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1
Meeus, Mira. "Differences in Pain Processing Between Patients with Chronic Low Back Pain, Recurrent Low Back Pain, and Fibromyalgia." May 2017 4, no. 20;4 (May 10, 2017): 307–18. http://dx.doi.org/10.36076/ppj.2017.318.
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Background: The impairment in musculoskeletal structures in patients with low back pain (LBP) is often disproportionate to their complaint. Therefore, the need arises for exploration of alternative mechanisms contributing to the origin and maintenance of non-specific LBP. The recent focus has been on central nervous system phenomena in LBP and the pathophysiological mechanisms underlying the various symptoms and characteristics of chronic pain. Knowledge concerning changes in pain processing in LBP remains ambiguous, partly due to the diversity in the LBP population. Objective: The purpose of this study is to compare quantitative sensory assessment in different groups of LBP patients with regard to chronicity. Recurrent low back pain (RLBP), mild chronic low back pain (CLBP), and severe CLBP are compared on the one hand with healthy controls (HC), and on the other hand with fibromyalgia (FM) patients, in which abnormal pain processing has previously been reported. Study Design: Cross-sectional study. Setting: Department of Rehabilitation Sciences, Ghent University, Belgium. Methods: Twenty-three RLBP, 15 mild CLBP, 16 severe CLBP, 26 FM, and 21 HC participated in this study. Quantitative sensory testing was conducted by manual pressure algometry and computercontrolled cuff algometry. A manual algometer was used to evaluate hyperalgesia as well as temporal summation of pain and a cuff algometer was used to evaluate deep tissue hyperalgesia, the efficacy of the conditioned pain modulation and spatial summation of pain. Results: Pressure pain thresholds by manual algometry were significantly lower in FM compared to HC, RLBP, and severe CLBP. Temporal summation of pain was significantly higher in FM compared to HC and RLBP. Pain tolerance thresholds assessed by cuff algometry were significantly lower in FM compared to HC and RLBP and also in severe CLBP compared to RLBP. No significant differences between groups were found for spatial summation or conditioned pain modulation. Limitations: No psychosocial issues were taken into account for this study. Conclusion: The present results suggest normal pain sensitivity in RLBP, but future research is needed. In mild and severe CLBP some findings of altered pain processing are evident, although to a lesser extent compared to FM patients. In conclusion, mild and severe CLBP presents within a spectrum, somewhere between completely healthy persons and FM patients, characterized by pain augmentation. Key words: Low back pain, fibromyalgia, pain assessment, quantitative sensory testing, central sensitization, hypersensitivity, temporal summation, spatial summation, conditioned pain modulation
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Malfliet, Anneleen, Kelly Ickmans, Eva Huysmans, Iris Coppieters, Ward Willaert, Wouter Van Bogaert, Emma Rheel, Thomas Bilterys, Paul Van Wilgen, and Jo Nijs. "Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain." Journal of Clinical Medicine 8, no. 7 (July 19, 2019): 1063. http://dx.doi.org/10.3390/jcm8071063.
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Chronic Low Back Pain (CLBP) is a major and highly prevalent health problem. Given the high number of papers available, clinicians might be overwhelmed by the evidence on CLBP management. Taking into account the scale and costs of CLBP, it is imperative that healthcare professionals have access to up-to-date, evidence-based information to assist them in treatment decision-making. Therefore, this paper provides a state-of-the-art overview of the best evidence non-invasive rehabilitation for CLBP. Taking together up-to-date evidence from systematic reviews, meta-analysis and available treatment guidelines, most physically inactive therapies should not be considered for CLBP management, except for pain neuroscience education and spinal manipulative therapy if combined with exercise therapy, with or without psychological therapy. Regarding active therapy, back schools, sensory discrimination training, proprioceptive exercises, and sling exercises should not be considered due to low-quality and/or conflicting evidence. Exercise interventions on the other hand are recommended, but while all exercise modalities appear effective compared to minimal/passive/conservative/no intervention, there is no evidence that some specific types of exercises are superior to others. Therefore, we recommend choosing exercises in line with the patient’s preferences and abilities. When exercise interventions are combined with a psychological component, effects are better and maintain longer over time.
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Pavelka, K., H. Jarosova, O. Sleglova, R. Svobodova, M. Votavova, L. Milani, Z. Prochazka, et al. "Chronic Low Back Pain: Current Pharmacotherapeutic Therapies and a New Biological Approach." Current Medicinal Chemistry 26, no. 6 (May 13, 2019): 1019–26. http://dx.doi.org/10.2174/0929867325666180514102146.
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Chronic low back pain (CLBP) syndrome represents one of the leading causes of long-term disability worldwide. The prevalence of CLBP has been rising significantly in relation to increasing average life expectancy. CLBP results from chronification of acute low back pain. There are many factors contributing to the CLBP crisis; common etiopathogenetic factors include e.g., functional blockage of intervertebral joints. The treatment of CLBP is complex. An important part of treatment consists of pain pharmacotherapy, for which several groups of drugs are used. The problem lies in the side effects of many of these traditionally used medications. Therefore, new and safer treatment methods are being sought. Innovative options for CLBP pharmacology include injections containing collagen, which can be combined with other traditionally used drugs, which helps reduce dosages and increase the overall safety of CLBP therapy.
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Suntsov, Vladislav, Filip Jovanovic, Emilija Knezevic, Kenneth D. Candido, and Nebojsa Nick Knezevic. "Can Implementation of Genetics and Pharmacogenomics Improve Treatment of Chronic Low Back Pain?" Pharmaceutics 12, no. 9 (September 21, 2020): 894. http://dx.doi.org/10.3390/pharmaceutics12090894.
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Etiology of back pain is multifactorial and not completely understood, and for the majority of people who suffer from chronic low back pain (cLBP), the precise cause cannot be determined. We know that back pain is somewhat heritable, chronic pain more so than acute. The aim of this review is to compile the genes identified by numerous genetic association studies of chronic pain conditions, focusing on cLBP specifically. Higher-order neurologic processes involved in pain maintenance and generation may explain genetic contributions and functional predisposition to formation of cLBP that does not involve spine pathology. Several genes have been identified in genetic association studies of cLBP and roughly, these genes could be grouped into several categories, coding for: receptors, enzymes, cytokines and related molecules, and transcription factors. Treatment of cLBP should be multimodal. In this review, we discuss how an individual’s genotype could affect their response to therapy, as well as how genetic polymorphisms in CYP450 and other enzymes are crucial for affecting the metabolic profile of drugs used for the treatment of cLBP. Implementation of gene-focused pharmacotherapy has the potential to deliver select, more efficacious drugs and avoid unnecessary, polypharmacy-related adverse events in many painful conditions, including cLBP.
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Simon, Corey B., Trevor A. Lentz, Mark D. Bishop, Joseph L. Riley, Roger B. Fillingim, and Steven Z. George. "Comparative Associations of Working Memory and Pain Catastrophizing With Chronic Low Back Pain Intensity." Physical Therapy 96, no. 7 (July 1, 2016): 1049–56. http://dx.doi.org/10.2522/ptj.20150335.
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Abstract Background Because of its high global burden, determining biopsychosocial influences of chronic low back pain (CLBP) is a research priority. Psychological factors such as pain catastrophizing are well established. However, cognitive factors such as working memory warrant further investigation to be clinically useful. Objective The purpose of this study was to determine how working memory and pain catastrophizing are associated with CLBP measures of daily pain intensity and movement-evoked pain intensity. Design This study was a cross-sectional analysis of individuals with ≥3 months of CLBP (n=60) compared with pain-free controls (n=30). Method Participants completed measures of working memory, pain catastrophizing, and daily pain intensity. Movement-evoked pain intensity was assessed using the Back Performance Scale. Outcome measures were compared between individuals with CLBP and those who were pain-free using nonparametric testing. Associations were determined using multivariate regression analyses. Results Participants with CLBP (mean age=47.7 years, 68% female) had lower working memory performance (P=.008) and higher pain catastrophizing (P<.001) compared with pain-free controls (mean age=47.6 years, 63% female). For individuals with CLBP, only working memory remained associated with daily pain intensity (R2=.07, standardized beta=−.308, P=.041) and movement-evoked pain intensity (R2=.14, standardized beta=−.502, P=.001) after accounting for age, sex, education, and interactions between pain catastrophizing and working memory. Limitations The cross-sectional design prevented prospective analysis. Findings also are not indicative of overall working memory (eg, spatial) or cognitive performance. Conclusion Working memory demonstrated the strongest association with daily pain and movement-evoked pain intensity compared with (and after accounting for) established CLBP factors. Future research will elucidate the prognostic value of working memory on prevention and recovery of CLBP.
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França, Verônica Leonor, Micheline Henrique Araújo da Luz Koerich, and Guilherme S. Nunes. "Sleep quality in patients with chronic low back pain." Fisioterapia em Movimento 28, no. 4 (December 2015): 803–10. http://dx.doi.org/10.1590/0103-5150.028.004.ao17.
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Abstract Introduction : Sleep performs a restorative function for the body. Medical conditions such as Chronic Low Back Pain (CLBP) may cause sleep changes and impair sleep quality. Objectives : To identify the prevalence of sleep disorders among individuals with CLBP, and investigate whether there is an association between these disorders and perceived functional disability. Materials and methods : This observational, descriptive study was conducted with 51 patients seen at the Clinic of the School of Physical Therapy of Santa Catarina State University. Data were collected through interviews addressing socio-demographic and clinical data, and administration of the Roland-Morris Disability Questionnaire (RMDQ) and Pittsburgh Sleep Quality Index (PSQI). Results : Participants had high levels of functional disability (mean, 16.71 ± 4.16 score points). 82.35% of patients had poor sleep quality (mean, 10.22 ± 4.84 score points). The PSQI components with the highest mean scores were: sleep latency and sleep disturbances. There was also a weak association between functional disability and sleep quality (Spearman = 0.31; p = 0.025), i.e., the higher the disability, the worse the quality of sleep. Conclusion : We found a high prevalence of sleep disorders among patients with CLBP, and a weak association with the level of perceived disability. It is important to conduct further studies on the relationship between these factors and sleep quality. Moreover, there is a need for a multidisciplinary approach in the treatment of CLBP, in order to treat sleep disorders and improve patients' quality of life.
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Frizziero, Antonio, Giacomo Pellizzon, Filippo Vittadini, Davide Bigliardi, and Cosimo Costantino. "Efficacy of Core Stability in Non-Specific Chronic Low Back Pain." Journal of Functional Morphology and Kinesiology 6, no. 2 (April 22, 2021): 37. http://dx.doi.org/10.3390/jfmk6020037.
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(1) Background: Management of chronic low back pain (cLBP) is often multidisciplinary, involving a combination of treatments, including therapeutic exercises. Core stability exercises aim to improve pain and disability in cLBP increasing spinal stability, neuromuscular control, and preventing shear force that causes injury to the lumbar spine. The purpose of this study was to review the available evidence about the effectiveness in reducing pain and improving disability of core stability exercises for non-specific cLBP. (2) Methods: We perform a systematic research on common Medline databases: PubMed, Pedro, and Cochrane Library. Search results were limited to articles written in English and published between January 2005 and November 2020.The search provided a total of 420 articles. Forty-nine articles met the inclusion criteria and 371 articles were excluded. (3) Results: Core stability provides great therapeutic effects in patients with non-specific chronic low back pain reducing pain intensity, functional disability, and improving quality of life, core muscle activation, and thickness. Evidences suggest that core stability is more effective than rest or no/minimal intervention and combination with other types of exercise for cLBP have shown grater efficacy. (4) Conclusion: Core stability could be proposed in a comprehensive approach in cLBP, the combination with other modalities of therapeutic exercise should be promoted. Patient compliance is crucial to determine the efficacy of the intervention.
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Smith, James Kenneth, and Jack R. Crisler. "Chronic Low Back Pain: The Treatment Dichotomy and Implications for Rehabilitation Counselors." Journal of Applied Rehabilitation Counseling 16, no. 1 (March 1, 1985): 28–31. http://dx.doi.org/10.1891/0047-2220.16.1.28.
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Persons with chronic low back pain (CLBP) are being referred to private and state rehabilitation programs in increasing numbers. The difficulty of rehabilitating the CLBP person is well documented. Treatment approaches to CLBP vary but generally fall into conservative and surgical treatment categories. This paper presents an overview of the treatment approaches and psychological factors, and makes suggestions for rehabilitation counselor strategy.
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Islam, Mollah Mohammad Muzahidul, Tulshi Chandra Saha, Abu Saleh Mohammad Mainul Hasan, Sarwar Bin Zakir, and Saifur Ahmed. "Assessment of Risk Factors for Chronic Low Back Pain in Adult Male." Faridpur Medical College Journal 15, no. 2 (June 8, 2021): 74–78. http://dx.doi.org/10.3329/fmcj.v15i2.53892.
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Chronic low back pain (CLBP) is an important health problem in Bangladeshi adult males. This case control study was carried out in the department of Physical Medicine and Rehabilitation, BSMMU, Dhaka from January 2015 to December 2015 to determine the association between CLBP and family history, smoking, level of education, level of income, level of exercise, bad posture and BMI in adult male. Total 171 patients with CLBP were taken as cases, and 171 male without CLBP were taken as controls. Data were collected using a structured interviewer-administered questionnaire, enquiring about demographic data and details of risk factors. Heights and weights were measured to calculate body mass index (BMI). Age range was 18 to 60 years. Mean age (± SD) for cases was 35.8±11 years and that of controls was 37.2±13 years. It was found that Bad posture (p value <.001), lack of exercise (p value<.001) and moderate level of education (p value .044) were significant risk factors for CLBP. Family history, smoking, level of income and BMI did not have a significant association with CLBP.
Faridpur Med. Coll. J. 2020;15(2): 74-78
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Penn, Terence M., Demario S. Overstreet, Edwin N. Aroke, Deanna D. Rumble, Andrew M. Sims, Caroline V. Kehrer, Ava N. Michl, et al. "Perceived Injustice Helps Explain the Association Between Chronic Pain Stigma and Movement-Evoked Pain in Adults with Nonspecific Chronic Low Back Pain." Pain Medicine 21, no. 11 (April 24, 2020): 3161–71. http://dx.doi.org/10.1093/pm/pnaa095.
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Abstract Objective For most patients with chronic low back pain (cLBP), the cause is “nonspecific,” meaning there is no clear association between pain and identifiable pathology of the spine or associated tissues. Laypersons and providers alike are less inclined to help, feel less sympathy, dislike patients more, suspect deception, and attribute lower pain severity to patients whose pain does not have an objective basis in tissue pathology. Because of these stigmatizing responses from others, patients with cLBP may feel that their pain is particularly unjust and unfair. These pain-related injustice perceptions may subsequently contribute to greater cLBP severity. The purpose of this study was to examine whether perceived injustice helps explain the relationship between chronic pain stigma and movement-evoked pain severity among individuals with cLBP. Methods Participants included 105 patients with cLBP who completed questionnaires assessing chronic pain stigma and pain-related injustice perception, as well as a short physical performance battery for the assessment of movement-evoked pain and physical function. Results Findings revealed that perceived injustice significantly mediated the association between chronic pain stigma and cLBP severity (indirect effect = 6.64, 95% confidence interval [CI] = 2.041 to 14.913) and physical function (indirect effect = −0.401, 95% CI = −1.029 to −0.052). Greater chronic pain stigma was associated with greater perceived injustice (P = 0.001), which in turn was associated with greater movement-evoked pain severity (P = 0.003). Conclusions These results suggest that perceived injustice may be a means through which chronic pain stigma impacts nonspecific cLBP severity and physical function.
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Giesbrecht, R. Jason S., and Michele C. Battié. "A Comparison of Pressure Pain Detection Thresholds in People With Chronic Low Back Pain and Volunteers Without Pain." Physical Therapy 85, no. 10 (October 1, 2005): 1085–92. http://dx.doi.org/10.1093/ptj/85.10.1085.
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Abstract Background and Purpose. Palpation is often utilized in the physical examination of patients with low back pain. The purpose of this study was to compare the pressure pain detection threshold (PPDT) of people with chronic low back pain (CLBP) and subjects without pain. Subjects and Methods. Thirty female subjects with CLBP were recruited from the offices of primary care physicians and physical therapists and compared with 30 female volunteers without pain for differences in PPDT at 6 sites tested bilaterally. Results. A significantly lower mean PPDT was found for all test site groups in subjects with CLBP compared with subjects without pain. A lower global PPDT was found in subjects with CLBP compared with subjects without pain (5.6 lb/cm2 versus 6.9 lb/cm2). This also was the case for PPDT for the group of test sites unrelated to the lumbar spine (5.1 lb/cm2 versus 6.1 lb/cm2) and for PPDT related to the lumbar spine (5.9 lb/cm2 versus 8.0 lb/cm2). Discussion and Conclusion. Neurobiological or biopsychosocial influences may have contributed to the lower PPDT evident in subjects with CLBP. Subjects with CLBP demonstrated a lower global PPDT compared with subjects without pain, which should be taken into account when interpreting findings of pain or tenderness from palpation.
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Budhrani-Shani, Pinky, Donna L. Berry, Patricia Arcari, Helene Langevin, and Peter M. Wayne. "Mind-Body Exercises for Nurses with Chronic Low Back Pain: An Evidence-Based Review." Nursing Research and Practice 2016 (2016): 1–10. http://dx.doi.org/10.1155/2016/9018036.
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Background. Chronic low back pain (CLBP) among nurses is a growing health concern. The multimodal nature of mind-body exercises has potential to impact physiological and psychological processes associated with chronic pain, affording possible advantages over conventional unimodal therapies. This paper summarizes the prevalence of and risk factors for CLBP among nurses, reviews the effectiveness in treating pain and disability of mind-body exercises (yoga and tai chi) for CLBP among the general and nursing population, and describes implications.Methods. Articles, published during or prior to 2015, were systematically identified through the PubMed/MEDLINE, Web of Science, and ScienceDirect databases using the following search terms:nurses, mind-body, integrative, biopsychosocial, yoga, tai chi, back pain,and/orrisk factors.Results. Prevalence estimates of CLBP among nurses ranged from 50% to 80%. Associated risk factors for CLBP included lifestyle and physical, psychological, psychosocial, and occupational factors. No published studies were identified that evaluated yoga or tai chi for nurses with CLBP. Studies in the general population suggested that these interventions are effective in reducing pain and disability and may improve factors/processes predictive of CLBP.Conclusion. This review suggests that evaluating the impact of multimodal interventions such as yoga and tai chi for nurses with CLBP warrants investigation.
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Giordano, Lorenzo, William D. Murrell, and Nicola Maffulli. "Prolotherapy for chronic low back pain: a review of literature." British Medical Bulletin 138, no. 1 (April 21, 2021): 96–111. http://dx.doi.org/10.1093/bmb/ldab004.
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Abstract Introduction Low back pain is common and imposes major societal burdens for patient suffering and costs. Prolotherapy injections are used for musculoskeletal conditions including tendinopathies, osteoarthritis and low back pain to enhance soft-tissue healing. This review aims to clarify the place of prolotherapy in chronic low back pain (CLBP). Sources of data Using multiple databases, a systematic search was performed to identify studies detailing the use of prolotherapy to manage CLBP. A total of 12 articles was included in the present work. Areas of agreement Considering the level of evidence and the quality of the studies assessed using the modified Coleman Score, prolotherapy is an effective management modality for CLBP patients in whom conservative therapies failed. Areas of controversy The presence of co-interventions and the clinical heterogeneity of the work contributes to confound the overall conclusions. Growing points and areas for research The analysis of the studies included in the review, using appropriate tools, showed how their quality has decreased over the years, reflecting the need for appropriately powered well planned and performed randomized control trials.
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Luiggi-Hernandez, José G., Jean Woo, Megan Hamm, Carol M. Greco, Debra K. Weiner, and Natalia E. Morone. "Mindfulness for Chronic Low Back Pain: A Qualitative Analysis." Pain Medicine 19, no. 11 (August 16, 2017): 2138–45. http://dx.doi.org/10.1093/pm/pnx197.
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Abstract Objective Mindfulness is a nonpharmacologic mind-body therapy that has been shown to be effective in older adults with chronic low back pain (cLBP). There are few first-person accounts in the literature that describe the older adult experience and perspective while learning mindfulness and meditation to treat pain. The objective of this study was to investigate dominant themes present in the experiences of older adults applying mindfulness and meditation to cope with cLBP. Design Qualitative analysis of four focus groups. Subject Twenty-five adults age 65 years or older who had completed an eight-week mindfulness program. Methods The focus groups met for a comprehensive discussion session about their experience with mindfulness and meditation. The audio for each session was recorded, and the discussions were transcribed. Codebook development, qualitative coding, and thematic analysis were performed. The coders each coded all four transcripts, following which they met to adjudicate all coding differences until they were in complete agreement on coding. Results Several key themes were brought up by older adults utilizing mindfulness as a means of coping with pain, which included overcoming fear of pain (“Before [learning mindfulness], I used to dread pain”), pain awareness (“You’re focusing more on being aware than the pain; now that’s what helps me”), and pain significance (“It becomes insignificant”). Conclusions The themes identify several ways mindfulness impacts older adults with cLBP, including decreased negative emotions related to chronic pain such as fear of pain, a different perspective or change in awareness about pain, and reducing the significance of pain.
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Wang, Haili. "Does Long-Term Opioid Therapy Reduce Pain Sensitivity of Patients with Chronic Low Back Pain? Evidence from Quantitative Sensory Testing." July 2012 3S;15, no. 3S;7 (July 14, 2012): ES135—ES143. http://dx.doi.org/10.36076/ppj.2012/15/es135.
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Background: Long-term opioid treatment has been used extensively in treatment of chronic low back pain (cLBP) in the last decades. However, there are serious limitations to the long-term efficacy of opioids and related side effects. Objectives: In this study we investigated whether long-term opioid treatment changes pain sensitivity of patients with cLBP. Study Design: A prospective, nonrandomized, cross-sectional study. Setting: Multidisciplinary pain management clinic, specialty referral center, university hospital in Germany. Methods: Using quantitative sensory testing (QST), we compared the pain sensitivity of the low back bilaterally among 3 groups: 35 patients with cLBP undergoing a long-term opioid therapy (OP); 35 patients with cLBP administered no opioids (ON), and 28 subjects with neither pain nor opioid intake (HC). Results: OP patients showed significantly higher bilateral thermal detection thresholds to warm stimuli on the back as compared to both ON (P = 0.009 for left low back, P = 0.008 for right low back) and HC subjects (P = 0.004 for left low back, P = 0.003 for right low back). Pain thresholds for cold and heat on the hand were similar in OP and ON groups; both showed, however, significantly reduced heat pain thresholds in comparison with HC participants (P = 0.012 for OP, P = 0.001 for ON). Factors such as age, sex, duration and dose of opioid intake, and self-reported pain intensity, but not depression and pain duration, correlated significantly with QST results. Limitations: Limitations include small numbers of patients with heterogeneous opioid therapy and the nonrandomized observational nature of the study. Conclusions: The current study demonstrated that chronic opioid intake may only reduce the temperature sensitivity but not pain sensitivity measured by QST which is a useful tool in detecting characteristic changes in pain perception of patients with chronic low back pain after long-term opioid intake. Key words: Pain sensitivity, opioid treatment, chronic low back pain (cLBP), quantitative sensory testing (QST)
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Allegri, Massimo, Silvana Montella, Fabiana Salici, Adriana Valente, Maurizio Marchesini, Christian Compagnone, Marco Baciarello, Maria Elena Manferdini, and Guido Fanelli. "Mechanisms of low back pain: a guide for diagnosis and therapy." F1000Research 5 (June 28, 2016): 1530. http://dx.doi.org/10.12688/f1000research.8105.1.
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Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 3 months. CLBP represents the second leading cause of disability worldwide being a major welfare and economic problem. The prevalence of CLBP in adults has increased more than 100% in the last decade and continues to increase dramatically in the aging population, affecting both men and women in all ethnic groups, with a significant impact on functional capacity and occupational activities. It can also be influenced by psychological factors, such as stress, depression and/or anxiety. Given this complexity, the diagnostic evaluation of patients with CLBP can be very challenging and requires complex clinical decision-making. Answering the question “what is the pain generator” among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a mis-diagnosis can generate therapeutical mistakes. Traditionally, the notion that the etiology of 80% to 90% of LBP cases is unknown has been mistaken perpetuated across decades. In most cases, low back pain can be attributed to specific pain generator, with its own characteristics and with different therapeutical opportunity. Here we discuss about radicular pain, facet Joint pain, sacro-iliac pain, pain related to lumbar stenosis, discogenic pain. Our article aims to offer to the clinicians a simple guidance to identify pain generators in a safer and faster way, relying a correct diagnosis and further therapeutical approach.
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Allegri, Massimo, Silvana Montella, Fabiana Salici, Adriana Valente, Maurizio Marchesini, Christian Compagnone, Marco Baciarello, Maria Elena Manferdini, and Guido Fanelli. "Mechanisms of low back pain: a guide for diagnosis and therapy." F1000Research 5 (October 11, 2016): 1530. http://dx.doi.org/10.12688/f1000research.8105.2.
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Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 3 months. CLBP represents the second leading cause of disability worldwide being a major welfare and economic problem. The prevalence of CLBP in adults has increased more than 100% in the last decade and continues to increase dramatically in the aging population, affecting both men and women in all ethnic groups, with a significant impact on functional capacity and occupational activities. It can also be influenced by psychological factors, such as stress, depression and/or anxiety. Given this complexity, the diagnostic evaluation of patients with CLBP can be very challenging and requires complex clinical decision-making. Answering the question “what is the pain generator” among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a mis-diagnosis can generate therapeutical mistakes. Traditionally, the notion that the etiology of 80% to 90% of LBP cases is unknown has been mistaken perpetuated across decades. In most cases, low back pain can be attributed to specific pain generator, with its own characteristics and with different therapeutical opportunity. Here we discuss about radicular pain, facet Joint pain, sacro-iliac pain, pain related to lumbar stenosis, discogenic pain. Our article aims to offer to the clinicians a simple guidance to identify pain generators in a safer and faster way, relying a correct diagnosis and further therapeutical approach.
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Gregg, Chris, Chris Hoffman, Hamilton Hall, Greg McIntosh, and Peter Robertson. "Outcomes of an interdisciplinary rehabilitation programme for the management of chronic low back pain." Journal of Primary Health Care 3, no. 3 (2011): 222. http://dx.doi.org/10.1071/hc11222.
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BACKGROUND AND CONTEXT: The health and economic costs associated with chronic low back pain (CLBP) have increased substantially over the past few decades. Despite extensive research, a consistently valid, reliable and effective diagnostic and treatment regime for CLBP is yet to be determined. ASSESSMENT OF PROBLEM: This paper presents an established interdisciplinary rehabilitation model for CLBP initially developed by the Canadian Back Institute. An audit describes the symptomatic, functional and vocational outcomes achieved for patients who attended the programme over three years throughout a national network of primary health care facilities in New Zealand. RESULTS: Over a three-year period, 899 patients with CLBP completed their rehabilitation programme at one of eight affiliated clinics. Of the 899 patients discharged, 780 (86.8%) reported that their back pain had gone or reduced at the end of their rehabilitation. There was a statistically significant, and clinically relevant, improvement in both average pain and subjective functional scores from baseline assessment levels to discharge and follow-up scores (p<0.001). STRATEGIES FOR IMPROVEMENT: Previous studies have shown that functional rehabilitation can improve outcomes in individuals with CLBP. This audit provides further support for the development of interdisciplinary functional rehabilitation programmes to help manage CLBP within the community. LESSONS: The routine measurement of symptomatic, functional and vocational outcomes throughout the rehabilitation process can assist in quantifying the effect of treatment and providing evidence of value for patients, stakeholders and funding groups. KEYWORDS: Low back pain; outcomes; rehabilitation
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Castro-Méndez, Aurora, Inmaculada Concepción Palomo-Toucedo, Manuel Pabón-Carrasco, Javier Ramos-Ortega, Juan Antonio Díaz-Mancha, and Lourdes María Fernández-Seguín. "Custom-Made Foot Orthoses as Non-Specific Chronic Low Back Pain and Pronated Foot Treatment." International Journal of Environmental Research and Public Health 18, no. 13 (June 25, 2021): 6816. http://dx.doi.org/10.3390/ijerph18136816.
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Excessive foot pronation has been reported as being related to chronic low back pain symptoms and risk factors in sports-specific pathologies. Compensating custom-made foot orthotics treatment has not been entirely explored as an effective therapy for chronic low back pain (CLBP). This study aims to observe the effects of custom-made foot orthoses, in subjects with foot pronation suffering from CLBP. A total of 101 patients with nonspecific CLBP and a pronated foot posture index (FPI) were studied. They were randomized in two groups: an experimental one (n = 53) used custom-made foot orthotics, and the control group (n = 48) were treated with non-biomechanical effect orthoses. The CLBP was measured using the Oswestry Disability Index (ODI) Questionnaire and a visual analogue scale (VAS), both for lower back pain. The symptoms were evaluated twice, at first when the subject was included in the study, and later, after 4 weeks of treatment. The analysis of outcomes showed a significant decrease in CLBP in the custom-made foot orthoses participants group (p < 0.001 ODI; p < 0.001 VAS). These findings suggest that controlling excessive foot pronation by using custom-made foot orthoses may significantly contribute to improving CLBP.
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Cinaroglu, Songul. "Risk factors associated with chronic low back pain: an analysis of Turkey health survey data." International Journal Of Community Medicine And Public Health 5, no. 2 (January 24, 2018): 454. http://dx.doi.org/10.18203/2394-6040.ijcmph20180219.
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Background: Turkey, a developing country has low back disorders as the most common symptom among adults with 33% prevalence in 2014. The patient’s self reports are important to determine the condition as chronic low back pain (CLBP) is a symptom rather than the disease. However, there is a scarcity of knowledge about self-reported CLBP among adults from developing countries. Methods: A community-based cross-sectional population survey study conducted by face-to-face interviews. To identify socio-demographic factors, health, behavior, and comorbidities associated with (CLBP). 6729 adults (≥15 years) with self-reported CLBP and 12400 non-CLBP adults who participated 2014 Turkey Health Survey (THS) were included. Data on smoking, alcohol consumption, physical activity, healthy eating behavior, muscle strengthening activities, and kinesitherapist and psychotherapist visits were collected. Socio-demographic characteristics, comorbidities, and health of CLBP and non-CLBP adults were compared using logistic regression analysis. Results: Age, gender, marital status, occupational status and health insurance were associated with a higher likelihood to report CLBP (p<0.001). The likelihood of diabetes and hypertension was higher in patients with CLBP (p<0.001). Visiting a psychotherapist, smoking and healthy eating were associated with a higher likelihood of CLBP (p<0.001) whereas, alcohol consumption, physical activity, muscle strengthening activities and visiting kinesiotherapist were associated with a lower likelihood of CLBP (p<0.001). Conclusions: Reduced smoking and alcohol consumption, healthy eating, increased physical activity, kinesitherapy and psychotherapy can be employed to manage CLBP.
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Rachmawati, Yusnita. "The Role of Substance P in Chronic Low Back Pain (CLBP)." Journal of Islamic Pharmacy 4, no. 2 (January 3, 2020): 9. http://dx.doi.org/10.18860/jip.v4i2.8163.
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<p>Low Back Pain is one of the disease that causing global disability in the worldwide. In the past 10 years, prevalence of LBP has not decreased, it makes global burden increase substantially. Chronic low back pain(CLBP) is pain that is almost experienced daily by patients in the lower back region in a period of more than 3 months. Chronic low back pain is a mixture of pain that arises through nociceptive and neuropathic mechanisms. Over the past decade, numerous guidelines have been used in the management of CLBP. Problems that are still a controversy include the management of pain. The mechanism of many treatment measures is still in the low to moderate effectiveness stage, so that the pain management target is not optimal. Substance P is a neuropeptide that release both in acute and chronic pain. Therefore study about mechanisms that affect SP release may show important information regarding pathological alterations in pain perception.</p>
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Butowicz, Courtney M., Sheri P. Silfies, Jennifer Vendemia, Shawn Farrokhi, and Brad D. Hendershot. "Characterizing and Understanding the Low Back Pain Experience Among Persons with Lower Limb Loss." Pain Medicine 21, no. 5 (November 9, 2019): 1068–77. http://dx.doi.org/10.1093/pm/pnz293.
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Abstract Objective This study preliminarily characterizes and compares the impact of lower limb loss and development of chronic low back pain (cLBP) on psychosocial factors, as well as the relationship between these factors and low back pain–related functional disability. Design Cross-sectional study. Methods Participants were adults, active duty or retired military, with traumatic lower limb loss with and without chronic low back pain. Psychosocial factors and low back pain–related functional disability were measured using common clinical self-report questionnaires. The presence of psychosocial factors was compared between those with and without cLBP using multivariate analysis of covariance (P < 0.05), and correlations determined relationships between psychosocial factors and cLBP-related functional disability. Results There were no statistically significant differences among psychosocial factors between those with vs without cLBP (F(4, 13) = 0.81, P = 0.54, η2= 0.19). Employment status (ρ = 0.43, P = 0.02), anxiety (ρ = 0.45, P = 0.04), and kinesiophobia (ρ = 0.47, P = 0.04) were moderately associated with low back pain–related disability. Conclusions Psychological (i.e., anxiety) and social (i.e., employment status) factors may influence how persons with traumatic lower limb loss respond to self-reported measures of low back pain–related disability. The findings suggest that the Modified Oswestry Disability Index identifies cLBP-related functional disability in the context of lower limb loss. These results support the interdependence among biological, psychological, and social factors, which should be collectively considered during the development of rehabilitative strategies to treat secondary musculoskeletal conditions within this population.
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Stensland, Meredith, and Sara Sanders. "Living a Life Full of Pain: Older Pain Clinic Patients’ Experience of Living With Chronic Low Back Pain." Qualitative Health Research 28, no. 9 (March 30, 2018): 1434–48. http://dx.doi.org/10.1177/1049732318765712.
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Chronic low back pain (CLBP) is older adults’ most common pain complaint and is associated with many physical and psychosocial consequences, which have been quantitatively examined. However, little research has qualitatively examined the experience itself of CLBP in later life. Study objective was to understand older adults’ lived CLBP experience. Guided by van Manen’s phenomenological method, 21 pain clinic patients aged 66 to 83 completed semistructured interviews. Under the main theme “living a life full of pain,” results are reflected in four existential subthemes: (a) Corporeality: The pain is relentless and constantly monitored, (b) Temporality: To live with pain is to live by pacing day and night, (c) Relationality: Pain creates limits that can be tested or obeyed, and (d) Spatiality: Manipulating the space around me to accommodate the pain. Findings improve understanding of the patient experience of late life CLBP and highlights the importance of empathy and patient-centeredness when treating older adults.
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Kim, Jin-Hwan, Jae Taek Hong, Chong-Suh Lee, Keun-Su Kim, Kyung-Soo Suk, Jin-Hyok Kim, Ye-Soo Park, et al. "Prevalence of Neuropathic Pain and Patient-Reported Outcomes in Korean Adults with Chronic Low Back Pain Resulting from Neuropathic Low Back Pain." Asian Spine Journal 11, no. 6 (December 31, 2017): 917–27. http://dx.doi.org/10.4184/asj.2017.11.6.917.
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<sec><title>Study Design</title><p>A noninterventional, multicenter, cross-sectional study.</p></sec><sec><title>Purpose</title><p>We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP).</p></sec><sec><title>Overview of Literature</title><p>Among patients with CLBP, 20%–55% had NP.</p></sec><sec><title>Methods</title><p>Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4<4) groups.</p></sec><sec><title>Results</title><p>A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; <italic>p</italic><0.01), in patients who had pain based on radiological and neurological findings (59.0%; <italic>p</italic><0.01), and in patients who had severe pain (49.0%; <italic>p</italic><0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; <italic>p</italic><0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; <italic>p</italic><0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; <italic>p</italic><0.01) and higher QBPDS (β=7.0; <italic>p</italic><0.01) scores than those without NP.</p></sec><sec><title>Conclusions</title><p>NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.</p></sec>
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Morlion, Bart, Gabriele Finco, Dominic Aldington, Michael Überall, and Ravi Karra. "Severe chronic low back pain: patient journey from onset of symptoms to strong opioid treatments in Europe." Pain Management 11, no. 5 (September 2021): 595–602. http://dx.doi.org/10.2217/pmt-2021-0009.
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Aim: We report the first patient roadmap in severe chronic low back pain (cLBP) in Europe, assessing the views of cLBP patients and general practitioners (GPs) who treat cLBP with regard to current cLBP management. Methodology: Patient journey mapping was conducted in four European countries to assess the views of cLBP patients (n = 20) and GPs (n = 40). Results: Four broad phases of cLBP, subdivided into eight individual steps, were identified as part of the patient journey, showing a disconnect between patients’ and physicians’ treatment goals, and expectations regarding pain relief levels for some patients. Conclusion: Improved communication, with greater involvement of patients in multimodal management decisions, might benefit the GP–patient relationship and overall outcomes for cLBP patients.
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Wang, Juan, Changcheng Chen, Mengsi Peng, Yizu Wang, Bao Wu, Yili Zheng, and Xueqiang Wang. "Intra- and Inter-Rater Reliability of Three Measurements for Assessing Tactile Acuity in Individuals with Chronic Low Back Pain." Evidence-Based Complementary and Alternative Medicine 2020 (November 24, 2020): 1–14. http://dx.doi.org/10.1155/2020/8367095.
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Objective. To investigate the intra- and inter-rater reliability of three measurements on painful and pain-free sides in participants with chronic low back pain (CLBP) at different ages. Methods. We recruited 60 participants with CLBP and divided them equally into a group of younger participants with chronic low back pain (18 ≤ age ≤ 35, Y-CLBP) and a group of older participants with chronic low back pain (36 ≤ age ≤ 65, O-CLBP). Participants were assessed by two testers within the same day (10 min interval), and one of the testers repeated the assessment program 24 h later. The intraclass correlation coefficient (ICC) was used to assess reliability. The Pearson correlation coefficient was used to analyze the correlation between tactile acuity and age, waistline, and pain-related variables. Results. In the Y-CLBP group, the intra-rater reliability of two-point discrimination (TPD), point-to-point test (PTP), and two-point estimation (TPE) on the painful and pain-free sides was good (ICC range: 0.74–0.85), whereas the inter-rater reliability of TPD, PTP, and TPE on the painful and pain-free sides was moderate to good (ICC range: 0.65–0.76). In the O-CLBP group, the intra-rater reliability of TPD, PTP, and TPE on the painful and pain-free sides was good (ICC range: 0.75–0.85), whereas the inter-rater reliability of TPD, PTP, and TPE on the painful and pain-free sides was moderate to good (ICC range: 0.70–0.85). Age, waistline, duration of pain, maximum pain, general pain, and unpleasant score caused by pain were positively correlated with tactile acuity thresholds (D-TPD, A-TPD, PTP, and TPE) (r > 0.365, p < 0.05 ). When BMI was controlled, age, waistline, and pain-related variables were positively correlated with tactile acuity thresholds (r > 0.388; p < 0.05 ). Conclusion. In the participants of Y-CLBP and O-CLBP groups, TPD, PTP, and TPE have moderate-to-good intra- and inter-rater reliability on the painful and pain-free sides of the fifth lumbar vertebrae.
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Poojari, Spoorthi, Babita Ghai, Kashinath Metri, Sheetal Jindal Gupta, and Prashant Verma. "Chronic low back pain: Can Yoga as an integrative approach be the best way forward?" Integrative Medicine Case Reports 1, no. 1 (2020): 6. http://dx.doi.org/10.38205/imcr.010106.
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Chronic Low Back pain (CLBP) is common public health problem, and globally one of the leading cause of disability. Several research studies advocate Yoga may add on as an effective therapy for CLBP patients. The present case study is an attempt to elucidate the outcome of Integrated Approach of Yoga Therapy (IAYT) intervention (which included loosening practices, asanas with breathing, relaxation, pranayama and meditation techniques) as an adjunct and integrative therapy to reduce pain symptoms, pain-associated disability and their overall quality of life in CLBP adult patients. The manuscript illustrates the two CLBP patients, refractory to conservative management, visiting pain clinic at Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Both the patients received a series of 60 minutes IAYT class conducted for a span of 15 days along with the institutional usual care regime as their treatment protocol. Patients were evaluated at baseline, 1 month and 3 month using various assessment tools (for pain intensity, disability, neuropathic pain component, quality of life, pain experiences, mental health, fear of movements and overall clinical benefit). Both the patients showed steady and gradual progression in reducing their pain intensity and its associated disability, quality of life and mental health. The patients narrated their experience and their ability to manage bio-psycho-socio aspects associated with CLBP. They attributed their positive changes to IAYT protocol.
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Manniche, Claus, and Gerard M. Hall. "Chronic low back pain, Modic changes and low-grade virulent infection: efficacy of antibiotic treatment." Future Science OA 7, no. 6 (July 2021): FSO703. http://dx.doi.org/10.2144/fsoa-2021-0026.
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Chronic low back pain (CLBP) has consistently been associated with the longest number of years lived with a disability in global studies, while commonly used treatments for CLBP are largely ineffective. In 2013 a randomized, double-blind, controlled study demonstrated significant improvements in CLBP patients demonstrating Modic changes type 1 on their MRI scans and undergoing long-term oral antibiotic treatment (100 days). Much of the ensuing debate has focused on whether this was a true infection or contamination. Newer and more advanced technologies clearly point to an ongoing low-grade infection. We have reviewed all of the clinical trials published in the recent past and conclude that there is compelling evidence for the effect of long-term oral antibiotic treatment for this patient group.
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DePalma, Michael J. "Multivariable Analysis of the Relationship Between Pain Referral Patterns and the Source of Chronic Low Back Pain." Pain Physician 2;15, no. 2;3 (March 14, 2012): 171–78. http://dx.doi.org/10.36076/ppj.2012/15/171.
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Background: Discogenic, facet joint, and sacroiliac joint mediated axial low back pain may be associated with overlapping pain referral patterns into the lower limb. Differences between pain referral patterns for these three structures have not been systematically investigated. Objective: To examine the individual and combined relationship of age, hip/girdle pain, leg pain, and thigh pain and the source of internal disc disruption (IDD), facet joint pain (FJP), or sacroiliac joint pain (SIJP) in consecutive chronic low back pain (CLBP) patients. Design: Retrospective chart review. Setting: Community based interventional spine practice. Patients: 378 cases from 358 consecutive patients were reviewed and 157 independent cases from 153 patients who underwent definitive diagnostic injections were analyzed. Methods: Charts of consecutive low back pain patients who underwent definitive diagnostic spinal procedures were retrospectively reviewed. Patients underwent provocation lumbar discography, dual diagnostic medial branch blocks, or intra-articular diagnostic sacroiliac joint injections based on clinical presentation. Some subjects underwent multiple diagnostic injections until the source of their chronic low back pain (CLBP) was identified. Main Outcome Measurements: Based on the results of diagnostic injections, subjects were classified as having IDD, FJP, SIJP, or other. The mean age/standard deviation and the count/percentage of patients reporting hip girdle pain, leg pain, or thigh pain were estimated for each diagnostic group and compared statistically among the IDD, FJP, SIJP, and other source groups. Next, the 4 predictor variables were simultaneously modeled with a single multinomial logistic regression model to explore the adjusted relationship between the predictors and the source of CLBP. Results: The mean age was significantly different among the source groups. IDD cases were significantly younger than FJP, SIJP, and other source groups and FJP cases were significantly younger than other sources. The age by thigh pain interaction effect was statistically significant (P = 0.021), indicating that the effect of age on the source of CLBP depends on thigh pain, and similarly, that the effect of thigh pain on the source of CLBP depends on age. Limitations: Retrospective study design. Conclusions: The presence or absence of thigh pain possesses a significant correlation on the source of CLBP for varying ages, whereas the presence of hip/girdle pain or leg pain did not significantly discriminate among IDD, FJP, or SIJP as the etiology of CLBP. Younger age was predictive of IDD regardless of the presence or absence of thigh pain. Key words: low back pain, intervertebral disc, zygapophyseal joint, sacroiliac joint, pain referral patterns
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King, Richard, Victoria Robinson, Helene L. Elliott-Button, James A. Watson, Cormac G. Ryan, and Denis J. Martin. "Pain Reconceptualisation after Pain Neurophysiology Education in Adults with Chronic Low Back Pain: A Qualitative Study." Pain Research and Management 2018 (September 12, 2018): 1–10. http://dx.doi.org/10.1155/2018/3745651.
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Pain neurophysiology education (PNE) is an educational intervention for patients with chronic pain. PNE purports to assist patients to reconceptualise their pain away from the biomedical model towards a more biopsychosocial understanding by explaining pain biology. This study aimed to explore the extent, and nature, of patients’ reconceptualisation of their chronic low back pain (CLBP) following PNE. Eleven adults with CLBP underwent semistructured interviews before and three weeks after receiving PNE. Interviews were transcribed verbatim and thematically analysed in a framework approach using four a priori themes identified from our previous research: (1) degrees of reconceptualisation, (2) personal relevance, (3) importance of prior beliefs, and (4) perceived benefit of PNE. We observed varying degrees of reconceptualisation from zero to almost complete, with most participants showing partial reconceptualisation. Personal relevance of the information to participants and their prior beliefs were associated with the degree of benefit they perceived from PNE. Where benefits were found, they manifested as improved understanding, coping, and function. Findings map closely to our previous studies in more disparate chronic pain groups. The phenomenon of reconceptualisation is applicable to CLBP and the sufficiency of the themes from our previous studies increases confidence in the certainty of the findings.
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Schukro, Regina P., Matthias J. Oehmke, Angelika Geroldinger, Georg Heinze, Hans-Georg Kress, and Sibylle Pramhas. "Efficacy of Duloxetine in Chronic Low Back Pain with a Neuropathic Component." Anesthesiology 124, no. 1 (January 1, 2016): 150–58. http://dx.doi.org/10.1097/aln.0000000000000902.
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Abstract Background Among patients with chronic low back pain (CLBP), approximately 37% show signs of a neuropathic pain component (radicular pain). Treatment of this condition remains challenging. Therefore, the current study aimed to investigate the efficacy of duloxetine in the treatment of CLBP patients with neuropathic leg pain. Methods The study was conducted as a prospective, randomized, placebo-controlled, double-blind crossover trial. CLBP with a visual analog scale (VAS) score greater than 5 and a neuropathic component that was assessed clinically and by the painDETECT questionnaire (score > 12) were required for inclusion. Patients were randomly assigned to either duloxetine or placebo for 4 weeks followed by a 2-week washout period before they crossed over to the alternate phase that lasted another 4 weeks. Duloxetine was titrated up to 120 mg/day. The primary outcome parameter was mean VAS score during the last week of treatment in each phase (VASweek4). Results Of 41 patients, 21 patients completed both treatment phases. In the intention-to-treat analysis (n = 25), VASweek4 was significantly lower in the duloxetine phase compared with placebo (4.1 ± 2.9 vs. 6.0 ± 2.7; P = 0.001), corresponding to an average pain reduction of 32%. The painDETECT score at the end of each treatment phase was significantly lower in the duloxetine phase compared with placebo (17.7 ± 5.7 vs. 21.3 ± 3.6 points; P = 0.0023). Adverse events were distributed equally between the duloxetine (65%) and placebo phases (62%) (P = 0.5). Conclusion In this crossover study, duloxetine proved to be superior to placebo for the treatment of CLBP with a neuropathic leg pain.
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Deyo, Richard A., Samuel F. Dworkin, Dagmar Amtmann, Gunnar Andersson, David Borenstein, Eugene Carragee, John Carrino, et al. "Report of the NIH Task Force on Research Standards for Chronic Low Back Pain." Physical Therapy 95, no. 2 (February 1, 2015): e1-e18. http://dx.doi.org/10.2522/ptj.2015.95.2.e1.
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Note fr'5ym PTJ's Editor in Chief: Both investigators and readers get frustrated reading research on low back pain because of different definitions of “chronic” and different outcome measures. Lack of consensus on study methods makes it difficult to determine if contradictory findings are based on different methods or different interventions; lack of consensus also prevents synthesis across studies. Dr. Partap Khalsa, Deputy Director, National Center for Complementary and Integrative Health, announced the release of Research Standards for Chronic Low Pain, and the hope is that future investigations will adopt them and reduce variability in research reporting. The task force on research standards was an international, multidisciplinary team including Anthony Delitto, PT, PhD, FAPTA. Its findings have been published in leading pain journals. PTJ is among the first professional journals to share the report with its readers. Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting “responder analyses” in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement. Perspective: A task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.
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Shigetoh, Hayato, Yuki Nishi, Michihiro Osumi, and Shu Morioka. "Combined abnormal muscle activity and pain-related factors affect disability in patients with chronic low back pain: An association rule analysis." PLOS ONE 15, no. 12 (December 17, 2020): e0244111. http://dx.doi.org/10.1371/journal.pone.0244111.
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Objectives In patients with chronic low back pain (CLBP), reduced lumbar flexion-relaxation and reduced variability of muscle activity distribution are reported as abnormal muscle activity. It is not known how abnormal muscle activity and pain-related factors are related to CLBP-based disability. Here, we performed an association rule analysis to investigated how CLBP disability, muscle activity, and pain-related factors in CLBP patients are related. Methods Surface electromyographic signals were recorded from over the bilateral lumbar erector spinae muscle with four-channel electrodes from 24 CLBP patients while they performed a trunk flexion re-extension task. We calculated the average value of muscle activities of all channels and then calculated the flexion relaxation ratio (FRR) and the spatial variability of muscle activities. We also assessed the pain-related factors and CLBP disability by a questionnaire method. A clustering association rules analysis was performed to determine the relationships among pain-related factors, the FRR, and the variability of muscle activity distribution. Results The association rules of severe CLBP disability were divisible into five classes, including ‘low FRR-related rules.’ The rules of the mild CLBP disability were divisible into four classes, including ‘high FRR-related rules’ and ‘high muscle variability-related rules.’ When we combined pain-related factors with the FRR and muscle variability, the relationship between abnormal FRR/muscle variability and CLBP disability became stronger. Discussion Our findings thus highlight the importance of focusing on not only the patients’ pain-related factors but also the abnormal motor control associated with CLBP, which causes CLBP disability.
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PALADINI, LUIS HENRIQUE, NICOLE ALMEIDA, RACIELE IVANDRA GUARDA KORELO, RAFAEL MICHEL DE MACEDO, LUIZ CESAR GUARITA-SOUZA, TALITA GIANELLO GNOATO ZOTZ, and ANA CAROLINA BRANDT DE MACEDO. "SHORT-WAVE DIATHERMY IN PATIENTS WITH CHRONIC LOW BACK PAIN: A SYSTEMATIC REVIEW." Coluna/Columna 19, no. 3 (July 2020): 218–22. http://dx.doi.org/10.1590/s1808-185120201903219301.
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ABSTRACT The aim of this study was to evaluate the evidence of application of short-wave diathermy (SWD) in individuals with chronic low back pain (CLBP) and its prescription parameters. The data sources (MEDLINE, PubMed, LILACS, DARE, PsycINFO, AusportMed, SciELO, PEDro and the Cochrane Central Register of Controlled Trials) were systematically searched for articles published up to December 2017. Randomized and non-randomized clinical trial studies that investigated the effect of the application of SWD on CLBP were selected. Two independent reviewers assessed the risk of bias in studies using the Jadad and the Downs & Black scales. Five studies (731 patients) were included, all of whom presented improvements in CLBP. The majority used continuous mode SWD, with only one using pulsed mode (82 and 200 Hz). SWD produced improvements in CLBP, but there is limited evidence for its application, and a lack of standardization of the parameters used. Furthermore, the results that address this topic should be interpreted with caution due to their low methodological quality and limited number. Level of evidence II; Systematic review.
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Finta, R., I. Polyák, T. Bender, and E. Nagy. "Effects of exercise therapy on postural stability, multifidus thickness, and pain intensity in patients with chronic low-back pain." Developments in Health Sciences 2, no. 1 (March 2019): 15–21. http://dx.doi.org/10.1556/2066.2.2019.003.
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Purpose We examined the effects of exercise therapy on postural stability, multifidus thickness, and pain intensity in patients with low-back pain. Materials and methods Subjects were divided into a chronic low-back pain (CLBP; n = 10) group and a healthy control (C; n = 10) group. Group CLBP took part in an 8-week training programme, whereas group C did not. The thickness of the multifidus in both groups was assessed using ultrasonography before and after 8 weeks, in prone and kneeling positions, in relaxed and contracted states. A standing heel-raising test was used to assess postural stability. Results After the intervention in group CLBP, the thickness of the contracted multifidus increased in the prone position, whereas the thickness of both the contracted and relaxed multifidus decreased in the kneeling position. In group C after 8 weeks, multifidus thickness decreased in both positions, while both relaxed and contracted. Group C performed the standing heel-raising test significantly better than group CLBP before the 8-week period. After the training, group CLBP improved significantly, but no changes were found in group C. Discussion and conclusions Changes in thickness of the multifidus correlate with improved postural stability and decreased pain intensity. Decreasing thickness in healthy individuals may be an early sign of developing CLBP.
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Bansal, Dipika. "High Prevalence of Hypovitaminosis D in Indian Chronic Low Back Patients." Pain Physician 5;18, no. 5;9 (September 14, 2015): E853—E862. http://dx.doi.org/10.36076/ppj.2015/18/e853.
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Background: Vitamin D has a significant role to play in bone metabolism and neuromuscular function. Several researchers have indicated that Vitamin D deficiency may be possibly related to chronic musculoskeletal pain including chronic low back pain (CLBP). Objectives: The present study was conducted to determine the prevalence of hypovitaminosis D and its contribution to chronic lower back pain. Study Design: Controlled study Setting: Outpatient pain clinic of tertiary care hospital. Methods: Data presented in this manuscript are from patients who were screened for inclusion in an open label, single arm clinical trial aimed to assess the effectiveness of vitamin D supplementation in patients with CLBP. Consecutive patients visiting the outpatient pain clinic of a tertiary care hospital with a diagnosis of CLBP with or without leg pain were recruited. A visual analogue scale (VAS) was used to measure low back pain intensity, and the Modified Oswestry disability questionnaire (MODQ) was used to measure functional ability. Plasma 25-OHD levels of all patients were measured and the prevalence of hypovitaminosis D was calculated. The multivariate logistic regression model was used to investigate the association between vitamin D deficiency and patient characteristics. Results: A total of 328 patients were included in the study. Mean age of the study population was 43.8 years. Two hundred eighty-two (86%) (men 153/172 [89%], women 129/156 [83%]) of patients had below normal plasma vitamin D levels. Among these, 217 (66%) (men 126 [73%], women 91 [58%]) were found to be deficient and 65 (20%) (men 27 [16%], women 38 [24%]) were had insufficient levels. Multivariate regression analysis found that men were significantly more prone to have deficiency as compared to women (OR = 1.78 (1.10 – 2.88), P = 0.02). We also found a significantly positive relationship between vitamin D deficiency and increased functional disability (OR = 1.53 (1.24 – 1.87), P = 0.01). However, we did not find any relationship with pain severity, presence of other co-morbidities and educational level. Limitations: Not possible to access a good quality data on sun exposure and vitamin D dietary inake dieat in study population. No bone scans were performed. Conclusion: The result of this study provides a message about the high prevalence of hypovitaminosis D in the Indian CLBP population. Clinical guidelines for managing CLBP should include assessment of vitamin D status, together with advice on appropriate vitamin D supplementation in those found to be deficient. Clinical trial registration: CTRI/2014/03/004459 Key words: Chronic low back pain, disability, hypovitaminosis D, India, pain severity, prevalence, vitamin D, visual analogue scale
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Yeh, Chao Hsing, Lung Chang Chien, Devora Balaban, Rebecca Sponberg, Jaclyn Primavera, Natalia E. Morone, Ronald Glick, et al. "A Randomized Clinical Trial of Auricular Point Acupressure for Chronic Low Back Pain: A Feasibility Study." Evidence-Based Complementary and Alternative Medicine 2013 (2013): 1–9. http://dx.doi.org/10.1155/2013/196978.
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Objectives. This prospective, randomized clinical trial (RCT) was designed to investigate the feasibility and effects of a 4-week auricular point acupressure (APA) for chronic low back pain (CLBP).Methods. Participants were randomized to either true APA (true acupoints with taped seeds on the designated ear points for CLBP) or sham APA (sham acupoints with taped seeds but on different locations than those designated for CLBP). The duration of treatment was four weeks. Participants were assessed before treatment, weekly during treatment, and 1 month following treatment.Results. Participants in the true APA group who completed the 4-week APA treatment had a 70% reduction in worst pain intensity, a 75% reduction in overall pain intensity, and a 42% improvement in disability due to back pain from baseline assessment. The reductions of worst pain and overall pain intensity in the true APA group were statistically greater than participants in the sham group(P<0.01)at the completion of a 4-week APA and 1 month followup.Discussion. The preliminary findings of this feasibility study showed a reduction in pain intensity and improvement in physical function suggesting that APA may be a promising treatment for patients with CLBP.
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Ferrer-Peña, Raúl, César Calvo-Lobo, Ramón Aiguadé, and Josué Fernández-Carnero. "Which Seems to Be Worst? Pain Severity and Quality of Life between Patients with Lateral Hip Pain and Low Back Pain." Pain Research and Management 2018 (October 22, 2018): 1–7. http://dx.doi.org/10.1155/2018/9156247.
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Purpose. The aim of this study was to compare the pain severity, health-related quality of life (HRQoL), and risk of continue having pain with prognostic risk scores (PRS), between patients referring greater trochanteric pain syndrome (GTPS) and chronic low back pain (CLBP). Methods. A descriptive, cross-sectional design using nonprobability convenience sampling was performed. A total sample of 102 patients were recruited from two primary health-care centers and divided into GTPS (n = 51) and CLBP (n = 51) groups. The primary outcome was pain severity which was assessed with the Spanish version of the Graded Chronic Pain Scale (GCPS). The secondary outcome was the HRQoL which was measured using the Spanish version of EuroQoL Five Dimensions and Five Levels (EQ-5D-5L) as well as the PRS. Results. Significant differences (P<0.05) were found within both groups in the pain severity global score with a medium effect size showing greater values for the CLBP group with regards to the GTPS group. The PRS in both groups did not show statistical differences (P>0.05). Nevertheless, subjects referring CLBP showed greater levels in the PRS than patients with GTPS. Comparing both groups, the HRQoL showed statistical differences (P<0.05) in the “pain/discomfort” domain in the CLBP group with respect to the GTPS group, but not in the other domains. Conclusions. Patients who suffered from CLBP showed greater pain severity and HRQoL discomfort with regard to patients with GTPS. Despite greater scores for CLBP, the PRS did not seem to be different between both conditions.
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BOMBARDIER, CLAIRE, CHRIS J. EVANS, NATHANIEL KATZ, JACK MARDEKIAN, GERGANA ZLATEVA, and LEE S. SIMON. "Further Qualification of a Therapeutic Responder Index for Patients with Chronic Low Back Pain." Journal of Rheumatology 38, no. 2 (November 1, 2010): 362–69. http://dx.doi.org/10.3899/jrheum.091444.
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Objective.Previously, a preliminary patient responder index (RI) in chronic low back pain (CLBP) was developed and validated in 5 placebo-controlled clinical trials. The resulting RI was a > 30% improvement in CLBP and patient global assessment (PGA), and no worsening (< 20%) in the Roland Morris Disability Questionnaire (RMDQ) total score. Our objective was to provide further characterization of the preliminary RI in a trial with an active control.Methods.Data from a 6-week randomized, double-blind study of celecoxib compared to tramadol hydrochloride was analyzed to determine differences by treatment group on the CLBP RI and its components, to compare the CLBP RI with each of its individual components, and to reanalyze the original cutoff points for the responder criteria.Results.Of the celecoxib arm, 50.7%, and of the tramadol hydrochloride arm, 43.7% were classified as responders under the CLBP RI (p = 0.043). The PGA is the most important component in the RI (45% of the sample failed to reach the > 30% improvement criteria on the PGA compared to 34% on the low back pain visual analog scale and only 11% on the RMDQ. The agreement among the CLBP RI with each of its 3 components was largest for the PGA component (κ coefficient 0.849) and smallest for the RMDQ component (κ coefficient 0.207).Conclusion.The RI appears to be particularly sensitive to the cutoff point used for improvement in the PGA component. Further testing of the index in trials with other active comparators is required to gain a fuller understanding of its performance.
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Rabey, Martin, Anne Smith, Peter Kent, Darren Beales, Helen Slater, and Peter O’Sullivan. "Chronic low back pain is highly individualised: patterns of classification across three unidimensional subgrouping analyses." Scandinavian Journal of Pain 19, no. 4 (October 25, 2019): 743–53. http://dx.doi.org/10.1515/sjpain-2019-0073.
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Abstract Background and aims Chronic low back pain (CLBP) is a complex disorder where central and peripheral nociceptive processes are influenced by factors from multiple dimensions associated with CLBP (e.g. movement, pain sensitivity, psychological). To date, outcomes for treatments matched to unidimensional subgroups (e.g. psychologically-based) have been poor. Therefore, unidimensional subgrouping may not reflect the complexity of CLBP presentations at an individual level. The aim of this study was therefore to explore patterns of classification at an individual level across the three previously-published, data-driven, within-dimension subgrouping studies. Methods Cross-sectional, multidimensional data was collected in 294 people with CLBP. Statistical derivation of subgroups within each of three clinically-important dimensions (pain sensitivity, psychological profile, pain responses following repeated spinal bending) was briefly reviewed. Patterns of classification membership were subsequently tabulated across the three dimensions. Results Of 27 possible patterns across these dimensions, 26 were represented across the cohort. Conclusions This result highlights that while unidimensional subgrouping has been thought useful to guide treatment, it is unlikely to capture the full complexity of CLBP. The amount of complexity important for best patient outcomes is currently untested. Implications For clinicians this study highlights the high variability of presentations of people with CLBP at the level of the individual. For example, clinician’s should not assume that those with high levels of pain sensitivity will also have high psychological distress and have pain summation following repeated spinal bending. A more flexible, multidimensional, clinically-reasoned approach to profile patient complexity may be required to inform individualised, patient-centred care. Such individualised care might improve treatment efficacy. This study also has implications for researchers; highlighting the inadequacy of unidimensional subgrouping processes and methodological difficulties in deriving subgroups across multidimensional data.
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Jacob, Louis, Wolfgang Rathmann, Ai Koyanagi, Josep Maria Haro, and Karel Kostev. "Association between type 2 diabetes and chronic low back pain in general practices in Germany." BMJ Open Diabetes Research & Care 9, no. 1 (July 2021): e002426. http://dx.doi.org/10.1136/bmjdrc-2021-002426.
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IntroductionThere are conflicting results on the association between type 2 diabetes and chronic low back pain (CLBP). Therefore, the goal was to investigate the relationship between type 2 diabetes and CLBP in individuals followed in general practices in Germany.Research design and methodsAdults diagnosed for the first time with type 2 diabetes in 809 general practices in Germany between 2005 and 2018 (index date) were included. Adults without type 2 diabetes were matched (1:1) to those with type 2 diabetes by sex, age, index year, and the annual number of medical consultations (index date: a randomly selected visit date). The association between type 2 diabetes and the 10-year incidence of CLBP was analyzed in conditional Cox regression models adjusted for a wide range of comorbidities, including hypertension, lipid metabolism disorders, and obesity.ResultsThere were 139 002 individuals included in this study (women: 58.0%; mean (SD) age 62.5 (13.4) years). There was a positive association between type 2 diabetes and the incidence of CLBP in the overall sample (HR=1.23, 95% CI: 1.13 to 1.35). Sex-stratified analyses showed a higher risk of CLBP in women (HR=1.68, 95% CI: 1.43 to 1.90) and a lower risk in men with than in their counterparts without type 2 diabetes (HR=0.83, 95% CI: 0.71 to 0.97).ConclusionsNewly diagnosed type 2 diabetes was associated with an increased risk of CLBP. There were important sex differences in the type 2 diabetes-CLBP relationship, and more research is warranted to investigate the underlying factors explaining these differences.
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Satar, Abdul, Shaista Ali, Zahin Anjum, Samir Khan Kabir, Muhammad Waqar, and Muhammad Arif. "Psychological Profile of Patients with Chronic Low Back Pain." Journal of Gandhara Medical and Dental Science 8, no. 2 (April 1, 2021): 3–8. http://dx.doi.org/10.37762/jgmds.8-2.161.
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OBJECTIVES:
To assess the frequency of depression, anxiety, and stress in patients with Chronic Low Back Pain (CLBP) using Depression Anxiety Stress Scale (DASS-42).
METHODOLOGY:
This descriptive study was performed from January 2019 to June 2019. All those patients with chronic low back pain with duration of more than 6 months were included. Patients below 20 and above 60 years were excluded to eliminate the effect of extreme ages. The Depression Anxiety Stress Scale (DASS-42) was used in this study.
RESULTS:
In this study, a total of 127 patients were successfully interviewed. The mean age of the sample was 36.46 (SD±7.38) with a minimum age of 22 years and maximum of 59 years. Out of these 127 patients, 83 (65.4%) were female while 44 (34.6%) were male patients. The minimum duration of chronic low back pain in our patients was 8 months while the maximum was 55 months with a mean of 28 months (SD 9.9). The mean DASS score for depression was 11.8 (SD±4.23), anxiety was 7.5 (SD±2.9), stress was 12.1 (SD±4.0). Similarly, both genders had equal level of depression and anxiety but females were more experiencing the stress.
CONCLUSION:
Abnormal levels of stress anxiety and depression are a common finding in our population with CLBP
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Nieto-García, Juan, Luis Suso-Martí, Roy La Touche, and Mónica Grande-Alonso. "Somatosensory and Motor Differences between Physically Active Patients with Chronic Low Back Pain and Asymptomatic Individuals." Medicina 55, no. 9 (August 23, 2019): 524. http://dx.doi.org/10.3390/medicina55090524.
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Background and Objectives: Chronic low back pain (CLBP) is the most common occupational disorder due to its associated disability and high risk of recurrence and chronicity. However, the mechanisms underlying physical and psychological variables in patients with CLBP remain unclear. The main objective of this study was to assess whether there were differences between physically active patients with nonspecific CLBP compared with asymptomatic individuals in sensorimotor and psychological variables. Materials and Methods: This was an observational cross-sectional design with a nonprobabilistic sample. The sample was divided into two groups: individuals with nonspecific CLBP (n = 30) and asymptomatic individuals as a control (n = 30). The psychological variables assessed were low back disability, fear of movement, pain catastrophizing, and self-efficacy. The sensorimotor variables assessed were two-point discrimination, pressure pain threshold, lumbopelvic stability, lumbar flexion active range of motion, and isometric leg and back strength. Results: Statistically significant differences between the groups in terms of catastrophizing levels (p = 0.026) and fear of movement (p = 0.001) were found, but no statistically significant differences between groups were found in self-efficacy (p > 0.05). No statistically significant differences between the groups in any of the sensorimotor variables were found (p > 0.05). Conclusion: No sensorimotor differences were found between patients with asymptomatic and chronic low back pain, but differences were found in the psychological variables of catastrophizing and fear of movement.
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Ebenbichler, Gerold, Richard Habenicht, Sara Ziegelbecker, Josef Kollmitzer, Patrick Mair, and Thomas Kienbacher. "Age- and sex-specific effects in paravertebral surface electromyographic back extensor muscle fatigue in chronic low back pain." GeroScience 42, no. 1 (November 27, 2019): 251–69. http://dx.doi.org/10.1007/s11357-019-00134-7.
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AbstractThe impact of aging on the back muscles is not well understood, yet may hold clues to both normal aging and chronic low back pain (cLBP). This study sought to investigate whether the median frequency (MF) surface electromyographic (SEMG) back muscle fatigue method—a proxy for glycolytic muscle metabolism—would be able to detect age- and sex-specific differences in neuromuscular and muscle metabolic functions in individuals with cLBP in a reliable way, and whether it would be as sensitive as when used on healthy individuals. With participants seated on a dynamometer (20° trunk anteflexion), paraspinal SEMG activity was recorded bilaterally from the multifidus (L5), longissimus (L2), and iliolumbalis (L1) muscles during isometric, sustained back extensions loaded at 80% of maximum from 117 younger (58 females) and 112 older (56 female) cLBP individuals. Tests were repeated after 1–2 days and 6 weeks. Median frequency, the SEMG variable indicating neuromuscular fatigue, was analyzed. Maximum back extensor strength was comparable between younger and older participants. Significantly less MF-SEMG back muscle fatigue was observed in older as compared to younger, and in older female as compared to older male cLBP individuals. Relative reliability was excellent, but absolute reliability appeared large for this SEMG-fatigue measure. Findings suggest that cLBP likely does not mask the age-specific diagnostic potential of the MF-SEMG back extensor fatigue method. Thus, this method possesses a great potential to be further developed into a valuable biomarker capable of detecting back muscle function at risk of sarcopenia at very early stages.
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Ashmen, Kathleen J., C. Buz Swanik, and Scott M. Lephart. "Strength and Flexibility Characteristics of Athletes with Chronic Low-Back Pain." Journal of Sport Rehabilitation 5, no. 4 (November 1996): 275–86. http://dx.doi.org/10.1123/jsr.5.4.275.
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The purpose of this study was to identify strength and flexibility deficits in subjects with chronic low-back pain (CLBP). Subjects were 16 female Division I athletes: 8 athletes who had experienced CLBP for at least 6 months prior to testing and a control group of 8 matched subjects. Athletes with neurological symptoms, previous back operations, and leg length discrepancies and those who were diagnosed with scoliosis, spondylolisthesis, or spondylolysis were excluded from this study. Variables assessed included abdominal strength, erector spinae endurance, hip flexion and extension endurance, torso lateral flexibility, and low-back flexibility. Strength and endurance were calculated as a function of time in seconds. Goniometric measurements were used to determine flexibility. Significant mean differences were found by using dependentttests for abdominal strength, erector Spinae endurance, hip extension, and right lateral flexion of the torso. The results validate the necessity for pelvic stabilization and indicate that strength and flexibility deficits vary among populations.
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Lauche, Romy, Klaus Wübbeling, Rainer Lüdtke, Holger Cramer, Kyung-Eun Choi, Thomas Rampp, Andreas Michalsen, Jost Langhorst, and Gustav J. Dobos. "Randomized Controlled Pilot Study: Pain Intensity and Pressure Pain Thresholds in Patients with Neck and Low Back Pain Before and After Traditional East Asian "Gua Sha" Therapy." American Journal of Chinese Medicine 40, no. 05 (January 2012): 905–17. http://dx.doi.org/10.1142/s0192415x1250067x.
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Gua Sha is a traditional East Asian healing technique where the body surface is "press-stroked" with a smooth-edged instrument to raise therapeutic petechiae that last 2–5 days. The technique is traditionally used in the treatment of both acute and chronic neck and back pain. This study aimed to measure the effects of Gua Sha therapy on the pain ratings and pressure pain thresholds of patients with chronic neck pain (CNP) and chronic low back pain (CLBP). A total of 40 patients with either CNP or CLBP (mean age 49.23 ± 10.96 years) were randomized to either a treatment group (TG) or a waiting list control group (WLC). At baseline assessment (T1), all patients rated their pain on a 10 cm visual analog scale (VAS). Patients' pressure pain thresholds (PPT) at a site of maximal pain (pain-maximum) and an adjacent (pain-adjacent) site were also established. The treatment group then received a single Gua Sha treatment. Post-intervention measurements were taken for both groups at T2, seven days after baseline assessment (T1), using the same VAS and PPT measurements in precisely the same locations as at T1. Final analysis were conducted with 21 patients with CNP and 18 patients with CLBP. The study groups were equally distributed with regard to randomization. Patients in both the CNP and the CLBP treatment groups reported pain reduction (p < 0.05) and improved health status from their one Gua Sha treatment, as compared to the waiting list group. Pain sensitivity improved in the TG in CNP, but not in CLBP patients, possibly due to higher pressure sensitivity in the neck area. No adverse events were reported. These results suggest that Gua Sha may be an effective treatment for patients with chronic neck and low back pain. Further study of Gua Sha is warranted.
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Mukherjee, Ushnish, Sourav Kundu, Rachit Gulati, and Prabir Mandal. "Lumbosacral Angle Variations in Middle Aged Patients with Chronic Low Back Pain - A Retrospective Study." Journal of Evidence Based Medicine and Healthcare 8, no. 04 (January 25, 2021): 208–12. http://dx.doi.org/10.18410/jebmh/2021/40.
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BACKGROUND Chronic low back pain (CLBP) is one of the common debilitating condition in middle-age population. Often the pain is "non-specific" or related to mechanical origin; so, often it is termed as chronic mechanical low back pain. Among the various predisposing factors, abnormal lumber lordosis is more often seen. Radiographic assessment of lumbar lordosis can be done by measuring lumbosacral angle (LSA). Therefore, study of variations in LSA among these patients can give important clues in both pathogenesis and management. The aim of the study is to determine different factors leading to the variations of lumbosacral angle amongst the middle-aged patients presenting with chronic mechanical low back pain. METHODS This retrospective study was conducted by analysing records of 105 CLBP patients of both sex (male = 32, female = 73) in the age group of 45 - 65 years. LSA was directly measured digitally by Ferguson technique from the selected patients’ lateral lumbosacral radiographs. Data was collected in Microsoft Excel 2016 and analysis was done with International Business Machines Statistical Package for the Social Sciences (IBM SPSS) Statistics version 23. RESULTS The difference in median of LSA of male [Median (IQR) = 37.00 (10.00)] and female [Median (IQR) = 45.00 (8.50)] patients was statistically significant (p-value 0.000). Significant positive correlation was also found between LSA and BMI for both sexes, but more in case of female (Spearman’s rho 0.806 p = 0.000) than male (Spearman’s rho 0.680 p-value 0.000). CONCLUSIONS Variation of LSA was found to have significant relations with sex and body mass index (BMI), but not with the age. Statistically significant positive correlation between LSA and BMI alongside higher BMI of the females in the study group suggested that they are more prone to develop CLBP. To formulate proper rehabilitation protocol for middle aged CLBP patients, LSA variations and related factors can be kept in mind. KEYWORDS Chronic Low Back Pain (CLBP), Lumbosacral Angle (LSA), Lordosis, Rehabilitation, Body Mass Index, Lordosis, Spine, Radiography, Rehabilitation
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Nowotny, Alexandre Henrique, Mariene Guizeline Calderon, Pablo Albuquerque de Souza, Andreo Fernando Aguiar, Guillaume Léonard, Bruno Mazziotti Oliveira Alves, Cesar Ferreira Amorim, and Rubens Alexandre da Silva. "Lumbar stabilisation exercises versus back endurance-resistance exercise training in athletes with chronic low back pain: protocol of a randomised controlled trial." BMJ Open Sport & Exercise Medicine 4, no. 1 (November 2018): e000452. http://dx.doi.org/10.1136/bmjsem-2018-000452.
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BackgroundChronic low back pain (CLBP) is an important disorder in athletes that may negatively affect their performance in competitions. The literature usually recommends physiotherapy based on exercises for back pain management in athletes. Recent evidence suggests that interventions based on lumbar muscle stabilisation exercises (LMSE) and back endurance-resistance exercises (BERE) may improve back pain and function performance. However, it is still unclear which type of exercise is more effective for the treatment of CLBP in athletes.ObjectiveTo compare the efficacy of LMSE versus BERE in athletes with CLBP.DesignThe study is a 2-arm, prospectively registered, randomised controlled trial.SettingThe physical therapy clinical and biomechanics laboratory of the UNOPAR University.Participants32 male athletes with CLBP, age between 18 and 40 years old, recruited from the local community.InterventionAn 8-week intervention programme will be carried out with LMSE s versus BERE.MeasurementsTrunk neuromuscular patterns during balance tasks (unipodal and over a ball) using electromyography and force platform parameters, pain, disability, fear and avoidance will be assessed by a blinded assessor at baseline and at follow-up after 8 weeks of intervention period.LimitationsThe absence of blinding intervention and the exclusion of female athletes, seated sports and swimmers will affect the internal and external validity of the study.ConclusionsThe results of this study will elucidate which of these two interventions promote better results in trunk neuromuscular pattern, back pain and function in male athletes with CLBP.
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Nyström, Bo. "Spinal Fusion in the Treatment of Chronic Low Back Pain: Rationale for Improvement." Open Orthopaedics Journal 6, no. 1 (November 8, 2012): 478–81. http://dx.doi.org/10.2174/1874325001206010478.
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Results following fusion for chronic low back pain (CLBP) are unpredictable and generally not very satisfying. The major reason is the absence of a detailed description of the symptoms of patients with pain, if present, in a motion segment of the spine. Various radiological findings have been attributed to discogenic pain, but if these radiological signs were really true signs of such pain, fusion would have been very successful. If discogenic pain exists, it should be possible to select these patients from all others within the CLBP population. Even if this selection were 100% perfect, however, identification of the painful segment would remain, and at present there is no reliable test for doing so. Regardless of whether an anterior or posterior type of fusion is performed, or even if artificial discs are used, solving the puzzle of pain associated with the presumed segmental disorder must be the primary goal.
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Weiner, Debra K., Angela Gentili, Katherine Coffey-Vega, Natalia Morone, Michelle Rossi, and Subashan Perera. "Biopsychosocial Profiles and Functional Correlates in Older Adults with Chronic Low Back Pain: A Preliminary Study." Pain Medicine 20, no. 7 (April 16, 2018): 1300–1310. http://dx.doi.org/10.1093/pm/pny065.
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Abstract Objective To describe key peripheral and central nervous system (CNS) conditions in a group of older adults with chronic low back pain (CLBP) and their association with pain severity and self-reported and performance-based physical function. Design Cross-sectional. Setting Outpatient VA clinics. Subjects Forty-seven community-dwelling veterans with CLBP (age 68.0 ± 6.5 years, range = 60–88 years, 12.8% female, 66% white) participated. Methods Data were collected on peripheral pain generators—body mass index, American College of Rheumatology hip osteoarthritis criteria, neurogenic claudication (i.e., spinal stenosis), sacroiliac joint (SIJ) pain, myofascial pain, leg length discrepancy (LLD), and iliotibial band pain; and CNS pain generators—anxiety (GAD-7), depression (PHQ-9), insomnia (Insomnia Severity Index), maladaptive coping (Fear Avoidance Beliefs Questionnaire, Cognitive Strategies Questionnaire), and fibromyalgia (fibromyalgia survey). Outcomes were pain severity (0 to 10 scale, seven-day average and worst), self-reported pain interference (Roland Morris [RM] questionnaire), and gait speed. Results Approximately 96% had at least one peripheral CLBP contributor, 83% had at least one CNS contributor, and 80.9% had both peripheral and CNS contributors. Of the peripheral conditions, only SIJ pain and LLD were associated with outcomes. All of the CNS conditions and SIJ pain were related to RM score. Only depression/anxiety and LLD were associated with gait speed. Conclusions In this sample of older veterans, CLBP was a multifaceted condition. Both CNS and peripheral conditions were associated with self-reported and performance-based function. Additional investigation is required to determine the impact of treating these conditions on patient outcomes and health care utilization.