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Smolanka, V. I., V. M. Fedurtsya, and B. B. Pavlov. "Discogenic low back pain: interventional treatment." Pain medicine 3, no. 3 (2018): 16–26. http://dx.doi.org/10.31636/pmjua.v3i3.2.
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Low back pain (LBP) is one of the most common causes of disability in the adult population. A significant place in its genesis is occupied by a degenerative-dystrophic diseases of intervertebral discs. The article highlights the classification and mechanism of discogenic pain origin. Various types of interventions aredescribed for this pathology: indications, specificities of carrying out manipulations and therapeutic effects, efficiency and possible complications of procedures.
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Falco, Frank J. E. "An Update of the Effectiveness of Therapeutic Lumbar Facet Joint Interventions." Pain Physician 6;15, no. 6;12 (2012): E909—E953. http://dx.doi.org/10.36076/ppj.2012/15/e909.
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Background: Therapeutic lumbar facet joint interventions are implemented to provide long-term pain relief after the facet joint has been identified as the basis for low back pain. The therapeutic lumbar facet joint interventions generally used for the treatment of low back pain of facet joint origin are intraarticular facet joint injections, lumbar facet joint nerve blocks, and radiofrequency neurotomy. Objective: To evaluate and update the effect of therapeutic lumbar facet joint interventions in managing chronic low back pain. Study Design: A systematic review of therapeutic lumbar facet joint interventions for the treatment of chronic low back pain. Methods: The available literature on lumbar facet joint interventions in managing chronic low back pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventative Services Task Force. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 through June 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief with short-term relief defined as up to 6 months and long-term relief as 12 months. Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this systematic review, 122 studies were identified. Of these, 11 randomized trials and 14 observational studies met inclusion criteria for methodological quality assessment. The evidence for radiofrequency neurotomy is good and fair to good for lumbar facet joint nerve blocks for short- and long-term improvement; whereas the evidence for intraarticular injections and pulsed radiofrequency neurotomy is limited. Limitations: The limitations of this systematic review include the continued paucity of evidence, specifically for intraarticular injection therapy. Conclusion: In summary, there is good evidence for the use of conventional radiofrequency neurotomy, and fair to good evidence for lumbar facet joint nerve blocks for the treatment of chronic lumbar facet joint pain resulting in short-term and long-term pain relief and functional improvement. There is limited evidence for intraarticular facet joint injections and pulsed radiofrequency thermoneurolysis. Key Words: Spinal pain, chronic low back pain, lumbar intraarticular facet joint blocks, lumbar facet joint nerve blocks, lumbar conventional radiofrequency neurotomy, pulsed radiofrequency neurolysis
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Swathi, Saina, Senthil P., and Shazia Neelam. "Nonspecific low back pain in sedentary workers: A narrative review." Biomedicine 42, no. 5 (2022): 863–69. http://dx.doi.org/10.51248/.v42i5.1484.
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A sedentary lifestyle is a risk factor, significantly increasing the incidence of low back pain (LBP). Higher levels of sedentary lifestyle were witnessed in the workers who spent the greatest amount of their time in sitting positions in the workplace and during free time. The incidence and prevalence of low back pain in sedentary workers were 14-37% and 34-62%. Noticeably, the people with low back pain had higher productivity loss. It specifies more research is required to help individuals with back pain to stay in their work. The main intention of this study briefly reviews the risk factors, associated adaptations, and Interventions in physical therapy for preventing and managing nonspecific low back pain in sedentary workers. To do this review, Information was gathered from the offline library resources and online electronic search databases (Scopus, COCHRANE, PUBMED). The keywords used were low back pain, sedentary workers, risk factors, adaptations, exercise therapy, and sedentary lifestyle. The prognosis and management of low back pain were greatly influenced by several risk factors related to physical, psychological, and occupational factors. During the transition of low back pain from acute to chronic stages, adaptations in various domains like psychological, behavioral, and neuromuscular changes are seen. Exercise therapy itself or in addition to other therapeutic approaches is successful in preventing and treatment of nonspecific low back pain in sedentary workforces. By identifying associated risk factors, and changes adapted by individual patients, Therapists can design proper exercise therapeutic approaches that will provide more effective interventions.
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Gupta, Rishabh, Shavi Mahajan, Deepika Dewan, and Rajat Gupta. "Study of group education interventions for people with low back pain." International Journal Of Community Medicine And Public Health 4, no. 3 (2017): 652. http://dx.doi.org/10.18203/2394-6040.ijcmph20170734.
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Background: Backcare education administered in a group situation is one of the most effective and economic methods of treating back pain. It is based on available scientific knowledge of the physiology and mechanics of the spinal structures and their relationship to daily activities. It provides the patient with a better understanding of the problem, aiming primarily at helping the patient take responsibility for his or her back pain, while relieving pain and functional disability.Methods: This study was carried out on 100 patients of chronic low back pain, attending the OPD of Post Graduate Department of Orthopaedics, Government Medical College Jammu for a period of one year. Assessment was carried out before the treatment and after the treatment at four weeks, three months & six months post treatment. The following scales were used to measure the therapeutic response: the Modified Oswestry low back pain disability index, Visual analogue score (VAS), and clinical parameters like finger to floor distance and straight leg raising.Results: The patients showed significant improvement at 1 month, 3 months and 6 months post treatment when compared to base-line data (p<0.001).Conclusions: It was concluded that all chronic low back pain patients would benefit from a group program of back care education.
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Datta, Sukdeb. "Systematic Assessment of Diagnostic Accuracy and Therapeutic Utility of Lumbar Facet Joint Interventions." Pain Physician 2;12, no. 2;3 (2009): 437–60. http://dx.doi.org/10.36076/ppj.2009/12/437.
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Background: Lumbar facet joints are a well recognized source of low back pain and referred pain in the lower extremity in patients with chronic low back pain. Conventional clinical features and other non-invasive diagnostic modalities are unreliable in diagnosing lumbar zygapophysial joint pain. Controlled diagnostic studies have shown the prevalence of lumbar facet joint pain in 27% to 40% of the patients with chronic low back pain without disc displacement or radiculitis, with a false-positive rate of 27% to 47% with a single diagnostic block. Study Design: A systematic review of diagnostic and therapeutic lumbar facet joint interventions. Objective: To determine the clinical utility of diagnostic and therapeutic lumbar facet joint interventions in managing chronic low back pain of facet joint origin. Methods: Review of the literature for clinical studies on efficacy and utility of facet joint interventions in diagnosing and managing facet joint pain was performed according to the Agency for Healthcare Research and Quality (AHRQ) criteria for diagnostic studies and observational studies and the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials. Data sources included relevant literature of the English language identified through searches of Medline and EMBASE from 1966 to December 2008 and manual searches of bibliographies of known primary and review articles. Analysis results were performed for diagnostic and therapeutic interventions separately. Level of Evidence: The level of evidence was defined as Level I, II, or III with 3 subcategories in Level II based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF) for therapeutic interventions. Outcome Measures: For diagnostic interventions, studies must have been performed utilizing controlled local anesthetic blocks. Pain relief was categorized as at least 80% pain relief from baseline pain and ability to perform previously painful movements. For therapeutic interventions, the primary outcome measure was pain relief with secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake. For therapeutic interventions, short-term pain relief was defined as relief lasting 6 months or less and long-term relief as longer than 6 months. Results: Based on USPSTF criteria, evidence showed Level I or II-1 for diagnostic facet joint nerve blocks. Based on the review of included therapeutic studies, Level II-1 to II-2 evidence was indicated for lumbar facet joint nerve blocks with indicated level of evidence of Level II-2 to II-3 for lumbar radiofrequency neurotomy. Limitations: The shortcoming of this systematic review of lumbar facet joint interventions is the paucity of published literature. Conclusion: The evidence for diagnosis of lumbar facet joint pain with controlled local anesthetic blocks is Level I or II-1. The indicated level of evidence for therapeutic lumbar facet joint interventions is Level II1 or II-2 for lumbar facet joint nerve blocks, Level II-2 or II-3 evidence for radiofrequency neurotomy, and Level III (limited) evidence for intraarticular injections. Key words: Chronic low back pain, lumbar facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, controlled comparative local anesthetic blocks, lumbar radiofrequency neurotomy, lumbar intraarticular facet joint injections
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Hansen, Hans C. "Sacroiliac Joint Interventions: A Systematic Review." Pain Physician 1;10, no. 1;1 (2007): 165–84. http://dx.doi.org/10.36076/ppj.2007/10/165.
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Background: The sacroiliac joint is a diarthrodial synovial joint with abundant innervation and capability of being a source of low back pain and referred pain in the lower extremity. There are no definite historical, physical, or radiological features to provide definite diagnosis of sacroiliac joint pain, although many authors have advocated provocational maneuvers to suggest sacroiliac joint as a pain generator. An accurate diagnosis is made by controlled sacroiliac joint diagnostic blocks. The sacroiliac joint has been shown to be a source of pain in 10% to 27% of suspected cases with chronic low back pain utilizing controlled comparative local anesthetic blocks. Intraarticular injections, and radiofrequency neurotomy have been described as therapeutic measures. This systematic review was performed to assess diagnostic testing (non-invasive versus interventional diagnostic techniques) and to evaluate the clinical usefulness of interventional techniques in the management of chronic sacroiliac joint pain. Objective: To evaluate and update the available evidence regarding diagnostic and therapeutic sacroiliac joint interventions in the management of sacroiliac joint pain. Study Design: A systematic review using the criteria as outlined by the Agency for Healthcare Research and Quality (AHRQ), Cochrane Review Group Criteria for therapeutic interventions and AHRQ, and Quality Assessment for Diagnostic Accuracy Studies (QUADAS) for diagnostic studies. Methods: The databases of EMBASE and MEDLINE (1966 to December 2006), and Cochrane Reviews were searched. The searches included systematic reviews, narrative reviews, prospective and retrospective studies, and cross-references from articles reviewed. The search strategy included sacroiliac joint pain and dysfunction, sacroiliac joint injections, interventions, and radiofrequency. Results: The results of this systematic evaluation revealed that for diagnostic purposes, there is moderate evidence showing the accuracy of comparative, controlled local anesthetic blocks. Prevalence of sacroiliac joint pain is estimated to range between 10% and 27% using a double block paradigm. The false-positive rate of single, uncontrolled, sacroiliac joint injections is around 20%. The evidence for provocative testing to diagnose sacroiliac joint pain is limited. For therapeutic purposes, intraarticular sacroiliac joint injections with steroid and radiofrequency neurotomy were evaluated. Based on this review, there is limited evidence for short-term and longterm relief with intraarticular sacroiliac joint injections and radiofrequency thermoneurolysis. Conclusions: The evidence for the specificity and validity of diagnostic sacroiliac joint injections is moderate. The evidence for accuracy of provocative maneuvers in diagnosis of sacroiliac joint pain is limited. The evidence for therapeutic intraarticular sacroiliac joint injections is limited. The evidence for radiofrequency neurotomy in managing chronic sacroiliac joint pain is limited. Keywords: Low back pain, sacroiliac joint pain, axial pain, spinal pain, diagnostic block, sacroiliac joint injection, thermal radiofrequency, and pulsed radiofrequency
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Croft, P. "Low Back Pain in Primary Care: Effectiveness of Diagnostic and Therapeutic Interventions." BMJ 313, no. 7049 (1996): 122. http://dx.doi.org/10.1136/bmj.313.7049.122.
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Romanova, Stilyana, Kristin Grigorova, and Antoaneta Dimitrova. "Therapeutic Education and Physiotherapy in Low Back Pain Management." Open Access Macedonian Journal of Medical Sciences 9, B (2021): 1778–84. http://dx.doi.org/10.3889/oamjms.2021.7414.
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BACKGROUND: Low-back pain (LBP) is one of the most common musculoskeletal problems; it is the leading cause of disability worldwide. Therapeutic patient education is a method that enables health care professionals to pass on their knowledge and experience to patients so that they can participate consciously and actively in their recovery. AIM: The present study aims to examine the effect of therapeutic education (TE) combined with a specific physiotherapy (PT) approach in people with LBP. МАTERIALS AND METHODS: This was an experimental pre- and post-study design. The study involved 25 patients, mean age 43.08 ± 12 years, divided into two groups: experimental group (EG), with TE (n =18) and control group (CG), without TE (n = 7). The PT treatment frequency and duration were consistent between groups. The patients were monitored for one month, and the intervention under supervision – face-to-face and self-monitored home-based PT have been organized. The included outcome measures were Oswestry Disability Index, Tampa Scale for Kinesiophobia, STarT Back Screening Tools, and the movement-induced pain in the lumbar spine. RESULTS: At the end of the study improved pain-free movements in the lumbar region, functionality, reduced catastrophizing was observed in both groups. There is a tendency for better results in the EG compared to the CG in terms of functionality and pain-free movement. The subjective feeling of the catastrophizing was reduced only in the EG below the cut-off score from 45.2 ± 7.7 to 33.2 ± 3.3 points. CONCLUSION: TE in combination with PT interventions improves functional abilities, decreases the pain during movements, and the subjective perception of kinesiophobia. The results suggest TE should be included in a LBP management approach.
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Smidt, Gary L. "Therapeutic Intervention for Low Back Pain—Questions, Issues, Ideas." Journal of Orthopaedic & Sports Physical Therapy 13, no. 6 (1991): 276–77. http://dx.doi.org/10.2519/jospt.1991.13.6.276a.
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Hansen, Hans. "A Systematic Evaluation of the Therapeutic Effectiveness of Sacroiliac Joint Interventions." Pain Physician 3;15, no. 3;5 (2012): E247—E278. http://dx.doi.org/10.36076/ppj.2012/15/e247.
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Background: The contribution of the sacroiliac joint to low back and lower extremity pain has been a subject of debate with extensive research. It is generally accepted that approximately 10% to 25% of patients with persistent low back pain may have pain arising from the sacroiliac joints. In spite of this, there are currently no definite conservative, interventional, or surgical management options for managing sacroiliac joint pain. In addition, there continue to be significant variations in the application of various techniques as well as a paucity of literature. Study Design: A systematic review of therapeutic sacroiliac joint interventions. Objective: To evaluate the accuracy of therapeutic sacroiliac joint interventions. Methods: The available literature on therapeutic sacroiliac joint interventions in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized trials of interventional techniques and the criteria developed by the Newcastle-Ottawa Scale for observational studies. The level of evidence was classified as good, fair, or limited (or poor) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature published from 1966 through December 2011 that was identified through searches of PubMed and EMBASE, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this systematic review, 56 studies were considered for inclusion. Of these, 45 studies were excluded and a total of 11 studies met inclusion criteria for methodological quality assessment with 6 randomized trials and 5 non-randomized studies. The evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain is fair. The evidence for effectiveness of intraarticular steroid injections is limited (or poor). The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is limited (or poor). The evidence for effectiveness of conventional radiofrequency neurotomy is limited (or poor). The evidence for pulsed radiofrequency is limited (or poor). Limitations: The limitations of this systematic review include a paucity of literature on therapeutic interventions, variations in technique, and variable diagnostic standards for sacroiliac joint pain. Conclusions: The evidence was fair in favor of cooled radiofrequency neurotomy and limited (or poor) for short-term and long-term relief from intraarticular steroid injections, periarticular injections with steroids or botulin toxin, pulsed radiofrequency, and conventional radiofrequency neurotomy. Key words: Chronic low back pain, sacroiliac joint pain, sacroiliitis, sacroiliac joint injection, sacroiliac joint dysfunction, thermal radiofrequency, pulsed radiofrequency
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Kumar Verma, Akhilesh. "EXPLORING AYURVEDIC APPROACHES TO LOW BACK PAIN: A COMPREHENSIVE REVIEW." International Journal of Advanced Research 12, no. 04 (2024): 228–35. http://dx.doi.org/10.21474/ijar01/18540.
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Introduction:Low back pain (LBP) is a common musculoskeletal disorder affecting individuals worldwide, causing significant disability and healthcare burden. While conventional treatments focus on symptomatic relief, Ayurveda, the ancient Indian system of medicine, offers a holistic approach that addresses the root cause of LBP. This comprehensive review aims to explore Ayurvedic perspectives, diagnostic methods, therapeutic interventions, and herbal formulations for managing LBP. Ayurvedic Perspective:Ayurveda views LBP as a manifestation of imbalances in the Tridosha (Vata, Pitta, and Kapha) and the Saptadhatus (seven body tissues). Vata dosha vitiation is predominantly implicated in LBP, leading to symptoms such as stiffness, spasms, and radiating pain. Pitta and Kapha imbalances may exacerbate inflammation and structural degeneration, respectively. Ayurvedic diagnosis of LBP involves assessing the individuals Prakriti (constitutional type), Vikriti (current imbalance), Agni (digestive fire), and Srotas (channels of circulation). Diagnostic Methods:Ayurvedic physicians employ a combination of clinical examination, palpation, and pulse diagnosis (Nadi Pariksha) to assess the underlying doshic imbalances and identify the specific etiology of LBP. Various factors such as lifestyle habits, occupation, dietary patterns, and psychological stressors are taken into account during the assessment. Therapeutic Interventions:Ayurvedic management of LBP is multifaceted, aiming to alleviate pain, reduce inflammation, restore musculoskeletal integrity, and prevent recurrence. Therapeutic interventions include: Panchakarma: Detoxification therapies such as Basti (medicated enema), Abhyanga (oil massage), and Swedana (herbal steam therapy) are utilized to eliminate ama (toxins) and pacify aggravated doshas. Ayurvedic Medications: Herbal formulations containing anti-inflammatory, analgesic, and muscle-relaxant herbs like Ashwagandha (Withania somnifera), Guggulu (Commiphora wightii), and Shallaki (Boswellia serrata) are prescribed to manage pain and inflammation. Yoga and Pranayama: Specific yoga asanas (postures) and pranayama (breathing exercises) are recommended to improve flexibility, strengthen the back muscles, and enhance prana (vital energy) flow to the affected area. Dietary Modifications: Dietary recommendations include consuming warm, light, and easily digestible foods, emphasizing anti-inflammatory spices like turmeric, ginger, and cinnamon, and avoiding cold, heavy, and processed foods that may aggravate Vata dosha. Lifestyle Management: Adopting a balanced daily routine (Dinacharya), practicing stress-reduction techniques such as meditation and mindfulness, and maintaining proper posture and ergonomics are crucial for long-term management of LBP. Clinical Evidence:Several clinical studies have investigated the efficacy of Ayurvedic interventions in LBP management. A randomized controlled trial comparing Ayurvedic treatment with conventional therapy demonstrated significant improvements in pain relief, functional disability, and quality of life among participants receiving Ayurvedic intervention. Furthermore, observational studies have reported favorable outcomes with Panchakarma therapies and herbal formulations in reducing pain intensity and enhancing mobility in patients with chronic LBP. Safety and Considerations:While Ayurvedic interventions are generally considered safe when administered under the guidance of a qualified practitioner, certain precautions should be observed. Individualized treatment plans based on the patients constitution, doshic imbalance, and overall health status are essential to optimize therapeutic outcomes and minimize potential adverse effects. Additionally, close monitoring and periodic reassessment are necessary to track progress and adjust treatment as needed. Conclusion:Ayurveda offers a holistic and individualized approach to managing low back pain, addressing not only the symptoms but also the underlying imbalances contributing to the condition. By incorporating Panchakarma therapies, herbal formulations, dietary modifications, and lifestyle interventions, Ayurvedic treatment aims to restore harmony within the body, promote self-healing, and prevent recurrence of LBP. Further research and collaboration between Ayurvedic and conventional healthcare systems are warranted to validate the efficacy and safety of Ayurvedic interventions and enhance their integration into mainstream healthcare for comprehensive LBP management.
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Maki, Maram, Shima A. Mohammad Zadeh, and Tamer M. Shousha. "Exploring physiotherapy interventions for chronic back pain: the role of shockwave therapy." Fizjoterapia Polska 24, no. 2 (2024): 178–82. http://dx.doi.org/10.56984/8zg5608np7.
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Chronic nonspecific low back pain (LBP) poses a significant global health challenge, necessitating multifaceted interventions for effective management. Physiotherapy, with its integrated approach, plays a pivotal role in addressing the complexity of chronic LBP, employing diverse modalities such as exercise and movement therapy, manual therapies, and education combined with lifestyle modifications. Cognitive Functional Therapy (CFT) has emerged as a promising, patient-centered intervention, emphasizing the importance of a personalized approach. However, challenges persist in delivering efficient, individualized treatments, leading to potential excess or inadequacy of interventions. Extracorporeal Shockwave Therapy (ESWT) has garnered attention as an emerging therapeutic intervention for chronic back pain, employing high-energy shockwaves to stimulate healing processes and alleviate pain. While ESWT shows promise in treating musculoskeletal conditions and inducing favorable effects in various studies, its specific application for chronic low back pain lacks comprehensive randomized clinical trials, especially concerning radial ESWT. The current body of evidence, often falling short of the highest standards of Evidence-Based Physiotherapy, poses challenges in objectively assessing the clinical effectiveness of widely practiced ESWT procedures for chronic low back pain. In conclusion, while physiotherapy remains integral for managing chronic nonspecific low back pain, including diverse interventions, the specific role and effectiveness of shockwave therapy, particularly in the context of chronic back pain, necessitate further robust research and clinical investigations. This review highlights the need for comprehensive studies to ascertain the clinical efficacy and optimal application of shockwave therapy within physiotherapy protocols for long-term pain management.
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M. Ubom, Ime, and John O. Onyezere. "Effect of Health Education on Posture Practices Towards Reduction of Low Back Pain Among Patients in Rivers State." International Journal of Social Health 2, no. 6 (2023): 354–61. http://dx.doi.org/10.58860/ijsh.v2i6.59.
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This study investigated the effect of health education on posture practices in reducing low back pain among patients in Rivers state, Nigeria. To achieve this, pretest-posttest quasi-experimental design was employed, and the study targeted 170 patients at the University of Port Harcourt Teaching Hospital in Nigeria. Two objectives having corresponding research questions and hypotheses guided the study, while convenience and stratified sampling techniques were used to select 50 participants, comprising 35 patients from the general outpatient clinic department and 15 patients from the spine physiotherapy unit, with 20 male and 30 female participants. Data collection was done by administering a self-structured, self-administered questionnaire, titled health education effect on ergonomic practices and low back pain, which had a reliability coefficient of 0.75. Both descriptive and inferential statistics were used to answer the research questions and test the hypotheses. The research found that educating patients on various methods of preventing low back pain, including healthy weight maintenance, warm-up exercises, and proper postural habits while sitting and standing, had a noteworthy impact on reducing pain. Moreover, the study also revealed that health education programmes were successful in therapeutic posture practices and reducing low back pain in patients residing in Rivers state. Therefore, the study concluded and recommended that health education interventions for functional and therapeutic posture practices are effective strategies for reducing low back pain among patients in Rivers state, and healthcare providers should incorporate these interventions into their treatment plans for patients suffering from low back pain.
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Saadat, Sajjad, Mozaffar Hosseininezhad, Seyed Sepehr Khatami, and Reza Ghasemi Jobaneh. "Psychological Interventions in Chronic Low Back Pain: A Systematic Review." Iranian Journal of Neurosurgery 7, no. 2 (2021): 67–74. http://dx.doi.org/10.32598/irjns.7.2.1.
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Background and Aim: Chronic low Back Pain (CLBP) is one of the most common musculoskeletal disorders with possible psychological consequences for the patients. This study aimed to review all evidence on the effectiveness of psychological interventions in improving the mental status of people with CLBP and providing recommendations for future therapeutic interventions. Methods and Materials/Patients: This systematic review was conducted on the articles published from January 2010 to December 2020. The keywords included “psychology”, “intervention”, “low back pain”, “chronic disease”, “quality of life”, “empowerment”, “psychotherapy”, “psychological interventions”, “clinical trials”, and “randomized clinical trials” in the indexing databases of Magiran, PubMed, Scopus, and Google Scholar. Of the total 1740 articles found, 14 articles were selected for review. Results: The results showed that Cognitive-Behavioral Therapy (CBT) and its combination therapies with mindfulness techniques played an influential role in improving psychological status and quality of life, and reducing pain perception in CLBP patients. The lack of RCT (randomized controlled trial) research and follow-up to assess long-term outcomes are the main limitations of the studies conducted in Iran. Conclusion: It is recommended that psychological interventions be considered alongside medical therapies to improve CLBP patients’ adjustment to chronic condition and their quality of life. Researchers and therapists should consider treatment programs based on RCT plans and long-term follow-up.
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Morales Osorio, Marco Antonio, Sergio Alejandro Kock Shulz, Johana Milena Mejia Mejia, and Heberto Suarez-Roca. "Impact of two therapeutic interventions in patients with non-specific low back pain." Salud Uninorte 34, no. 2 (2019): 338–48. http://dx.doi.org/10.14482/sun.34.2.612.88.
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Buenaventura, Ricardo M. "Systematic Review of Therapeutic Lumbar Transforaminal Epidural Steroid Injections." Pain Physician 1;12, no. 1;1 (2009): 233–51. http://dx.doi.org/10.36076/ppj.2009/12/233.
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Background: Epidural injection of corticosteroids is one of the most commonly used interventions in managing chronic spinal pain. The transforaminal route to the lumbar epidural space for steroid injection has gained rapid and widespread acceptance for the treatment of lumbar and leg pain. However, there are few well-designed randomized, controlled studies to determine the effectiveness of epidural injections. The role and value of transforaminal lumbar epidural steroid injections is still questioned. Study Design: A systematic review of transforaminal epidural injection therapy for low back and lower extremity pain. Objective: To evaluate the effect of transforaminal lumbar epidural steroid injections in managing lumbar (low-back) and sciatica (leg) pain. Methods: The available literature of lumbar transforaminal epidural injections in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to November 2008, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: The indicated evidence is Level II-1 for short-term relief and Level II-2 for long-term relief in managing chronic low back and lower extremity pain. . Limitations: The limitations of this systematic review include the paucity of literature. Conclusion: The indicated evidence for transforaminal lumbar epidural steroid injections is Level II-1 for short-term relief and Level II-2 for long-term improvement in the management of lumbar nerve root and low back pain. Key words: Spinal pain, chronic low back pain, lower extremity pain, transforaminal epidural steroids, radiculopathy, sciatica, steroids, local anesthetic
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Simopoulos, Thomas T. "Systematic Review of the Diagnostic Accuracy and Therapeutic Effectiveness of Sacroiliac Joint Interventions." Pain Physician 5;18, no. 5;9 (2015): E713—E756. http://dx.doi.org/10.36076/ppj.2015/18/e713.
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Background: The sacroiliac joint is well known as a cause of low back and lower extremity pain. Prevalence estimates are 10% to 25% in patients with persistent axial low back pain without disc herniation, discogenic pain, or radiculitis based on multiple diagnostic studies and systematic reviews. However, at present there are no definitive management options for treating sacroiliac joint pain. Objective: To evaluate the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. Study Design: A systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. Methods: The available literature on diagnostic and therapeutic sacroiliac joint interventions was reviewed. The quality assessment criteria utilized were the Quality Appraisal of Reliability Studies (QAREL) checklist for diagnostic accuracy studies, Cochrane review criteria to assess sources of risk of bias, and Interventional Pain Management Techniques – Quality Appraisal of Reliability and Risk of Bias Assessment (IPM – QRB) criteria for randomized therapeutic trials and Interventional Pain Management Techniques – Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM – QRBNR) for observational therapeutic assessments. The level of evidence was based on a best evidence synthesis with modified grading of qualitative evidence from Level I to Level V. Data sources included relevant literature published from 1966 through March 2015 that were identified through searches of PubMed and EMBASE, manual searches of the bibliographies of known primary and review articles, and all other sources. Outcome Measures: For the diagnostic accuracy assessment, and for the therapeutic modalities, the primary outcome measure of pain relief and improvement in functional status were utilized. Results: A total of 11 diagnostic accuracy studies and 14 therapeutic studies were included. The evidence for diagnostic accuracy is Level II for dual diagnostic blocks with at least 70% pain relief as the criterion standard and Level III evidence for single diagnostic blocks with at least 75% pain relief as the criterion standard. The evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain is Level II to III. The evidence for conventional radiofrequency neurotomy, intraarticular steroid injections, and periarticular injections with steroids or botulinum toxin is limited: Level III or IV. Limitations: The limitations of this systematic review include inconsistencies in diagnostic accuracy studies with a paucity of high quality, replicative, and consistent literature. The limitations for therapeutic interventions include variations in technique, variable diagnostic standards for inclusion criteria, and variable results.Conclusion: The evidence for the accuracy of diagnostic and therapeutic effectiveness of sacroiliac joint interventions varied from Level II to Level IV. Key words: Chronic low back pain, sacroiliac joint pain, sacroiliitis, sacroiliac joint injection, sacroiliac joint dysfunction, thermal radiofrequency, pulsed radiofrequency
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Gotani, Aiham. "Unveiling the Placebo Effect: How Belief Shapes Relief in Low Back Pain." International Journal Papier Advance and Scientific Review 5, no. 2 (2024): 1–6. http://dx.doi.org/10.47667/ijpasr.v5i2.298.
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Low back pain is a complex condition that is influenced by biological, psychological and social factors and poses considerable challenges for effective treatment. The biopsychosocial model of pain emphasizes the importance of incorporating various factors into treatment strategies. In this context, the placebo effect emerges as a remarkable phenomenon that offers insights into the interplay of persuasion and relief in the treatment of low back pain. This paper explores the multifaceted nature of low back pain and highlights the role of the placebo effect in shaping treatment outcomes. It looks at recent research highlighting the influence of patient-practitioner interactions, contextual factors and neurobiological mechanisms on placebo responses. It also discusses how placebo interventions, ranging from inert substances to sham surgery, have shown significant efficacy in relieving low back pain symptoms. Neuroimaging studies have provided valuable insights into the neural mechanisms underlying the placebo effect, enabling the development of targeted interventions. In addition, ethical considerations related to the use of placebos, including transparency, informed consent and harm minimization, are addressed to ensure ethical practice. Healthcare providers are encouraged to harness the placebo effect through evidence-based interventions and patient-centered care. Through the use of positive communication, empathy and complementary therapies, clinicians can optimize treatment outcomes and improve the overall well-being of patients. Looking to the future, interdisciplinary collaboration and advances in neuroscience promise to further unlock the therapeutic potential of the placebo effect in the treatment of low back pain. By combining scientific rigor and compassionate care, healthcare providers can navigate the complexities of placebo use in an ethical and effective manner, ultimately improving outcomes for patients with low back pain and other chronic conditions.
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Mehta, Trupti B., and Amit Sharma. "Lower cross syndrome: specific treatment protocol versus generalized treatment protocol. A randomized single-blinded trial." Folia Medica 66, no. 5 (2024): 662–72. http://dx.doi.org/10.3897/folmed.66.e135838.
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Introduction: Lower crossed syndrome (LCS) is a biomechanical muscle imbalance causing low back pain. Aim: This study aimed to compare specific treatment protocols versus generalized treatment protocols for managing low back pain associated with LCS. Materials and methods: This randomized, single-blinded trial involved 200 patients (aged 20-40 years) with low back pain and LCS. Patients were divided into four groups: A1 and A2 (specific protocols for posterior and anterior LCS), and B1 and B2 (generalized protocols). Interventions were administered thrice weekly for two weeks. Outcome measures included Numerical Pain Rating Scale (NPRS), Modified Oswestry Disability Questionnaire (MODQ), Lumbar Lordosis Index (LLI), abdominal and gluteal muscle strength, and iliopsoas and back extensor flexibility. Results: All groups showed significant improvements in all parameters (p&lt;0.01). However, specific protocols demonstrated superior outcomes. Group A1 showed the greatest reductions in pain (median NPRS decrease: 5), disability (median MODQ decrease: 45), iliopsoas tightness (median decrease: 12°) and back extensor tightness (median decrease 6.5). Group A2 exhibited the highest improvements in abdominal strength (median increase: 8 kg) and gluteal muscle strength (median increase: 8 kg). Conclusion: Specific treatment protocols were significantly more effective than generalized protocols in managing low back pain associated with LCS. These findings emphasize the importance of accurate LCS classification and tailored interventions for optimal therapeutic outcomes in patients with low back pain.
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hoque, Dr Md Ahsanul, Dr Md Shawkat Hossain, Dr Monjur Ahmed, Dr ABM Zafar Sadeque, Dr Asiful Haque, and Dr Mohammad Ilias. "Effects of Transcutaneous Electrical Nerve Stimulation in Patients with Chronic Non-Specific Low Back Pain." Scholars Journal of Applied Medical Sciences 10, no. 7 (2022): 1094–104. http://dx.doi.org/10.36347/sjams.2022.v10i07.010.
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The management of low back pain (LBP) encompasses a diverse range of possible interventions including drug therapy, surgery, exercise, patient education, physiotherapy, cognitive-behavioral therapy and various other non-pharmacological therapies. Acute and chronic LBP warrant separate consideration as they may respond differently to the same interventions. Transcutaneous electrical nerve stimulation (TENS) is widely used as a therapeutic adjunct in the management of low back pain. It is relatively safe, non-invasive and easy to use modality that makes it an attractive treatment option. For more than four decades, TENS has been applied in the treatment of acute and chronic pain syndromes. Hence there is still uncertainty about the most effective therapeutic approach in chronic non-specific low back pain. Methods: This randomized controlled clinical trial was conducted in the department of Physical Medicine and Rehabilitation, Chatto gram from 13/01/2019 to 13/06//2019. The aim of the study was to evaluate the effects of Transcutaneous Electrical Nerve Stimulation on Chronic Non-specific Low Back Pain Patients. 120 patients with chronic low back pain were treated according to inclusion & exclusion criteria. Patients were equally distributed in three groups. Group-A patients (n=40) treated with NSAID+ADL, and Group-B patients (n=40) treated with NSAID+ADL+TENS and Group-C patients (n=40) treated with NSAID+ ADL+ Back extension exercise. Written informed consent was obtained from all patients. Data were calculated and analyzed by computer based software SPSS (Statistical Package for social Science) windows 16.0 version. Main Outcome Measure (S): Age, Sex, Occupational status, Socio-economic status, Subjective pain intensity score, Visual Analogue Scale, Tenderness index, Disability due to pain, Spinal mobility index, Oswestry disability Index. Results: The mean age was found 41.82±11.95 years in group A and 42.7±12.52 years in group B and 40.52±13.40 in group C.........
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Jones, Kaitlyn C., Evelyn C. Tocco, Ashley N. Marshall, Tamara C. Valovich McLeod, and Cailee E. Welch Bacon. "Pain Education With Therapeutic Exercise in Chronic Nonspecific Low Back Pain Rehabilitation: A Critically Appraised Topic." Journal of Sport Rehabilitation 29, no. 8 (2020): 1204–9. http://dx.doi.org/10.1123/jsr.2019-0345.
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Clinical Scenario: Low back pain is widely prevalent in the general population as well as in athletes. Therapeutic exercise is a low-risk and effective treatment option for chronic pain that can be utilized by all rehabilitation clinicians. However, therapeutic exercise alone does not address the psychosocial aspects that are associated with chronic low back pain. Pain education is the umbrella term utilized to encompass any type of education to the patient about their chronic pain. Therapeutic exercise in combination with pain education may allow for more well-rounded and effective treatment for patients with chronic nonspecific low back pain (NS-LBP). Clinical Question: Does pain education combined with therapeutic exercise, compared with therapeutic exercise alone, improve patient pain in adults with chronic NS-LBP over a 2- to 3-month treatment period? Summary of Key Findings: A thorough literature review yielded 8 studies potentially relevant to the clinical question, and 3 studies that met the inclusion criteria were included. The 3 studies included reports that exercise therapy reduced symptoms. Two of the 3 included studies support the claim that exercise therapy reduces the symptoms of chronic NS-LBP when combined with pain education, whereas one study found no difference between pain education with therapeutic exercise. Clinical Bottom Line: There is moderate evidence to support the use of pain education along with therapeutic exercise when attempting to reduce symptoms of pain and disability in patients with chronic NS-LBP. Educational interventions should be created to educate patients about the foundation of pain, and pain education should be implemented as a part of the clinician’s strategy for the rehabilitation of patients with chronic NS-LBP. Strength of Recommendation: Grade B evidence exists to support the use of patient education with therapeutic exercise for decreasing pain in patients with chronic NS-LBP.
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Nayak, Bibhu K., Dharmendra K. Singh, Nishith Kumar, and Binita Jaiswal. "Recovering from nonspecific low back pain despair: Ultrasound-guided intervention in iliolumbar syndrome." Indian Journal of Radiology and Imaging 30, no. 04 (2020): 448–52. http://dx.doi.org/10.4103/ijri.ijri_382_19.
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Abstract Background: Iliolumbar syndrome is a frequent cause of chronic nonspecific low back pain. The cornerstone of its treatment lies upon the specific diagnosis of the iliolumbar syndrome. The ultrasound guided interventions have the potential for the specific diagnosis and treatment of the iliolumbar syndrome. Objective: To assess the role of ultrasound-guided intervention for the diagnosis and treatment of the iliolumbar syndrome. Materials and Methods: The study comprised of fifty-seven patients of nonspecific low back pain with the clinically suspected iliolumbar syndrome. Two-staged ultrasound-guided interventions were performed: Primary diagnostic and secondary therapeutic interventions. Favorable response after the injection of local anesthetic agent in iliolumbar ligament (defined as VAS score to ≥3) was classified as confirmed Ilio-lumbar syndrome. Clinico radiological efficacy after platelet-rich plasma (PRP) injection in confirmed iliolumbar syndrome patients was done. Results: Out of 57 patients, 45 (78.95’) were diagnosed with confirmed Iliolumbar syndrome after primary diagnostic intervention. The mean value of VAS at presentation was 8.02 ± 0.72 which was decreased to 3.16 ± 1.63; P < 0.0001. All 45 patients underwent PRP injection in iliolumbar ligament and 42 patients (93.33’) showed reduction in mean VAS score from 8 ± 0.67 (at presentation) to 0.89 ± 1.23 after 6 weeks follow up; P < 0.0001. Iliolumbar ligament thickness was decreased from the day of presentation (2.66 ± 0.22) to 6 weeks after therapeutic intervention (0.91 ± 0.42); P < 0.0001. Conclusion: The ultrasound guided diagnostic and therapeutic intervention were found to result in a specific diagnosis and remarkable recovery in the iliolumbar syndrome group of nonspecific low back pain patients.
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Kosińska, Barbara, Paweł Turczyn, Krzysztof Wesołowski, Beata Tarnacka, and Małgorzata Malec-Milewska. "Central sensitization in chronic lumbar spine pain – possibilities of therapeutic interventions." BÓL 21, no. 2 (2020): 45–53. http://dx.doi.org/10.5604/01.3001.0014.5098.
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Patients with chronic low back pain are a heterogeneous group. Therapeutic management of these patients should address the underlying mechanism of pain, which can be revealed after performing diagnostic tests. The management of patients with the predominant central sensitization component of includes multimodal therapy consisting of pharmacological and non-pharmacological treatment. An important element is also the identification and exclusion of the most important pathophysiological factors affecting the maintenance of central sensitization mechanisms in each patient. The paper describes pharmacological and non-pharmacological therapeutic options in patients with central sensitization component, considering that these methods may differ significantly in the patients. It should be stated that despite the individualized, multimodal therapy based on pain mechanisms, in some patients substantial pain relief may not be achieved.
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Mallika, Makwana, Shaikh Tehsin, S. Saiyad Sajidali, and Sejarali Sayeed Mohmad. "Physiological and Biomechanical Outcomes in Patients with Chronic Low Back Pain: An Analysis of Therapeutic Interventions." International Journal of Pharmaceutical and Clinical Research 16, no. 10 (2024): 67–71. https://doi.org/10.5281/zenodo.14031114.
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<strong>Introduction: </strong>Chronic Low Back Pain (CLBP) affects millions globally and presents challenges to healthcare systems. It involves both physical and psychological factors, including disability, fear-avoidance beliefs, and reduced quality of life. While conservative treatments like exercise and pain management are common, fascia’s role in musculoskeletal pain is increasingly recognized. Myofascial Release Therapy (MFR) and Motor Control Exercises (MCE) have shown positive outcomes for CLBP. This study examines the combined effect of MFR, MCE, and a Moist Heat Pack on pain, disability, fear-avoidance beliefs, and quality of life in CLBP patients. <strong>Aims and Objectives: </strong>The primary goal is to assess the combined efficacy of MFR, MCE, and a Moist Heat Pack in reducing pain (NPRS), disability (ODI-G), fear-avoidance beliefs (FABQ-G), and improving quality of life (EQ-5D-5L). Additionally, the study evaluates trunk endurance differences using the Flexor Endurance Test (FET) and Extensor Endurance Test (EET). <strong>Methodology: </strong>This randomized controlled trial involved 48 CLBP patients divided into three groups: <strong>Group A</strong>: MFR, MCE, and a Moist Heat Pack. <strong>Group B</strong>: MCE only. <strong>Group C</strong>: Control group (no intervention). The interventions lasted six weeks, five days a week, excluding the control group. Pain, disability, fear-avoidance beliefs, quality of life, and trunk endurance were measured at baseline, week 3, and week 6. Data analysis used ANOVA with a significance threshold of p < 0.05. <strong>Results: </strong>Baseline characteristics were similar across groups (p > 0.05). By week 6, Group A showed significant improvements in pain, disability, and fear-avoidance beliefs (p < 0.05) compared to Groups B and C. Group B showed moderate improvements, while no significant changes in trunk endurance were observed in any group (p > 0.05). <strong>Discussion: </strong>The combination of MFR, MCE, and a Moist Heat Pack significantly reduced pain, disability, and fear-avoidance beliefs, enhancing the quality of life. Group A exhibited the greatest benefits, reinforcing the therapeutic value of these interventions. However, the lack of significant trunk endurance improvement suggests a need for additional endurance training. <strong>Conclusion: </strong>The combination of MFR, MCE, and a Moist Heat Pack is effective in reducing pain, disability, and fear-avoidance beliefs while improving quality of life in CLBP patients. Future research should explore the long-term effects of this therapy and additional strategies for improving trunk endurance.
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P Coelho, Alexandra Isabel, João Santos Faria, Carla HovenKamp, and João Paulo Branco. "Coluna Degenerativa – Novas Evidências." Revista de Medicina Desportiva Informa 14, no. 1 (2023): 21–23. http://dx.doi.org/10.23911/coluna_degenerativa_2023_jan.
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Low back pain is a frequent complaint in the general population, that may also affect veteran athletes. Understanding the etiology of low back pain is essential for a correct therapeutic orientation, which should include behavioral changes and a rehabilitation program. In some cases, it may be necessary to associate pharmacological therapy, minimally invasive procedures, or even surgical interventions. Minimally invasive procedures include a variety of techniques and procedures that have demonstrated low to moderate degrees of evidence in pain management. As they are not risk free and have a limited duration of action, they should be reserved for cases refractory to conservative treatment.
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Simplicio, Claudio, Gabriel Santos, Gilson Shinzato, et al. "Extracorporeal Shockwave Treatment for Low Back Pain." Biologic Orthopedics Journal 4, SP1 (2022): e96-e105. http://dx.doi.org/10.22374/boj.v4isp1.46.
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Low back pain is a common symptom in patients with chronic musculoskeletal conditions, affecting several individuals. In most cases, low back pain can often prove to be nonspecific or even multifactorial. Current treatment approach is based on surgical and noninvasive interventions, including pharmacological, psychological, physiotherapeutic, or complementary strategies. Extracorporeal shock wave therapy (ESWT) is a type of noninvasive mechanotherapy that has become popular in recent years due to its applicability in the treatment of various musculoskeletal disorders, especially in the lumbar spine of individuals with osteopo-rosis, sacroiliitis, and even spinal cord disorders. The objective of this manuscript is to review the scientific evidence supporting the application of this therapy in the management of low back pain, and give a brief description of the treatment techniques used in clinical settings. The articles included in this descriptive review were selected from databases using the Google Scholar tool, from which a total of 13 applicable studies matching the topic were included. Despite the need for more clinical trials, shock waves have been applied in medical health for many years with satisfactory results. Its application in the treatment of lumbar spine disorders has been shown to be advantageous in the management of pathological progression, such as the natural wear and tear process of musculoskeletal structures. In this sense, shockwave therapy may represent a viable alternative for the treatment of lumbar spine disorders; however, its therapeutic effects andmechanisms require further elucidation.
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Rupert, Matthew P. "Evaluation of Sacroiliac Joint Interventions: A Systematic Appraisal of the Literature." Pain Physician 2;12, no. 2;3 (2009): 399–418. http://dx.doi.org/10.36076/ppj.2009/12/399.
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Background: The sacroiliac joint has been implicated as a source of low back and lower extremity pain. There are no definite historical, physical, or radiological features that can definitively establish a diagnosis of sacroiliac joint pain. Based on the present knowledge, an accurate diagnosis is made only by controlled sacroiliac joint diagnostic blocks. The sacroiliac joint has been shown to be a source of pain in 10% to 27% of suspected patients with chronic low back pain utilizing controlled comparative local anesthetic blocks. Study Design: A systematic review of diagnostic and therapeutic sacroiliac joint interventions. Objective: To evaluate the accuracy of diagnostic sacroiliac joint interventions and the utility of therapeutic sacroiliac joint interventions. Methods: The literature search was carried out by searching the databases of PubMed, EMBASE, and Cochrane reviews. Methodologic quality assessment of included studies was performed using the Agency for Healthcare Research and Quality (AHRQ) methodologic quality criteria for diagnostic accuracy and observational studies, whereas randomized trials were evaluated utilizing the Cochrane review criteria. Only studies with scores of 50 or higher were included for assessment. Level of evidence was based on the U.S. Preventive Services Task Force (USPSTF) criteria. Outcome Measures: For diagnostic interventions, the outcome criteria included at least 50% pain relief coupled with a patient’s ability to perform previously painful maneuvers with sustained relief using placebo-controlled or comparative local anesthetic blocks. For therapeutic purposes, outcomes included significant pain relief and improvement in function and other parameters. Short-term relief for therapeutic interventions was defined as 6 months or less, whereas long-term effectiveness was defined as greater than 6 months. Results: The indicated level of evidence is II-2 for the diagnosis of sacroiliac joint pain utilizing comparative, controlled local anesthetic blocks. The prevalence of sacroiliac joint pain is estimated to range between 10% and 38% using a double block paradigm in the study population. The false-positive rate of single, uncontrolled, sacroiliac joint injections is 20% to 54%. The evidence for provocative testing to diagnose sacroiliac joint pain is Level II-3 or limited. For radiofrequency neurotomy the indicated evidence is limited (Level II-3) for short- and longterm relief. Limitations: The limitations of this systematic review include the paucity of literature evaluating the role of both diagnostic and therapeutic interventions and widespread methodological flaws. Conclusions: The indicated evidence for the validity of diagnostic sacroiliac joint injections is Level II-2. The evidence for the accuracy of provocative maneuvers in the diagnosing of sacroiliac joint pain is limited (Level II-3). The evidence for radiofrequency neurotomy is also limited (Level II-3). Key words: Chronic low back pain, sacroiliac joint pain, sacroiliitis, sacroiliac joint injection, sacroiliac joint dysfunction, thermal radiofrequency, pulsed radiofrequency
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Bertolini, Sonia Maria Marques Gomes, and Maria Lúcia Ziroldo. "Comparison between kinesiotherapy and back school in the treatment of low back pain in older adults." Revista da Rede de Enfermagem do Nordeste 16, no. 5 (2015): 699. http://dx.doi.org/10.15253/2175-6783.2015000500011.
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Objective: to compare the efficacy of physiotherapy treatment involving kinesiotherapy and back school in older adults’ lowback pain. Methods: study of the case-series type. The pain visual analog scale and the WHOQOL-bref were used for assessingquality of life, and the Timed Up and Go Test was used for testing agility. A total of 21 older adults, who had had low back painfor over three months, participated in the study. The sample was divided in two groups (kinesiotherapy and back school).The older adults were assessed before and after the therapeutic interventions. Results: both groups obtained better scoresin all the variables analyzed in the post-test in relation to the pre-test, and as a result, in the inter-group comparison, theresults did not reveal statistically significant differences (p>0.05). Conclusion: back school and conventional kinesiotherapywere effective in improving the pain, quality-of-life and agility of older adults with low back pain.
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Nurrakhmi, Sulistia Intan, and Mustikasari Mustikasari. "Relaxation Techniques and Therapeutic Communication On Anxiety And Grieving Of Clients with Low Back Pain." UI Proceedings on Health and Medicine 4, no. 1 (2020): 16. http://dx.doi.org/10.7454/uiphm.v4i1.243.
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<p class="AbstractContent"><strong>Objective:</strong> Low back pain client may have an alteration in their job and had a grieving process with anxiety. Client who experienced it will feel anxiety with certain level and grieving with certain phases. This writing discuss about Mrs. RL’s case about low back pain with anxiety and grieving as psychosocial problems.</p><p class="AbstractContent"><strong>Methods: </strong>This case study aimed to evaluate nursing management given to patient with low back pain to pass grieving process and decrease their anxiety. Nursing management in grieving and anxiety was relaxation techniques and exploring feelings.</p><p class="AbstractContent"><strong>Results:</strong> The evaluation for nursing management was the resolved nursing problem either anxiety or grieving with the teaching interventions. <strong></strong></p><p class="AbstractContent"><strong>Conclusion: </strong>Application of the relaxation techniques with adjusted time for patients in daily living to keep patient’s psychosocial conditions can be performed by nurse.</p><div><p class="Keywords"><strong>Keywords: </strong>Anxiety; Grieving; Low Back Pain; Relaxation Technique</p></div>
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Manchikanti, Laxmaiah. "An Algorithmic Approach for Clinical Management of Chronic Spinal Pain." Pain Physician 4;12, no. 4;7 (2009): E225—E264. http://dx.doi.org/10.36076/ppj.2009/12/e264.
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Interventional pain management, and the interventional techniques which are an integral part of that specialty, are subject to widely varying definitions and practices. How interventional techniques are applied by various specialties is highly variable, even for the most common procedures and conditions. At the same time, many payors, publications, and guidelines are showing increasing interest in the performance and costs of interventional techniques. There is a lack of consensus among interventional pain management specialists with regards to how to diagnose and manage spinal pain and the type and frequency of spinal interventional techniques which should be utilized to treat spinal pain. Therefore, an algorithmic approach is proposed, providing a stepby-step procedure for managing chronic spinal pain patients based upon evidence-based guidelines. The algorithmic approach is developed based on the best available evidence regarding the epidemiology of various identifiable sources of chronic spinal pain. Such an approach to spinal pain includes an appropriate history, examination, and medical decision making in the management of low back pain, neck pain and thoracic pain. This algorithm also provides diagnostic and therapeutic approaches to clinical management utilizing case examples of cervical, lumbar, and thoracic spinal pain. An algorithm for investigating chronic low back pain without disc herniation commences with a clinical question, examination and imaging findings. If there is evidence of radiculitis, spinal stenosis, or other demonstrable causes resulting in radiculitis, one may proceed with diagnostic or therapeutic epidural injections. In the algorithmic approach, facet joints are entertained first in the algorithm because of their commonality as a source of chronic low back pain followed by sacroiliac joint blocks if indicated and provocation discography as the last step. Based on the literature, in the United States, in patients without disc herniation, lumbar facet joints account for 30% of the cases of chronic low back pain, sacroiliac joints account for less than 10% of these cases, and discogenic pain accounts for 25% of the patients. The management algorithm for lumbar spinal pain includes interventions for somatic pain and radicular pain with either facet joint interventions, sacroiliac joint interventions, or intradiscal therapy. For radicular pain, epidural injections, percutaneous adhesiolysis, percutaneous disc decompression, or spinal endoscopic adhesiolysis may be performed. For non-responsive, recalcitrant, neuropathic pain, implantable therapy may be entertained. In managing pain of cervical origin, if there is evidence of radiculitis, spinal stenosis, post-surgery syndrome, or other demonstrable causes resulting in radiculitis, an interventionalist may proceed with therapeutic epidural injections. An algorithmic approach for chronic neck pain without disc herniation or radiculitis commences with clinical question, physical and imaging findings, followed by diagnostic facet joint injections. Cervical provocation discography is rarely performed. Based on the literature available in the United States, cervical facet joints account for 40% to 50% of cases of chronic neck pain without disc herniation, while discogenic pain accounts for approximately 20% of the patients. The management algorithm includes either facet joint interventions or epidural injections with surgical referral for disc-related pain and rarely implantable therapy. In managing thoracic pain, a diagnostic and therapeutic algorithmic approach includes either facet joint interventions or epidural injections. Key words: Algorithmic approach, chronic pain, chronic spinal pain, diagnostic interventional techniques, therapeutic interventional techniques, comprehensive evaluation, documentation, medical decision making.
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Naqvi, Waqar. "THE OUTCOMES OF A MCKENZIE-BASED APPROACH COMBINED WITH OTHER INTERVENTIONS FOR A PATIENT WITH LOW BACK PAIN AND PIVD." Journal of Medical pharmaceutical and allied sciences 10, no. 5 (2021): 3653–55. http://dx.doi.org/10.22270/jmpas.v10i5.1344.
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Low backache is the most common health condition among adults which leads to pain and disability. Radiculopathy is a impaired condition that causes low back pain that radiates to the lower extremity. The aim of this case study is to establish a comprehensive physical therapy plan for a patient who has chronic low back pain and PIVD. The patient was a 30-year-old female with a one month history of LBP. The pain further radiated to both legs. Further magnetic resonance imaging (MRI) was done, which indicated PIVD at the level ofL4-L5The patient's main concern about her condition was that she was unable to work, engage in her once-loved hobbies, and function without pain or discomfort, and pain has disrupted her sleep. After eight weeks the pain level on the Numerical Pain Rating Scale had reduced from 7/10 at worst to 2/10. The patient said that aggravating pain is reduced. Capacity to function has been restored and sleeping has also been improved. A detailed physical therapy program that included a patient with chronic low back pain and PIVD are McKenzie extension exercise, therapeutic exercise, electrical stimulation, individualized patient education, manual techniques, superficial heat and home exercise program.
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Lewkowicz, Daniel, Tamara Slosarek, Sarah Wernicke, Antonia Winne, Attila M. Wohlbrandt, and Erwin Bottinger. "Digital Therapeutic Care and Decision Support Interventions for People With Low Back Pain: Systematic Review." JMIR Rehabilitation and Assistive Technologies 8, no. 4 (2021): e26612. http://dx.doi.org/10.2196/26612.
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Background Low back pain (LBP) is the leading cause of worldwide years lost because of disability, with a tremendous economic burden for health care systems. Digital therapeutic care (DTC) programs provide a scalable, universally accessible, and low-cost approach to the multidisciplinary treatment of LBP. Moreover, novel decision support interventions such as personalized feedback messages, push notifications, and data-driven activity recommendations amplify DTC by guiding the user through the program while aiming to increase overall engagement and sustainable behavior change. Objective This systematic review aims to synthesize recent scientific literature on the impact of DTC apps for people with LBP and outline the implementation of add-on decision support interventions, including their effect on user retention and attrition rates. Methods We searched bibliographic databases, including MEDLINE, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, from March 1, 2016, to October 15, 2020, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted this review based on related previously published systematic reviews. Besides randomized controlled trials (RCTs), we also included study designs with the evidence level of at least a retrospective comparative study. This enables the consideration of real-world user-generated data and provides information regarding the adoption and effectiveness of DTC apps in a real-life setting. For the appraisal of the risk of bias, we used the Risk of Bias 2 Tool and the Risk of Bias in Non-Randomized Studies of Interventions Tool for the RCTs and nonrandomized trials, respectively. The included studies were narratively synthesized regarding primary and secondary outcome measures, DTC components, applied decision support interventions, user retention, and attrition rates. Results We retrieved 1388 citations, of which 12 studies are included in this review. Of the 12 studies, 6 (50%) were RCTs and 6 (50%) were nonrandomized trials. In all included studies, lower pain levels and increased functionality compared with baseline values were observed in the DTC intervention group. A between-group comparison revealed significant improvements in pain and functionality levels in 67% (4/6) of the RCTs. The study population was mostly homogeneous, with predominantly female, young to middle-aged participants of normal to moderate weight. The methodological quality assessment revealed moderate to high risks of biases, especially in the nonrandomized trials. Conclusions This systematic review demonstrates the benefits of DTC for people with LBP. There is also evidence that decision support interventions benefit overall engagement with the app and increase participants’ ability to self-manage their recovery process. Finally, including retrospective evaluation studies of real-world user-generated data in future systematic reviews of digital health intervention trials can reveal new insights into the benefits, challenges, and real-life adoption of DTC programs.
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Sung, Paul S. "Disability and back muscle fatigability changes following two therapeutic exercise interventions in participants with recurrent low back pain." Medical Science Monitor 19 (2013): 40–48. http://dx.doi.org/10.12659/msm.883735.
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Ruíz-del Río, David, Roy La Touche, Gwendoline Giolito, Silvia Di Bonaventura, Mónica Grande-Alonso, and Álvaro Reina Varona. "Effectiveness of biobehavioral therapeutic education in chronic low back pain intensity and disability: a systematic review." Journal of MOVE and Therapeutic Science 6, no. 1 (2024): 593–611. http://dx.doi.org/10.37382/jomts.v6i1.1179.
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Background: Chronic low back pain (CLBP) is a prevalent musculoskeletal issue that could lead to significant disability. CLBP involves persistent pain and psychological factors contributing to its complexity. Therapeutic education combining cognitive-behavioral approaches may aid in managing CLBP. Objectives: This systematic review evaluates the efficacy of therapeutic education based on a biobehavioral approach in modifying beliefs and promoting active coping strategies in CLBP patients. Methods: Following PRISMA guidelines, we searched PubMed, EBSCO host, and Google Scholar for randomized controlled trials (RCTs) and quasi-experimental studies from March 27 to April 16, 2022, with an update on June 15, 2024. Inclusion criteria focused on adults with CLBP undergoing therapeutic education aimed at behavioral modification. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated using RoB 2.0. Results: Out of 532 studies, four met the inclusion criteria. The interventions combined therapeutic education with therapeutic exercise or conventional physical therapy. Pain intensity and disability were the main outcomes measured. One study found significant improvements in pain and disability, while others showed trends towards improvement without statistical significance. The quality of evidence was very low. Conclusion: Combining therapeutic education with active coping strategies and other therapies may reduce pain intensity and disability in CLBP patients. However, the evidence quality is very low, highlighting the need for further research.
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Schuttert, Ingrid, Hans Timmerman, Gerbrand J. Groen, Kristian Kjær Petersen, Lars Arendt-Nielsen, and Andre P. Wolff. "Human assumed central sensitisation (HACS) in patients with chronic low back pain radiating to the leg (CLaSSICO study)." BMJ Open 12, no. 1 (2022): e052703. http://dx.doi.org/10.1136/bmjopen-2021-052703.
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IntroductionPatients with chronic low back pain radiating to the leg (CLBPr) are sometimes referred to a specialised pain clinic for a precise diagnosis based, for example, on a diagnostic selective nerve root block. Possible interventions are therapeutic selective nerve root block or pulsed radiofrequency. Central pain sensitisation is not directly assessable in humans and therefore the term ‘human assumed central sensitisation’ (HACS) is proposed. The possible existence and degree of sensitisation associated with pain mechanisms assumed present in the human central nervous system, its role in the chronification of pain and its interaction with diagnostic and therapeutic interventions are largely unknown in patients with CLBPr. The aim of quantitative sensory testing (QST) is to estimate quantitatively the presence of HACS and accumulating evidence suggest that a subset of patients with CLBPr have facilitated responses to a range of QST tests.The aims of this study are to identify HACS in patients with CLBPr, to determine associations with the effect of selective nerve root blocks and compare outcomes of HACS in patients to healthy volunteers.Methods and analysisA prospective observational study including 50 patients with CLBPr. Measurements are performed before diagnostic and therapeutic nerve root block interventions and at 4 weeks follow-up. Data from patients will be compared with those of 50 sex-matched and age-matched healthy volunteers. The primary study parameters are the outcomes of QST and the Central Sensitisation Inventory. Statistical analyses to be performed will be analysis of variance.Ethics and disseminationThe Medical Research Ethics Committee of the University Medical Center Groningen, Groningen, the Netherlands, approved this study (dossier NL60439.042.17). The results will be disseminated via publications in peer-reviewed journals and at conferences.Trial registration numberNTR NL6765.
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Mohd Isa, Isma Liza, Seong Lin Teoh, Nurul Huda Mohd Nor, and Sabarul Afian Mokhtar. "Discogenic Low Back Pain: Anatomy, Pathophysiology and Treatments of Intervertebral Disc Degeneration." International Journal of Molecular Sciences 24, no. 1 (2022): 208. http://dx.doi.org/10.3390/ijms24010208.
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Intervertebral disc (IVD) degeneration is a major contributing factor for discogenic low back pain (LBP), causing a significant global disability. The IVD consists of an inner core proteoglycan-rich nucleus pulposus (NP) and outer lamellae collagen-rich annulus fibrosus (AF) and is confined by a cartilage end plate (CEP), providing structural support and shock absorption against mechanical loads. Changes to degenerative cascades in the IVD cause dysfunction and instability in the lumbar spine. Various treatments include pharmacological, rehabilitation or surgical interventions that aim to relieve pain; however, these modalities do not halt the pathologic events of disc degeneration or promote tissue regeneration. Loss of stem and progenitor markers, imbalance of the extracellular matrix (ECM), increase of inflammation, sensory hyperinnervation and vascularization, and associated signaling pathways have been identified as the onset and progression of disc degeneration. To better understand the pain originating from IVD, our review focuses on the anatomy of IVD and the pathophysiology of disc degeneration that contribute to the development of discogenic pain. We highlight the key mechanisms and associated signaling pathways underlying disc degeneration causing discogenic back pain, current clinical treatments, clinical perspective and directions of future therapies. Our review comprehensively provides a better understanding of healthy IVD and degenerative events of the IVD associated with discogenic pain, which helps to model painful disc degeneration as a therapeutic platform and to identify signaling pathways as therapeutic targets for the future treatment of discogenic pain.
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Veihelmann, Andreas. "Spinal Injections, Epidural Neurolysis and Denervation for Specific Low Back Pain and Sciatica." Zeitschrift für Orthopädie und Unfallchirurgie 157, no. 04 (2018): 417–25. http://dx.doi.org/10.1055/a-0767-7428.
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Abstract Background Many members of the adult population suffer acute low back pain at some stage in life. A specific cause is found in only a rather small number of these patients. Some of the patients develop chronic low back pain and this is a major source of disability. On the other hand, there has been a great increase in Germany in the number of spinal operations due to degenerative spine disease and, in turn, unnecessary surgery on the spine is under debate. Methods This is a narrative review of different minimally invasive spine procedures in the treatment of specific low back pain. The effectiveness of spinal injections, radiofrequency of the facet joints as well as epidural adhesiolysis/neurolysis are described. An analysis of the literature was performed via PubMed, Medline and the Cochrane Database. Results Facet-, epidural and intradiscal steroid injections for specific pain generators in the degenerative spine show different short- and long-term results; they are able to improve low back pain in specific patients with chronic low back pain and may be able to prevent some of these patients from having to undergo open surgery. Furthermore, there are promising results from interventions such as epidural neurolysis for sciatica and radiofrequency of the medial branch of the dorsal root for the treatment of axial facet-related back pain. Facet and intradiscal steroid injections give only short-term effects in axial low back pain and should therefore only be considered reluctantly, whereas the different forms of epidural steroid injections in patients with sciatica due to radicular compression offer a well proven adjuvant treatment option within a conservative therapeutic regimen. The overview of the literature with the use of different steroids has shown that use of non-particulate steroids show better results with respect to the safety and avoidance of major complications, especially when used at the cervical spine. However, in Germany the use of these steroids is still off label and patients have to give informed consent prior to injection. In summary, careful use of spinal injections and interventions within a conservative physiotherapeutic regimen seem to improve chronic back pain and, in turn, to be able to prevent some patients from having to undergo spine surgery.
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Moran, Monica, and Jenny Strong. "Outcomes of a Rehabilitation Programme for Patients with Chronic Back Pain." British Journal of Occupational Therapy 58, no. 10 (1995): 435–38. http://dx.doi.org/10.1177/030802269505801010.
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In order to evaluate the effectiveness of a rehabilitation programme for patients with chronic back pain, data on the subjective outcomes of perceived pain intensity (as measured by the Visual Analogue Scale Horizontal) and perceived level of disability (as measured by the Oswestry Low Back Pain Disability Questionnaire), and the objective outcome of functional capacity (as measured by the West Standardised Evaluation), were collected on 51 subjects prior to entry into a back pain rehabilitation programme and at discharge. The results at discharge showed a significant reduction in the perceived level of disability and a significant Increase in the functional capacity. The perceived pain intensity did not change significantly. The discussion focuses on the importance of directing therapeutic interventions towards increasing physical function rather than concentrating on the reduction or elimination of pain.
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Manchikanti, Laxmaiah. "Evaluation of Lumbar Facet Joint Nerve Blocks in the Management of Chronic Low Back Pain: Preliminary Report of A Randomized, Double-Blind Controlled Trial: Clinical Trial NCT00355914." Pain Physician 3;10, no. 5;3 (2007): 425–40. http://dx.doi.org/10.36076/ppj.2007/10/425.
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Background: The prevalence of persistent low back pain with the involvement of lumbar facet or zygapophysial joints has been described in controlled studies as varying from 15% to 45% based on the criteria of the International Association for the Study of Pain. Therapeutic interventions utilized in managing chronic low back pain of facet joint origin include intraarticular injections, medial branch nerve blocks, and neurolysis of medial branch nerves. Objective: To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks in managing chronic low back pain of facet joint origin. Design: A prospective, randomized, double-blind trial. Setting: An interventional pain management setting in the United States. Methods: In this preliminary analysis, data from a total of 60 patients were included, with 15 patients in each of 4 groups. Thirty patients were in a non-steroid group consisting of Groups I (control, with lumbar facet joint nerve blocks using bupivacaine ) and II (with lumbar facet joint nerve blocks using bupivacaine and Sarapin); another 30 patients were in a steroid group consisting of Groups III (with lumbar facet joint nerve blocks using bupivacaine and steroids) and IV (with lumbar facet joint nerve blocks using bupivacaine, Sarapin, and steroids). All patients met the diagnostic criteria of lumbar facet joint pain by means of comparative, controlled diagnostic blocks. Outcome Measures: Numeric Rating Scale (NRS) pain scale, the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake. Results: Significant improvement in pain and functional status were observed at 3 months, 6 months, and 12 months, compared to baseline measurements. The average number of treatments for 1 year was 3.7 with no significant differences among the groups. Duration of average pain relief with each procedure was 14.8 ± 7.9 weeks in the non-steroid group, and 12.5 ± 3.3 weeks in the steroid group, with no significant differences among the groups. Conclusion: Therapeutic lumbar facet joint nerve blocks with local anesthetic, with or without Sarapin or steroids, may be effective in the treatment of chronic low back pain of facet joint origin. Key words: Chronic back pain, lumbar facet joint pain, lumbar zygapophysial joint pain, medial branch blocks, therapeutic lumbar facet joint nerve blocks, local anesthetic.
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Na, Annalisa, Joke Bradt, Julie Fritz, Gediminas Gliebus, and Laura Gitlin. "PAIN MANAGEMENT IN DEMENTIA: A NEED FOR SPECIFICITY AND SUSTAINABILITY IN EXERCISE-BASED PROGRAMS." Innovation in Aging 8, Supplement_1 (2024): 1362. https://doi.org/10.1093/geroni/igae098.4345.
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Abstract Over 50% of people living with dementia (PLWD) experience pain associated with functional decline. Pain and dementia are heterogeneous and complex, making the development of effective nonpharmacological interventions challenging. Hence, we used Intervention Mapping (IM), an evidence-based process for designing complex behavioral interventions. This study focuses on completing Step 1 of IM (needs assessment) to define population and intervention priorities. We conducted and synthesized the findings of three studies: (1) a scoping review of 81 studies summarizing current literature, (2) an analysis of the National Health and Aging Trends Study (NHATS) database (n=9,974) to characterize pain among community-dwelling PLWD, (3) qualitative interviews with clinicians (n=19) and PLWD/caregivers (n=17) to assess perspectives on current care. The scoping review revealed that most research focuses on passive interventions in long-term care facilities and lacks specificity in reporting pain diagnosis and dementia severity. From the NHATS database, low back and knee osteoarthritis were the most prevalent pain conditions among community-dwelling PLWD. Qualitative analysis of interviews confirmed scoping review findings of an overall lack of exercise-based interventions for pain despite being standard care among cognitively intact individuals. While there was a shared interest in exercise-based interventions, clinicians expressed concerns about adapting and sustaining these programs. Triangulating data (epidemiological and qualitative sources) and following IM provides foundational support to design clinical interventions for pain in PLWD. Specifically, intervention development should prioritize community-dwelling PLWD with knee and/or low back pain using therapeutic exercises tailored to the individual’s interests and abilities; however, research is needed to address sustainability.
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Reeh, Colton. "Treatment of Low Back Pain Elicited by Middle Cluneal Neuralgia: Case Report and Literature Review of Interventional Treatments." Pain Medicine Case Reports 7, no. 5 (2023): 239–43. http://dx.doi.org/10.36076/pmcr.2023.7.239.
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BACKGROUND: Cluneal neuralgia is increasingly becoming recognized as an etiology of low back pain. The majority of the literature on cluneal nerve interventions describes modalities targeting the superior cluneal nerves with little emphasis on the middle cluneal nerves. CASE REPORT: A 21-year-old woman with a medical history of congenital myelomeningocele with tethered cord at L5-S1, status post 3 decompressive releases, presented to the clinic with chronic low back pain and associated sacroiliac paresthesia. Over 11 months, she underwent 7 ultrasound-guided bilateral middle cluneal nerve blocks, without corticosteroid, resulting in significant, immediate pain relief sustained for 4 to 6 weeks. CONCLUSIONS: A nerve block with local anesthetic has proven to be therapeutic for middle cluneal neuralgia, but with varying long-term efficacy. The use of radiofrequency ablation, peripheral nerve stimulation, regenerative medicine, and alcohol neurolysis have shown promise as long-term therapeutic options and as a substitute for invasive surgical release. KEY WORDS: Alcohol neurolysis, cluneal nerve block, middle cluneal neuralgia, peripheral nerve stimulation, prolotherapy, radiofrequency ablation, tethered cord
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Rasool, Anbreena, Javeria Ashraf, Mariam Mehmood, Rubina Zulfqar, Mehneel Saqib, and Mahnoor Zia. "EFFECTS OF SLUMP NEURAL MOBILIZATION FOR THE TREATMENT OF CHRONIC RADICULAR LOW BACK PAIN." Insights-Journal of Health and Rehabilitation 2, no. 2 (Health & Allied) (2024): 419–26. https://doi.org/10.71000/ijhr190.
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Background: Low back pain is a prevalent global health issue affecting individuals across all age groups, impacting their physical, mental, and social well-being. It is a significant concern in both developed and underdeveloped countries and a leading cause of disability worldwide. Chronic radicular low back pain, characterized by radiating discomfort due to neural irritation, demands effective therapeutic interventions to alleviate symptoms and improve quality of life. Objective: This study aimed to evaluate the effects of slump neural mobilization in conjunction with baseline treatments for managing chronic radicular low back pain. Methods: A randomized clinical trial was conducted in outpatient departments of multiple hospitals, enrolling 20 participants who met the inclusion and exclusion criteria. Participants were randomly allocated into two groups, with 10 in each group. Group A received slump neural mobilization combined with proprioceptive neuromuscular facilitation rhythmic stabilization and hot pack therapy. Group B received rhythmic stabilization techniques and hot pack therapy alone. Interventions were provided three times per week for five weeks. Pain intensity was assessed at baseline, the second week, and the fifth week using the Numeric Pain Rating Scale. Statistical analyses included the Mann-Whitney test for between-group comparisons and the Friedman test for within-group comparisons. Results: Between-group analysis revealed significant reductions in pain levels, with p-values of 0.018 at baseline and 0.02 at the fifth week, while results at the second week were not significant (p = 0.173). Within-group analysis using the Friedman test demonstrated statistically significant reductions in pain for both groups, with p = 0.000. In the treatment group, mean pain scores decreased from 5.70 at baseline to 3.90 at the second week and 1.40 at the fifth week, while the control group showed reductions from 4.20 at baseline to 3.30 at the second week and 2.90 at the fifth week. Conclusion: The study concluded that slump neural mobilization, when combined with baseline treatments, significantly reduced pain levels in patients with chronic radicular low back pain. These findings support its incorporation as an effective non-invasive intervention in physical therapy.
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Sakulsriprasert, Prasert, Roongtiwa Vachalathiti, and Pathaimas Kingcha. "Responsiveness of pain, functional capacity tests, and disability level in individuals with chronic nonspecific low back pain." Hong Kong Physiotherapy Journal 40, no. 01 (2019): 11–17. http://dx.doi.org/10.1142/s101370252050002x.
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Background: Clinical outcomes are very important in clinical assessment, and responsiveness is a component inside the outcome measures that needs to be investigated, particularly in chronic nonspecific low back pain (CNSLBP). Objective: This study aimed to investigate the responsiveness of pain, functional capacity tests, and disability in individuals with CNSLBP. Methods: Twenty subjects were assessed in pain using the following methods: visual analog scale (VAS) and numeric pain rating scale (NPRS), functional capacity tests: functional reach test (FRT), five-time sit-to-stand test (5 TSST), and two-minute step test (2 MST), and disability level: modified Oswestry Disability Questionnaire (MODQ), Thai version before and after 2-week intervention session. For interventions, the subjects received education, spinal manipulative therapy, and individual therapeutic exercise twice a week, for a total of two weeks. The statistics analyzed were change scores, effect size (ES), and standardized response mean (SRM). Results: The most responsive parameter for individuals with CNSLBP was pain as measured by numeric pain rating scale (NPRS) (ES [Formula: see text]0.986, SRM [Formula: see text]0.928) and five-time sit-to-stand test (5 TSST) (SRM [Formula: see text]0.846). Conclusion: This study found that NPRS pain and 5 TSST were responsive in individuals with CNSLBP at two weeks after the beginning of interventions.
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Pawel, Lizis1 *. Wojciech Kobza2 Grzegorz Manko3 Jaroslaw JaszczurNowicki4 Joanna Bukowska4 Jacek Perlinski5 Barbara Para6 Damian Wisniewski7 and Jolanta Nawara8. "Osteopathic Manual Treatment vs Kaltenborn-Evjenth Orthopedic Manual Therapy for Chronic Low Back Pain: A Proposal for a Protocol for Randomized Trials." Journal of Biomedical Research & Environmental Sciences 1, no. 8 (2020): 383–88. https://doi.org/10.37871/jbres1169.
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Introduction: Numerous modalities of conservative therapeutic interventions are available to achieve the best health benefits in people with Low Back Pain (LBP), e.g., kinesiotherapy, physical therapy, behavior therapy. People with LBP continue to experience pain and disability despite receiving the best evidence based therapy. Osteopathic Manual Therapy (OMT) and KaltenbornEvjenth Ortopedic Manual Therapy (KEOMT) are the other options, although their effectiveness remains controversial. The aim of this study is a proposal for a protocol for randomized trials to compare the effectiveness of OMT vs. KEOMT on pain and disability in people suffering from LBP.
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Deshmukh, Mitushi. "COMPREHENSIVE PHYSIOTHERAPY MANAGEMENT IN PIVD PATIENT." Journal of Medical pharmaceutical and allied sciences 10, no. 5 (2021): 3640–42. http://dx.doi.org/10.22270/jmpas.v10i5.1340.
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Back pain from prolapsed intervertebral disc is a common reason for physiotherapy management. Therefore, the objective of this case study was to define and address the use of electrotherapy modalities with the lumbar exercises and core stabilization workout with a lumbar herniated disc patient. Patient information and diagnosis: A 37 year old women patient consulted to the physiotherapy treatment with scan confirmed by MRI of prolapsed intervertebral disc (L5-S1). The key symptoms of the patient was pain in the back region and radiating ache in the right buttock followed by numbness and tingling sensation in the right leg. Therapeutic interventions: The first therapeutic initial weeks composed of modalities (TENS) with back muscles exercises and core stabilization exercises. As an addendum to the extension exercises, mechanical traction and strengthening and stability exercises were added for the following weeks. Outcome indicators include the functional scale for back pain and the numerical pain assessment scale (NPRS). Outcomes from initial assessment to discharge the functional back pain scale 34/60 to 58/60 and NPRS 7/10 to 0/10) showed that the patient no longer suffered from low back pain and enhanced functional status. The patient no longer worried of numbness and tingling in the right leg and the patient's objectives were achieved. The evidence from this case report indicates back muscles exercises and core stabilization exercises with modalities that encouraged the patient's pain improvement and return to the previous function stage.
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Pacheco-da-Costa, Soraya, Concepción Soto-Vidal, Victoria Calvo-Fuente, María José Yuste-Sánchez, Beatriz Sánchez-Sánchez, and Ángel Asúnsolo-del-Barco. "Evaluation of Physical Therapy Interventions for Improving Musculoskeletal Pain and Quality of Life in Older Adults." International Journal of Environmental Research and Public Health 19, no. 12 (2022): 7038. http://dx.doi.org/10.3390/ijerph19127038.
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Background: The ageing process may lead to functional limitations, musculoskeletal pain, and worsened quality of life. The aim of this paper is to evaluate two physical therapy interventions for reducing musculoskeletal pain and improving quality of life in older adults. Methods: A cohort study was carried out with older people (60–75 years old). The Geriatric Physical Therapy group (n = 70) received massage therapy, therapeutic exercise, and therapeutic education program for 5 weeks; the Standardized Therapeutic Exercise group (n = 140) received a standardized therapeutic exercise and therapeutic education program for 3 weeks. Health-related quality of life (SF-36v2) and musculoskeletal pain intensity (VAS) were collected at baseline (A0), post-intervention (A1), and 12 weeks after baseline (A2). Results: There was pain intensity reduction in both groups (p < 0.05) and health-related quality of life improvement, except for Emotional Role (p = 0.34); Physical Function (p = 0.07), Bodily Pain (p = 0.02), and General Health (p = 0.09). At A2 there was a difference (p < 0.05) for neck pain in favor of the Geriatric Physical Therapy Group. Conclusions: Within the limitations of the study, it was possible to conclude that both physical therapy interventions showed a positive effect for reducing non-specific neck pain and low back pain in older adults, which may contribute to health-related quality of life improvement.
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Rodríguez, Alberto Benito, Hugo Guillermo Ternavasio-de la Vega, José Ángel Santos Sánchez, et al. "Therapeutic and Preventive Efficacy of an Intervention on Workers in a Back School." International Journal of Environmental Research and Public Health 19, no. 2 (2022): 1000. http://dx.doi.org/10.3390/ijerph19021000.
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Back pain and its ailments are the main cause of absenteeism and sick leave. Furthermore, the cause of pain and disability in a large number of workers is unknown, and treatments are not effective in controlling it. For this reason, the Back Schools (BSs) provide theoretical and practical training to workers so that they can acquire knowledge and skills that will allow them to adequately manage their back problems, enabling them to recover their autonomy and prevent relapses. The aim of the study is to analyse the efficacy of a BS by means of the evaluation of pain and disability scales in workers in different sectors and in construction. The most important clinical benefits obtained after the intervention of a BS are the reduction of pain and disability. Statistically significant and clinically relevant results have been observed between the initial assessment and the 6-month review. BS has been shown to be effective in reducing low back and neck pain and disability during the first 6 months of follow-up. Construction workers have pain and disability rates at the overall mean and with improvements between the initial assessment and the 6-month review. Their rates of improvement are clinically more relevant than for the overall population analysed.
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Forner-Álvarez, Carlos, Ferran Cuenca-Martínez, Rafael Moreno-Gómez-Toledano, Celia Vidal-Quevedo, and Mónica Grande-Alonso. "Multimodal physiotherapy treatment based on a biobehavioral approach in a patient with chronic low back pain: A case report." AIMS Medical Science 11, no. 2 (2024): 77–89. http://dx.doi.org/10.3934/medsci.2024007.
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<abstract> <p>Low back pain and its chronification are among the most common causes of disabilities worldwide. This is why multiple interventions and treatment approaches have been investigated around this pathology in recent years. Currently, the evidence is increasingly leaning towards treating chronic low back pain with a treatment based on the patient's centered biopsychosocial model. This case report presents the evaluation and treatment of a 43-year-old woman with chronic low back pain using a multimodal physiotherapy based on a biobehavioral approach. In the physiotherapy intervention, the patient's pain characteristics and somatosensory, motor-functional, and affective-cognitive states were first evaluated. Subsequently, a multimodal treatment including therapeutic exercise, pain neuroscience education, and orthopedic manual and physical therapies was applied for a total of 14 sessions over a period of 9 weeks. Finally, a post-intervention evaluation and at the one-month follow-up were carried out, in which it was observed that the treatment had significantly improved the patient's symptomatology and their general state. This case suggests that a multimodal physiotherapy treatment based on a biobehavioral approach is an effective option to improve pain symptoms and somatosensory, motor-functional, and affective-cognitive aspects in the reported patient; therefore, a treatment of these characteristics may be an option for patients with chronic low back pain.</p> </abstract>
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Ferreira, Paulo H., Manuela L. Ferreira, Christopher G. Maher, Kathryn M. Refshauge, Jane Latimer, and Roger D. Adams. "The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain." Physical Therapy 93, no. 4 (2013): 470–78. http://dx.doi.org/10.2522/ptj.20120137.
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Background The impact of the relationship (therapeutic alliance) between patients and physical therapists on treatment outcome in the rehabilitation of patients with chronic low back pain (LBP) has not been previously investigated. Objective The purpose of this study was to investigate whether the therapeutic alliance between physical therapists and patients with chronic LBP predicts clinical outcomes. Design This was a retrospective observational study nested within a randomized controlled trial. Methods One hundred eighty-two patients with chronic LBP who volunteered for a randomized controlled trial that compared the efficacy of exercises and spinal manipulative therapy rated their alliance with physical therapists by completing the Working Alliance Inventory at the second treatment session. The primary outcomes of function, global perceived effect of treatment, pain, and disability were assessed before and after 8 weeks of treatment. Linear regression models were used to investigate whether the alliance was a predictor of outcome or moderated the effect of treatment. Results The therapeutic alliance was consistently a predictor of outcome for all the measures of treatment outcome. The therapeutic alliance moderated the effect of treatment on global perceived effect for 2 of 3 treatment contrasts (general exercise versus motor control exercise, spinal manipulative therapy versus motor control exercise). There was no treatment effect modification when outcome was measured with function, pain, and disability measures. Limitations Therapeutic alliance was measured at the second treatment session, which might have biased the interaction during initial stages of treatment. Data analysis was restricted to primary outcomes at 8 weeks. Conclusions Positive therapeutic alliance ratings between physical therapists and patients are associated with improvements of outcomes in LBP. Future research should investigate the factors explaining this relationship and the impact of training interventions aimed at optimizing the alliance.
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Long, Cynthia R., Anthony J. Lisi, Robert D. Vining, et al. "Veteran Response to Dosage in Chiropractic Therapy (VERDICT): Study Protocol of a Pragmatic Randomized Trial for Chronic Low Back Pain." Pain Medicine 21, Supplement_2 (2020): S37—S44. http://dx.doi.org/10.1093/pm/pnaa289.
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Conflicts of interest: No potential conflicts exist for any author listed.Abstract Background Low back pain is a leading cause of disability in veterans. Chiropractic care is a well-integrated, nonpharmacological therapy in Veterans Affairs health care facilities, where doctors of chiropractic provide therapeutic interventions focused on the management of low back pain and other musculoskeletal conditions. However, important knowledge gaps remain regarding the effectiveness of chiropractic care in terms of the number and frequency of treatment visits needed for optimal outcomes in veterans with low back pain. Design This pragmatic, parallel-group randomized trial at four Veterans Affairs sites will include 766 veterans with chronic low back pain who are randomly allocated to a course of low-dose (one to five visits) or higher-dose (eight to 12 visits) chiropractic care for 10 weeks (Phase 1). After Phase 1, participants within each treatment arm will again be randomly allocated to receive either monthly chiropractic chronic pain management for 10 months or no scheduled chiropractic visits (Phase 2). Assessments will be collected electronically. The Roland Morris Disability Questionnaire will be the primary outcome for Phase 1 at week 10 and Phase 2 at week 52. Summary This trial will provide evidence to guide the chiropractic dose in an initial course of care and an extended-care approach for veterans with chronic low back pain. Accurate information on the effectiveness of different dosing regimens of chiropractic care can greatly assist health care facilities, including Veterans Affairs, in modeling the number of doctors of chiropractic that will best meet the needs of patients with chronic low back pain.