The longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients

Cells and circuits for amygdala neuroplasticity in the transition to chronic pain

Maladaptive plasticity is linked to the chronification of diseases such as pain, but the transition from acute to chronic pain is not well understood mechanistically. Neuroplasticity in the central nucleus of the amygdala (CeA) has emerged as a mechanism for sensory and emotional-affective aspects of injury-induced pain, although evidence comes from studies conducted almost exclusively in acute pain conditions and agnostic to cell type specificity. Here, we report time-dependent changes in genetically distinct and projection-specific CeA neurons in neuropathic pain. Hyperexcitability of CRF projection neurons and synaptic plasticity of parabrachial (PB) input at the acute stage shifted to hyperexcitability without synaptic plasticity in non-CRF neurons at the chronic phase. Accordingly, chemogenetic inhibition of the PB→CeA pathway mitigated pain-related behaviors in acute, but not chronic, neuropathic pain. Cell-type-specific temporal changes in neuroplasticity provide neurobiological evidence for the clinical observation that chronic pain is not simply the prolonged persistence of acute pain.

Measurement Properties of Two Questionnaires Assessing Fear-Avoidance in Patients With Chronic Low Back Pain

The Fear-Avoidance Components Scale (FACS) and the Fear of Daily Activities Questionnaire (FDAQ) assess fear-avoidance model components. However, the questionnaires are not available in Brazilian Portuguese. This study aimed to translate the original English FACS and FDAQ into Brazilian (Br) Portuguese and assess their measurement properties in patients with Chronic Low Back Pain (CLBP). One hundred thirty volunteers with CLBP participated in this study. Structural validity, internal consistency, test-retest reliability, and hypothesis testing for construct validity were analyzed. Results indicated a 2-factor solution for the FACS-Br, while the FDAQ-Br had a one-factor solution. Internal consistency showed acceptable Cronbach's alpha (alpha >.8). Suitable reliability was found for the FDAQ-Br (Intraclass Correlation Coefficient [ICC] = .98). For both FACS-Br factors, suitable reliability was found as well (ICC = .95 and .94). Hypothesis testing for construct validity confirmed more than 75% of the hypotheses proposed a priori for the FACS maladaptive pain/movement-related beliefs domain and the FDAQ-Br. In conclusion, the FACS-Br and FDAQ-Br demonstrated acceptable reliability, internal consistency, and structural validity measurement properties and their correlation (r < .50) suggests that the tools are not interchangeable measures.

Barriers and facilitators for physical activity in people living with chronic pain: a systematic review and combined analysis

ABSTRACT

Chronic pain is a prevalent and complex health issue associated with physical, emotional, and social consequences. Management of pain is multifactorial and challenging; however, physical activity (PA) has consistently been shown to be beneficial. Despite this, PA levels among people with chronic pain are low. This study aimed to identify facilitators and barriers to PA among adults with chronic pain and analyse these using the structure of a validated behaviour change model: the capability, opportunity, and motivation behaviour change model (COM-B). We performed a systematic review of 6 databases and subsequent combined analysis including peer-reviewed primary research published in English up to November 15, 2023. Search terms consisted of 3 components: pain, PA, and facilitators/barriers. Quality appraisal of studies was conducted using appropriate tools. The systematic search yielded 40 eligible studies with a total of 2164 participants. The studies represented various chronic pain conditions, locations, and study designs. The key barriers to engagement in PA were the impact of pain severity, comorbidities, lack of knowledge about PA benefits, and time constraints. Key facilitators were a personalised approach, social support, and awareness of the benefits. The findings were categorised according to the COM-B model, allowing for the identification of modifiable factors. Person-centred approaches, education, and accessible environments were identified as important aspects to consider for successful PA promotion among people with chronic pain. Utilising the factors identified in the COM-B model is crucial for successful future interventions to increasing PA uptake and adherence in this population.

Pain Lowers Subjective Survival Probabilities Among Middle-Aged and Older Adults

OBJECTIVES

Pain is a leading cause of disability and a limiting factor in individuals' assessments of their own subjective health; however, its association with subjective longevity has yet to be explored. Subjective survival probabilities (SSPs), or one's own perceived chances of living to a given age, can influence individuals' behavior as they plan for their futures. This study assesses whether pain correlates to lower SSPs.

METHODS

We use a repeated cross-section of the 2000-2018 waves of the Health and Retirement Study, a longitudinal and nationally representative survey of Americans aged 51 and older (N = 31,773).

RESULTS

Fractional logit regressions indicate that, across all age groups, respondents with severe and/or interfering pain reported significantly lower SSPs than those with no pain (Marginal Effect [ME] = -0.03 to -0.06, p < .05). Controlling for all covariates, mild or moderate noninterfering pain was only associated with a significant reduction in SSPs among the youngest group reporting their chances of living to age 75 (ME = -0.02, p < .001). Descriptively and in the model results, respondents with mild or moderate noninterfering pain appeared to more closely resemble pain-free respondents than those with severe or interfering pain.

DISCUSSION

These findings highlight the importance of pain on SSPs, and contribute to the growing evidence that pain interference is uniquely important in predicting meaningful health outcomes.

COMPARISON OF THE EFFECTS OF EIGHT DIFFERENT TOPICAL NONSTEROIDAL ANTI-INFLAMMATORY DRUGS ON REDUCING INTRAVITREAL INJECTION-INDUCED PAIN

PURPOSE

To compare topical nonsteroidal anti-inflammatory drug (NSAID) efficacy on intravitreal injection-induced pain reduction and determine the most efficient topical NSAID.

METHODS

This randomized-controlled study included 662 eyes of 662 patients. Based on the types of NSAID administered before intravitreal injection, eight subgroups were formed. In the control group, a sterile saline solution was applied instead of NSAIDs. The visual analog scale was used to assess pain scores after intravitreal injection. The visual analog scale scores were noted immediately and 6 hours following injection (sixth hour).

RESULTS

Nepafenac 0.3%, nepafenac 0.1%, and bromfenac 0.09% had the lowest scores, immediately after and after 6 hours, with no significant differences. Diclofenac and ketorolac had higher visual analog scale scores than the first trio but lower scores than the control group. Flurbiprofen, pranoprofen, and indomethacin did not significantly affect immediate pain; however, at the sixth hour, the visual analog scale scores were significantly reduced.

CONCLUSION

Nepafenac 0.3%, nepafenac 0.1%, and bromfenac 0.09% were the most effective NSAIDs for pain reduction. Although some NSAIDs did not have a significant effect on immediate pain, they all provided significant benefits at the sixth hour.

Assessment of factors affecting quality of life in patients with chronic pain due to knee osteoarthritis and spondylosis: spine versus knee?

OBJECTIVE

There is no study comparing knee and spine osteoarthritis. The purpose of the study is to examine the effects of pain and disability on quality of life (QoL) and the factors affecting QoL in patients with knee osteoarthritis and spondylosis.

METHODS

This cross-sectional study included 114 patients with spondylosis and 126 patients with knee osteoarthritis. Demographic data were recorded. The visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Roland Morris Questionnaire (RMQ), and the Short Form Health Questionnaire (SF-36) were filled out.

RESULTS

Statistically, patients with spondylosis and knee osteoarthritis did not differ significantly in terms of gender, age, body mass index, number of concomitant conditions, marital status, years of schooling, pain scores, or SF-36 characteristics. SF-36 physical function, vitality, and mental health assessments were lower in women than men, while VAS scores were higher. There was no correlation between marital status, educational level, and QoL subscales. WOMAC and RMQ scores were negatively correlated with the SF-36 subscales. RMS scores were not related to mental health.

CONCLUSIONS

Spondylosis and knee osteoarthritis affect all subscales of QoL in the same way. The management of patients with spondylosis and knee osteoarthritis should focus on pain and functionality to improve QoL.

Underestimating or Overestimating Improvement in Pain on a Smartphone Pain App: Role of Disability, Negative Affect, and Pain App Engagement

Clinicians often ask people with chronic pain about their perceived benefit from interventions designed to improve their pain. The aim of this study is to identify factors that contribute to underestimating or overestimating perceived changes in daily pain intensity over a month of daily assessments. We examined data from individuals with chronic pain who provided at least 28 daily assessments using a pain app as secondary analyses. Participants provided baseline demographic information and completed questionnaires assessing pain, activity interference, mood, pain disability, and catastrophizing. Using the pain app, they entered daily ratings of pain (0 = none, 10 = worst pain possible) and impressions of perceived day-to-day change (0 = better, 5 = same, and 10 = worse). Two hundred fifty-two (N = 252) subjects with chronic pain met the inclusion criteria of completing at least 28 daily assessments. Those who underestimated their improvement tended to have higher pain intensity at baseline (P < .001), reported greater activity interference and disability (P < .001), and were prone to greater catastrophizing and anxiety and depression (P < .01). People who were more accurate in assessing their improvement engaged less with the app with fewer 2-way messages compared with those who either underestimated or overestimated their improvement and who had more 2-way messaging (P < .05). This longitudinal study suggests that those who report greater levels of catastrophizing and anxiety and depression are more likely to underestimate any improvements in their pain over time but seem to engage more with a pain app. Future research will help in our understanding of what magnitude of perceived change in pain ratings is clinically meaningful. PERSPECTIVE: Those who report greater levels of pain, disability, anxiety, depression, and catastrophizing are most prone to underestimate improvements of their pain over time.

Comparative Review of the Socioeconomic Burden of Lower Back Pain in the United States and Globally

Internationally, the United States (U.S.) cites the highest cost burden of low back pain (LBP). The cost continues to rise, faster than the rate of inflation and overall growth of health expenditures. We performed a comprehensive literature review of peer-reviewed and non- peer-reviewed literature from PubMed, Scopus, and Google Scholar for contemporary data on prevalence, cost, and projected future costs. Policymakers in the U.S. have long attempted to address the high-cost burden of LBP through limiting low-value services and early imaging. Despite these efforts, costs (~$40 billion; ~$2,000/patient/yr) continue to rise with increasing rates of unindicated imaging, high rates of surgery, and subsequent revision surgery without proper trial of non-pharmacologic measures and no corresponding reduction in LBP prevalence. Globally, the overall prevalence of LBP continues to rise largely secondary to a growing aging population. Cost containment methods should focus on careful and comprehensive clinical assessment of patients to better understand when more resource-intensive interventions are indicated.

Quality of Life in Patients with Chronic Low Back Pain and Differences by Sex: A Longitudinal Study

BACKGROUND

The experience of chronic low back pain has a significant impact on the quality of life of affected people, resulting in difficulties in performing basic activities of daily living.

AIM

To study the perceived quality of life of people affected by chronic low back pain and the associated factors by sex.

METHODS

A prospective, longitudinal and observational design was used.

RESULTS

A total of 129 people (58.1% women) with chronic low back pain were studied. The mean pain intensity scores were of moderate severity (6.42 points), with a modest improvement at follow-up (6.17 points). Epidural nerve blocks were the most effective therapeutic intervention in reducing the intensity of pain. Participants described a negative perception of their health with regard to quality of life, with low scores for the two constructs both at baseline (health index, 0.444; perception of health, 38.76 points) and at follow-up (health index, 0.447; perception of health, 40.43 points). Participants had severe functional limitation scores (50.79 points). The results were significantly better among men. There was an inverse relationship between the average pain intensity (β = -0.304; p < 0.001), functional limitation (β = -0.466; p < 0.001) and mental health (β = -0.565; p < 0.001) and quality of life.

CONCLUSIONS

The chronification of low back pain complicates people's biopsychosocial adaptation to life. There is a longitudinal inverse association between pain and functional limitation and health-related quality of life.

The relationship between chronic diseases and the intensity and duration of low back pain

BACKGROUND

Low back pain (LBP) is a worldwide problem that affects numerous people and limits their mobility. Several factors, including chronic diseases, increase the risk of developing LBP. To date, the information available about the relationship between chronic diseases and the intensity and duration of LBP is quite limited.

AIM

The aim of the present study was to address the relationship between chronic diseases and both the intensity and duration of LBP.

DESIGN

This is an observational cross-sectional study.

SETTING

The study was conducted in the community of Saudi Arabia.

POPULATION

2181 adult participants (aged 18 years or more, mean age of 33 and standard deviation [SD] of ±11, 61% females) from Saudi Arabia with either recent or recurring LBP participated in the study.

METHODS

The participants of this study were surveyed, and their demographic information was obtained. They were asked whether they had LBP during the past year, and if they had, they were asked about their LBP in terms of the pain intensity on a scale that runs from 0 to 10, where 0 indicates no pain and 10 indicates extreme pain. Further, the participants were asked how long their pain lasted (in days). They were also inquired whether they had any of the following chronic diseases: diabetes mellitus, high blood pressure, hypotension, arthritis, cardiopulmonary diseases, kidney diseases, and hypothyroidism. Logistic regression was used to analyze the relationships between both of LBP's intensity and duration, and the presence of chronic diseases, while adjusting for the potential effect of age and gender.

RESULTS

A total of 2181 adults with either new onset of or recurrent LBP during the past 12 months participated in the present study. Of these, 356 (16%), who had LBP, suffered from one or more of the said chronic diseases. It was found that having one or more chronic diseases had statistically significant relationship with increased LBP's intensity (P=0.002), as well as prolonged duration (P=0.001). In particular, hypertension, arthritis, and hypothyroidism have statistically significant relationship with increased the intensity of the pain (P<0.05). Only, hypertension and arthritis have statistically significant relationship with increased the duration of pain (P≤0.001).

CONCLUSIONS

The presence of chronic diseases was associated with a more intense and longer duration of LBP.

CLINICAL REHABILITATION IMPACT

In view of the results of this study, we expect that those who have chronic diseases will have a longer duration of LBP and more intense pain.

Fascia Tissue Manipulations in Chronic Low Back Pain: A Pragmatic Comparative Randomized Clinical Trial of the 4xT Method® and Exercise Therapy

BACKGROUND

The 4xT method is a protocolized practice in treating musculoskeletal disorders. The 4xT method consists of four components: Test (functional diagnostic test), Trigger (fascia tissue manipulations), Tape (elastic taping), and Train (exercise). There is a lack of clinical studies evaluating the treatment effects of the use of the 4xT method.

METHODS

A randomized controlled trial was conducted to compare the effectiveness of the 4xT method and exercise therapy-only in patients with chronic nonspecific low back pain. Based on a priori sample size calculation, fifty-one individuals with chronic nonspecific low back pain were randomly assigned to either the 4xT or exercise group. Both groups underwent a six-week rehabilitation program with two treatments per week. The primary outcomes were trunk flexion and extension mobility, trunk flexion, and extension mobility-dependent pain, and quality of life evaluated during a 6-week therapy period and after a 6-week therapy-off period.

RESULTS

Interaction effects were noted in all outcomes. The 4xT group showed significant improvements over time for trunk flexion and extension mobility, trunk flexion and extension mobility-dependent pain, and quality of life (p < 0.05), with no significant relapse post-therapy (except for extension mobility). The exercise group exhibited significant within-time changes in the quality of life, as measured with the VAS (p < 0.05), but not for EQ-5D-3L.

CONCLUSIONS

The results of this study demonstrate that the 4xT method stands out as a promising and impactful treatment option for chronic nonspecific low back pain individuals, as it demonstrated significant reductions in mobility-dependent pain, increased trunk mobility, and improved quality of life compared to exercise-only treatments.

Mobile technologies for rehabilitation in non-specific spinal disorders: a systematic review of the efficacy and potential for implementation in low- and middle-income countries

PURPOSE

The aim of this systematic review was primarily to identify the types of mHealth technologies for the rehabilitation of non-specific spinal disorders, second to evaluate their efficacy, and finally to determine their applicability in LMICs.

METHODS

Three databases (Scopus, PubMed, and Web of Science) were searched for randomized controlled trials and clinical trials from January 2012 until December 2022. Studies were found eligible when using mHealth technologies for the rehabilitation of non-specific spinal disorders. To evaluate efficacy, the primary outcome was pain intensity, and the secondary outcomes were disability and quality of life. To evaluate the applicability in LMICs, information about financial and geographical accessibility, offline usability, and languages was extracted.

RESULTS

Fifteen studies were included comprising 1828 participants who suffer from non-specific low back pain (86.05%) and non-specific neck pain (13.95%). Fourteen distinct smartphone-based interventions and two sensor system interventions were found, with a duration ranging from four weeks to six months. All mHealth interventions demonstrated efficacy for the improvement of pain, disability and quality of life in non-specific spinal disorders, particularly low back pain. Five of the evaluated smartphone applications were free of charge accessible and had language features that could be adapted for use in LMICs.

CONCLUSION

mHealth interventions can be used and integrated into the conventional treatment of non-specific spinal disorders in rehabilitation. They have demonstrated efficacy and could be implemented in LMICs with minor adaptations to overcome language barriers and the absolute necessity of the internet.

What do people living with chronic pain want from a pain forecast? A research prioritization study

Because people with chronic pain feel uncertain about their future pain, a pain-forecasting model could support individuals to manage their daily pain and improve their quality of life. We conducted two patient and public involvement activities to design the content of a pain-forecasting model by learning participants' priorities in the features provided by a pain forecast and understanding the perceived benefits that such forecasts would provide. The first was a focus group of 12 people living with chronic pain to inform the second activity, a survey of 148 people living with chronic pain. Respondents prioritized forecasting of pain flares (100, or 68%) and fluctuations in pain severity (94, or 64%), particularly the timing of the onset and the severity. Of those surveyed, 75% (or 111) would use a future pain forecast and 80% (or 118) perceived making plans (e.g., shopping, social) as a benefit. For people with chronic pain, the timing of the onset of pain flares, the severity of pain flares and fluctuations in pain severity were prioritized as being key features of a pain forecast, and making plans was prioritized as being a key benefit.

Cost-utility Analysis of Evoke Closed-loop Spinal Cord Stimulation for Chronic Back and Leg Pain

OBJECTIVES

The effectiveness of Evoke closed-loop spinal cord stimulation (CL-SCS), a novel modality of neurostimulation, has been demonstrated in a randomized controlled trial (RCT). The objective of this cost-utility analysis was to develop a de novo economic model to estimate the cost-effectiveness of Evoke CL-SCS when compared with open-loop SCS (OL-SCS) for the management of chronic back and leg pain.

METHODS

A decision tree followed by a Markov model was used to estimate the costs and outcomes of Evoke CL-SCS versus OL-SCS over a 15-year time horizon from the UK National Health Service perspective. A "high-responder" health state was included to reflect improved levels of SCS pain reduction recently reported. Results are expressed as incremental cost per quality-adjusted life year (QALY). Deterministic and probabilistic sensitivity analysis (PSA) was conducted to assess uncertainty in the model inputs.

RESULTS

Evoke CL-SCS was estimated to be the dominant treatment strategy at ~5 years postimplant (ie, it generates more QALYs while cost saving compared with OL-SCS). Probabilistic sensitivity analysis showed that Evoke CL-SCS has a 92% likelihood of being cost-effective at a willingness to pay threshold of £20,000/QALY. Results were robust across a wide range of scenario and sensitivity analyses.

DISCUSSION

The results indicate a strong economic case for the use of Evoke CL-SCS in the management of chronic back and leg pain with or without prior spinal surgery with dominance observed at ~5 years.

Construct validity of movement-evoked pain operational definitions in older adults with chronic low back pain

OBJECTIVE

Movement-evoked pain (MeP) may predispose the geriatric chronic low back pain (LBP) population to health decline. As there are differing operational definitions for MeP, the question remains as to whether these different definitions have similar associations with health outcomes in older adults with chronic LBP.

DESIGN

Cross-sectional analysis of an observational study.

SETTING

Clinical research laboratory.

SUBJECTS

226 older adults with chronic LBP.

METHODS

This secondary analysis used baseline data from a prospective cohort study (n = 250). LBP intensity was collected before and after the repeated chair rise test, stair climbing test, and 6-minute walk test; MeP change scores (ie, sum of pretest pain subtracted from posttest pain) and aggregated posttest pain (ie, sum of posttest pain) variables were calculated. LBP-related disability and self-efficacy were measured by the Quebec Back Pain Disability Scale (QBPDS) and Low Back Activity Confidence Scale (LOBACS), respectively. Physical function was measured with the Health ABC Performance Battery. Robust regression with HC3 standard errors was used to evaluate adjusted associations between both MeP variables and disability, self-efficacy, and physical function.

RESULTS

Greater aggregated posttest MeP was independently associated with worse disability (b = 0.593, t = 2.913, P = .004), self-efficacy (b = -0.870, t = -3.110, P = .002), and physical function (b = -0.017, t = -2.007, P = .039). MeP change scores were not associated with any outcome (all P > .050).

CONCLUSIONS

Aggregate posttest MeP was linked to poorer health outcomes in older adults with chronic LBP, but MeP change scores were not. Future studies should consider that the construct validity of MeP paradigms partially depends on the chosen operational definition.

Effects of exercise therapy on disability, mobility, and quality of life in the elderly with chronic low back pain: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Exercise is an effective treatment in chronic low back pain (CLBP), but there are few studies on CLBP in the elderly, and the intervention effect is controversial. We aimed to compare the efficacy of different exercises therapy on CLBP, dysfunction, quality of life, and mobility in the elderly.

METHODS

We searched Web of Science, MEDLINE, Cochrane Library, Chinese National Knowledge Infrastructure, EMBASE, and PubMed from the database inception till December 31, 2022. The publication languages were Chinese and English. Randomized controlled trials (RCTs) of exercise intervention in the elderly (≥ 60 years) with CLBP were included. Two reviewers independently extracted the data and evaluated them using the Revised Cochrane Risk of Bias Tool for Randomized Trials 2 (RoB2). The pooled effect sizes on different aspects of outcome measures were calculated.

RESULTS

Sixteen articles (18 RCTs) were included, comprising a total of 989 participants. The quality of included studies was relatively high. Meta-analysis results indicated that exercise therapy could improve visual analog scale (VAS) (WMD = - 1.75, 95% CI - 2.59, - 0.92, p < 0.05), Oswestry disability index (ODI) (WMD = - 9.42, 95% CI - 15.04, - 3.79, p < 0,005), short-form 36-item health survey physical composite summary (SF-36PCS) (WMD = 7.07, 95% CI 1.01, 13.14, p < 0.05), short-form 36-item health survey mental composite summary (SF-36MCS) (WMD = 7.88, 95% CI 0.09, 15.67, p < 0.05), and timed up and go test (TUG) (WMD = - 0.92, 95% CI - 2.22, 0.38, p < 0.005).

CONCLUSION

Exercise therapy effectively improved VAS, ODI, and SF-36 indexes in the elderly. Based on the subgroup, when designing the exercise therapy regimen, aerobics, strength, and mind-body exercise (≥ 12 weeks, ≥ 3 times/week, ≥ 60 min) should be considered carefully, to ensure the safety and effectiveness for the rehabilitation of CLBP patients. More high-quality trials are needed in future to confirm the effect of exercise on SF-36 and TUG indexes.

Fibrin glue delivery system containing rhein ameliorates intervertebral disc degeneration by anti-inflammatory efficacy

PURPOSE

To construct an injectable, sustained-release fibrin gel containing rhein to solve the problem of low bioavailability of rhein, and observe its efficacy in the treatment of intervertebral disc degeneration.

METHODS

The fibrin gel containing rhein was first synthesized in advance. Subsequently, the materials were characterized by various experimental methods. Secondly, the degenerative cell model was constructed by stimulating nucleus pulposus cells with lipopolysaccharide (LPS), and the corresponding intervention treatment was carried out to observe the effect in vitro. Finally, the rat tail intervertebral disc was acupunctured by needles to establish the intervertebral disc degeneration model, and the effect of the material was observed through intradiscal injection.

RESULTS

The fibrin glue containing rhein (rhein@FG) showed good injectability, sustained release and biocompatibility. Rhein@FG can improve the LPS-induced inflammatory microenvironment, regulate ECM metabolic disorders of nucleus pulposus cells and aggregation of the NLRP3 inflammasome in vitro, and inhibit cell pyroptosis. Furthermore, in vivo experiments, rhein@FG effectively prevented needle puncture-induced intervertebral disc degeneration in rats.

CONCLUSIONS

Rhein@FG has better efficacy than rhein or FG alone due to its slow release and mechanical properties, which can be used as a potential replacement therapy for intervertebral disc degeneration.

Movement-Evoked Pain Versus Widespread Pain: A Longitudinal Comparison in Older Adults With Chronic Low Back Pain From the Delaware Spine Studies

It is currently unknown which pain-related factors contribute to long-term disability and poorer perceived health among older adults with chronic low back pain (LBP). This investigation sought to examine the unique influence of movement-evoked pain (MeP) and widespread pain (WP) on longitudinal health outcomes (ie, gait speed, perceived disability, and self-efficacy) in 250 older adults with chronic LBP. MeP was elicited with 3 standardized functional tests, while presence of WP was derived from the McGill Pain Map. Robust regression with HC3 standard errors was used to examine associations between these baseline pain variables and health outcomes at 12-month follow-up. Covariates for these models included age, sex, body mass index, resting and recall LBP intensity, LBP duration, depression, pain catastrophizing, and baseline outcome (eg, baseline gait speed). Greater MeP was independently associated with worse 12-month LBP-related disability (b = .384, t = 2.013, P = .046) and poorer self-efficacy (b = -.562, t = -2.074, P = .039); but not gait speed (P > .05). In contrast, WP and resting and recall LBP intensity were not associated with any prospective health outcome after adjustment (all P > .05). Compared to WP and resting and recall LBP intensity, MeP is most strongly related to longitudinal health outcomes in older adults with chronic LBP. PERSPECTIVE: This article establishes novel independent associations between MeP and worse perceived disability and self-efficacy at 12-months in older adults with chronic LBP. MeP likely has biopsychosocial underpinnings and consequences and may therefore be an important determinant of health outcomes in LBP and other geriatric chronic pain populations.

The (cost-)effectiveness of combined lifestyle interventions for people with persistent low-back pain who are overweight or obese: A systematic review

INTRODUCTION

Lifestyle factors are expected to contribute to the persistence and burden of low-back pain (LBP). However, there are no systematic reviews on the (cost-)effectiveness of combined lifestyle interventions for overweight or obese people with LBP.

AIM

To assess whether combined lifestyle interventions are (cost-)effective for people with persistent LBP who are overweight or obese, based on a systematic review.

DESIGN

Systematic review METHOD: PubMed, Cochrane, Embase, CINAHL, PsycINFO and the Wiley/Cochrane Library were searched from database inception till January 6^th 2023. Two independent reviewers performed study selection, data-extraction and risk of bias scoring using the Cochrane RoB tool 2 and/or the Consensus Health Economic Criteria list. GRADE was used to assess the level of certainty of the evidence.

RESULTS

In total 2510 records were screened, and 4 studies on 3 original RCTs with 216 participants were included. Low certainty evidence (1 study) showed that combined lifestyle interventions were not superior to usual care for physical functioning, pain and lifestyle outcomes. Compared to usual care, moderate certainty evidence showed that healthcare (-$292, 95%CI: 872; -33), medication (-$30, 95% CI -65; -4) and absenteeism costs (-$1000, 95%CI: 3573; -210) were lower for the combined lifestyle interventions.

CONCLUSION

There is low certainty evidence from 3 studies with predominantly small sample sizes, short follow-up and low intervention adherence that combined lifestyle interventions are not superior to physical functioning, pain and lifestyle outcomes compared to usual care, but are likely to be cost-effective.

Pain-Related Cognitive Processes, Pain Interference, and Alexithymia in Patients With Primary Headaches

Objectives This study aims to investigate the effects of pain-related cognitive processes (PRCPs) and emotional state on pain-related disability (PRD) and pain interference (difficulty in performing daily routines, difficulty in engaging in social activities [the enjoyment of life], and the impact on work and/or school performance) in patients with primary headaches (PHs). Methodology PRCPs were evaluated with the Pain Anxiety Symptom Scale-20 (PASS-20), Pain Catastrophizing Scale (PCS), and Pain Belief Questionnaire (PBQ). Anxiety, depression, and alexithymia were investigated to assess the emotional state. PRD was assessed by Headache Impact Test-6 (HIT-6). Health-related quality of life (HRQoL) was evaluated under three headings: daily activities (with Short Form-36 [SF-36] Question [Q] 22), social activities (with Graded Chronic Pain Scale-Revised [GCPS-R] Q 4), as well as the working ability (with GCPS-R Q 5). Two separate models were constructed to identify the factors influencing PRD and HRQoL in PHP: M1 to reveal the factors affecting PRD and M2 to determine the independent factors affecting pain interference. In both models, correlation analysis was applied first and the significant data were then evaluated with regression analysis. Results A total of 364 participants (74 healthy controls [HCs] and 290 PHPs) completed the study. In M1, the following domains were significantly associated with PRD: cognitive anxiety (β = 0.098; 95% confidence interval [CI] = 0.001-0.405; P = 0.049); helplessness (β = 0.107; 95% CI = 0.018-0.356; P = 0.031); alexithymia (β = 0.077; 95% CI = 0.005-0.116; P = 0.033); depression (β = 0.083; 95% CI = 0.014-0.011; P = 0.025). In M2, factors associated with impairment in daily activities for PHP were as follows: duration of pain, pain intensity, alexithymia, escape-avoidance response, psychological anxiety, anxiety, and poor sleep quality (R = 0.770; R² = 0.588). The independent factors affecting social activities for PHP were pain intensity and pain-related anxiety (R = 0.90; R² = 0.81). Independent risk factors that affected the ability to work for PHP were pain intensity, cognitive anxiety, escape-avoidance response, and pain anxiety (R = 0.90; R² = 0.81). Conclusions This study highlights the importance of cognitive and emotional processes that help increase our understanding of the patient with PHs. This understanding may help to reduce disability and improve the quality of life in this population by helping to guide multidisciplinary treatment goals.

Critical Appraisal of Current Acute LBP Management and the Role of a Multimodal Analgesia: A Narrative Review

Acute low back pain (LBP) stands as a leading cause of activity limitation and work absenteeism, and its associated healthcare expenditures are expected to become substantial when acute LBP develops into a chronic and even refractory condition. Therefore, early intervention is crucial to prevent progression to chronic pain, for which the management is particularly challenging and the most effective pharmacological therapy is still controversial. Current guideline treatment recommendations vary and are mostly driven by expertise with opinion differing across different interventions. Thus, it is difficult to formulate evidence-based guidance when the relatively few randomized clinical trials have explored the diagnosis and management of LBP while employing different selection criteria, statistical analyses, and outcome measurements. This narrative review aims to provide a critical appraisal of current acute LBP management by discussing the unmet needs and areas of improvement from bench-to-bedside, and proposes multimodal analgesia as the way forward to attain an effective and prolonged pain relief and functional recovery in patients with acute LBP.

Effect of Restorative Neurostimulation on Major Drivers of Chronic Low Back Pain Economic Impact

BACKGROUND

High-impact chronic low back pain (CLBP) correlates with high healthcare resource utilization. Therapies that can alter impact status may provide beneficial long-term economic benefits. An implantable restorative neurostimulation system (ReActiv8, Mainstay Medical) designed to over-ride multifidus inhibition to facilitate motor control restoration, thereby resolving mechanical low back pain symptoms, has shown significant durable clinical effects in moderately and severely impacted patients.

OBJECTIVE

To examine changes in high-impact chronic low back pain in patients treated with restorative neurostimulation at 2 years.

METHODS

ReActiv8-B is a prospective, international, multicenter trial to evaluate the safety and efficacy of restorative neurostimulation in patients with intractable CLBP and no prior surgery. For this longitudinal subanalysis, patients were stratified into low-, moderate-, and high-impact CLBP categories using the US Department of Health and Human Services definition comprising pain intensity, duration, and impact on work, self-care, and daily activities.

RESULTS

Of 2-year completers (n = 146), 71% had high-impact CLBP at baseline and this proportion reduced to 10%, with 85% reporting no or low impact. This corresponds with measurements of HRQoL returning to near-population norms.

CONCLUSION

In addition to clinically meaningful improvements in pain and function with long-term durability, the overwhelming majority of patients transitioned from a high- to a no- or low-impact CLBP state. This is typically associated with significantly lower healthcare-utilization levels. The of recovery trajectory is consistent with a restorative mechanism of action and suggests that over the long term, the improvement in these health states will be maintained.

Life-course socioeconomic circumstances in acute, chronic and disabling pain among young employees: a double suffering

BACKGROUND

Pain is known to be socioeconomically patterned and associated with disability. However, knowledge is scarce concerning life-course socioeconomic circumstances and pain among young adults. Our aim was to examine the associations of childhood and current socioeconomic circumstances with acute pain and chronic pain with low and high disability levels among young Finnish municipal employees.

METHODS

We analysed questionnaire data retrieved from the Young Helsinki Health Study (n=4683) covering 18-39-year-old employees of the City of Helsinki, Finland. We included multiple indicators of childhood and current socioeconomic circumstances and examined their associations with acute pain and with chronic pain with low and high disability levels. The level of chronic pain-related disability was assessed by the chronic pain grade questionnaire. Multinomial logistic regression analyses were conducted with stepwise adjustments for sociodemographic, socioeconomic and health-related covariates.

RESULTS

Childhood and current socioeconomic disadvantage were associated with acute and chronic pain, particularly with chronic pain with high disability level. The strongest associations after adjustments for covariates remained between chronic pain with high disability level and low educational level (odds ratio (OR) 3.38, 95% confidence interval (CI) 2.18-5.24), manual occupation (OR 3.75, 95% CI 1.92-7.34) and experiencing frequent economic difficulties (OR 3.07, 95% CI 2.00-4.70).

CONCLUSIONS

Pain is a common complaint that contributes to disability among young employees, particularly the most socioeconomically vulnerable. There is a socioeconomic gradient in both pain chronicity and the level of chronic pain-related disability. Life-course socioeconomic factors should be considered in pain-preventing strategies and in clinical practice.

Physiotherapy research on low back pain in the indian context: A bibliometric analysis using the scopus database

BACKGROUND

Low back pain (LBP) is a common musculoskeletal condition that necessitates public health concerns. It also attracts considerable research interest among physiotherapists.

OBJECTIVE

This study conducted a bibliometric analysis to reveal the affinity of Indian physiotherapists toward research on LBP using the Scopus database.

METHODS

An electronic search was performed on December 23, 2020, using specific keywords. The data was downloaded in a Scopus plain text file (.txt) format and were analyzed using R studio (biblioshiny) software.

RESULTS

Two hundred and thirteen articles concerning LBP published from 2003 to 2020 were retrieved from the Scopus database. Among those articles (N= 213), 85.45% (n= 182) were published between 2011 and 2020. An article published by "James SL (2018)" in the Lancet had the highest citation of 1439. The highest collaboration was between India and the United Kingdom, and India and the United States of America jointly accounted for 12.2% (n= 26) of the entire articles (N= 213).

CONCLUSION

Indian physiotherapists have shown an interest through gradually increasing their research output on LBP since 2015. They contributed effectively to various journals and international collaboration. Nevertheless, there is room to improve the quality and quantity of LBP articles in high-quality journals, thereby enhancing the citation count. This study recommends improving the scientific output of Indian physiotherapists on LBP by expanding their international networks.

Health-related quality of life among spondyloarthritis and chronic low back pain patients: results from a nationwide population-based survey

PURPOSE

Both spondyloarthritis and chronic low back pain (CLBP) significantly impact health-related quality of life (HRQoL). It is important to clarify whether these disorders have different impacts on the several domains of HRQoL as different mechanisms may necessitate different treatment interventions. Moreover, the factors associated with HRQoL can inform more targeted group interventions to promote HRQoL.

METHODS

We used data from EpiReumaPt, a population-based survey conducted from September 2011 to December 2013. HRQoL was assessed with EuroQoL-5-Dimensions (EQ-5D). Spondyloarthritis was diagnosed by expert opinion (rheumatologist) and predefined criteria. CLBP was diagnosed if low back pain was present on the day of the interview and persisted for > 90 days. Univariable and multivariable linear regression analyses compared HRQoL among subjects with spondyloarthritis, CLBP, and no rheumatic diseases. Multivariable linear regression analyses evaluated HRQoL factors in spondyloarthritis and CLBP subjects.

RESULTS

We included 92 spondyloarthritis patients, 1376 CLBP patients, and 679 subjects without rheumatic diseases. HRQoL was similarly affected in spondyloarthritis and CLBP (ß =  - 0.03, 95% CI [- 0.08; 0.03]) in all EQ5D dimensions. A much lower HRQoL was found in spondyloarthritis and CLBP patients compared with subjects without rheumatic diseases (ß =  - 0.14, 95% CI [- 0.19; - 0.10]; ß =  - 0.12, 95% CI [- 0.14; - 0.09], respectively). In spondyloarthritis subjects, multimorbidity and active disease were associated with worse HRQoL (ß =  - 0.18; 95% CI [- 0.24; 0.03]; ß =  - 0.13; 95% CI [- 0.29; - 0.05], respectively), and regular physical exercise was associated with better HRQoL (ß = 0.18; 95% CI [0.10; 0.30]). In CLBP subjects, multimorbidity (β =  - 0.11; 95% CI [- 0.14; - 0.08]), obesity (β =  - 0.04; 95% CI [- 0.08; - 0.01]), and low back pain intensity (β =  - 0.02; 95% CI [- 0.03; - 0.02]) were associated with worse HRQoL, and regular physical exercise (β = 0.08; 95% CI [0.05; 0.11]) was significantly associated with better HRQoL.

CONCLUSION

Spondyloarthritis and CLBP subjects reported similar levels of impairment in the mental, physical, and social domains of HRQoL. Future health plans should address modifiable factors associated with HRQoL in these conditions to achieve better outcomes.

Global perceived improvement and health-related quality of life after physical therapy in Lebanese patients with chronic non-specific low back pain

BACKGROUND

The effectiveness of physical therapy (PT) in patients with chronic non-specific low back pain (CNSLBP) is mainly evaluated through pain, disability, and health-related quality of life (HRQOL). However, recent studies have recommended the consideration of improvement from patients' perspectives.

OBJECTIVE

This study aimed to investigate the relationship between the global perception of improvement in Lebanese patients with CNSLBP who have undergone PT, the HRQOL levels, as well as pain intensity.

METHODS

132 patients with CNSLBP who have undergone PT completed a questionnaire consisting of sociodemographic and CNSLBP characteristics questions, pain intensity numeric scale (NRS), 12-Item Short-Form Health Survey (SF-12), and the Global Perceived Effect scale (GPE). Binary logistic regressions and Pearson correlation coefficient were used for analyses.

RESULTS

Global perceived improvement of PT varies according to HRQOL levels. A significant correlation was found between pain intensity after PT, perceived improvement from PT, and HRQOL. Educational level and pain irradiation have been shown to be predictive factors of perceived improvement after PT.

CONCLUSION

Pain and HRQOL are interrelated and contributed to elucidating the global perception of improvement after PT in patients with CNSLBP. The findings suggest that patients' global perception of improvement should be considered in evaluating the benefits of physical therapy in addition to pain and HRQOL.

The relationship between the Keele STarT back screening tool, the short form of central sensitivity inventory and health-related quality of life in patients with low back pain

INTRODUCTION

It has been reported that the scores of the Keele STarT Back Screening Tool (SBST) and the short form of Central Sensitization Inventory (CSI-9) are associated with Health-Related Quality of Life (HRQoL) in patients with low back pain (LBP). However, it is unclear which screening tool is more associated with HRQoL in patients with LBP.

OBJECTIVE

To identify which SBST and CSI-9 are more related to HRQoL and investigate the association between SBST and CSI-9 scores.

STUDY DESIGN

Cross-sectional study.

METHOD

A multiple regression analysis was conducted to examine the factors associated with the HRQoL using age, pain intensity, disability, SBST score, and CSI-9 score as independent variables. Spearman's rank correlation coefficient was also conducted to determine the association between SBST and CSI-9 score.

RESULTS

Multiple regression analysis revealed that the Oswestry Disability Index (ODI) score (p < 0.01, β = -0.62, VIF = 1.70) and SBST score (p < 0.01, β = -0.32, VIF = 1.86) were significant associated variables. A significant association was found between SBST and CSI-9 scores (p < 0.01, ρ = 0.47).

CONCLUSION

The results showed that in patients with LBP the association of HRQoL with SBST was more substantial than with CSI-9.

ISASS Policy Statement 2022: Literature Review of Intraosseous Basivertebral Nerve Ablation

The index 2020 ISASS Guideline Statement "Intraosseous Ablation of the Basivertebral Nerve for the Relief of Chronic Low Back Pain" was generated in response to growing requests for background, supporting literature, evidence, as well as proper coding for intraosseous basivertebral nerve ablation. Since the guideline was published, the American Medical Association has added Current Procedural Terminology category I codes for basivertebral nerve ablation: 64628 and 64629. Additionally, the has recognized a need for greater specificity in differentiating various types of low back pain and has designatedthe International Classification of Diseases, 10th revision, Clinical Modification code M54.51, vertebrogenic low back pain, to ensure correct diagnosis. The timing of these additions provides an opportunity to refresh the ISASS Guideline to ensure proper diagnosis and procedural coding and to update the supporting literature and evidence.

Quality of Life and Mental Distress in Patients with Chronic Low Back Pain: A Cross-Sectional Study

The aim of this study was to examine the levels of health-related quality of life (HRQoL), pain intensity, and mental distress in participants with chronic low back pain (CLBP), and to examine the differences in the HRQoL of participants with respect to mental distress and the correlations of the examined variables. Data were collected from 148 patients using the SF-36 Health Status Questionnaire (SF-36), the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) questionnaire, and the visual-analog pain scale (VAS). The results indicate poorer self-assessment of physical health (M_e = 28.1) compared to mental health (M_e = 39.4). Participants with higher levels of mental distress reported significant emotional limitations (p = 0.003), lower energy (p < 0.001), poorer psychological health (p < 0.001) and social functioning (p < 0.001), more pain (p = 0.007), and, ultimately, poorer general health (p < 0.001). The level of mental distress was related to the level of HRQoL, while a correlation with the level of pain of the participants was not found. The study results indicate a connection between the presence of mental distress and almost all aspects of HRQoL in participants with CLBP.

Pain and the Triple Network Model

Acute pain is a physiological response that causes an unpleasant sensory and emotional experience in the presence of actual or potential tissue injury. Anatomically and symptomatically, chronic pathological pain can be divided into three distinct but interconnected pathways, a lateral “painfulness” pathway, a medial “suffering” pathway and a descending pain inhibitory circuit. Pain (fullness) can exist without suffering and suffering can exist without pain (fullness). The triple network model is offering a generic unifying framework that may be used to understand a variety of neuropsychiatric illnesses. It claims that brain disorders are caused by aberrant interactions within and between three cardinal brain networks: the self-representational default mode network, the behavioral relevance encoding salience network and the goal oriented central executive network. A painful stimulus usually leads to a negative cognitive, emotional, and autonomic response, phenomenologically expressed as pain related suffering, processed by the medial pathway. This anatomically overlaps with the salience network, which encodes behavioral relevance of the painful stimuli and the central sympathetic control network. When pain lasts longer than the healing time and becomes chronic, the pain- associated somatosensory cortex activity may become functionally connected to the self-representational default mode network, i.e., it becomes an intrinsic part of the self-percept. This is most likely an evolutionary adaptation to save energy, by separating pain from sympathetic energy-consuming action. By interacting with the frontoparietal central executive network, this can eventually lead to functional impairment. In conclusion, the three well-known pain pathways can be combined into the triple network model explaining the whole range of pain related co-morbidities. This paves the path for the creation of new customized and personalized treatment methods.

eDOL mHealth App and Web Platform for Self-monitoring and Medical Follow-up of Patients With Chronic Pain: Observational Feasibility Study

BACKGROUND

Chronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue.

OBJECTIVE

We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL.

METHODS

We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians.

RESULTS

Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1.

CONCLUSIONS

This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management.

TRIAL REGISTRATION

ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694.

Risk factors for low back pain outcome: Does it matter when they are measured?

BACKGROUND

The early identification of factors that increase risk of poor recovery from acute low back pain (LBP) is critical to prevent the transition to chronicity. Although most studies of risk factors for poor outcome in LBP tend to investigate the condition once it is already persistent, there is evidence to suggest that this differs from risk factors measured during the early-acute stage. This study aimed to identify early risk factors for poor outcome in the short- and long-term in individuals with acute LBP, and to compare this with factors identified at 3 months in the same cohort.

METHODS

One hundred and thirty-three individuals were recruited within 2 weeks of an acute LBP episode and completed questionnaires related to their sociodemographic, psychological, clinical and history/treatment status at baseline and 3 months later, and their pain-level fortnightly for 12 months.

RESULTS

Of the 133 participants recruited, follow-up data was provided by 120 at 3 months, 97 at 6 months, 85 at 9 months and 94 at 12 months. Linear regression identified various factors at baseline (acute phase) and 3 months later that predicted short- and long-term outcome (pain level, change in pain). Key findings were that: (1) depressive symptoms at baseline most consistently predicted worse outcome; (2) psychological factors in general at 3 months were more predictive of outcome than when measured at baseline; (3) early health care utilisation predicted better outcome, whereas use of pain medication later (3 months) predicted worse outcome; and (4) sex and BMI predicted outcome inconsistently over 12-months.

CONCLUSIONS

The results highlight the multidimensional nature of risk factors for poor outcome in LBP and the need to consider time variation in these factors.

Correlation of self-reported pain severity and healthcare expenditures in older United States adults

OBJECTIVES

Healthcare expenditures of older United States (US) adults with different pain severity levels are important to investigate given the increasing prevalence of pain in this population. This study assessed the correlation of healthcare expenditures among older US adults with different pain severities, hypothesizing that expenditures would increase as pain severity increased.

METHODS

This retrospective cross-sectional database study used 2018 Medical Expenditure Panel Survey (MEPS) data and included US adults aged ≥50 with self-reported pain in the past four weeks and positive healthcare costs. Adjusted linear regression models with logarithmically transformed expenditure data compared differences in: total; office-based; outpatient; emergency room; inpatient; other; and prescription medication expenditures, between those with little, moderate, quite a bit, and extreme pain. Analyses were weighted to account for the complex MEPS design and to obtain nationally representative estimates. The a priori alpha level was 0.05.

RESULTS

The eligible sample of 5,123 individuals produced a weighted study population of 57,134,711 US adults aged ≥50 with pain (little = 53.1%, moderate = 21.6%, quite-a-bit = 18.5%, extreme = 6.8%). In adjusted linear regression models, compared to little pain, extreme pain had the greatest level of costs, followed by quite a bit pain and moderate pain, for total, office-based, and prescription medication costs. For instance, compared to little pain, total healthcare costs were 78% greater for those with extreme pain, 51% greater for quite a bit pain, and 37% greater for moderate pain. However, this pattern was not observed for outpatient, emergency room, inpatient, and other costs, where ≥1 comparison for each cost category was not statistically significant.

CONCLUSIONS

This study found total healthcare costs increased as pain severity increased, yet this was not always the case when analyzing subcategories of healthcare costs. Further research is needed to investigate why some types of healthcare costs are greater with increasing pain severity, yet others are not.

Determinants of quality of life in individuals with chronic low back pain: a systematic review

OBJECTIVE

Chronic low back pain (CLBP) is a prominent medical condition that can affect an individual at some point in their life time which could lead to poor quality of life (QOL). Low back pain has affected approximately 577 million individuals globally by 2017. The aim of the current systematic review is to synthesise the existing evidence on the factors influencing the QOL in individuals with CLBP and to identify strategies to improve their QOL.

METHOD

PubMed, ScienceDirect, PsychNet and Google Scholar were used to extract studies reporting quantitative relationships between QOL and its possible determinants in individuals having CLBP and the intervention strategies to improve QOL.

RESULTS

10,851 studies were initially identified and twenty-six studies which met the inclusion criteria were selected for the review. 21 studies reported relationship between QOL and potential determinants and five studies assessed the influence of interventions on QOL. Determinants were classified as kinesiophobia, fear avoidance belief, or pain belief; occupation-related factors; pain and disability; activity; personal factors including age, gender, employment status; and other psychological factors including anxiety, quality of sleep, and health locus of control. Intervention strategies including MBSR, Pilates method and Back School Programme improved QOL in individuals with CLBP.

CONCLUSION

Psychosocial factors as well as the physical status of the individual contributed to the QOL in individuals having CLBP.

Medical Cannabis Patients Report Improvements in Health Functioning and Reductions in Opiate Use

Purpose: Opioid use rates have dropped as North American patients gain access to medical cannabis, indicating a harm reduction role, yet health outcomes remain mostly unexplored. This study presents self-reported medical cannabis use, perceptions of health functioning, and changes in opioid pain medication use in Florida medical cannabis patients.Methods: Patients (n = 2,183) recruited from medical dispensaries across Florida completed a 66-item cross-sectional survey that included demographic, health, and medication usage items, along with items from the Medical Outcomes Survey (SF-36) to assess health functioning before and after cannabis initiation.Results: Most participants were between the ages of 20 and 70 years of age (95%), over 54% were female, 47% were employed, and most (85%) were white. Commonly reported ailment groups were Pain and Mental Health combined (47.92%), Mental Health (28.86%) or Pain (9.07%). Health domains of bodily pain, physical functioning, and social functioning improved while limitations due to physical and emotional problems were unchanged. Most patients rated medical cannabis as being important to their quality of life. Many (60.98%) reported using pain medications prior to medical cannabis, 93.36% of these reported a change in pain medication after medical cannabis. The majority of participants (79%) reported either cessation or reduction in pain medication use following initiation of medical cannabis and 11.47% described improved functioning.Conclusions: The findings suggest that some medical cannabis patients decreased opioid use without harming quality of life or health functioning, soon after the legalization of medical cannabis. The public health implications of medical cannabis as an alternative pain medication are discussed.

The influence of low back pain on health – related quality of life and the impact of balneal treatment

Introduction. Low back pain has a direct and proportional impact on function and a general one on the quality of life. The present study aims to evaluate the functional impact of low back pain using specific self-assessment tools as indexes of appreciation and epidemiological correlations of potential risk factors involved. The conceptual model of our research is based on the importance of correlating symptoms with clinical assessment, using scales of pain, disability, quality of life, and determination of epidemiological correlations of these areas and the determined factors of the pathology. Material and method. The study group is made up of 106 cases with clinical diagnostic of low back pain, admitted from 28 September 2020 to 28 March 2021, at Balneal and Rehabilitation Sanatorium of Techirghiol. After performing anamnesis, general clinical examination, specific neuro-musculo-skeletal examination, the patients filled the surveys highlighting the impact of their low back pain on functionality and disability deriving from it. The survey included the Oswestry Disability Index, the Functional Independence Measure (FIM) instrument and the Visual analog scale (VAS) score evaluated at the moment of hospitalization and at discharge. Statistical analysis of data was carried out and correlations between variables resulting from study were highlighted. The study was conducted according to the norms of deontology and medical ethics. The authors declare no conflict of interest. Results and discussions. Lumbar pathology is common in patients who are hospitalized for a complex balneary-physical-kinetic treatment at Balneal and Rehabilitation Sanatorium of Techirghiol. About 80% of patients who have addressed to our unit in which the study was conducted, have presented low back pain. The majority of patients were females, representing 57,55% of the total number. Regarding the patients’ age, 58,5% of them were in the 50-70 years interval. The study reveals a major positive impact of our treatment on spinal symptomatology, an effect pointed out by the relevant statistical differences between the admittance and discharge VAS scores(p<0.001). Reporting the investigated disability with the Oswestry questionnaire of painful lumbar syndrome, and functional evaluation scale (FIM) demonstrates the impact of this pathology on the patient's social life, once again emphasizing the special attention to be paid to axial pathology, both as curative treatment and the importance of prophylactic treatment. Statistical analysis of identified risk factors, reveals the importance of prophylaxis and patient’s education in this area. A strong and important statistical correlation was found between the Oswestry total score and the walking and standing items, and a moderate, but strong correlation with the other items. Regarding the sex life item, the correlation is existent, but at a modest level. Conclusions. The study reveals the importance of correlation of the data obtained from anamnesis, the general clinical examination and the specific examination neuromioarthrokinetic with assessment tools that determine the level of functional independence, the functional impact on social life in high-frequency pathologies treated in medical facilities that provide healthcare in the field of medical recovery. It is necessary to quantify the therapeutic results obtained, in order to assess the level of improvement in quality of life. Keywords: low back pain, balneal, functional indicators, quality of life,

Burden of chronic low back pain: Association with pain severity and prescription medication use in five large European countries

OBJECTIVE

This study assessed associations between severity of, and prescription medication use for, chronic low back pain (CLBP) and health-related quality of life, health status, work productivity, and healthcare resource utilization.

METHODS

This cross-sectional study utilized SF-12, EQ-5D-5L, and work productivity and activity impairment (WPAI) questionnaires, and visits to healthcare providers among adults with self-reported CLBP participating in the National Health and Wellness Survey in Germany, France, UK, Italy, and Spain. Respondents were stratified into four groups according to pain severity (mild or moderate/severe) and prescription medication use (Rx-treated or Rx-untreated). Differences between groups were estimated using generalized linear models controlling for sociodemographics and health characteristics.

RESULTS

Of 2086 respondents with CLBP, 683 had mild pain (276 Rx-untreated, 407 Rx-treated) and 1403 had moderate/severe pain (781 Rx-untreated, 622 Rx-treated). Respondents with moderate/severe pain had significantly worse health-related quality of life (SF-12v2 physical component summary), health status (EQ-5D-5L), and both absenteeism and presenteeism compared with those with mild pain, including Rx-untreated (moderate/severe pain Rx-untreated vs. mild pain Rx-untreated, p ≤ 0.05) and Rx-treated (moderate/severe pain Rx-treated vs. mild pain Rx-treated, p ≤ 0.05) groups. Significantly more visits to healthcare providers in the last 6 months were reported for moderate/severe pain compared with mild pain for Rx-treated (least squares mean 13.01 vs. 10.93, p = 0.012) but not Rx-untreated (8.72 vs. 7.61, p = 0.072) groups. Health-related quality of life (SF-12v2 physical component summary) and health status (EQ-5D-5L), as well as absenteeism and presenteeism, were significantly worse, and healthcare utilization was significantly higher, in the moderate/severe pain Rx-treated group compared with all other groups (all p ≤ 0.05).

CONCLUSION

Greater severity of CLBP was associated with worse health-related quality of life, health status, and absenteeism and presenteeism, irrespective of prescription medication use. Greater severity of CLBP was associated with increased healthcare utilization in prescription medication users.

Effects of a Remotely Delivered Cognitive Behavioral Coaching Program on the Self-Rated Functional Disability of Participants with Low Back Pain

PURPOSE

A remotely delivered cognitive behavioral coaching (CBC) program was offered as a service benefit for commercial health plan members with low back pain (LBP). This study describes changes in self-rated functional disability in a sample of plan members participating in the program (N=423).

METHODS

Independent measures included demographics, length of program enrollment, total CBC sessions, and baseline self-reported patient activation and presenteeism levels. Participants rated their functional disability level due to LBP using the Oswestry Disability Index (ODI). Dependent outcomes quantified change in participant functional disability rating (final ODI score minus baseline ODI score). Nonparametric tests compare differences between groups and within-group ODI score change. Two generalized linear models test for associations between independent variables and the ODI change score.

RESULTS

A significant difference between baseline and final ODI scores was observed at the overall program level (p<.001) and within all independent variable categories of interest. Over 68% of total participants (n=289) reported improved functional ability from baseline to final (decrease in ODI score). Participants who completed more CBC sessions demonstrated significantly greater improvement in functional ability (p=.038) compared to those who completed fewer sessions. Participants aged 55 and older were significantly more likely to show deterioration in functional ability from baseline to final (p=.021).

CONCLUSION

Outcomes suggest that program participation can influence self-rated functional disability in the management of LBP.

The anatomy of pain and suffering in the brain and its clinical implications

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Chronic pain, with a prevalence of 20-30 % is the major cause of human suffering worldwide, because effective, specific and safe therapies have yet to be developed. It is unevenly distributed among sexes, with women experiencing more pain and suffering. Chronic pain can be anatomically and phenomenologically dissected into three separable but interacting pathways, a lateral 'painfulness' pathway, a medial 'suffering' pathway and a descending pain inhibitory pathway. One may have pain(fullness) without suffering and suffering without pain(fullness). Pain sensation leads to suffering via a cognitive, emotional and autonomic processing, and is expressed as anger, fear, frustration, anxiety and depression. The medial pathway overlaps with the salience and stress networks, explaining that behavioural relevance or meaning determines the suffering associated with painfulness. Genetic and epigenetic influences trigger chronic neuroinflammatory changes which are involved in transitioning from acute to chronic pain. Based on the concept of the Bayesian brain, pain (and suffering) can be regarded as the consequence of an imbalance between the two ascending and the descending pain inhibitory pathways under control of the reward system. The therapeutic clinical implications of this simple pain model are obvious. After categorizing the working mechanisms of each of the available treatments (pain killers, psychopharmacology, psychotherapy, neuromodulation, psychosurgery, spinal cord stimulation) to 1 or more of the 3 pathways, a rational combination can be proposed of activating the descending pain inhibitory pathway in combination with inhibition of the medial and lateral pathway, so as to rebalance the pain (and suffering) pathways.

Medial Prefrontal High-Definition Transcranial Direct Current Stimulation to Improve Pain Modulation in Chronic Low Back Pain: A Pilot Randomized Double-blinded Placebo-Controlled Crossover Trial

Chronic low back pain (CLBP) is highly disabling, but often without identifiable source. Focus has been on impaired anti-nociceptive mechanisms contributing to pain maintenance, though methods of targeting this impairment remain limited. This randomised-controlled cross-over pilot trial used active versus sham medial prefrontal cortex (mPFC) high-definition transcranial direct current stimulation (HD-tDCS) for 3-consecutive days to improve descending pain inhibitory function. Twelve CLBP patients were included with an average visual analogue scale (VAS) pain intensity of 3.0 ± 1.5 and pain duration of 5.3 ± 2.6 years. Pressure pain thresholds (PPTs), conditioned pain modulation (CPM), and temporal summation of pain (TSP) assessed by cuff algometry, as well as pain symptomatology (intensity, unpleasantness, quality, disability) and related psychological features (pain catastrophizing, anxiety, affect), were assessed on Day1 before 3 consecutive days of HD-tDCS sessions (each 20 minutes), at 24-hours (Day 4) and 2-weeks (Day 21) following final HD-tDCS. Blinding was successful. No significant differences in psychophysical (PPT, CPM, TSP), symptomatology or psychological outcomes were observed between active and sham HD-tDCS on Day4 and Day21. CPM-effects at Day 1 negatively correlated with change in CPM-effect at Day4 following active HD-tDCS (P = .002). Lack of efficacy was attributed to several factors, not least that patients did not display impaired CPM at baseline. TRIAL REGISTRATION: : ClinicalTrials.gov (NCT03864822). PERSPECTIVE: Medial prefrontal HD-tDCS did not alter pain, psychological nor psychophysical outcomes, though correlational analysis suggested response may depend on baseline pain inhibitory efficacy, with best potential effects in patients with severe impairments in descending pain inhibitory mechanisms. Future work should focus on appropriate patient selection and optimising stimulation targeting.

Myofascial Release for Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Background: Chronic low back pain (CLBP) is one of the most common musculoskeletal diseases in the elderly, which has a severe impact on the health of the elderly. However, CLBP treatment is very challenging, and more effective treatment methods are needed. Myofascial release may be an effective therapy for the management of chronic musculoskeletal pain. It is widely used clinically to treat CLBP, but its clinical efficacy is still controversial. Objective: This study aims to systematically evaluate the effectiveness of myofascial release for patients with CLBP. Methods: We selected PubMed, Cochrane Library, EMBASE database, and Web of Science database articles published until April 5, 2021. Randomized controlled trials (RCTs) of myofascial release for CLBP were included. Outcome measures included pain, physical function, quality of life, balance function, pain pressure-threshold, trunk mobility, and mental health. For each outcome, Standardized mean differences (SMD) or mean differences (MD) and 95% confidence intervals (CIs) were calculated. Results: Eight RCTs (n = 375) were included based on inclusion and exclusion criteria. The meta-analysis showed that the overall efficacy of myofascial release for CLBP was significant, including two aspects: pain [SMD = -0.37, 95% CI (-0.67, -0.08), I 2 = 46%, P = 0.01] and physical function [SMD = -0.43, 95% CI (-0.75, -0.12), I 2 = 44%, P = 0.007]. However, myofascial release did not significantly improve quality of life [SMD = 0.13, 95% CI (-0.38, 0.64), I 2 = 53%, P = 0.62], balance function [SMD = 0.58, 95% CI (-0.49, 1.64), I 2 = 82%, P = 0.29], pain pressure-threshold [SMD = 0.03,95% CI (-0.75, 0.69), I 2 = 73%, P = 0.93], trunk mobility [SMD = 1.02, 95% CI (-0.09, 2.13), I 2 = 92%, P = 0.07] and mental health [SMD = -0.06, 95% CI (-0.83, 0.71), I 2 = 73%, P = 0.88]. Conclusions: In this study, we systematically reviewed and quantified the efficacy of myofascial release in treating CLBP. The meta-analysis results showed that myofascial release significantly improved pain and physical function in patients with CLBP but had no significant effects on balance function, pain pressure-threshold, trunk mobility, mental health, and quality of life. However, due to the low quality and a small number of included literature, more and more rigorously designed RCTs should be included in the future to verify these conclusions.

Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults

Chronic low back pain is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. The existing low back pain research has relied almost exclusively on White/Caucasian participant samples. This study examines the correlates of chronic low back pain among a sample of underserved urban African American and Latino older adults. Controlling for age, gender, race/ethnicity, education, living arrangement, and number of major chronic conditions, associations between low back pain and the following outcome variables are examined: (1) healthcare utilization, (2) health-related quality of life (HR-QoL) and self-rated quality of health; and (3) physical and mental health outcomes.

METHODS

We recruited nine hundred and five (905) African American and Latino older adults from the South Los Angeles community using convenience and snowball sampling. In addition to standard items that measure demographic variables, our survey included validated instruments to document HR-QoL health status, the Short-Form McGill Pain Questionnaire-2, Geriatric Depression Scale, sleep disorder, and healthcare access. Data analysis includes bivariate and 17 independent multivariate models.

RESULTS

Almost 55% and 48% of the Latino and African American older adults who participated in our study reported chronic low back pain. Our data revealed that having low back pain was associated with three categories of outcomes including: (1) a higher level of healthcare utilization measured by (i) physician visits, (ii) emergency department visits, (iii) number of Rx used, (iv) a higher level of medication complexity, (v) a lower level of adherence to medication regimens, and (vi) a lower level of satisfaction with medical care; (2) a lower level of HR-QoL and self-assessment of health measured by (i) physical health QoL, (ii) mental health QoL, and (iii) a lower level of self-rated health; and (3) worse physical and mental health outcomes measured by (i) a higher number of depressive symptoms, (ii) a higher level of pain, (iii) falls, (iv) sleep disorders, (v) and being overweight/obese.

DISCUSSION

Low back pain remains a public health concern and significantly impacts the quality of life, health care utilization, and health outcomes of underserved minority older adults. Multi-faceted and culturally sensitive interventional studies are needed to ensure the timely diagnosis and treatment of low back pain among underserved minority older adults. Many barriers and challenges that affect underserved African American and Latino older adults with low back pain simply cannot be addressed in over-crowded EDs. Our study contributes to and raises the awareness of healthcare providers and health policymakers on the necessity for prevention, early diagnosis, proper medical management, and rehabilitation policies to minimize the burdens associated with chronic low back pain among underserved older African American and Latino patients in an under-resourced community such as South Los Angeles.

The effects of myofascial release technique for patients with low back pain: A systematic review and meta-analysis

OBJECTIVE

The purpose of this meta-analytic review was to quantitatively examine the effects of myofascial release technique (MFR) on pain intensity, back disability, lumbar range of motion, and quality of life in patients with low back pain (LBP).

METHODS

Potential articles were retrieved using five electronic databases (Web of Science, PubMed, Scopus, China National Knowledge Infrastructure, and Wanfang). The search period was from inception to January 27, 2021. Two researchers independently completed record retrieval and selection, data extraction, and methodological quality assessment. Randomized controlled trials (RCTs) assessing the effect of MFR on pain intensity, back disability, lumbar range of motion, and quality of life in LBP patients were included. Pooled effect sizes were calculated using random effects models and 95 % confidence interval (95 % CI).

RESULTS

Data from eight RCTs (386 patients with back pain) meeting the inclusion criteria were extracted for meta-analysis with methodological quality assessment scores ranging from 6 to 10. Compared to the control intervention, MFR induced significant decrease in back disability (SMD = -0.35, 95 % confidence interval [CI] = -0.68, -0.02, P = 0.04, I² = 46 %, n = 284). MFR induced non-significant decrease in the pain intensity (SMD = -0.12, 95 % confidence interval[CI] = -0.35, 0.11, P = 0.32, I² = 0%, n = 294), non-significant improvement in quality of life (SMD = -0.09, 95 % confidence interval [CI] = -0.46, 0.28, P = 0.62, I² = 0%, n = 114), and non-significant improvement in lumbar range of motion (Flexion SMD = 0.57,95 % confidence interval [CI] = -0.09, 1.24, P = 0.09, I² = 54 %, n = 80) (Extension SMD = 0.68, 95 % confidence interval[CI] = -0.72, 2.08, P = 0.34, I² = 89 %, n = 80) (Right flexion SMD = 0.05, 95 % confidence interval[CI] = -0.90, 0.99, P = 0.92, I² = 78 %, n = 80) (Left flexion SMD = 0.14, 95 % confidence interval[CI] = -0.59, 0.88, P = 0.70, I² = 64 %, n = 80).

CONCLUSION

The findings suggest that MFR can improve the effect of physical therapy alone and exercise therapy alone, and that MFR can be an effective adjuvant therapy. Meta-analysis showed that MFR has a significant effect on reducing back disability in patients with low back pain, but no significant effect on reducing pain intensity, improving quality of life, and improving lumbar range of motion.

Effects of a multimodal exercise intervention on physical and cognitive functions in patients with chronic low back pain (MultiMove): study protocol for a randomized controlled trial

BACKGROUND

Chronic low back pain (CLBP) is a common medical condition in adults over the age of 50. It is associated with severe disability, ranging from physical impairments to psychosocial distress. Since current treatments provide only small to moderate short-term effects, alternative interventions are required, whereby guidelines recommended multimodal approaches. Dancing can be considered as an inherently multimodal approach, as it requires a combination of physical and cognitive functions. Furthermore, it has already been applied effectively in neurorehabilitation. Therefore, it seems promising to merge a dance-therapeutic component together with motor-cognitive, strength and flexibility exercises in a novel multimodal treatment (MultiMove) to target the impaired everyday mobility and cognition of CLBP patients. The aim of this study is to analyse specific physical, cognitive and psychosocial effects of MultiMove in CLBP patients.

METHODS

A prospective, two-arm, single-blinded, randomized controlled trial will be conducted with an estimated sample size of 100 CLBP patients, assigned to either the MultiMove group or a control group. The intervention group will receive MultiMove twice a week for 60 min each over a period of 12 weeks. The primary outcome will be the mobility and function of the lower extremities assessed by the Timed Up-and-Go Test. Secondary outcomes comprise further physical and physiological functions (e.g. gait variability and haemodynamic response in the prefrontal cortex during motor-cognitive dual tasks), subjective health state (e.g. disability in daily life), executive functions (e.g. cognitive flexibility) and psychosocial aspects (e.g. kinesiophobia). Measures will be taken at baseline, after the intervention and at a 12-week follow-up. It is assumed that MultiMove improves the mentioned outcome parameters.

DISCUSSION

The combined assessment of changes in physical and cognitive functions as well as neuropsychological aspects in response to MultiMove will allow a better understanding of the motor-cognitive adaptations induced by multimodal exercises in CLBP patients. The specific conclusions will lead to recommendations for the conservative treatment approach in this clinically relevant patient group.

TRIAL REGISTRATION

German Clinical Trial Register (ID: DRKS00021696 / 10.07.2020), https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021696.

Study on the Associations of Individual and Work-Related Factors with Low Back Pain among Manufacturing Workers Based on Logistic Regression and Structural Equation Model

Work-related musculoskeletal injuries are one of the major occupational health issues of the workers, especially low back pain (LBP). The aim of this study was to survey the prevalence of LBP among manufacturing workers and to identify associations of individual and work-related factors with LBP. A cross-sectional questionnaire study was performed with 1173 participating manufacturing workers. The questionnaire included individual factors, psychosocial and physical exposures, and musculoskeletal discomfort. It was analyzed by logistic regression and structural equation modeling (SEM). The 1-year prevalence of LBP among Chinese manufacturing workers was 33.6%. Logistic regression analysis showed that job tenure, awkward postures, vibration and job demand were positively—while social support and job control were negatively associated with LBP (p < 0.05). The SEM results indicated that, as shown in other studies, job types, job tenure, postural load, high job demand, low job control and vibration were directly associated with LBP, but also that job types, high job demand, low social support and vibration may have indirect effects on LBP—mediated by postural load.

Community Pharmacist's Role in Detecting Low Back Pain, and Patient Attitudes-A Cross-Sectional Observational Study in Italian Community Pharmacies

BACKGROUND

Low back pain (LBP) is one of the most frequent diseases for which patients seek advice in a community pharmacy. The study aimed to evaluate the feasibility of the administration by community pharmacists of questionnaires to assess the LBP intensity and disability degree in patients entering community pharmacies and the attitudes they have toward pain management by pharmacological and non-pharmacological strategies.

METHODS

An explorative, cross-sectional, observational, and quantitative study was performed. Twelve Italian community pharmacists were asked to submit a questionnaire on LBP to patients visiting their pharmacies. The questionnaire included a pain intensity scale, and two validated tools: the Roland and Morris Disability Questionnaire (RMDQ) and the Start Back Screening Tool (SBST) to determine the degree and risk of patient disability, respectively.

RESULTS

872 patients filled out the questionnaires in 6 months. No statistical differences between genders (p > 0.30) were recorded for pain intensity (Female: median score 6, IQR 4-7; Male: median scores 5, IQR 4-7; p > 0.30) and disability associated with LBP (RMDQ high-disability level: Females, 14.7%, Males, 15.0%; p > 0.90). Most of the patients (69%) reported a low degree of disability, but the risk of disability was medium and high in 36% and 18% of them, respectively (p < 0.05). About 14% of patients declare to never seek for physician's advice despite their medium-high degree of disability.

CONCLUSION

The study demonstrated the feasibility of validated tools for assessing the degree and risk of disability in LBP patients administrable in community pharmacies. Moreover, the community pharmacy resulted in an important care portal for patients suffering from moderate LBP and for intercepting patients who suffered from severe LBP but had never reported their problem to their physician.