Evidence-informed management of chronic low back pain with trigger point injections

Ultrasound-Guided Trigger Point Injections for the Treatment of Neck and Back Pain in the Emergency Department: A Randomized Trial

OBJECTIVES

Patients frequently present to the emergency department (ED) with neck or back pain, which can be difficult to treat. We sought to compare ultrasound-guided trigger point injection (TPI) to standard medications for patients with neck or back pain.

METHODS

We performed a single-center, open label, randomized controlled trial on ED patients with neck or back pain from myofascial pain syndrome comparing ultrasound-guided TPIs to those who received the combination of a nonsteroidal anti-inflammatory drug (NSAID) and a muscle relaxant (MR). The primary outcome of this study was the reduction in mean pain score at the time of ED disposition.

RESULTS

In total, we analyzed 196 patients. At the time of ED disposition, patients in the TPI group had a mean reduction in their pain scores of 45.0 mm as compared to 49.9 mm in the NSAID plus MR group (difference: 4.9 [95% confidence interval (CI) -3.0 to 12.7], P = .22). At the first reassessment, patients in the TPI group had greater pain reduction by 10.7 mm (95% CI 3.1 to 18.4). The rate of rescue therapy use was higher in the NSAID plus MR group (difference: 17.5% [95% CI 4.4 to 36.2]).

CONCLUSIONS

We found no difference in pain reduction at the time of ED disposition between patients randomized to the ultrasound-guided TPI group as compared to those who received an NSAID plus a MR. However, patients in the TPI group had greater pain reduction at the time of first reassessment and lower rates of rescue therapy use.

Myofascial low back pain

Low back pain is a common condition that is encountered by both primary care physicians as well as various specialists, which include: orthopedic surgeons, physical medicine and rehabilitation specialists, neurologists, rheumatologists, and pain management specialists. Associated muscular pain is very common and often a reactive response from nociception from other structures. Myofascial pain may arise, which is characterized by the presence of myofascial trigger points (MTrPs) that are located in fascia, tendons, and/or muscle. This article reviews the current evidence regarding the pathophysiology, assessment, and recommended treatment options for myofascial low back pain.

The qigong of 18 Luohan Hands and yoga for prevention of low back pain: A conceptual synthesis

The practice of hathayoga is based on the following assumptions: complexity and multidimensionality of various positive influences on an individual's wholeness through the mind, body and their conscious control. On the other hand, the practice of the qigong of 18 Luohan Hands is based on slow movements designed to mobilise qi within the body. This article presents a conceptual integration of yoga and qigong when considering the congruence of beneficial effects for various systems of the body and prevention of low back pain (LBP). The author emphasizes the usefulness of qigong and yoga practice in clinical units and explains how the essence of these practices relates to each other. The justification of this fusion as well as differences between these two modalities are also described and explained. Within the scope of this article the existence of several similarities between these two practices has been suggested for both practitioners and researchers. They can obtain valuable and additional arguments through cross-fertilization of ideas across presented studies united by shared, underlying biomechanical concepts and physiological effects. Such conceptual enrichment may be a useful source of inspiration for qigong and yoga practitioners who tend to prevent LBP and therapists (physiotherapists, occupational therapists, rehabilitants, nurses, bodywork and movement therapists or massage therapists) intended to manage their patients' back pains and overall health on a daily basis.

Myofascial low back pain: a review

Myofascial pain syndrome is a common nonarticular local musculoskeletal pain syndrome caused by myofascial trigger points located at muscle, fascia, or tendinous insertions, affecting up to 95% of people with chronic pain disorders. Clinically, myofascial pain syndrome can present as painful restricted range of motion, stiffness, referred pain patterns, and autonomic dysfunction. The underlying cause is often related to muscular imbalances, and following a thorough physical examination the condition should be treated with a comprehensive rehabilitation program. Additional treatment options include pharmacologic, needling with or without anesthetic agents or nerve stimulation, and alternative medicine treatments such as massage or herbal medicines. Repeated trigger point injections should be avoided, and corticosteroids should not be injected into trigger points.

Pilates for low back pain: a systematic review

OBJECTIVE

The aim of this paper is to systematically review all controlled clinical trials of Pilates to treat low back pain.

DATA SOURCES

A systematic review of nine databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Pedro, Rehadat, Rehab Trials) was conducted and the reference lists of all the papers were checked for further relevant publications until May 2010.

STUDY SELECTION

A first selection was performed by means of title and abstract. A second selection was made by means of predefined inclusion criteria: randomized controlled clinical trials testing Pilates in patients of any age or sex with low back pain.

DATA EXTRACTION

Data relating to changes in body function, quality of life and pain from the included studies were independently extracted by the reviewers on a standardized form. Study quality was assessed using the Oxford scale.

DATA SYNTHESIS

Four eligible randomized controlled clinical trials (n = 4) involving Pilates for the management of low back pain were included. The methodological quality of the RCTs was relatively low, varying from 1-4 on the Oxford scale. All studies were heterogeneous in terms of population of patients, control groups, inclusion and exclusion criteria, and outcome measures making a meta-analysis not feasible. Although there is some evidence supporting the effectiveness of Pilates in the management of low back pain, no definite conclusions can be drawn except that further research is needed with larger samples and using clearer definitions of the standard care and comparable outcome measures.

CONCLUSIONS

There is a wide diversity in research investigating the clinical and cost-effectiveness of Pilates in patients with low back pain.