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Öztürk GY, Yetişir A, Kocyigit BF. The positive effect of pulse electromagnetic field therapy on pain and disability in chronic low back pain: a comparative study. Rheumatol Int 2024; 44:1535-1541. [PMID: 38914776 PMCID: PMC11222228 DOI: 10.1007/s00296-024-05645-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/07/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Low back pain that lasts longer than three months is called chronic low back pain. Chronic low back pain is among the most common problems in the world, causing severe disability and loss of employment in patients. OBJECTIVE To investigate the effect of pulse electromagnetic field therapy (PEMFT) added to routine physical therapy on pain and functional status in patients with chronic low back pain. METHODS This retrospective comparative study included 69 patients with chronic low back pain. The patients were divided into two groups: those who received lumbar transcutaneous electrical nerve stimulation, infrared, and ultrasound treatments, and those who additionally received PEMFT. The files of patients with chronic low back pain were reviewed, and those who had been evaluated using the Quebec Back Pain Disability Scale (QBPDS) in terms of functional capacity and effects of low back pain and the Visual Analogue Scale (VAS) for pain both before and after treatment were included in the study. RESULTS No significant difference was detected between the two groups' pretreatment VAS and QBPDS scores (p > 0.05). The second-and-third measurement scores of both groups were significantly lower than their first-measurement VAS and QBPDS scores (p ˂ 0.001), but there was no significant difference between their second- and third-measurement scores (p > 0.05). According to the inter-group comparison of the VAS and QBPDS scores, the second and third-measurement scores of the PEMFT group were significantly lower than those of the control group (p ˂ 0.001). CONCLUSIONS PEMFT seems to be able to alleviate pain intensity and ameliorate disability in patients with chronic low back pain. PEMFT can be considered an effective and safe option that can be added to routine physical therapy modalities for relieving chronic low back pain frequently encountered in clinical practice. Further studies validating the effectiveness of PEMFT could strengthen its position in the management of chronic low back pain.
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Affiliation(s)
- Gülşah Yaşa Öztürk
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Training and Research Hospital, Adana, Türkiye.
| | - Ayşegül Yetişir
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Çukurova University, Adana, Türkiye
| | - Burhan Fatih Kocyigit
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Training and Research Hospital, Adana, Türkiye
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Yang F, Duan Y, Li Y, Zhu D, Wang Z, Luo Z, Zhang Y, Zhang G, He X, Kang X. S100A6 Regulates nucleus pulposus cell apoptosis via Wnt/β-catenin signaling pathway: an in vitro and in vivo study. Mol Med 2024; 30:87. [PMID: 38877413 PMCID: PMC11179208 DOI: 10.1186/s10020-024-00853-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Intervertebral disc degeneration (IDD) is a common musculoskeletal degenerative disease, which often leads to low back pain and even disability, resulting in loss of labor ability and decreased quality of life. Although many progresses have been made in the current research, the underlying mechanism of IDD remains unclear. The apoptosis of nucleus pulposus (NP) cells (NPCs) is an important pathological mechanism in intervertebral disc degeneration (IDD). This study evaluated the relationship between S100A6 and NPCs and its underlying mechanism. METHODS Mass spectrometry, bioinformatics, and quantitative real-time polymerase chain reaction (qRT-PCR) analyses were used to screen and verify hub genes for IDD in human IVD specimens with different degeneration degrees. Western blotting, immunohistochemistry (IHC), and/or immunofluorescence (IF) were used to detect the expression level of S100A6 in human NP tissues and NPCs. The apoptotic phenotype of NPCs and Wnt/β-catenin signaling pathway were evaluated using flow cytometry, western blotting, and IF. S100A6 was overexpressed or knocked down in NPCs to determine its impact on apoptosis and Wnt/β-catenin signaling pathway activity. Moreover, we used the XAV-939 to inhibit and SKL2001 to activate the Wnt/β-catenin signaling pathway. The therapeutic effect of S100A6 inhibition on IDD was also evaluated. RESULTS S100A6 expression increased in IDD. In vitro, increased S100A6 expression promoted apoptosis in interleukin (IL)-1β-induced NPCs. In contrast, the inhibition of S100A6 expression partially alleviated the progression of annulus fibrosus (AF) puncture-induced IDD in rats. Mechanistic studies revealed that S100A6 regulates NPC apoptosis via Wnt/β-catenin signaling pathway. CONCLUSIONS This study showed that S100A6 expression increased during IDD and promoted NPCs apoptosis by regulating the Wnt/β-catenin signaling pathway, suggesting that S100A6 is a promising new therapeutic target for IDD.
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Affiliation(s)
- Fengguang Yang
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Yanni Duan
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Yanhu Li
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Daxue Zhu
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Zhaoheng Wang
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Zhangbin Luo
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Yizhi Zhang
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Guangzhi Zhang
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Xuegang He
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Xuewen Kang
- Department of Orthopedics, The Second Hospital of Lanzhou University, 82 Cuiying Men, Lanzhou, Gansu Province, 730030, China.
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China.
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China.
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Baroncini A, Maffulli N, Schäfer L, Manocchio N, Bossa M, Foti C, Klimuch A, Migliorini F. Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis. Sci Rep 2024; 14:11546. [PMID: 38773302 PMCID: PMC11109223 DOI: 10.1038/s41598-024-62276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.
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Affiliation(s)
- Alice Baroncini
- GSpine4, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milano, Italy
| | - Nicola Maffulli
- Department of Orthopaedics, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke on Trent, ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
| | - Luise Schäfer
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
| | - Nicola Manocchio
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Michela Bossa
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Calogero Foti
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Alexandra Klimuch
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
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Porwal S, Rizvi MR, Sharma A, Ahmad F, Alshahrani MS, Raizah A, Shaik AR, Seyam MK, Miraj M, Alkhamis BA, Mukherjee D, Ahmad I. Enhancing Functional Ability in Chronic Nonspecific Lower Back Pain: The Impact of EMG-Guided Trunk Stabilization Exercises. Healthcare (Basel) 2023; 11:2153. [PMID: 37570393 PMCID: PMC10418369 DOI: 10.3390/healthcare11152153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Nonspecific lower back pain (NSLBP) is described as pain that is not caused by an identifiable, well-known disease, such as infection, tumor, osteoporosis, fracture, structural deformity, inflammatory condition, radicular syndrome, or cauda equina syndrome. AIM The aim of this study was to determine the effect of EMG-guided trunk stabilization exercises on functional disability associated with LBP. MATERIALS AND METHODS A single-blinded pre- and post-test experimental comparative design was used for this study. Fifty individuals with chronic NSLBP were screened for inclusion criteria. Of these, forty were randomly grouped into the EMG group receiving trunk-stability exercises with electromyography biofeedback and non-EMG group receiving trunk-stabilization exercises without EMG biofeedback. Participants performed five trunk-stability exercises 3 days a week for 4 weeks. The intensity of pain, range of motion, functional disability, and balance were measured at baseline and after 4 weeks. RESULTS Both techniques indicated a significant effect on chronic NSLBP; however, trunk-stability exercises combined with EMG biofeedback produced better results in alleviating the intensity of pain, increasing the range of motion, and improving functional disabilities and static balance. CONCLUSION The present study confirms that trunk-stability exercises with EMG biofeedback can be practiced safely, contributes to a greater boost in neuromuscular efficiency in the lumbar flexors and extensors, and is effective in modifying functional disability for patients with NSLBP.
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Affiliation(s)
- Shivani Porwal
- Department of Physiotherapy, School of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad 121001, India; (S.P.); (A.S.)
| | - Moattar Raza Rizvi
- School of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad 121001, India;
| | - Ankita Sharma
- Department of Physiotherapy, School of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad 121001, India; (S.P.); (A.S.)
| | - Fuzail Ahmad
- Respiratory Care Department, College of Applied Sciences, Almaarefa University, Diriya, Riyadh 13713, Saudi Arabia
| | - Mastour Saeed Alshahrani
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (M.S.A.); (B.A.A.); (D.M.)
| | - Abdullah Raizah
- Department of Orthopaedics, College of Medicine, King Khalid University, Abha 61413, Saudi Arabia;
| | - Abdul Rahim Shaik
- Department of Physical Therapy & Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majma’ah 15431, Saudi Arabia; (A.R.S.); (M.K.S.); (M.M.)
| | - Mohamed K. Seyam
- Department of Physical Therapy & Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majma’ah 15431, Saudi Arabia; (A.R.S.); (M.K.S.); (M.M.)
| | - Mohammad Miraj
- Department of Physical Therapy & Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majma’ah 15431, Saudi Arabia; (A.R.S.); (M.K.S.); (M.M.)
| | - Batool Abdulelah Alkhamis
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (M.S.A.); (B.A.A.); (D.M.)
| | - Debjani Mukherjee
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (M.S.A.); (B.A.A.); (D.M.)
| | - Irshad Ahmad
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (M.S.A.); (B.A.A.); (D.M.)
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Role of Advanced Glycation End Products in Intervertebral Disc Degeneration: Mechanism and Therapeutic Potential. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:7299005. [PMID: 36573114 PMCID: PMC9789911 DOI: 10.1155/2022/7299005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
The incidence of low back pain caused by lumbar disc degeneration is high, and it can lead to loss of work ability and impose heavy social and economic burdens. The pathogenesis of low back pain is unclear, and there are no effective treatments. With age, the deposition of advanced glycation end products (AGEs) in intervertebral disc (IVD) gradually increases and is accelerated by diabetes and a high-AGEs diet, leading to destruction of the annulus fibrosus (AF), nucleus pulposus (NP), and cartilage endplate (CEP) and finally intervertebral disc degeneration (IDD). Reducing the accumulation of AGEs in IVD and blocking the transmission of downstream signals caused by AGEs have a significant effect on alleviating IDD. In this review, we summarize the mechanism by which AGEs induce IDD and potential treatment strategies.
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Laborie F, Béal C, Sigaux J. Lumbar facet joint effusion. Joint Bone Spine 2022; 90:105516. [PMID: 36529420 DOI: 10.1016/j.jbspin.2022.105516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022]
Affiliation(s)
- Félix Laborie
- Service de rhumatologie, hôpital Avicenne, APHP, Bobigny, France
| | - Caroline Béal
- Service de rhumatologie, hôpital Avicenne, APHP, Bobigny, France
| | - Johanna Sigaux
- Service de rhumatologie, hôpital Avicenne, APHP, Bobigny, France; Inserm U1125, Bobigny, France; Université Sorbonne Paris Nord, UFR SMBH, Li2P, Bobigny, France.
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Tang L, Xu C, Xuan A, Zhu Z, Ruan D. Functionalized self-assembling peptide RADKPS hydrogels promote regenerative repair of degenerated intervertebral discs. Biomater Sci 2022; 10:5134-5145. [PMID: 35820128 DOI: 10.1039/d2bm00634k] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: the aim of this study was to investigate whether the functionalized self-assembling peptide hydrogel RADKPS is safe and effective for regenerative repair of degenerative intervertebral discs. Methods: an in vitro degenerative model of human nucleus pulposus cells was constructed by serum starvation culture, and their proliferation, apoptosis and viability were examined after three-dimensional culture with the RADKPS hydrogel. An in vivo degenerative model of the rabbit intervertebral disc was constructed by annulus fibrosus puncture, and the degeneration of the intervertebral disc was evaluated by imaging, histology, immunohistochemistry, and biomechanics after RADKPS hydrogel intervention. Results: through in vitro cell experiments it is shown that human degenerated nucleus pulposus cells after three-dimensional culture with the RADKPS hydrogel still exhibited better proliferation, viability, and low apoptosis rate. Through in vivo animal experiments we found that rabbit degenerated intervertebral discs intervened with the RADKPS hydrogel had higher water content, better histological morphology, more extracellular matrix synthesis, and better biomechanical properties. It is demonstrated that the RADKPS hydrogel may initiate the endogenous repair process through the sustained recruitment and enrichment of nucleus pulposus progenitor cells. Conclusion: it is verified from both in vitro cellular experiments and in vivo animal experiments that the regenerative repair effect of RADKPS, a functionalized self-assembling peptide hydrogel, on degenerated intervertebral discs is safe and effective. It is shown that it would be a new therapeutic approach for the regenerative repair action of intervertebral discs.
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Affiliation(s)
- Liang Tang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.,Department of Orthopedic Surgery, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China. .,Department of Orthopedic Surgery, Hengyang Central Hospital, Hunan, 421001, China
| | - Cheng Xu
- Department of Orthopedic Surgery, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China.
| | - Anwu Xuan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Zhenbiao Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Dike Ruan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.,Department of Orthopedic Surgery, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China.
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Nematimoez M, Thomas JS. The effect of head movement restriction on the kinematics of the spine during lifting and lowering tasks. ERGONOMICS 2022; 65:842-856. [PMID: 34694212 DOI: 10.1080/00140139.2021.1998646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to examine the effects of head movement restriction on relative angles and their derivatives using the stepwise segmentation approach during lifting and lowering tasks. Ten healthy men lifted and lowered a box using two styles (stoop and squat), with two loads (i.e. 10% and 20% of body weight); they performed these tasks with two instructed head postures [(1) Flexing the neck to keep contact between chin and chest over the task cycle; (2) No instruction, free head posture]. The neck flexion significantly affected the flexion angle of all segments of the spine and specifically the lumbar part. Additionally, this posture significantly affected the derivatives of the relative angles and manifested latency in spine segments movement, that is, cephalad-to-caudad or caudad-to-cephalad patterns. Conclusively, neck flexion as an awkward posture could increase the risk of low back pain during lifting and lowering tasks in occupational environments. Practitioner summary: Little information is available about the effects of neck flexion on other spine segments' kinematics and movement patterns, specifically about the lumbar spine. The result of this experimental study shows that neck flexion can increase the risk of low back pain by increasing lumbar flexion angle and spine awkward posture.
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Affiliation(s)
- Mehdi Nematimoez
- Department of Sport Science, University of Bojnord, Bojnord, Iran
| | - James S Thomas
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, USA
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Identification of SMIM1 and SEZ6L2 as Potential Biomarkers for Genes Associated with Intervertebral Disc Degeneration in Pyroptosis. DISEASE MARKERS 2022; 2022:9515571. [PMID: 35578687 PMCID: PMC9107366 DOI: 10.1155/2022/9515571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022]
Abstract
Background. Inflammatory reactions and pyroptosis play an important role in the pathology of intervertebral disc degeneration (IDD). The aim of the present study was to investigate pyroptosis in the nucleus pulposus cells (NPCs) of inflammatory induced IDD by bioinformatic methods and to search for possible diagnostic biomarkers. Methods. Gene expression profiles related to IDD were downloaded from the GEO database to identify differentially expressed genes (DEGs) between inflammation-induced IDD and non-inflammatory intervention samples. Pyroptosis genes were then searched for, and their expression in IDD was analyzed. Weighted gene co-expression network analysis (WGCNA) was then used to search for modules of IDD genes associated with pyroptosis and intersected with DEGs to discover candidate genes that would be diagnostically valuable. A LASSO model was developed to screen for genes that met the requirements, and ROC curves were created to clarify the diagnostic value of the genetic markers. Ultimately, the screened genes were further validated, and their diagnostic value assessed by selecting gene sets from the GEO database. RT-PCR was used to assess the mRNA expression of diagnostic markers in the nucleus pulposus (NP). Pan-cancer analysis was applied to demonstrate the expression and prognostic value of the screened genes in various tumors. Results. A total of 733 DEGs were identified in GSE41883 and GSE27494, which were mainly enriched in transmembrane receptor protein serine/threonine, kinase signaling pathway, response to lipopolysaccharide, and other biological processes, and they were mainly related to TGF beta signaling pathway, toll-like receptor signaling pathway, and TNF signaling pathway. A total of 81 genes related to pyroptosis were identified in the literature, and eight genes related to IDD were identified in the Veen diagram, namely, IL1A, IL1B, NOD2, GBP1, IL6, AK1, EEF2K, and PYCARD. Eleven candidate genes were obtained after locating the intersection of pyroptosis-related module genes and DEGs according to WGCNA analysis. A total of six valid genes were obtained after constructing a machine learning model, and five key genes were finally identified after correlation analysis. GSE23132 and GSE56081 validated the candidate genes, and the final IDD-related diagnostic markers were obtained as SMIM1 and SEZ6L2. RT-PCR results indicated that the mRNA expression of both was significantly elevated in IDD. The pan-cancer analysis demonstrated that SMIM1 and SEZ6L2 have important roles in the expression and prognosis of various tumors. Conclusion. In conclusion, this research identifies SMIM1 and SEZ6L2 as important biomarkers of IDD associated with pyroptosis, which will help to unravel the development and pathogenesis of IDD and determine potential therapeutic targets.
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Jia H, Lin X, Wang D, Wang J, Shang Q, He X, Wu K, Zhao B, Peng P, Wang H, Wang D, Li P, Yang L, Luo Z, Yang L. Injectable hydrogel with nucleus pulposus-matched viscoelastic property prevents intervertebral disc degeneration. J Orthop Translat 2022; 33:162-173. [PMID: 35415072 PMCID: PMC8980713 DOI: 10.1016/j.jot.2022.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 02/07/2023] Open
Abstract
Background/Objective Intervertebral disc (IVD) degeneration (IVDD) that greatly affected by regional biomechanical environment is a major cause of low back pain. Injectable hydrogels have been commonly studied for treatment of IVDD due to their capability of mimicking extracellular matrix structure to support cellular behavior and clinical prospects in minimally invasive treatment. However, most hydrogels suffer from complicated chemistry, potential uncertainty and toxicity from in-situ gelation, and mismatch with IVD mechanical environment that limit their therapeutic effects or clinical translation in IVDD or intervertebral disc defect repair. For IVD lesion repair, the study aims to develop a novel hydrogel with shear-thinning enabled injectability, high bio-safety, and mechanical properties adaptable to the IVD environment, using a simple chemistry and method. And therapeutic efficacy of the novel hydrogel in the treatment of IVDD or intervertebral disc defect will be revealed. Methods A glycerol cross-linked PVA gel (GPG) was synthesized based on multiple H-bonds formation between glycerol molecules and PVA chains. The rheological and mechanical properties were tested. The swelling ratio was measured. The micro-architecture was observed through scanning and transmission electron microscopes. Nucleus pulposus (NP) cells were cultured in GPG-coated plates or silicone chambers treated under hydrostatic or dynamic loading in vitro, and examined for proliferation, vitality, apoptosis, expression of catabolic and anabolic markers. GPG was injected in needle puncture (IDD) or NP discectomy (NPD) models in vivo, and examined through magnetic resonance imaging, micro-computed tomography scanning and histological staining. Results GPG had a highly porous structure consisting of interconnected pores. Meanwhile, the GPG had NP-like viscoelastic property, and was able to withstand the cyclic deformation while exhibiting a prominent energy-dissipating capability. In vitro cell tests demonstrated that, the hydrogel significantly down-regulated the expression of catabolic markers, maintained the level of anabolic markers, preserved cell proliferation and vitality, reduced apoptotic rate of NP cells under pathologically hydrostatic and dynamic loading environments compared to cells cultured on untreated plate or silicone chamber. In vivo animal studies revealed that injection of GPG efficiently maintained NP structural integrity, IVD height and relative water content in IDD models, and stimulated the fibrous repair in NPD models. Conclusion This study showed that GPG, with high injectability, NP-like viscoelastic characteristics, good energy-dissipating properties and swelling capacities, preserved NP cells vitality against pathological loading, and had therapeutic effects on IVD repair in IDD and NPD models. The translational potential of this article Effective clinical strategy for treatment of intervertebral disc degeneration (IVDD) is still lacking. This study demonstrates that injection of a hydrogel with nucleus pulposus-matched viscoelastic property could remarkably prevent the IVDD progress. Prepared with simple chemistry and procedure, the cell/drug-free GPG with high bio-safety and shear-thinning enabled injectability bears great translational potential for the clinical treatment of IVDD via a minimally invasive approach.
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Affiliation(s)
- Haoruo Jia
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xiao Lin
- Orthopedic Institute and Department of Orthopedics, The First Affiliated Hospital, Soochow University, Suzhou, 215000, China
| | - Dong Wang
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Jingwei Wang
- Department of Medicine Chemistry and Pharmaceutical Analysis, School of Pharmacy, Fourth Military Medical University, Xi'an, 710032, China
| | - Qiliang Shang
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xin He
- Department of Medicine Chemistry and Pharmaceutical Analysis, School of Pharmacy, Fourth Military Medical University, Xi'an, 710032, China
- Air Force Hospital of Eastern Theater Command, Nanjing, 210000, China
| | - Kang Wu
- Orthopedic Institute and Department of Orthopedics, The First Affiliated Hospital, Soochow University, Suzhou, 215000, China
| | - Boyan Zhao
- Department of Neurosurgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Pandi Peng
- Institute of Flexible Electronics, Northwestern Polytechnical University, Xi'an, 710129, China
| | - Han Wang
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Di Wang
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Pan Li
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
- Medical Research Institute, Northwestern Polytechnical University, Xi′an, 710032, China
| | - Liu Yang
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
- Medical Research Institute, Northwestern Polytechnical University, Xi′an, 710032, China
| | - Zhuojing Luo
- Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
- Medical Research Institute, Northwestern Polytechnical University, Xi′an, 710032, China
- Corresponding author. Institute of Orthopedic Surgery, The First Affiliated Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Lei Yang
- Orthopedic Institute and Department of Orthopedics, The First Affiliated Hospital, Soochow University, Suzhou, 215000, China
- Center for Health Science and Engineering (CHSE), School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300130, China
- Corresponding author. Center for Health Science and Engineering (CHSE), School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300130, China.
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11
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A potential target gene CD63 for different degrees of intervertebral disc degeneration. Sci Rep 2022; 12:957. [PMID: 35046480 PMCID: PMC8770635 DOI: 10.1038/s41598-022-05021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022] Open
Abstract
Understanding molecular mechanisms of intervertebral disc degeneration (IDD) and providing a novel target for the treatment of IDD have important implications. We sought to explore a new promising gene target for the treatment of IDD. This study integrated 19,678 genes of 38 IDD patients from two gene datasets. Differentially Expressed Genes (DEGs) of annulus fibrosus were analyzed in groups with mild disc degeneration (MDD) and severe disc degeneration (SDD). We screened the hub gene through biological information technology (bioinformatic) methods. Then, we further validated the hub gene using annulus fibrosus and nucleus pulposus tissues from 12 patients with qRT-PCR. In addition, we explored its underlying molecular mechanism with GO, KEGG and GSEA. Through multiple screening bioinformatics methods, the hub gene CD63 was identified. The qRT-PCR explored that CD63 decreased significantly in SDD group compared to that in MDD group (P < 0.001). The GO, KEGG and GSEA of CD63 explored significant enrichment of the molecular features (P < 0.001), including the cellular component (Extracellular matrix, P < 0.001), the molecular function (collagen binding, P < 0.001), the biological processes (protein targeting, collagen fibril organization and platelet degranulation, P < 0.001) and the signaling pathways. Our research explored and validated a new regulatory gene, CD63 for different degrees of IDD. A new novel form of therapeutic target for IDD may be developed.
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12
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Shetty S, KU DK, Chippala P. Supervised Physical Therapy Versus Video-Assisted Technique for Chronic Mechanical Low Back Pain: A Comparative Study. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0041-1740330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Objective To compare the effect of supervised physical therapy versus video-assisted technique in patients with chronic mechanical low back pain.
Materials and Methods This is a comparative study. Forty-two patients were recruited in the study where they were randomized by simple random sampling. Group A (n = 21) received supervised physical therapy, and Group B (n = 21) received the video-assisted technique. The intervention was given 45 minutes per day for 15 days. The measures of visual analog scale (VAS) and Roland–Morris Disability Questionnaire (RMQ) were taken both at baseline and after 15 days of intervention.
Results Comparison between the two groups using Mann–Whitney U test, supervised physiotherapy group showed significant improvement in VAS on activity, RMQ, and RMQ percentage (p < 0.005). However, Group A, VAS on rest was not significant (p > 0.005).
Conclusion Supervised physical therapy is effective in reducing pain on activity and improved the disability of patients with chronic mechanical low back pain than the video-assisted technique.
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Affiliation(s)
- Spoorthi Shetty
- Nitte Institute of Physiotherapy, Deralakatte, Mangalore, Karnataka, India
| | - Dhanesh Kumar KU
- Nitte Institute of Physiotherapy, Deralakatte, Mangalore, Karnataka, India
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13
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Intervertebral Disc Stem/Progenitor Cells: A Promising "Seed" for Intervertebral Disc Regeneration. Stem Cells Int 2021; 2021:2130727. [PMID: 34367292 PMCID: PMC8342144 DOI: 10.1155/2021/2130727] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is considered to be the primary reason for low back pain (LBP), which has become more prevalent from 21 century, causing an enormous economic burden for society. However, in spite of remarkable improvements in the basic research of IVD degeneration (IVDD), the effects of clinical treatments of IVDD are still leaving much to be desired. Accumulating evidence has proposed the existence of endogenous stem/progenitor cells in the IVD that possess the ability of proliferation and differentiation. However, few studies have reported the biological properties and potential application of IVD progenitor cells in detail. Even so, these stem/progenitor cells have been consumed as a promising cell source for the regeneration of damaged IVD. In this review, we will first introduce IVD, describe its physiology and stem/progenitor cell niche, and characterize IVDSPCs between homeostasis and IVD degeneration. We will then summarize recent studies on endogenous IVDSPC-based IVD regeneration and exogenous cell-based therapy for IVDD. Finally, we will discuss the potential applications and future developments of IVDSPC-based repair of IVD degeneration.
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14
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Yang F, Wang J, Chen Z, Yang Y, Zhang W, Guo S, Yang Q. Role of microRNAs in intervertebral disc degeneration (Review). Exp Ther Med 2021; 22:860. [PMID: 34178133 PMCID: PMC8220656 DOI: 10.3892/etm.2021.10292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
The incidence of lower back pain caused by intervertebral disc degeneration (IDD) is gradually increasing. IDD not only affects the quality of life of the patients, but also poses a major socioeconomic burden. There is currently no optimal method for delaying or reversing IDD, mainly due to its unknown pathogenesis. MicroRNAs (miRNAs/miRs) participate in the development of a number of diseases, including IDD. Abnormal expression of miRNAs in the intervertebral disc is implicated in various pathological processes underlying the development of IDD, including nucleus pulposus (NP) cell (NPC) proliferation, NPC apoptosis, extracellular matrix remodeling, inflammation and cartilaginous endplate changes, among others. The focus of the present review was the advances in research on the involvement of miRNAs in the mechanism underlying IDD. Further research is expected to identify markers for early diagnosis of IDD and new targets for delaying or reversing IDD.
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Affiliation(s)
- Fengguang Yang
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Jizu Wang
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Zhixin Chen
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Yuping Yang
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Wenhui Zhang
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Shifang Guo
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Qingshan Yang
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
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15
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Pennington Z, Ehresman J, McCarthy EF, Ahmed AK, Pittman PD, Lubelski D, Goodwin CR, Sciubba DM. Chordoma of the sacrum and mobile spine: a narrative review. Spine J 2021; 21:500-517. [PMID: 33589095 DOI: 10.1016/j.spinee.2020.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
Chordoma is a notochord-derived primary tumor of the skull base and vertebral column known to affect 0.08 to 0.5 per 100,000 persons worldwide. Patients commonly present with mechanical, midline pain with or without radicular features secondary to nerve root compression. Management of these lesions has classically revolved around oncologic resection, defined by en bloc resection of the lesion with negative margins as this was found to significantly improve both local control and overall survival. With advancement in radiation modalities, namely the increased availability of focused photon therapy and proton beam radiation, high-dose (>50 Gy) neoadjuvant or adjuvant radiotherapy is also becoming a standard of care. At present chemotherapy does not appear to have a role, but ongoing investigations into the ontogeny and molecular pathophysiology of chordoma promise to identify therapeutic targets that may further alter this paradigm. In this narrative review we describe the epidemiology, histopathology, diagnosis, and treatment of chordoma.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Edward F McCarthy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Patricia D Pittman
- Department of Neuropathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA.
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16
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Zaïri F, Moulart M, Fontaine C, Zaïri F, Tiffreau V, Logier R. Relevance of a novel external dynamic distraction device for treating back pain. Proc Inst Mech Eng H 2020; 235:264-272. [PMID: 33243076 DOI: 10.1177/0954411920971401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Low back pain is a common, expensive, and disabling condition in industrialized countries. There is still no consensus for its ideal management. Believing in the beneficial effect of traction, we developed a novel external dynamic distraction device. The purpose of this work was to demonstrate that external distraction allows limiting the pressure exerted in standing-up position on the lower intervertebral discs. Numerical and cadaveric studies were used as complementary approaches. Firstly, we implemented the device into a numerical model of a validated musculoskeletal software (Anybody Modeling System) and we calculated the lower disc pressure while traction forces were applied. Secondly, we performed an anatomical study using a non-formalin preserved cadaver placed in a sitting position. A pressure sensor was placed in the lower discs under fluoroscopic control through a Jamshidi needle. The intradiscal pressure was then measured continuously at rest while applying a traction force of 200 N. Both numerical and cadaveric studies demonstrated a decrease in intradiscal pressures after applying a traction force with the external device. Using the numerical model, we showed that tensile forces below 500 N in total were sufficient. The application of higher forces seems useless and potentially deleterious. External dynamic distraction device is able to significantly decrease the intradiscal pressure in a sitting or standing position. However, the therapeutic effects need to be proven using clinical studies.
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Affiliation(s)
- Fahed Zaïri
- Department of Neurosurgery, Hôpital privé Le Bois, Ramsay Générale de Santé, Lille, France
| | | | | | - Fahmi Zaïri
- Lille University, Civil Engineering and geo-Environmental Laboratory (ULR 4515 LGCgE), Lille, France
| | | | - Régis Logier
- CIC-IT, Lille University Hospital, Lille, France
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17
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Zhang T, Du L, Zhao J, Ding J, Zhang P, Wang L, Xu B. Biomimetic angle-ply multi-lamellar scaffold for annulus fibrosus tissue engineering. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:67. [PMID: 32705351 DOI: 10.1007/s10856-020-06404-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 05/21/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
Constructing a biomimetic scaffold that replicates the complex architecture of intervertebral disc annulus fibrosus (AF) remains a major goal in AF tissue engineering. In this study, a biomimetic angle-ply multi-lamellar polycaprolactone/silk fibroin (PCL/SF) AF scaffold was fabricated. Wet-spinning was used to obtain aligned PCL/SF microfiber sheets, and these were excised into strips with microfibers aligned at +30° or -30° relative to the strip long axis. This was followed by stacking two strips with opposing fiber alignment and wrapping them concentrically around a mandrel. Our results demonstrated that the scaffold possessed spatial structure and mechanical properties comparable to natural AF. The scaffold supported rabbit AF cells adhesion, proliferation, infiltration and guided oriented growth and extracellular matrix deposition. In conclusion, our angle-ply multi-lamellar scaffold offers a potential solution for AF replacement therapy and warrants further attention in future investigations.
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Affiliation(s)
- Tongxing Zhang
- Tianjin Medical University, Tianjin, PR China
- Department of Spine Surgery, Tianjin Hospital, Tianjin, PR China
| | - Lilong Du
- Tianjin Medical University, Tianjin, PR China
- Department of Spine Surgery, Tianjin Hospital, Tianjin, PR China
| | | | - Ji Ding
- Tianjin Medical University, Tianjin, PR China
- Department of Spine Surgery, Tianjin Hospital, Tianjin, PR China
| | - Peng Zhang
- Tianjin Medical University, Tianjin, PR China
| | - Lianyong Wang
- The Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, 300071, PR China
| | - Baoshan Xu
- Tianjin Medical University, Tianjin, PR China.
- Department of Spine Surgery, Tianjin Hospital, Tianjin, PR China.
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18
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Evans M, Sulley AM, Crowley DC, Langston J, Guthrie N. Pain Bloc-R Alleviates Unresolved, Non-Pathological Aches and Discomfort in Healthy Adults—A Randomized, Double-Blind, Placebo-Controlled, Crossover Study. Nutrients 2020; 12:nu12061831. [PMID: 32575480 PMCID: PMC7353407 DOI: 10.3390/nu12061831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022] Open
Abstract
The lack of effective treatment for chronic discomfort without negative side effects highlights the need for alternative treatments. Pain Bloc-R is a natural health product composed of vitamins B6, B12, D, white willow bark extract, Angelica root extract, acetyl L-carnitine HCl, caffeine, L-theanine, Benfotiamine, and L-tetrahydropalmatine. The objective of this study was to compare the effects of Pain Bloc-R, acetaminophen, and placebo on unresolved aches and discomfort as assessed by the brief pain inventory (BPI) and modified Cornell musculoskeletal discomfort questionnaires. This randomized, double-blind, placebo-controlled, crossover study consisted of three 7-day periods with Pain Bloc-R, acetaminophen, or placebo, each separated by a 7-day washout. Twenty-seven healthy adults (ages 22–63 years) were randomized to receive the three interventions in different sequences. The BPI “pain at its worst” scores were significantly lower when participants took Pain Bloc-R than when they took acetaminophen (21.8% vs. 9.8% decrease, p = 0.026) after seven days of supplementation. Pain Bloc-R achieved a significant improvement in the “pain at its least” score, significantly decreased the interference of discomfort in walking, and significantly decreased musculoskeletal discomfort total scores (34%, p = 0.040) after seven days. In a post hoc subgroup analysis based on age and gender, male participants ≤45 years taking Pain Bloc-R reported significant reductions in pain severity and pain interference vs. acetaminophen. Pain Bloc-R performed as well as acetaminophen in managing unresolved non-pathological pain in otherwise healthy individuals.
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Affiliation(s)
- Malkanthi Evans
- KGK Science Inc., London, ON N6A 5R8, Canada; (A.M.S.); (D.C.C.); (N.G.)
- Correspondence:
| | - Abdul M. Sulley
- KGK Science Inc., London, ON N6A 5R8, Canada; (A.M.S.); (D.C.C.); (N.G.)
| | - David C. Crowley
- KGK Science Inc., London, ON N6A 5R8, Canada; (A.M.S.); (D.C.C.); (N.G.)
| | | | - Najla Guthrie
- KGK Science Inc., London, ON N6A 5R8, Canada; (A.M.S.); (D.C.C.); (N.G.)
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Suzukamo C, Ishimaru K, Ochiai R, Osaki N, Kato T. Milk-Fat Globule Membrane Plus Glucosamine Improves Joint Function and Physical Performance: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study. J Nutr Sci Vitaminol (Tokyo) 2020; 65:242-250. [PMID: 31257264 DOI: 10.3177/jnsv.65.242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Care of the musculoskeletal system, including the muscles, joints, and bones, is important for a healthy life expectancy in today's aging society. The aim of this randomized, double-blind, placebo-controlled study was to investigate the effect of consumption of milk-fat globule membrane (MFGM) and glucosamine on joint function and physical performance. Participants were healthy Japanese men and women, aged 60-74 y, with a history of mild knee or low back pain at rest. They were randomized to receive tablets containing MFGM 1.0 g+glucosamine 1.5 g or placebo tablets for 8 wk. We assessed passive range of motion, active range of motion (self-reported VAS score), JKOM and JLEQ, and physical performance. Data were available for analysis for 25 participants in the active treatment group and 28 in the placebo group. The active group showed significant improvements in passive range of motion at the knee and active range of motion at both the knee and low back. The active group also showed significant improvements in some physical performance, including obstacle walking speed and speed of ascending stairs. The findings of this study suggest that consumption of a combination of MFGM and glucosamine may improve joint function and physical performance.
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Affiliation(s)
| | | | | | | | - Tatsuya Kato
- Medical Corporation Jikokai Kouki Internal Medicine Clinic
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20
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Veras MA, McCann MR, Tenn NA, Séguin CA. Transcriptional profiling of the murine intervertebral disc and age-associated changes in the nucleus pulposus. Connect Tissue Res 2020; 61:63-81. [PMID: 31597481 DOI: 10.1080/03008207.2019.1665034] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose/Aim: The intervertebral disc (IVD) is composed of cell types whose subtle phenotypic differences allow for the formation of distinct tissues. The role of the nucleus pulposus (NP) in the initiation and progression of IVD degeneration is well established; however, the genes and pathways associated with NP degeneration are poorly characterized.Materials and Methods: Using a genetic strategy for IVD lineage-specific fluorescent reporter expression to isolate cells, gene expression and bioinformatic analysis was conducted on the murine NP at 2.5, 6, and 21 months-of-age and the annulus fibrosus (AF) at 2.5 and 6 months-of-age. A subset of differentially regulated genes was validated by qRT-PCR.Results: Transcriptome analysis identified distinct profiles of NP and AF gene expression that were remarkably consistent at 2.5 and 6 months-of-age. Prg4, Cilp, Ibsp and Comp were increased >50-fold in the AF relative to NP. The most highly enriched NP genes included Dsc3 and Cdh6, members of the cadherin superfamily, and microRNAs mir218-1 and mir490. Changes in the NP between 2.5 and 6 months-of-age were associated with up-regulation of molecular functions linked to laminin and Bmp receptor binding (including up-regulation of Bmp5 & 7), with the most up-regulated genes being Mir703, Shh, and Sfrp5. NP degeneration was associated with molecular functions linked to alpha-actinin binding (including up-regulation of Ttn & Myot) and cytoskeletal protein binding, with the overall most up-regulated genes being Rnu3a, Snora2b and Mir669h.Conclusions: This study provided insight into the phenotypes of NP and AF cells, and identified candidate pathways that may regulate degeneration.
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Affiliation(s)
- Matthew A Veras
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The Bone and Joint Institute, The University of Western Ontario, London, Canada
| | - Matthew R McCann
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The Bone and Joint Institute, The University of Western Ontario, London, Canada.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Neil A Tenn
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The Bone and Joint Institute, The University of Western Ontario, London, Canada
| | - Cheryle A Séguin
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The Bone and Joint Institute, The University of Western Ontario, London, Canada
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Breen A, Claerbout E, Hemming R, Ayer R, Breen A. Comparison of intra subject repeatability of quantitative fluoroscopy and static radiography in the measurement of lumbar intervertebral flexion translation. Sci Rep 2019; 9:19253. [PMID: 31848427 PMCID: PMC6917745 DOI: 10.1038/s41598-019-55905-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/02/2019] [Indexed: 11/12/2022] Open
Abstract
Low back pain patients are sometimes offered fusion surgery if intervertebral translation, measured from static, end of range radiographs exceeds 3 mm. However, it is essential to know the measurement error of such methods, if selection for back surgery is going to be informed by them. Fifty-five healthy male (34) and female (21) pain free participants aged 21-80 years received quantitative fluoroscopic (QF) imaging both actively during standing and passively in the lateral decubitus position. The following five imaging protocols were extracted from 2 motion examinations, which were repeated 6 weeks apart: 1. Static during upright free bending. 2. Maximum during controlled upright bending, 3. At the end of controlled upright bending, 4. Maximum during controlled recumbent bending, 5. At the end of controlled recumbent bending. Intervertebral flexion translations from L2-S1 were determined for each protocol and their measurement errors (intra subject repeatability) calculated. Estimations using static, free bending radiographic images gave measurement errors of up to 4 mm, which was approximately twice that of the QF protocols. Significantly higher ranges at L4-5 and L5-S1 were obtained from the static protocol compared with the QF protocols. Weight bearing ranges at these levels were also significantly higher in males regardless of the protocol. Clinical decisions based on sagittal translations of less than 4 mm would therefore require QF imaging.
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Affiliation(s)
- Alexander Breen
- Centre for Biomechanics Research, AECC University College, Parkwood Rd, Bournemouth, BH5 2DF, UK
| | - Emilie Claerbout
- Centre for Biomechanics Research, AECC University College, Parkwood Rd, Bournemouth, BH5 2DF, UK
| | - Rebecca Hemming
- Arthritis Research UK Biomechanics and Bioengineering Centre, School of Healthcare Sciences, Cardiff University, Eastgate House 35 - 43 Newport Road, Cardiff, CF24 0AB, UK
| | - Ravi Ayer
- Radiology Department, Poole General Hospital NHS Foundation Trust, Longfleet Rd, Poole, BH15 2JB, UK
| | - Alan Breen
- Faculty of Science and Technology Bournemouth University, Fern Barrow, Poole, BH12 5BB, UK.
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Xia C, Zeng Z, Fang B, Tao M, Gu C, Zheng L, Wang Y, Shi Y, Fang C, Mei S, Chen Q, Zhao J, Lin X, Fan S, Jin Y, Chen P. Mesenchymal stem cell-derived exosomes ameliorate intervertebral disc degeneration via anti-oxidant and anti-inflammatory effects. Free Radic Biol Med 2019; 143:1-15. [PMID: 31351174 DOI: 10.1016/j.freeradbiomed.2019.07.026] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/26/2019] [Accepted: 07/23/2019] [Indexed: 01/08/2023]
Abstract
Excessive oxidative stress and inflammation are the key early events in the development of intervertebral disc degeneration (IVDD). The NACHT, LRR, and PYD domain-containing protein 3 (NLRP3) inflammasome has been identified as the major source of oxidative stress and the inflammatory responses and thus is an attractive therapeutic target for IVDD. However, currently, there are no reports on the use of mesenchymal stem cell (MSC)-derived exosomes to reduce NLRP3 inflammasome expression for IVDD treatment. The present study aimed to investigate the therapeutic effect of exosomes for use as IVDD therapeutics. We first manufactured and evaluated the characteristics of exosomes. Then, we investigated the effects of exosomes on H2O2-induced nucleus pulposus (NP) cell inflammation. Third, we tested the function of exosomes with respect to H2O2-induced ROS production and mitochondrial dysfunction. Finally, the therapeutic effect of exosomes on IVDD was investigated using a rabbit IVDD model. Results showed that exosomes play an anti-inflammatory role in pathological NP cells by suppressing inflammatory mediators and NLRP3 inflammasome activation. Moreover, it was suggested that exosomes might supply mitochondrial proteins to NP cells, and that the damaged mitochondria could be restored with this supplement. Further, in the rabbit IVDD model, exosomes significantly prevented the progression of degenerative changes. Our results confirmed that the NLRP3 inflammasome is an effective target for IVDD treatment and that the injection of exosomes could be a promising therapeutic strategy.
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Affiliation(s)
- Chen Xia
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China; Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Zhongyou Zeng
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corpsof Armed Police Forces, Jiaxing, China
| | - Bin Fang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Department of Orthopaedics, Shaoxing Central Hospital, Shaoxing, China
| | - Min Tao
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Chenhui Gu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Lin Zheng
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Yiyun Wang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Yiling Shi
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Chen Fang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Sheng Mei
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Qi Chen
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Juanjuan Zhao
- Department of Cardiology, Biomedical Research (Therapy) Center, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Xianfeng Lin
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Shunwu Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China.
| | - Yongming Jin
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.
| | - Pengfei Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China.
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Frapin L, Clouet J, Delplace V, Fusellier M, Guicheux J, Le Visage C. Lessons learned from intervertebral disc pathophysiology to guide rational design of sequential delivery systems for therapeutic biological factors. Adv Drug Deliv Rev 2019; 149-150:49-71. [PMID: 31445063 DOI: 10.1016/j.addr.2019.08.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/05/2019] [Accepted: 08/18/2019] [Indexed: 12/20/2022]
Abstract
Intervertebral disc (IVD) degeneration has been associated with low back pain, which is a major musculoskeletal disorder and socio-economic problem that affects as many as 600 million patients worldwide. Here, we first review the current knowledge of IVD physiology and physiopathological processes in terms of homeostasis regulation and consecutive events that lead to tissue degeneration. Recent progress with IVD restoration by anti-catabolic or pro-anabolic approaches are then analyzed, as are the design of macro-, micro-, and nano-platforms to control the delivery of such therapeutic agents. Finally, we hypothesize that a sequential delivery strategy that i) firstly targets the inflammatory, pro-catabolic microenvironment with release of anti-inflammatory or anti-catabolic cytokines; ii) secondly increases cell density in the less hostile microenvironment by endogenous cell recruitment or exogenous cell injection, and finally iii) enhances cellular synthesis of extracellular matrix with release of pro-anabolic factors, would constitute an innovative yet challenging approach to IVD regeneration.
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Przkora R, Kinsky MP, Fisher SR, Babl C, Heyde CE, Vasilopoulos T, Kaye AD, Volpi E. Functional Improvements Utilizing the Short Physical Performance Battery (SPPB) in the Elderly after Epidural Steroid Injections. Curr Pain Headache Rep 2019; 23:14. [PMID: 30796532 DOI: 10.1007/s11916-019-0748-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW The treatment of debilitating pain and loss of function secondary to lumbar stenosis is in high demand with the aging patient population. Options, including epidural steroid injections (ESIs) and medication therapy, are limited and it is unclear if they provide any functional improvements. In this prospective study, we evaluate functional outcomes in older adults with symptomatic lumbar stenosis treated with ESIs compared to those managed with medications by introducing the Short Physical Performance Battery (SPPB). Our study was IRB-approved and included 16 patients, 68 to 83 years old, with symptomatic back and radicular leg pain secondary to lumbar stenosis. Patients could elect to undergo a lumbar ESI (n = 11) or be treated via medication management (n = 5). Numeric pain score, SPPB score, and adverse events were measured and compared at baseline and a 1-month follow-up visit. RECENT FINDINGS Statistically significant improvements were observed from baseline compared to the 1-month follow-up for total SPPB score in the injection group. Similar improvements in the injection group were observed for pain scores and the SPPB subcomponents such as the 4-m walk test, chair stand time, and balance score. Comparatively, no statistically significant improvements were observed in the medication group. Lumbar ESIs improved objective physical capacity parameters and pain scores in elderly patients with symptomatic lumbar stenosis compared to medication management. In addition, the SPPB is an easy-to-use tool to measure changes in physical function in older adults and could easily be integrated into an outpatient pain clinic.
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Affiliation(s)
- Rene Przkora
- Department of Anesthesiology, University of Florida College of Medicine, SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA.
| | - Michael P Kinsky
- Departments of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Steve R Fisher
- Departments of Physical Therapy, University of Texas Medical Branch, Galveston, TX, USA
| | - Christopher Babl
- Department of Anesthesiology, University of Florida College of Medicine, SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA
| | - Christoph E Heyde
- Department of Orthopaedic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida College of Medicine, SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Elena Volpi
- Internal Medicine-Geriatrics, University of Texas Medical Branch, Galveston, TX, USA
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Chou L, Ranger TA, Peiris W, Cicuttini FM, Urquhart DM, Briggs AM, Wluka AE. Patients' perceived needs for allied health, and complementary and alternative medicines for low back pain: A systematic scoping review. Health Expect 2018; 21:824-847. [PMID: 29983004 PMCID: PMC6186543 DOI: 10.1111/hex.12676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Allied health and complementary and alternative medicines (CAM) are therapeutic therapies commonly accessed by consumers to manage low back pain (LBP). We aimed to identify the literature regarding patients' perceived needs for physiotherapy, chiropractic therapy and CAM for the management of LBP. METHODS A systematic scoping review of MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016) was conducted to identify studies examining patients' perceived needs for allied health and CAM for LBP. Data regarding study design and methodology were extracted. Areas of patients' perceived need for allied health and CAM were aggregated. RESULTS Forty-four studies from 2202 were included: 25 qualitative, 18 quantitative and 1 mixed-methods study. Three areas of need emerged: (i) physiotherapy was viewed as important, particularly when individually tailored. However, patients had concerns about adherence, adverse outcomes and correct exercise technique. (ii) Chiropractic therapy was perceived to be effective and needed by some patients, but others were concerned about adverse outcomes. (iii) An inconsistent need for CAM was identified with some patients perceiving a need, while others questioning the legitimacy and short-term duration of these therapies. CONCLUSIONS Our findings regarding patients' perceived needs for allied health and CAM for LBP may assist in informing development of more patient-centred guidelines and service models for LBP. Understanding patients' concerns regarding active-based physiotherapy, which is recommended in most guidelines, and issues surrounding chiropractic and CAM, which are generally not, may help inform management that better aligns patient's perceived needs with effective treatments, to improve outcomes for both patients and the health-care system.
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Affiliation(s)
- Louisa Chou
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Tom A. Ranger
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Waruna Peiris
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Flavia M. Cicuttini
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Donna M. Urquhart
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Andrew M. Briggs
- School of Physiotherapy and Exercise ScienceCurtin UniversityPerthWAAustralia
- Move: Muscle, Bone & Joint HealthMelbourneVicAustralia
| | - Anita E. Wluka
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
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Elevated Production of Nociceptive CC Chemokines and sE-Selectin in Patients With Low Back Pain and the Effects of Spinal Manipulation: A Nonrandomized Clinical Trial. Clin J Pain 2018; 34:68-75. [PMID: 29200015 PMCID: PMC5728592 DOI: 10.1097/ajp.0000000000000507] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The involvement of inflammatory components in the pathophysiology of low back pain (LBP) is poorly understood. It has been suggested that spinal manipulative therapy (SMT) may exert anti-inflammatory effects. PURPOSE The purpose of this study was to determine the involvement of inflammation-associated chemokines (CC series) in the pathogenesis of nonspecific LBP and to evaluate the effect of SMT on that process. METHODS Patients presenting with nonradicular, nonspecific LBP (minimum pain score 3 on 10-point visual analog scale) were recruited according to stringent inclusion criteria. They were evaluated for appropriateness to treat using a high velocity low amplitude manipulative thrust in the lumbar-lumbosacral region. Blood samples were obtained at baseline and following the administration of a series of 6 high velocity low amplitude manipulative thrusts on alternate days over the period of 2 weeks. The in vitro levels of CC chemokine ligands (CCL2, CCL3, and CCL4) production and plasma levels of an inflammatory biomarker, soluble E-selectin (sE-selectin), were determined at baseline and at the termination of treatments 2 weeks later. RESULTS Compared with asymptomatic controls baseline production of all chemokines was significantly elevated in acute (P=0.004 to <0.0001), and that of CCL2 and CCL4 in chronic LBP patients (P<0.0001). Furthermore, CCL4 production was significantly higher (P<0.0001) in the acute versus chronic LBP group. sE-selectin levels were significantly higher (P=0.003) in chronic but not in acute LBP patients. Following SMT, patient-reported outcomes showed significant (P<0.0001) improvements in visual analog scale and Oswestry Disability Index scores. This was accompanied by a significant decline in CCL3 production (P<0.0001) in both groups of patients. Change scores for CCL4 production differed significantly (P<0.0001) only for the acute LBP cohort, and no effect on the production of CCL2 or plasma sE-selectin levels was noted in either group. CONCLUSIONS The production of chemotactic cytokines is significantly and protractedly elevated in LBP patients. Changes in chemokine production levels, which might be related to SMT, differ in the acute and chronic LBP patient cohorts.
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Pavlova AV, Meakin JR, Cooper K, Barr RJ, Aspden RM. Variation in lifting kinematics related to individual intrinsic lumbar curvature: an investigation in healthy adults. BMJ Open Sport Exerc Med 2018; 4:e000374. [PMID: 30057776 PMCID: PMC6059291 DOI: 10.1136/bmjsem-2018-000374] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 12/30/2022] Open
Abstract
Objective Lifting postures are frequently implicated in back pain. We previously related responses to a static load with intrinsic spine shape, and here we investigate the role of lumbar spine shape in lifting kinematics. Methods Thirty healthy adults (18-65 years) performed freestyle, stoop and squat lifts with a weighted box (6-15 kg, self-selected) while being recorded by Vicon motion capture. Internal spine shape was characterised using statistical shape modelling (SSM) from standing mid-sagittal MRIs. Associations were investigated between spine shapes quantified by SSM and peak flexion angles. Results Two SSM modes described variations in overall lumbar curvature (mode 1 (M1), 55% variance) and the evenness of curvature distribution (mode 2 (M2), 12% variance). M1 was associated with greater peak pelvis (r=0.38, p=0.04) and smaller knee flexion (r=-0.40, p=0.03) angles; individuals with greater curviness preferred to lift with a stooped lifting posture. This was confirmed by analysis of those individuals with very curvy or very straight spines (|M1|>1 SD). There were no associations between peak flexion angles and mode scores in stoop or squat trials (p>0.05). Peak flexion angles were positively correlated between freestyle and squat trials but not between freestyle and stoop or squat and stoop, indicating that individuals adjusted knee flexion while maintaining their preferred range of lumbar flexion and that 'squatters' adapted better to different techniques than 'stoopers'. Conclusion Spinal curvature affects preferred lifting styles, and individuals with curvier spines adapt more easily to different lifting techniques. Lifting tasks may need to be tailored to an individual's lumbar spine shape.
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Affiliation(s)
- Anastasia V Pavlova
- Arthritis and Musculoskeletal Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Judith R Meakin
- Biophysics Research Group, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Faculty of Health and Social Care, Aberdeen, UK
| | - Rebecca J Barr
- Arthritis and Musculoskeletal Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Richard M Aspden
- Arthritis and Musculoskeletal Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Breen A, Mellor F, Breen A. Aberrant intervertebral motion in patients with treatment-resistant nonspecific low back pain: a retrospective cohort study and control comparison. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2831-2839. [PMID: 29926209 DOI: 10.1007/s00586-018-5666-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/02/2018] [Accepted: 06/12/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Intervertebral kinematic assessments have been used to investigate mechanical causes when back pain is resistant to treatment, and recent studies have identified intervertebral motion markers that discriminate patients from controls. However, such patients are a heterogeneous group, some of whom have structural disruption, but the effects of this on intervertebral kinematics are unknown. METHODS Thirty-seven patients with treatment-resistant back pain referred for quantitative fluoroscopy were matched to an equal number of pain-free controls for age and sex. All received passive recumbent flexion assessments for intervertebral motion sharing inequality (MSI), variability (MSV), laxity and translation. Comparisons were made between patient subgroups, between patients and controls and against normative levels from a separate group of controls. RESULTS Eleven patients had had surgical or interventional procedures, and ten had spondylolisthesis or pars defects. Sixteen had no disruption. Patients had significantly higher median MSI values (0.30) than controls (0.27, p = 0.010), but not MSV (patients 0.08 vs controls 0.08, p = 0.791). Patients who received invasive procedures had higher median MSI values (0.37) than those with bony defects (0.30, p = 0.018) or no disruption (0.28, p = 0.0007). Laxity and translation above reference limits were not more prevalent in patients. CONCLUSION Patients with treatment-resistant nonspecific back pain have greater MSI values than controls, especially if the former have received spinal surgery. However, excessive laxity, translation and MSV are not more prevalent in these patients. Thus, MSI should be investigated as a pain mechanism and for its possible value as a prognostic factor and/or target for treatment in larger patient populations. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Alexander Breen
- Centre for Biomechanics Research, AECC University College, Parkwood Campus, Bournemouth, BH5 2DF, UK
| | - Fiona Mellor
- Centre for Biomechanics Research, AECC University College, Parkwood Campus, Bournemouth, BH5 2DF, UK
| | - Alan Breen
- Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK.
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Zanjani-Pour S, Meakin JR, Breen A, Breen A. Estimation of in vivo inter-vertebral loading during motion using fluoroscopic and magnetic resonance image informed finite element models. J Biomech 2018; 70:134-139. [DOI: 10.1016/j.jbiomech.2017.09.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/23/2017] [Accepted: 09/25/2017] [Indexed: 11/30/2022]
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30
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Brady SRE, Monira Hussain S, Brown WJ, Heritier S, Wang Y, Teede H, Urquhart DM, Cicuttini FM. Predictors of Back Pain in Middle-Aged Women: Data From the Australian Longitudinal Study of Women's Health. Arthritis Care Res (Hoboken) 2017; 69:709-716. [DOI: 10.1002/acr.22982] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/20/2016] [Accepted: 06/28/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Sharmayne R. E. Brady
- School of Public Health and Preventive Medicine, Monash University; Melbourne Victoria Australia
| | - Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University; Melbourne Victoria Australia
| | - Wendy J. Brown
- School of Human Movement and Nutrition Studies, University of Queensland; St. Lucia Queensland Australia
| | - Stephane Heritier
- School of Public Health and Preventive Medicine, Monash University; Melbourne Victoria Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University; Melbourne Victoria Australia
| | - Helena Teede
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, and Monash Health; Clayton Victoria Australia
| | - Donna M. Urquhart
- School of Public Health and Preventive Medicine, Monash University; Melbourne Victoria Australia
| | - Flavia M. Cicuttini
- School of Public Health and Preventive Medicine, Monash University; Melbourne Victoria Australia
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Nam JW, Moon HS, Kim YH, Han BM. Percutaneous mechanical lumbar disc decompression using the enSpireTM interventional discectomy system: a preliminary study. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.1.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jin Woo Nam
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Sik Moon
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hye Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo Mi Han
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Schmocker A, Khoushabi A, Frauchiger DA, Gantenbein B, Schizas C, Moser C, Bourban PE, Pioletti DP. A photopolymerized composite hydrogel and surgical implanting tool for a nucleus pulposus replacement. Biomaterials 2016; 88:110-9. [DOI: 10.1016/j.biomaterials.2016.02.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/06/2016] [Accepted: 02/15/2016] [Indexed: 11/25/2022]
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Brady SRE, Hussain SM, Brown WJ, Heritier S, Billah B, Wang Y, Teede H, Urquhart DM, Cicuttini FM. Relationships Between Weight, Physical Activity, and Back Pain in Young Adult Women. Medicine (Baltimore) 2016; 95:e3368. [PMID: 27175634 PMCID: PMC4902476 DOI: 10.1097/md.0000000000003368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Back pain causes enormous financial and disability burden worldwide, which could potentially be reduced by understanding its determinants to develop effective prevention strategies. Our aim was to identify whether modifiable risk factors, weight and physical activity, are predictive of back pain in young adult women.Women born between 1973 and 1978 were randomly selected from the national health insurance scheme database to participate in The Australian Longitudinal Study of Women's Health. Self-reported data on back pain in the last 12 months, weight, height, age, education status, physical activity, and depression were collected in 2000, 2003, 2006, 2009, and 2012. In 2000, 9688 women completed the questionnaire and 83% completed follow-up 12 years later.At baseline, median age was 24.6 years and 41% had self-reported back pain. For every 5 kg higher weight at baseline, there was a 5% (95% confidence interval [CI] 4%-6%) increased risk of back pain over the next 12 years. Higher weight at each survey also predicted back pain risk 3 years later (P < 0.001). The effects of weight on back pain were most significant in those with BMI ≥25 kg/m and were observed at all levels of physical activity. Inadequate physical activity and depression were independent predictors of back pain over the following 12 years (both P < 0.001), after adjusting for age, weight, height, and education status.Back pain is common in community-based young adult women. Higher weight, inadequate levels of physical activity, and depression were all independent predictors of back pain over the following decade. Furthermore, the adverse effects of weight on back pain were not mitigated by physical activity. Our findings highlight the role of both higher weight and physical inactivity in back pain among young women and suggest potential opportunities for future prevention.
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Affiliation(s)
- Sharmayne R E Brady
- From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria (SREB, SMH, SH, BB, YW, DMU, FMC); School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, Queensland (WJB); Monash Center for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University (HT); and Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia (HT)
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