability (11 trials, n=1821, SMD -0.32, 95%CI -0.49, -0.14, I2=58%, p<0.001) compared to minimal care for people with OA. For knee OA there was low to moderate credibility evidence that weight loss interventions were not more effective than exercise only for pain intensity or disability (4 trials n=673, SMD -0.13, 95%CI -0.40, 0.14, I2= 55%; 5 trials, n=737, SMD -0.20 95%CI -0.41, 0.00, I2= 32%).
Conclusions:
Weight loss interventions may have small to moderate improvements on pain and disability for OA compared to minimal care. There was limited and inconclusive evidence for weight loss interventions targeting spinal pain. J Orthop Sports Phys Ther, Epub 9 Apr 2020. doi:10.2519/jospt.2020.9041.
... Low back pain (LBP) is common, leading to relevant economic burden [1,2]. On average, the lifetime prevalence of LBP is as high as 80% [3,4]. ...
Background
This Bayesian network meta-analysis investigated the available randomized control trials (RCTs) to point out which acupuncture protocol is the most effective for chronic aspecific low back pain (LBP). Efficacy was measured in terms of pain (Visual Analogic Scale, VAS) and disability (Roland Morris Disability Questionnaire, RMQ), Transcutaneous Electrical Nerve Stimulation (TENS).
Methods
PubMed, Google scholar, Embase, and Scopus were accessed in March 2022. All the RCTs comparing two or more acupuncture modalities for aspecific chronic LBP were accessed. Only studies which investigated the efficacy of acupuncture on patients with symptoms lasting a minimum of 1.5 months, or with at least three episodes in the previous 12 months, were considered eligible. The Review Manager Software (The Nordic Cochrane Collaboration, Copenhagen) was used for the methodological quality assessment. The STATA Software/MP, Version 14.1 (StataCorporation, College Station, Texas, USA), was used for the statistical analyses. The NMA was performed through the STATA routine for Bayesian hierarchical random-effects model analysis.
Results
Data from 44 RCTs (8338 procedures) were retrieved. 56% of patients were women. The mean age of the patients was 48 ± 10.6 years. The mean BMI was 26.3 ± 2.2 kg/m ² . The individual group (95% confidence interval (CI) 2.02, 7.98) and the standard combined with TENS (95% CI 2.03, 7.97) demonstrated the highest improvement of the RMQ. The VAS score was lower in the standard combined with TENS group (95% CI 3.28, 4.56). Considering the standard acupuncture group, different studies used similar protocols and acupuncture points and the results could thus be compared. The equation for global linearity did not find any statistically significant inconsistency in any of the network comparison.
Conclusion
Verum acupuncture is more effective than sham treatment for the non-pharmacological management of LBP. Among the verum protocols, individualized acupuncture and standard acupuncture with TENS were the protocols that resulted in the highest improvement in pain and quality of life.
Level of Evidence
Level I, Bayesian network meta-analysis of RCTs.
... The 2 criterion variables in the current secondary analyses were new onset of nonspecific neck or low back pain, with or without radiation and without a disease identified as the underlying cause of the complaints at the first episode of pain during the 12-month follow-up period using a monthly diary. 5,26 To assess this, the participants answered the question, "Have you experienced any neck or low back pain lasting .24 hours during the past month?" ...
Introduction:
Neck and low back pain are significant health problem in sedentary office workers. Active break and postural shift interventions has been proved to reduce the incidence of new onset of both neck and low back pain.
Objectives:
To identify variables that moderate the effects of active breaks and postural shift interventions on the development of neck and low back pain in office workers.
Methods:
Using data from a 3-arm (active break, postural shift, and control group) cluster randomized controlled trial (N = 193), we evaluated the moderating effects of age, job position, education level, sex, perceived psychological work demands, number of working hours, and using a chair with lumbar support on the benefits of 2 interventions designed to prevent the development of neck and low back pain in office workers. Moderation analyses were conducted using the Hayes PROCESS macro, with post hoc Johnson-Neyman techniques and logistic regressions.
Results:
Significant interactions between intervention groups and 3 moderators assessed at baseline emerged. For the prevention of neck pain, the effect of the active break intervention was moderated by the number of working hours and the effect of the postural shift intervention was moderated by the level of perceived psychological work demands and the number of working hours. For the prevention of low back pain, the effect of postural shift intervention was moderated by having or not having a chair with lumbar support.
Conclusions:
The study findings can be used to help determine who might benefit the most from 2 treatments that can reduce the risk of developing neck and low back pain in sedentary workers and may also help us to understand the mechanisms underlying the benefits of these interventions.
Background:
Lower back pain (LBP) is a common musculoskeletal disorder that may affect students' daily lives. Recent psychological research showed a relevant connection between LBP and multidimensional health. However, the association between LBP and lifestyle behavior has not been established, and improving knowledge in this area may help develop preventive strategies and optimize college students' quality of life.
Methods:
A cross-sectional study of 1420 college students in Saudi Arabia was conducted, and participants who attended Saudi Universities were recruited from May 2021 to November 2021. An established validated online survey assessed LBP, sleep quality, time spent sedentary (sedentary duration), health responsibility, physical activity, nutrition, spiritual growth, interpersonal relationships, and stress management. Generalized Linear Regression was used to assess the associations between LBP severity and lifestyle behaviors after controlling for covariates.
Results:
LBP was prevalent among college students from Saudi Arabia. Most of the sample were young (23.81 ± 6.02), and female (83.7%). There were significant differences between students with and without LBP regarding age, BMI, sex, marital status, pain severity, overall lifestyle behavior, health responsibility, physical activity, nutrition, stress management, and global sleep quality. After controlling for age, BMI, sex, and marital status, there were significant associations between pain severity and global sleep quality (ß=0.2, p < .001, CI: 16 to 0.24), and sedentary duration (ß=0.03, p = .01, CI:0.009 to 0.06).
Conclusions:
This study helped define the prevalence of LBP in college students in Saudi Arabia and evaluated the association between LBP and lifestyle behaviors. The findings showed that students with higher levels of poor sleep quality or sedentary behavior had higher levels of pain. Promoting sleep quality and reducing sedentary behavior may help establish preventive strategies for LBP in college students.
Background:
According to previous research, hip internal rotation (HIR) aggravates low back pain (LBP) symptoms, especially in patients with lumbar flexion with rotation (F + R) syndrome. Therefore, the present study aimed to examine the lumbopelvic-hip rhythm during the HIR test in patients with this syndrome.
Methods:
In this cross-sectional study, 20 men without LBP and 20 matched men with LBP, subcategorized in the F+R subgroup, participated. The participants performed the HIR test. Kinematics data were recorded using a motion analysis system. After processing the kinematics, a comparison was made in the hip and pelvic kinematics between the groups.
Results:
A statistical analysis based on an independent t test revealed a significant increased (P < 0.05) pelvic rotation during the tests with the dominant ( P = 0.007) and nondominant limbs (P = 0.025) in those with LBP. The analysis also showed that during the test with the dominant lower limb, the pelvis and hip moved with a more synchronized pattern in patients with LBP (P = 0.001).
Conclusion:
In the patients with lumbar F + R syndrome, there was a tendency for early pelvic rotation during the dominant HIR test. Moreover, LBP people also exhibited a greater pelvic rotation range of motion in the first half and whole pathways of the test. These impairments could be a risk factor for the development of LBP symptoms in these patients.
Long-term physical health conditions (LTPHCs) are associated with poorer psychological well-being, quality of life, and longevity. Additionally, individuals with LTPHCs report uncertainty in terms of condition aetiology, course, treatment, and ability to engage in life. An individual's dispositional ability to tolerate uncertainty-or difficulty to endure the unknown-is termed intolerance of uncertainty (IU), and may play a pivotal role in their adjustment to a LTPHC. Consequently, the current review sought to investigate the relationship between IU and health-related outcomes, including physical symptoms, psychological ramifications, self-management, and treatment adherence in individuals with LTPHCs. A systematic search was conducted for papers published from inception until 27 May 2022 using the databases PsycINFO, PubMed (MEDLINE), CINAHL Plus, PsycARTICLES, and Web of Science. Thirty-one studies (N = 6,201) met the inclusion criteria. Results indicated that higher levels of IU were associated with worse psychological well-being outcomes and poorer quality of life, though impacts on self-management were less clear. With the exception of one study (which looked at IU in children), no differences in IU were observed between patients and healthy controls. Although findings highlight the importance of investigating IU related to LTPHCs, the heterogeneity and limitations of the existing literature preclude definite conclusions. Future longitudinal and experimental research is required to investigate how IU interacts with additional psychological constructs and disease variables to predict individuals' adjustment to living with a LTPHC.
OBJECTIVE: To determine the effect of exercise on pain self-efficacy in adults with non-specific chronic low back pain (NSCLBP). DESIGN: Intervention systematic review with meta-analysis LITERATURE SEARCH: We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, PsycInfo and CINAHL databases to the 23/03/2022. SELECTION CRITERIA: We included randomised controlled trials that compared the effect of exercise on pain self-efficacy to control, in adults with NSCLBP. DATA SYNTHESIS: We conducted a meta-analysis using a random effects model. We evaluated the risk of bias using the Cochrane risk of bias tool (RoB2) and judged the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. RESULTS: Seventeen trials were included, of which eight (n=1121 participants, 60.6% female, mean age 49.6 years) were included in the meta-analysis. Exercise increased pain self-efficacy by 3.02 points (95% confidence interval 1.72 to 4.32) on the 60-point Pain Self-Efficacy Questionnaire. The certainty of evidence was moderate; all trials were at high risk of bias. CONCLUSION: There was moderate certainty evidence that exercise increased pain self-efficacy in adults with NSCLBP. Future research should investigate if this effect is meaningful, whether it increases with more targeted treatments to enhance pain self-efficacy, and the effects on outcomes for adults with NSCLBP.
Purpose:
To investigate the expectations regarding physiotherapists of patients attending an interdisciplinary CLBP rehabilitation programme and the response to these expectations.
Materials and methods:
A thematic analysis was conducted, based on interviews of working-age patients with CLBP and without significant comorbidities.
Results:
Twenty patients participated (9 male, 11 female, aged 21-58 years; symptoms duration 4.3 ± 3.0 years; pain VAS 53 ± 21 mm). Patients expected to learn pain and activity management. Expected outcomes were a reduction of pain, increased well-being and a return to normality. A collaborative approach involving therapeutic and relational adaptation was expected. Despite divergences concerning emotional aspects, patients expected a large range of applied psychosocial skills.The programme met the expectations of most patients, especially when its goals matched those reported by the individuals. For most participants, the pain relief was below expectations. Active therapies were valued. After the programme, patients felt more ready to take responsibility for their back.
Conclusion:
The expectation of developing self-management skills was prevalent. Expected treatments were mostly compatible with recommendations. Expectations to resume activities and decrease pain were in line with the rehabilitation goals, although the expected reduction in pain was overestimated. Relational expectations converged towards patient-centred care.
Background: Low back pain (LBP) is a socioeconomic burden worldwide and a major contributor to health-care costs. Mobilization and dry needling (DN) are well-known treatments for LBP, and both of them, as a part of treatment, can relieve LBP.
Objective: Due to the importance of choosing interventions with greater effects on patients' recovery, in this study we intend to compare DN and lumbar spine mobilization, as complementary therapies in combination with routine physical therapy in the treatment of patients with chronic non-specific LBP.
Methods and study design: The study is a two-arm randomized, double-blind, double-dummy, controlled trial comparing DN to lumbar spine mobilization in individuals (n=56; 18–45 years of age) with chronic non-specific LBP. The experimental group will receive DN plus sham mobilization and the control group will receive Maitland’s posterior-anterior mobilization plus sham DN. Both groups will receive exercise and low-power laser. The primary outcome is functional disability, and the secondary outcomes are pain, lumbar multifidus and quadratus lumborum function, lumbar range of motion, pain pressure threshold, DN side effects, and patient adherence to treatment. Each group will receive 8 treatment sessions during 4 weeks (2 treatment sessions per week). Primary and secondary outcomes will be assessed at baseline and 3 to 7 days after the final treatment session. A mixed-model (ANCOVA) for each dependent variable will be used All the study’s processes including recruitment, primary measurement, treating patients and final measurement will be completed in 5 to 6 months.
Discussion: In this study, we intend to solve the methodological problems of the previous study in this field. The results of this study allow the therapist to choose an intervention that has more therapeutic effects in combination with routine physiotherapy in the treatment of patients with chronic non-specific LBP.
Trial registration: 1) ClinicalTrials.gov registration number: NCT05214456. (date: 01/15/2021) 2) IRCT.ir registration number: IRCT20210706051802N1 (date: 04/27/2022).
The study of the occurrence of articular syndrome in general, and acute articular syndrome (AAS) in particular, is an important medical and social task, the solution of which makes it possible to determine the amount of necessary forces and means for the organization of medical care for these patients. Since 2008, the authors have been studying the features of diagnosis and treatment of patients with AAS, for the first time in the Russian Federation on the basis of the St. Petersburg Research Institute of Emergency Medicine named after I. I. Dzhanelidze introduced the concept of providing medical care to patients with AAS into clinical practice. The study of data on the prevalence of articular syndrome allows us to outline ways to optimize diagnostic and therapeutic algorithms, reducing the time of diagnosis of diseases and optimizing the duration of the inpatient stage of treatment.
Background: Low back pain (LBP) is a socioeconomic burden worldwide and a major contributor to health-care costs. Mobilization and dry needling (DN) are well-known treatments for LBP. Just one study has compared these two treatments with each other which has some limitations, therefore the purpose of this study is to compare them to each other.
Methods and study design: The study is a two-arm randomized, double-blind, double-dummy, controlled trial comparing DN to lumbar spine mobilization in individuals (n=56; 18–45 years of age) with chronic non-specific LBP (CNLBP). The experimental group will receive DN plus sham mobilization and the control group will receive Maitland’s anterior-posterior mobilization plus sham DN. Both groups will receive exercise and low-power laser. The primary outcomes are pain and functional disability, and the secondary outcomes are lumbar multifidus and quadratus lumborum function, lumbar range of motion, pain pressure threshold, DN side effects, and patient adherence to treatment. Primary and secondary outcomes will be assessed at baseline and 3 to 7 days after the final treatment session. Recruitment will begin immediately after acceptance of the protocol and it will take 5 to 6 months to complete the study.
Discussion: In this study, we intend to solve the methodological problems of the previous study in this field. The results of this study allow the therapist to choose an intervention that has more therapeutic effects in combination with routine physiotherapy in the treatment of patients with CNLBP.
Trial registration: 1) ClinicalTrials.gov registration number: NCT05214456. 2) IRCT.ir registration number: IRCT20210706051802N1.
Rationale:
In clinical practice, bee venom injection into acupuncture points is used to relieve various types of musculoskeletal pain. In the current study, we describe a patient who had persistent severe muscle pain caused by mistakenly injected high-dose bee venom.
Patient concerns:
A 63-year-old woman mistakenly received an injection of high-dose (2 mL; standard dose, 0.1 mL) bee venom (diluted in saline at a 1:2000 ratio). Immediately after the injection, extreme burning pain developed at the injection site, which persisted for 1 month with a mean pain score of 9 on the numeric rating scale. T1-weighted gadolinium-enhanced axial lumbar magnetic resonance imaging revealed increased intensity in the medial part of the left psoas muscle around the L4-5 intervertebral disc level.
Diagnosis:
This finding indicated the presence of inflammation in the left psoas muscle, which was thought to be associated with pain.
Interventions:
A buprenorphine transdermal patch (releasing 5 mcg/hours) was applied to alleviate the pain.
Outcomes:
Six months after the bee venom injection, the pain completely resolved.
Lessons:
Bee venom has a strong toxic effect; therefore, only a minimal dose of diluted bee venom should be administered for musculoskeletal pain control. Special caution is required during bee venom injection to avoid excessive doses of bee venom.
Background and objective:
Traumatic injuries are among the leading causes of death and disability in the world across all age groups. This systematic review aimed to (1) describe the role of post-traumatic stress symptoms (PTSS) on the development of chronic pain and/or pain-related disability following musculoskeletal trauma, and (2) report pain and or pain-related disability by injury severity/type.
Database and data treatment:
Electronic databases were searched, from inception to 31st November 2021 and updated on the 10th May 2022, to identify studies in which: participants were adults aged ≥16 years sustaining any traumatic event that resulted in one or more musculoskeletal injuries; an outcome measure of PTSS was used within three months of a traumatic event; and the presence of pain and/or pain-related disability was recorded at a follow-up of three months or more. Two reviewers independently screened papers and assessed the quality of included studies.
Results:
Eight studies were included. Owing to between-study heterogeneity, the results were synthesised using a narrative approach. Five studies investigated the relationship between PTSS and pain. Participants with PTSS were more likely to develop persistent pain for at least 12 months post-injury. Six studies assessed the relationship between PTSS and pain-related disability. The results suggest that patients with PTSS had significantly higher disability levels for at least 12-months post-injury.
Conclusion:
Findings from this comprehensive systematic review support a clear relationship between PTSS post-injury and future pain/disability, with potential importance of certain PTSS clusters (hyper-arousal and numbing).
Introduction. Chronic low back pain is a serious health problem in the world. The phenomena of peripheral and central sensitization play an important role in the transition of acute pain to chronic, as well as in the maintenance of chronic pain. One of the descending inhibitory mechanisms that modulates the perception of pain is conditioned pain modulation. Activation of this mechanism reduces neuronal activity at the level of the dorsal horn of the spinal cord, which leads to a decrease in pain and inhibition of hyperalgesia. For pathogenetic therapy of chronic low back pain drugs from the groups of antidepressants and anticonvulsants are indicated, but in practice, drugs from the group of nonsteroidal anti-inflammatory drugs are more often used. The purpose of the study: to evaluate the analgesic activity of etoricoxib and lornoxicam and their effect on central sensitization in chronic low back pain. Materials and methods. The study included 60 men and women with chronic low back pain. Patients were randomly divided into 2 even groups: 1st group — patients who took etoricoxib at a dose of 90 mg orally once a day for 21 days; 2nd group — patients who took lornoxicam at a dose of 8 mg orally twice a day for 21 days. All patients were examined neurologically, painDETECT questionnaire and central sensitization inventory were used, quantitative sensory testing along with conditioned pain modulation test was performed to determine pain thresholds. Results. Etoricoxib and lornoxicam have shown a significant pain reduction on the visual analog scale (VAS), but its dynamics in the etoricoxib group was higher: 7.47 points on the first day and 3.73 points on the 21st day, while in the lornoxicam group dynamics corresponded to 6.80 and 5.10 points, respectively. The number of patients with allodynia compared with the 1st day decreased on the 21st day of treatment from 18 to 4 patients in the etoricoxib group, and from 18 to 15 patients in the lornoxicam group. Dynamics of allodynia area: in the etoricoxib group on 21st day the allodynia area decreased compared to the 1st day from 15.11 to 6 cm2 and in the lornoxicam group — from 17.5 to 9.4 cm2. Dynamics of central sensitization inventory scores on day 21: in the etoricoxib group changes were more significant (decrease from 54.13 to 33.67 points) and corresponded to a mild degree of central sensitization, while in the lornoxicam group it decreased to a moderate level — from 54.80 to 46.00 points. The neuropathic signs in the painDETECT questionnaire were statistically significantly reduced throughout the treatment period in the etoricoxib group, reaching almost a 2-fold decrease on day 21st (from 12.40 on the first day to 6.67), while in the lornoxicam group a significant improvement was observed on day 7th of treatment, and later, on days 14th and 21st, the results almost returned to previous level. On the 14th day of therapy with etoricoxib the pain threshold of the nail area significantly improved after the conditioned pain modulation test, the same was also observed on the 21st day both in the nail and back area. Both improvements were not observed in the lornoxicam group. Conclusions. Etoricoxib and lornoxicam have shown different impact on pain reduction and central sensitization. Etoricoxib has shown better level of pain reduction by VAS, better allodynia and central sensitization questionnaire score reduction after 21 days of treatment compared to baseline. In addition, the use of etoricoxib was accompanied by a decrease in neuropathic signs by the painDETECT questionnaire, as well as an increase in pain thresholds before and after the conditioned pain modulation test.
Background:
Different hypotheses have been proposed about the role of lumbar connective tissue in low back pain (LBP). However, none of the previous studies have examined the change in the elastic behavior of lumbar fascia in patients with LBP. The present study aimed to evaluate the changes in the elastic behavior of lumbar fascia in patients with chronic non-specific LBP based on ultrasound imaging.
Methods:
The sonographic strain imaging assessed the thoracolumbar fascia (TLF) of 131 human subjects (68 LBP and 63 non-LBP). Assessments were done at L2-L3 and L4-L5 levels bilaterally. The points were located 2 cm lateral to the midpoint of the interspinous ligament.
Results:
There were no significant differences in age, sex, and BMI between LBP and healthy individuals. There is a strong inverse relationship between pain severity (r=-0.76, n=68, P=0.004) and the TLF elastic modulus coefficient. No significant relationship were observed between age (r=0.053, n=68, P=0.600), BMI (r=-0.45, n=68, P=0.009), and gender (r=-0.09, n=68, P=0.231) with the TLF elasticity coefficient. The LBP group had a 25-30% lower TLF elastic modulus coefficient than healthy individuals.
Conclusion:
The present study is the first to evaluate the elastic coefficient of TLF using the ultrasound imaging method. The study results showed that the TLF elastic coefficient in patients with LBP was reduced compared to healthy individuals and directly related to LBP severity.
Background
Unresolved postpartum LBP may affect women’s physical and psychological health.
Aim
To investigate the analgesic effects of laser acupuncture therapy (LAT) for postpartum LBP.
Method
Postpartum women with LBP were recruited and randomly assigned to the intervention group or the control group from November 2017 to July 2018. The participants in the intervention group received LAT and standard care. The participants in the control group received only standard care. The primary outcome was the Visual Analogue Scale for LBP. Secondary outcomes were limitation of daily activities and physical activity; perceived stress scale; and salivary cortisol values.
Results
In all, 106 participants were recruited and assigned to the intervention group or the control group. As compared with the control group, the participants in the LAT group had significantly lower intensity of LBP (mean ± SD: 1.21 ± 0.99 vs 3.25 ± 1.14; p < .001), limitations of daily activities (mean ± SD: 3.17 ± 2.09 vs 10.40 ± 4.72; p < .001) and physical activity (mean ± SD: 3.04 ± 2.17 vs 9.79 ± 4.71; p < .001), perceived stress (mean ± SD: 26.13 ± 3.97 vs 28.85 ± 4.26; p = .001), and salivary cortisol levels (mean ± SD: 0.194 ± 0.131 vs 0.280 ± 0.234; p = .02) post-intervention.
Conclusions
For postpartum LBP, LAT combined with standard care had greater analgesic efficacy, lower perceived stress, lower limitations of daily activities and physical activity, and lower salivary cortisol levels than standard care alone.
PurposeNon-specific chronic low back pain (CLBP) is the most common form of CLBP without clear clinical evidence. This study evaluated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) as a noninvasive technique for pain reduction in non-specific CLBP using functional connectivity (FC) method.Methods
Fifteen participants with non-specific CLBP received 20 Hz rTMS over the motor cortex. The pain intensity was measured using a Visual Analog Scale (VAS), and brain functional scans were obtained before and after brain stimulation. The percentage pain reduction (PPR%) and the FC differences in the insula (INS), thalamus (THA), supplementary motor area (SMA), and anterior cingulate cortex (ACC) were determined using paired t-test analysis. The correlation between PPR% and FCs was explored using the Pearson correlation coefficient.ResultsPain intensity reduced significantly after rTMS (P < 0.05). FC between bilateral SMA and ACC, and bilateral INS decreased while the FC between bilateral INS and bilateral THA increased following rTMS. Moreover, there was a negative correlation between the FC of INS (R)-SMA (R) and that of PPR% (r=-0.56).ConclusionFC between SMA and INS was associated with analgesia of rTMS in non-specific CLBP, indicating the potential role of FC as a novel objective parameter to predict the outcome of clinical use of rTMS for pain relief in CLBP patients.
Chronic low back pain it is one of the most common health problems worldwide. Usually is accompanied by a complex set of symptoms and generates significant direct and indirect socioeconomic and health costs. From a therapeutic point of view, there are a wide variety of methods to address the treatment of this pathology, however, these therapies have not been shown definitive efficacy. To investigate the effect of a mixed treatment with exercise and electrical stimulation versus exercise and kinesio taping in patients with non-specific chronic low back pain. A total of 58 patients participated in this single-blinded randomised clinical trial. Participants were assigned to the exercises- kinesio taping group, or exercises- analgesic current group, both received 12 treatment sessions. Disability, fear of movement, anxiety, depression, sleeps quality, pain, lower limb mechanosensitivity and pressure-pain thresholds were recorded at baseline and after 4 weeks of treatment. The 2 × 2 mixed analysis of covariance test showed statistically significant differences between groups for pain ( P = 0.046). Pair-wise comparisons with baseline demonstrated significant differences for both groups in pain ( P ≤ 0.001), disability ( P ≤ 0.001), pressure-pain thresholds ( P ≤ 0.044), lower limb mechanosensitivity, ( P ≤ 0.047), anxiety ( P ≤ 0.001), depression ( P ≤ 0.001) and sleep quality ( P ≤ 0.010). Patients with chronic low back pain who received a combined treatment of exercises and kinesio taping or analgesic current showed an improvement in pain, disability, anxiety, depression and sleep pattern. Moreover, exercises combined with electrotherapy produces greater improvements over these variables.
Trial registration: NCT02812459.
Objective
Maximal exercise testing is considered the gold standard to assess V̇O 2 max. However, maximal exercise testing was previously deemed unfeasible and unsafe in chronic low back pain (CLBP) patients. Consequently, most previous studies on aerobic capacity and functioning in patients with CLBP were performed with submaximal testing protocols. A recent study demonstrated the safety, feasibility and tolerance of maximal exercise testing in patients with CLBP. Therefore, the relation between aerobic capacity and functioning should be reevaluated. This cross-sectional study aims to determine the relationship between maximal aerobic capacity and four measures of functioning: lifting capacity, work ability, pain-related disability and physical functioning in patients with CLBP.
Methods
The maximal aerobic capacity of patients with CLBP was assessed with a maximal cardiopulmonary exercise test. Functioning was measured with a floor-to-waist lifting capacity test and three questionnaires: Work Ability Score, Pain Disability Index and Physical Functioning subscale of RAND-36. The associations between maximal aerobic capacity and each of the functioning measures were analysed with multiple linear regression analyses while controlling for potential confounders.
Results
Data of n=74 patients with CLBP were analysed. After controlling for potential confounders, maximal aerobic capacity was moderately associated with lifting capacity (β=0.32, p=0.006), but not with any of the other functioning measures (β=−0.08 to 0.12, p>0.288).
Conclusion
A higher level of maximal aerobic capacity is moderately associated with a higher lifting capacity, but not with self-reported work ability, pain-related disability and physical functioning.
Introduction. A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of low back pain. Methods. Evidence from randomized controlled trials (RCTs) and observational studies was identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and data synthesis. Meta-analysis was conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized studies. Developing Recommendations. An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater relative to a control based on panel expertise and empiric results) in patient-important outcomes was required for a recommendation. Statistical significance was also required, but was insufficient alone. Patient-important outcomes were decided by consensus as being pain, function, patient global assessment, quality of life, and return to work, providing that these outcomes were assessed with a scale for which measurement reliability and validity have been established. Validating the Recommendations. A feedback survey questionnaire was sent to 324 practitioners from 6 professional organizations. The response rate was 51%. Results. Four positive recommendations of clinical benefit were developed. Therapeutic exercises were found to be beneficial for chronic, subacute, and postsurgery low back pain. Continuation of normal activities was the only intervention with beneficial effects for acute low back pain. These recommendations were mainly in agreement with previous EBCPGs, although some were not covered by other EBCPGs. There was wide agreement with these recommendations from practitioners (greater than 85%). For several interventions and indications (eg, thermotherapy, therapeutic ultrasound, massage, electrical stimulation), there was a lack of evidence regarding efficacy. Conclusions. This methodology of developing EBCPGs provides a structured approach to assessing the literature and developing guidelines that incorporates clinicians' feedback and is widely acceptable to practicing clinicians. Further well-designed RCTs are warranted regarding the use of several interventions for patients with low back pain where evidence was insufficient to make recommendations.
Many guidelines for the management of low back pain in primary care have been published during recent years, but guidelines for physiotherapy do not yet exist. Therefore, physiotherapy guidelines have been developed, reflecting the consequences of the current state of knowledge of effective and appropriate physiotherapy for low back pain. They aim to improve the efficiency and effectiveness of physiotherapeutic care for patients with low back pain. The guidelines were constructed on the basis of the phases of the physiotherapy process, using the Dutch method of developing physiotherapy guidelines. Scientific evidence of systematic reviews was used as the basis for the recommendations. A computerised literature search of Medline, Cinahl, the Cochrane Database of Systematic Reviews and the Database of the Dutch National Institute of Allied Health Professions was conducted to identify relevant systematic reviews. If no evidence was available, consensus between experts was obtained. The guidelines were pilot tested among one hundred physiotherapists and reviewed by an external multidisciplinary panel. The guidelines recommend that the diagnostic process should focus on disability and participation problems resulting from back pain. The treatment should consist of an active approach, in which the patients learn to take control over their back pain. For patients with a normal course, where activities and participation gradually increase, reassurance, adequate information and advice to stay active are the most important recommendations. For patients with an abnormal course, where activities and participation do not increase, exercise therapy should also be provided, with a behavioural approach if necessary. These are the first national physiotherapy guidelines for low back pain. The recommendations are largely in line with other primary care guidelines for low back pain. Implementation will be a major challenge for the near future.
To quantify the relative contribution of premorbid and episode specific factors in determining the long term persistence of disabling symptoms of low back pain.
Prospective cohort study.
Two general practices in the south Manchester area.
180 patients, who previously participated in a cross sectional population survey, who consulted because of low back pain during the study period. They were followed at 1 week and 3 and 12 months after consultation.
Persistent disabling low back pain in the 12 months after the consultation.
Disabling low back pain persisted in one third of participants after consultation and was more common with increasing age, among those with a history of low back pain, and in women. Persistence of symptoms was associated with "premorbid" factors (high levels of psychological distress (odds ratio 3.3; 95% confidence interval 1.5 to 7.2), poor self rated health (3.6; 1.9 to 6.8), low levels of physical activity (2.8; 1.4 to 5.6), smoking (2. 1; 1.0 to 4.3), dissatisfaction with employment (2.4; 1.3 to 4.5)) and factors related to the episode of low back pain (duration of symptoms, pain radiating to the leg (2.6; 1.3 to 5.1), widespread pain (6.4; 2.7 to 15), and restriction in spinal mobility). A multivariate model based on six factors identified groups whose likelihood of persistent symptoms ranged from 6% to 70%.
The presence of persistent low back pain is determined not only by clinical factors associated with pain but also by the premorbid state.
This paper reports the results of a 'cost-of-illness' study of the socio-economic costs of back pain in the UK. It estimates the direct health care cost of back pain in 1998 to be pound1632 million. Approximately 35% of this cost relates to services provided in the private sector and thus is most likely paid for directly by patients and their families. With respect to the distribution of cost across different providers, 37% relates to care provided by physiotherapists and allied specialists, 31% is incurred in the hospital sector, 14% relates to primary care, 7% to medication, 6% to community care and 5% to radiology and imaging used for investigation purposes. However, the direct cost of back pain is insignificant compared to the cost of informal care and the production losses related to it, which total pound10668 million. Overall, back pain is one of the most costly conditions for which an economic analysis has been carried out in the UK and this is in line with findings in other countries. Further research is needed to establish the cost-effectiveness of alternative back pain treatments, so as to minimise cost and maximise the health benefit from the resources used in this area.
The treatment of chronic low back pain is not primarily focused on removing an underlying organic pathology, but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioural interventions are commonly used in the treatment of chronic (disabling) low back pain.
The objective of this systematic review was to determine if behavioural therapy is more effective than reference treatments for chronic non-specific low back pain, and which type of behavioural treatment is most effective.
We searched the Medline, PsycLit databases, and the Cochrane Controlled Trials Register up to April 1999, Embase up to September 1999. We also screened references of identified randomised trials and relevant systematic reviews.
Only randomised trials on any type of behavioural treatment for non-specific chronic low back pain were included.
Methodological quality assessment and data extraction was done by two reviewers independently. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioural outcomes, overall improvement, back pain specific and generic functional status, return to work, and pain intensity) using the random effects model.
Only 6 studies (25%) were high quality. There is strong evidence (level 1) that behavioural treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% CI 0.25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI -0.04, 0.74) and behavioural outcomes (pooled effect size 0.40; 95% CI 0.10, 0.70) of chronic low back pain patients when compared to waiting list controls or no treatment. There is moderate evidence (level 2) that an additional behavioural component to a usual treatment program for chronic low back pain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% CI - 0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI - 0.30, 0. 36) and behavioural outcomes (pooled effect size 0.19; 95% CI - 0.08, 0.45).
Behavioural treatment seems to be an effective treatment for chronic low back pain patients, but it is still unknown what type of patients benefit most from what type of behavioural treatment.
A systematic review of randomized and nonrandomized controlled trials.
Lumbar supports are used in the treatment of low back pain, but also to prevent the onset (primary prevention) or recurrences of a low back pain episode (secondary prevention).
To assess the effects of lumbar sup-ports for prevention and treatment of nonspecific low back pain.
The Medline, Cinahl, and Current Contents databases; the Cochrane Controlled Trials Register up to September 1999; and the Embase database up to September 1998 were all searched. References of identified trials and systematic reviews were reviewed and the Science Citation Index used to identify additional trials. Methodologic quality assessment and data extraction were performed by two reviewers independently. A quantitative analysis was performed in which the strength of evidence was classified as strong, moderate, limited or conflicting, and no evidence.
Five randomized and two nonrandomized preventive trials and six randomized therapeutic trials were included in the review. Only 4 of the 13 studies were of high quality. There was moderate evidence that lumbar supports are not effective for primary prevention. No evidence was found on the effectiveness of lumbar supports for secondary prevention. The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment, whereas it is still unclear whether lumbar supports are more effective than other interventions for treatment of low back pain.
There continues to be a need for high quality randomized trials on the effectiveness of lumbar supports. One of the most essential issues to tackle in these future trials seems to be the realization of adequate compliance.
To estimate the prevalence of chronic regional and widespread musculoskeletal pain in a sample of the general adult population and study the association to age, sex, socioeconomic class, immigration, and housing area.
A cross sectional survey with a postal questionnaire to 3928 inhabitants on the west coast of Sweden.
The age and sex adjusted prevalence of chronic regional pain (CRP) was 23.9% and chronic widespread pain (CWP) 11.4% among 2425 subjects who responded to the complete questionnaire. Odds ratio (OR) for CWP showed a systematic increasing gradient with age and was highest in the age group 59-74 yrs (OR 6.36, 95% CI 3.85-10.50) vs age group 20-34 yrs. CWP was also associated with female sex (OR 1.91, 95% CI 1.41-2.61), being an immigrant (OR 1.83, 95% CI 1.22-2.77), living in a socially compromised housing area (OR 3.05, 95% CI 1.48-6.27), and being an assistant nonmanual lower level employee (OR 1.92, 95% CI 1.09-3.38) or manual worker (OR 2.72, 95% CI 1.65-4.49) vs being an intermediate/higher nonmanual employee. OR for CRP showed a systematic increasing gradient with age and was highest in the age group 59-74 yrs (OR 2.22, 95% CI 1.62-3.05) vs age group 20-34 yrs. CRP was also associated with being a manual worker (OR 1.63, 95% CI 1.19-2.23) vs being an intermediate/higher nonmanual employee.
Chronic musculoskeletal pain is common in the general population. Sociodemographic variables were overall more frequently and strongly associated with CWP than with CRP, which indicates different pathophysiology in the development or preservation of pain in the 2 groups.
To assess the effect of multidisciplinary biopsychosocial rehabilitation on clinically relevant outcomes in patients with chronic low back pain.
Systematic literature review of randomised controlled trials.
A total of 1964 patients with disabling low back pain for more than three months.
Pain, function, employment, quality of life, and global assessments.
Ten trials reported on a total of 12 randomised comparisons of multidisciplinary treatment and a control condition. There was strong evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration improves function when compared with inpatient or outpatient non-multidisciplinary treatments. There was moderate evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain when compared with outpatient non-multidisciplinary rehabilitation or usual care. There was contradictory evidence regarding vocational outcomes of intensive multidisciplinary biopsychosocial intervention. Some trials reported improvements in work readiness, but others showed no significant reduction in sickness leaves. Less intensive outpatient psychophysical treatments did not improve pain, function, or vocational outcomes when compared with non-multidisciplinary outpatient therapy or usual care. Few trials reported effects on quality of life or global assessments.
The reviewed trials provide evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain and improves function in patients with chronic low back pain. Less intensive interventions did not show improvements in clinically relevant outcomes.
Back pain is a common problem for which cyclobenzaprine hydrochloride is frequently prescribed.
To perform a systematic review of cyclobenzaprine's effectiveness in the treatment of back pain.
We searched MEDLINE, PsycLIT, CINAHL, EMBASE, AIDSLINE, HEALTHSTAR, CANCERLIT, the Cochrane Library, Micromedex, Federal Research in Progress, and the references of reviewed articles, and contacted Merck, Sharpe and Dohme for English-language, randomized, placebo-controlled trials of cyclobenzaprine in adults with back pain. Outcomes included global improvement and 5 specific domains of back pain (local pain, muscle spasm, range of motion, tenderness to palpation, and activities of daily living). Study quality was assessed using the methods of Jadad. Summary outcomes were obtained using a random-effects model.
Patients treated with cyclobenzaprine were nearly 5 times (odds ratio, 4.7; 95% confidence interval, 2.7-8.1) as likely to report symptom improvement by day 14 as were those treated with placebo. Slightly fewer than 3 individuals (2.7; 95% confidence interval, 2.0-4.2) needed treatment for 1 to improve. The magnitude of this improvement was modest, with an effect size of 0.38 to 0.58 in all 5 outcomes (local pain, muscle spasm, tenderness to palpation, range of motion, and activities of daily living). Treatment efficacy for these 5 outcomes was greatest early, in the first few days of treatment, declining after the first week. Patients receiving cyclobenzaprine also experienced more adverse effects, the most common being drowsiness.
Cyclobenzaprine is more effective than placebo in the management of back pain; the effect is modest and comes at the price of greater adverse effects. The effect is greatest in the first 4 days of treatment, suggesting that shorter courses may be better. Studies comparing the relative value of acetaminophen, nonsteroidal anti-inflammatory drugs, and cyclobenzaprine individually and in combination in the treatment of back pain are needed.
In a cross-sectional postal questionnaire study we compared individuals with localized low back pain (LBP) with individuals with LBP as part of widespread musculoskeletal pain, according to demographic and lifestyle characteristics and functional ability. All the inhabitants in Ullensaker county born 1918-20, 1928-30, 1938-40, 1948-50, 1958-60 and 1968-70 were sent a questionnaire in 1994. The study population comprised 2,893 responders. LBP as part of widespread pain indicated reduced functional ability, and the groups differed in several demographic and lifestyle characteristics.
Exercise therapy encompasses a heterogeneous group of interventions. There continues to be uncertainty about the most effective exercise approach in chronic low back pain.
To identify particular exercise intervention characteristics that decrease pain and improve function in adults with nonspecific chronic low back pain.
MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004 and citation searches and bibliographic reviews of previous systematic reviews.
Randomized, controlled trials evaluating exercise therapy in populations with chronic (>12 weeks duration) low back pain.
Two reviewers independently extracted data on exercise intervention characteristics: program design (individually designed or standard program), delivery type (independent home exercises, group, or individual supervision), dose or intensity (hours of intervention time), and inclusion of additional conservative interventions.
43 trials of 72 exercise treatment and 31 comparison groups were included. Bayesian multivariable random-effects meta-regression found improved pain scores for individually designed programs (5.4 points [95% credible interval (CrI), 1.3 to 9.5 points]), supervised home exercise (6.1 points [CrI, -0.2 to 12.4 points]), group (4.8 points [CrI, 0.2 to 9.4 points]), and individually supervised programs (5.9 points [CrI, 2.1 to 9.8 points]) compared with home exercises only. High-dose exercise programs fared better than low-dose exercise programs (1.8 points [CrI, -2.1 to 5.5 points]). Interventions that included additional conservative care were better (5.1 points [CrI, 1.8 to 8.4 points]). A model including these most effective intervention characteristics would be expected to demonstrate important improvement in pain (18.1 points [CrI, 11.1 to 25.0 points] compared with no treatment and 13.0 points [CrI, 6.0 to 19.9 points] compared with other conservative treatment) and small improvement in function (5.5 points [CrI, 0.5 to 10.5 points] compared with no treatment and 2.7 points [CrI, -1.7 to 7.1 points] compared with other conservative treatment). Stretching and strengthening demonstrated the largest improvement over comparisons.
Limitations of the literature, including low-quality studies with heterogeneous outcome measures and inconsistent and poor reporting; publication bias.
Exercise therapy that consists of individually designed programs, including stretching or strengthening, and is delivered with supervision may improve pain and function in chronic nonspecific low back pain. Strategies should be used to encourage adherence. Future studies should test this multivariable model and further assess specific patient-level characteristics and exercise types.
The aim of this Discussion Paper is to estimate the social costs of back pain in the UK and assess the potential for reducing these costs by increasing the appropriateness of management of back pain. 50% to 80% of the population suffer from back pain at some stage of their life. With or without treatment, 90% of back pain problems improve within six weeks, but repeated episodes are very common. Although back pain and its management has been the subject of several thousand research papers over the past three decades, it still remains something of an enigma. Only 15% of cases can be clearly diagnosed. However, the great majority are due to mechanical low back pain which is the focus of this paper. Due to the paucity of data it is only possible to make crude estimates of the costs of back pain to the NHS, and these probably lie between £265 million and £383 million. Most of these costs are generated in 1) General Practice, due to the large number of consultations, and 2) Hospital in-patient management, due to the high treatment cost per person. Between 1986 and 1992 sickness and invalidity benefit claims for back pain alone increased in the UK by about 104%, while claims for other causes of sickness increased by 60%. The intangible costs of back pain and disability affecting the individual are likely to be considerable. When the problem has become chronic and intractable after about six months, the individual’s function and social activities may become severely curtailed. The General Practitioner is the key worker for back pain patients, and recent data suggests that these account for between 5.8 to 8.6 million consultations every year. Most consultations are associated with a prescription for medication, and advice to rest, despite the fact that the evidence is heavily weighted towards early resumption of normal activities. The processes are not well understood and treatment therefore is usually palliative. High quality outcome research is hampered by a number of
Objective
To assess the effect of multidisciplinary biopsychosocial rehabilitation on clinically relevant outcomes in patients with chronic low back pain.
Design
Systematic literature review of randomised controlled trials.
Participants
A total of 1964 patients with disabling low back pain for more than three months.
Main outcome measures
Pain, function, employment, quality of life, and global assessments.
Results
Ten trials reported on a total of 12 randomised comparisons of multidisciplinary treatment and a control condition. There was strong evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration improves function when compared with inpatient or outpatient non-multidisciplinary treatments. There was moderate evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain when compared with outpatient non-multidisciplinary rehabilitation or usual care. There was contradictory evidence regarding vocational outcomes of intensive multidisciplinary biopsychosocial intervention. Some trials reported improvements in work readiness, but others showed no significant reduction in sickness leaves. Less intensive outpatient psychophysical treatments did not improve pain, function, or vocational outcomes when compared with non-multidisciplinary outpatient therapy or usual care. Few trials reported effects on quality of life or global assessments.
Conclusions
The reviewed trials provide evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain and improves function in patients with chronic low back pain. Less intensive interventions did not show improvements in clinically relevant outcomes.
What is already known on this topic
What is already known on this topic
Disabling chronic pain is regarded as the result of interrelating physical, psychological, and social or occupational factors requiring multidisciplinary intervention Two previous systematic reviews of multidisciplinary rehabilitation for chronic pain were open to bias and did not include any of the randomised controlled trials now available
What this study adds
What this study adds
Intensive, daily biopsychosocial rehabilitation with a functional restoration approach improves pain and function in chronic low back pain Less intensive interventions did not show improvements in clinically relevant outcomes
It is unclear whether the improvements are worth the cost of these intensive treatments
This Quick Reference Guide for Clinicians contains highlights from the Clinical Practice Guideline version of Acute Low Back Problems in Adults, which was developed by a private-sector panel of health care providers and consumers. The Quick Reference Guide is an example of how a clinician might implement the panel’s findings and recommendations on the management of acute low back problems in working-age adults. Topics covered include the initial assessment of patients presenting with acute low back problems, identification of red flags that may indicate the presence of a serious underlying medical condition, initial management, special studies and diagnostic considerations, and further management considerations. Instructions for clinical testing for sciatic tension, recommendations for sitting and unassisted lifting, tests for identification of clinical pathology, and algorithms for patient management are included.
BACK pain ranks second only to upper respiratory illness as a symptomatic reason for office visits to physicians.¹ About 70% of adults have low back pain at some time, but only 14% have an episode that lasts more than 2 weeks. About 1.5% have such episodes with features of sciatica.2,3 Most causes of back pain respond to symptomatic and physical measures, but some are surgically remediable and some are systemic diseases (cancer or disseminated infection) requiring specific therapy, so careful diagnostic evaluation is important. Features of the clinical history and physical examination influence not only therapeutic choices but also decisions about diagnostic imaging, laboratory testing, and specialist referral.
ANATOMIC/PHYSIOLOGIC ORIGINS OF FINDINGS IN THE LOW BACK Low back pain may arise from several structures in the lumbar spine, including the ligaments that interconnect vertebrae, outer fibers of the annulus fibrosus, facet joints, vertebral periosteum, paravertebral musculature and fascia,
In the United Kingdom (UK), 9% of adults consult their doctor annually with back pain. The treatment recommendations are based on orthopaedic teaching, but the current management is causing increasing dissatisfaction. Many general practitioners (GPs) are confused about what constitutes effective advice.
To review all randomized controlled trials of bed rest and of medical advice to stay active for acute back pain.
A systematic review based on a search of MEDLINE and EMBASE from 1966 to April 1996 with complete citation tracking for randomized controlled trials of bed rest or medical advice to stay active and continue ordinary daily activities. The inclusion criteria were: primary care setting, patients with low back pain of up to 3 months duration, and patient-centred outcomes (rate of recovery from the acute attack, relief of pain, restoration of function, satisfaction with treatment, days off work and return to work, development of chronic pain and disability, recurrent attacks, and further health care use).
Ten trials of bed rest and eight trials of advice to stay active were identified. Consistent findings showed that bed rest is not an effective treatment for acute low back pain but may delay recovery. Advice to stay active and to continue ordinary activities results in a faster return to work, less chronic disability, and fewer recurrent problems.
A simple but fundamental change from the traditional prescription of bed rest to positive advice about staying active could improve clinical outcomes and reduce the personal and social impact of back pain.
With the emergent concept of evidence-based practice, various countries have produced clinical guidelines for the management of acute low back pain since 1993-94. By and large the evidence-base for these proposals is consistent, though over the last 4 years it has increased considerably, and there has been a slight change of emphasis in several aspects. As all the guidelines are based on the same evidence, the similarity between them is not surprising. The common features are diagnostic triage along with periodic assessment to guide management strategies. There has been progressive reduction in the recommendation of rest as a treatment option, and early activation is increasingly recognized as a potent intervention. There has been a progressive recognition that psychosocial factors are important determinants for the risk of chronicity, and that such factors need to be addressed clinically. Specific therapeutic recommendations vary, but these are probably less important than the overall strategy. It is obviously hoped that clinical management should improve as a result of these initiatives, but effective dissemination and implementation are persisting concerns, and the effectiveness of clinical guidelines in changing clinical practice is still unproven.
Previously published epidemiologic studies of low back pain (LBP) have reported that the prevalence of low back disability has increased dramatically. These studies based their findings on either the number of disability claims filed, the disability duration, or both. This information was from countries other than the United States or from the US Social Security Disability Insurance data, with findings reported only to the early 1980s. More recent studies of US workers' compensation LBP claims reported a decrease in the incidence rate from the late 1980s to the mid-1990s. No studies have been found that report on the trends of disability duration for workers' compensation LBP claims. This study examined recent trends in the length of disability (LOD) for LBP claims and associated costs, using a large sample of claims from the privately insured US workers' compensation market. LOD and cost information were derived for injuries from 1988, 1990, 1992, 1994, and 1996. For each year, the distributions of LOD and cost were skewed, with the small percentage of claims that lasted more than one year (4.6%-8.8%, depending on the year) accounting for a large percentage of the total disability days (77.6%-90.1%) and cost (64.9%-84.7%). From 1988 to 1996, the average LOD decreased 60.9%, from 156 days to 61 days. The probability of being on disability for a long period of time has decreased over the years. Over the study period, the average cost of a claim decreased 41.4%, while the median cost increased 19.7%. The most influential change in the LOD and cost distributions was a reduction in expensive claims with a long disability duration. The evolution of LOD and cost is also detailed for different disability durations for the study period.
The prevalence of low back pain (LBP) has been reported in the literature for different populations. Methodological differences among studies and lack of methodological rigor have made it difficult to draw conclusions from these studies. A systematic review was done for adult community prevalence studies of LBP published from 1981 to 1998. The technique of capture-recapture was performed to estimate the completeness of the search strategy used. Established guidelines and a methodological scoring system were used to critically appraise the studies. Thirteen studies were deemed methodologically acceptable. Differences in the duration of LBP used in the studies appeared to affect the prevalence rates reported and explain much of the variation seen. It was estimated that the point prevalence rate in North America is 5.6%. Further studies using superior methods are needed, however, before this estimate can be used with confidence to make health care policies and decisions relating to physical therapy.
In this case study, a diverse panel of 6 practitioners of mainstream and/or alternative medicine plus a moderator convened as an experiment in practicing integrative medicine to examine, diagnose, and prescribe for a patient suffering from chronic, severe, treatment-resistant back pain. Although panel members represented a wide range of theories of health and healing, they were able to communicate easily with one another by limiting themselves to the scientific language of biomedicine. From the perspective of medical anthropology, this can be interpreted as an unplanned and unconscious process of cultural imitation in a medical marketplace in which cultural differentiation formerly prevailed. Although the shift from differentiation to imitation was limited in this experiment to the sharing of a single language of discourse and to recommendations of mutually compatible treatment options, it raises an important question. With the institutionalization of integrated medical practice, will alternative medical systems survive only if they are stripped down to being no more than alternative therapeutic modalities?
A systematic literature review of population prevalence studies of low back pain between 1966 and 1998 was conducted to investigate data homogeneity and appropriateness for pooling. Fifty-six studies were analyzed using methodologic criteria that examined sample representativeness, data quality, and pain definition. Acceptable studies were assessed for homogeneity and appropriateness for pooling. Thirty were methodologically acceptable. Of these there were significant differences in study design, patient age, mode of data collection, potential temporal effects, and prevalence results. Point prevalence ranged from 12% to 33%, 1-year prevalence ranged from 22% to 65%, and lifetime prevalence ranged from 11% to 84%. A limited number of studies were left for analysis, making the pooling of data difficult. A model using uniform best-practice methods is proposed.
A systematic review of randomized and double-blind controlled trials was performed.
Nonsteroidal anti-inflammatory drugs are the most frequently prescribed medications worldwide and are widely used for patients with low back pain.
To assess the effects of nonsteroidal anti-inflammatory drugs in the treatment of nonspecific low back pain with or without radiation, and to assess which type of nonsteroidal anti-inflammatory drug is most effective.
For this study, the Cochrane Controlled Trials Register, Medline and Embase, and reference lists of articles were searched. Two reviewers blinded with respect to authors, institution, and journal independently extracted data and assessed the methodologic quality of the studies. If data were considered clinically homogeneous, a meta-analysis was performed. If data were considered clinically heterogeneous, a qualitative analysis was performed using a rating system with four levels of evidence: strong, moderate, limited, and no evidence.
This review involved 51 trials and 6057 patients. Of these trials, 16 (31%) were of high quality. The pooled relative risk for global improvement after 1 week was 1.24 (95% confidence interval [CI] = 1.10-1.41), and for additional analgesic use was 1.29 (95% CI = 1.05-1.57), indicating a statistically significant but small effect in favor of nonsteroidal anti-inflammatory drugs as compared with a placebo. The results of the qualitative analysis showed that there is conflicting evidence (Level 3) that nonsteroidal anti-inflammatory drugs are more effective than paracetamol for acute low back pain, and that there is moderate evidence (Level 2) that nonsteroidal anti-inflammatory drugs are not more effective than other drugs for acute low back pain. There is strong evidence (Level 1) that various types of nonsteroidal anti-inflammatory drugs are equally effective for acute low back pain.
The evidence from the 51 trials included in this review suggests that nonsteroidal anti-inflammatory drugs are effective for short-term symptomatic relief in patients with acute low back pain. Furthermore, there does not seem to be a specific type of nonsteroidal anti-inflammatory drug that is clearly more effective than others. Sufficient evidence on chronic low back pain still is lacking.
A systematic review of randomized controlled trials.
To evaluate the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults.
Multidisciplinary biopsychosocial rehabilitation programs for neck and shoulder pain require substantial staff and financial resources. They are widely used, despite questionable evidence of their effectiveness.
The reviewed randomized controlled and controlled trials appraising the effectiveness of biopsychosocial rehabilitation for working age patients with neck and shoulder pain were identified by searching electronic bibliographic databases, checking references, and consulting experts in the rehabilitation field. Four blinded reviewers selected the trials. Two specialists on rehabilitation evaluated the clinical relevance. Two other blinded reviewers extracted the data and assessed the main results and the methodologic quality of the studies. A qualitative analysis was performed to evaluate the level of scientific evidence.
After 1808 abstracts and the references of 65 reviews were screened, only two relevant studies were found that satisfied the criteria. One of these was considered a methodologically low-quality randomized controlled trial, and the other was a methodologically low-quality controlled clinical trial. The clinical relevance of included studies was satisfactory. The level of scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain was limited.
There appears to be little scientific evidence for the effectiveness on neck and shoulder pain of multidisciplinary biopsychosocial rehabilitation compared with other rehabilitation methods. There is an urgent need for high-quality trials in this field.
A systematic review of randomized controlled trials was performed.
To evaluate the effectiveness of multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working-age adults.
Multidisciplinary biopsychosocial rehabilitation programs are widely applied for patients with chronic low back pain. The multidisciplinary biopsychosocial approach for prolonged low back pain could be considered to prevent chronicity. Work site visits and a close relationship with occupational health care might produce results in terms of patients working ability.
Reviewed randomized controlled trials as well as controlled trials were identified from electronic bibliographic databases, reference checking, and consultation with experts in the rehabilitation field. Four blinded reviewers selected the trials. Two rehabilitation specialists evaluated the clinical relevance. Two other blinded reviewers extracted the data and assessed the main results along with the methodologic quality of the studies. A qualitative analysis was performed to evaluate the level evidence.
Of 1808 references, only 2 relevant studies were included. Both were considered to be methodologically low-quality randomized controlled trials. The clinical relevance of the studies was sufficient. The level of scientific evidence was moderate, showing that multidisciplinary rehabilitation involving work site visit or more comprehensive occupational health care intervention helps patients return to work faster, makes sick leaves less, and alleviates subjective disability.
There is moderate evidence showing that multidisciplinary rehabilitation for subacute low back pain is effective, and that work site visit increases the effectiveness, but because the analyzed studies had some methodologic shortcomings, an obvious need still exists for high-quality trials in this field.
Low back pain (LBP) affects a large proportion of the population. Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as an alternative therapy to pharmacological treatments for chronic pain. However, despite its widespread use, the effectiveness of TENS is still controversial.
The aim of this systematic review was to determine the efficacy of TENS in the treatment of chronic LBP.
We searched MEDLINE, EMBASE, PEDro and the Cochrane Controlled Trials Register up to June 1, 2000.
Only randomized controlled clinical trials of TENS for the treatment of patients with a clinical diagnosis of chronic LBP were included. Abstracts were excluded unless further data could be obtained from the authors.
Two reviewers independently selected trials and extracted data using predetermined forms. Heterogeneity was tested with Cochran's Q test. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results are presented as weighted mean differences (WMD) with 95% confidence intervals (95% CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences (SMD) were calculated by dividing the difference between the treated and control by the baseline variance. SMD were used when different scales were used to measure the same concept. Dichotomous outcomes were analyzed with odds ratios.
Five trials were included, with 170 subjects randomized to the placebo group receiving sham-TENS and 251 subjects receiving active TENS (153 for conventional mode, 98 for acupuncture-like TENS). The schedule of treatments varied greatly between studies ranging from one treatment/day for two consecutive days, to three treatments/day for four weeks. There were no statistically significant differences between the active TENS group when compared to the placebo TENS group for any outcome measures. Subgroup analysis performed on TENS application and methodological quality did not demonstrate a significant statistical difference. Remaining pre-planned subgroup analysis was not conducted due to the small number of included trials and the variety of outcome measures reported.
The results of the meta-analysis present no evidence to support the use of TENS in the treatment of chronic low back pain. Clinicians and researchers should consistently report the characteristics of the TENS device and the application techniques used. New trials on TENS should make use of standardized outcome measures. This meta-analysis lacked data on how TENS effectiveness is affected by four important factors: type of applications, site of application, treatment duration of TENS, optimal frequencies and intensities.
Descriptive study.
To compare national clinical guidelines on low back pain.
To rationalize the management of low back pain, clinical guidelines have been issued in various countries around the world. Given that the available scientific evidence is the same, irrespective of the country, one would expect these guidelines to include more or less similar recommendations regarding diagnosis and treatment.
Guidelines were included that met the following criteria: the target group consisted of primary care health professionals, and the guideline was published in English, German, or Dutch. Only one guideline per country was included: the one most recently published.
Clinical guidelines from 11 different countries published from 1994 until 2000 were included in this review. The content of the guidelines appeared to be quite similar regarding the diagnostic classification (diagnostic triage) and the use of diagnostic and therapeutic interventions. Consistent features were the early and gradual activation of patients, the discouragement of prescribed bed rest, and the recognition of psychosocial factors as risk factors for chronicity. However, there were discrepancies for recommendations regarding exercise therapy, spinal manipulation, muscle relaxants, and patient information.
The comparison of clinical guidelines for the management of low back pain showed that diagnostic and therapeutic recommendations were generally similar. Updates of the guidelines are planned in most countries, although so far produced only in the United Kingdom. However, new evidence may lead to stronger conclusions and enable future guidelines to become even more concordant.