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Kehl C, Suter M, Johannesdottir E, Dörig M, Bangerter C, Meier ML, Schmid S. Associations between pain-related fear and lumbar movement variability during activities of daily living in patients with chronic low back pain and healthy controls. Sci Rep 2024; 14:22889. [PMID: 39358482 PMCID: PMC11447241 DOI: 10.1038/s41598-024-73430-8] [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: 02/22/2024] [Accepted: 09/17/2024] [Indexed: 10/04/2024] Open
Abstract
Low back pain (LBP) is a global issue involving biological, psychological, and social factors. Pain-related fear has been shown to influence movement behavior, however, its association with some measures of movement behavior, such as spinal movement variability, remains inconclusive. To further investigate this, spinal kinematics during various activities of daily living (i.e., walking, running, lifting, and stair climbing) of 49 patients with chronic LBP and a group of 51 sex-, age-, and BMI-matched healthy controls were used to calculate lumbar spine movement variability which was quantified using different indices (i.e., coefficient of variation, coupling angle variability in vector coding, deviation phase of the continuous relative phase and an angle-angular velocity variability). General and task-specific pain-related fear was assessed using the Tampa Scale of Kinesiophobia and the Photograph Series of Daily Activities-Short Electronic Version, respectively. Linear regression analyses showed no significant association between movement variability and pain-related fear, however, the sample consisted of younger individuals with moderate disability and with low levels of pain and pain-related fear. In addition, the different variability indices were weakly correlated and varied greatly depending on the method used and the task performed. Therefore, comparisons between studies with different movement variability calculation methods or different activities should be treated with caution.
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Affiliation(s)
- Corinne Kehl
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Magdalena Suter
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Embla Johannesdottir
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Monika Dörig
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Bangerter
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Michael L Meier
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Schmid
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
- Faculty of Medicine, University of Basel, Basel, Switzerland.
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Stover JD, Trone MAR, Weston J, Lewis C, Levis H, Farhang N, Philippi M, Zeidan M, Lawrence B, Bowles RD. Therapeutic CRISPR epigenome editing of inflammatory receptors in the intervertebral disc. Mol Ther 2024:S1525-0016(24)00610-5. [PMID: 39295148 DOI: 10.1016/j.ymthe.2024.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 08/07/2024] [Accepted: 09/13/2024] [Indexed: 09/21/2024] Open
Abstract
Low back pain (LBP) ranks among the leading causes of disability worldwide and generates a tremendous socioeconomic cost. Disc degeneration, a leading contributor to LBP, can be characterized by the breakdown of the extracellular matrix of the intervertebral disc (IVD), disc height loss, and inflammation. The inflammatory cytokine tumor necrosis factor α (TNF-α) has multiple signaling pathways, including proinflammatory signaling through tumor necrosis factor receptor 1 superfamily, member 1a (TNFR1 or TNFRSF1A), and has been implicated as a primary mediator of disc degeneration. We tested our ability to regulate the TNFR1 signaling pathway in vivo, utilizing CRISPR epigenome editing to slow the progression of disc degeneration in rats. Sprague-Dawley rats were treated with TNF-α and CRISPR interference (CRISPRi)-based epigenome-editing therapeutics targeting TNFR1, showing decreased behavioral pain in a disc degeneration model. Surprisingly, while treatment with the vectors alone was therapeutic, the TNF-α injection became therapeutic after TNFR1 modulation. These results suggest direct inflammatory receptor modulation as a potent strategy for treating disc degeneration.
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Affiliation(s)
- Joshua D Stover
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Matthew A R Trone
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Jacob Weston
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Christian Lewis
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Hunter Levis
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Niloofar Farhang
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Matthew Philippi
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84112, USA
| | - Michelle Zeidan
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84112, USA
| | - Brandon Lawrence
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84112, USA
| | - Robby D Bowles
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84112, USA.
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Chauhan D, Sharma S. Adjunctive Approach to Therapeutic Laser and Exercise Therapies in Alleviating Pain and Disability in Patients with Low Back Pain: A Systematic Review. J Lifestyle Med 2024; 14:69-79. [PMID: 39280939 PMCID: PMC11391339 DOI: 10.15280/jlm.2024.14.2.69] [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: 04/08/2024] [Revised: 05/02/2024] [Accepted: 05/16/2024] [Indexed: 09/18/2024] Open
Abstract
Low back pain (LBP), a globally prevalent musculoskeletal condition, affects mobility, mental well-being, and overall quality of life. It is generally caused by disc degeneration, muscular strain, ligamentous sprain, or a disease located at the lumbar spine. Owing to this disability, the social and occupational interactions of an individual might get affected. Modern medicine frequently combines exercise therapy with light amplification by stimulated emission of radiation (LASER) therapy, especially high intensity LASER therapy (HILT) or low level LASER therapy (LLLT), to increase the efficacy of the treatment modalities for LBP. This review aimed to determine the effect of the combined approach of LASER and exercise therapies in managing pain and reducing disability in patients with LBP. PubMed, Google Scholar, Cochrane Library, MEDLINE, and PEDro were searched for full-text research articles published from 2000 to 2023. Overall, 3,913 records were screened from these databases and six high methodological quality studies (PEDro ≥ 5) were included in this review after eligibility assessment. Review manager 5.4.1 was utilized to evaluate the overall quality of the review articles. In conclusion, HILT and LLLT serve as effective adjuncts to exercise therapy in treating LBP, contributing to pain reduction and disability alleviation.
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Affiliation(s)
- Divya Chauhan
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Haryana, India
| | - Sunita Sharma
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Haryana, India
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Kögl N, Petr O, Löscher W, Liljenqvist U, Thomé C. Lumbar Disc Herniation—the Significance of Symptom Duration for the Indication for Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:440-448. [PMID: 38835174 DOI: 10.3238/arztebl.m2024.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Lumbar disc surgery is among the more common spinal procedures. In this paper, we report the current treatment recommendations for patients with symptomatic disc herniation. METHODS This review is based on pertinent publications retrieved by a selective literature search in PubMed using the terms [timing] AND [lumbar disc herniation], supplemented by other relevant articles and guidelines. RESULTS Symptoms resolve in 60% to 80% of patients with herniated discs in 6-12 weeks, and in 80% to 90% over the long term (≥ 1 year). According to the guidelines, 6-12 weeks of conservative treatment are recommended in the absence of significant neu - rologic deficits. Early surgery is indicated in case of worsening pain or new onset of neurologic deficits. Lumbar disc herniation associated bladder or bowel dysfunction (cauda equina syndrome) is considered an absolute surgical emergency that requires immediate decompression (within 24 to 48 hours). Patients with severe motor deficits (MRC ≤ 3/5) benefit from early intervention and should be offered surgery within three days, if possible, for the best chance of recovery. The degree of weakness and the duration of symptoms have been identified as risk factors for incomplete recovery. Early surgery can be considered in patients with mild paresis (MRC 4/5) in case of functional impairment (e.g., quadriceps paresis). CONCLUSION Longer symptom duration and lower motor scores are associated with worse outcome and a lower chance of neurologic recovery. The recovery rate for motor deficits ranges from 33% to 75%, depending on the timing and modality of treatment as well as the motor score.
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Miller A, Candido KD, Knezevic NN, Rivera J, Lunseth P, Levinson DJ, Formoso F, Solanki D, Tavel E, Krull A, Radnovich R, Burkhead D, Souza D, Helm S, Katz N, Dworkin RH, Cohen SP, Rathmell JP, Buvanendran A, Levin J, Stannard E, Ambrose C, Jaros M, Vought K, Lissin D. A randomized, placebo-controlled trial of long-acting dexamethasone viscous gel delivered by transforaminal injection for lumbosacral radicular pain. Pain 2024:00006396-990000000-00626. [PMID: 38875121 DOI: 10.1097/j.pain.0000000000003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 04/29/2024] [Indexed: 06/16/2024]
Abstract
TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03372161.
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Affiliation(s)
- Alan Miller
- Coastal Clinical Research Specialists, Fernandina Beach, FL, United States
| | | | | | - José Rivera
- Tampa Pain Relief Center, Tampa, FL, United States
| | - Paul Lunseth
- Clinical Research of West Florida, Inc, Tampa, FL, United States
| | - Dennis J Levinson
- Chicago Clinical Research Institute, Inc, Chicago, IL, United States
| | - Ferdinand Formoso
- Coastal Clinical Research Specialists, Jacksonville, FL, United States
| | | | - Edward Tavel
- Clinical Trials of South Carolina, Charleston, SC, United States
| | - Angela Krull
- Physicians' Research Options, LLC, Draper, UT, United States
| | | | | | - Dmitri Souza
- Western Reserve Hospital, Cuyahoga Falls, OH, United States
| | - Standiford Helm
- The Helm Center for Pain Management, Laguna Hills, CA, United States
| | | | - Robert H Dworkin
- Department of Anesthesiology and Perioperative Medicine, Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - James P Rathmell
- Department of Anethesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | | | - Joshua Levin
- Departments of Orthopedic Surgery and Neurosurgery, Stanford University, Stanford, CA, United States
| | - Elizabeth Stannard
- Clinical Development and Medical Affairs, Consultants to Scilex Holding Company, Palo Alto, CA, United States
| | - Chris Ambrose
- Clinical Development, Scilex Holding Company, Palo Alto, CA, United States
| | - Mark Jaros
- Summit Analytical LLC, Denver, CO, United States
| | - Kip Vought
- Clinical Development and Medical Affairs, Consultants to Scilex Holding Company, Palo Alto, CA, United States
| | - Dmitri Lissin
- Clinical Development, Scilex Holding Company, Palo Alto, CA, United States
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Molina-Payá FJ, Sánchez Romero EA, Fernández-Carnero S, Noguera-Iturbe Y, Selva-Sarzo F. Effect of transcutaneous neuromodulation on normalization of dermal body temperature and pain in a tender scar in the presence of low back pain: An update and case report. SAGE Open Med Case Rep 2024; 12:2050313X241249058. [PMID: 38746022 PMCID: PMC11092538 DOI: 10.1177/2050313x241249058] [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: 11/17/2023] [Accepted: 04/05/2024] [Indexed: 05/16/2024] Open
Abstract
Low back pain affects over 20% of individuals during their lifetime, and in some patients, it may be associated with scar tissue formation after surgery. Small-fiber neuropathy and scar tissue dysfunction can lead to localized pain by affecting signals to the thalamus. Transcutaneous neuromodulation using Tape with Magnetic Particles shows promise in relieving perceived pain, modulating vascularization and the autonomic nervous system, and reducing dermal temperature. In the present case, a 24-year-old woman with L5-S1 disk herniation experienced low back pain and leg pressure. The surgical intervention provided temporary relief, but scar restrictions caused pain recurrence. Tape with Magnetic Particles application initially induced scar hypothermia and pressure tolerance during posteroanterior tests on lumbar spinous processes increased, reducing pain perception for at least 12 h. Transcutaneous neuromodulation with Tape with Magnetic Particles modulated dermal temperature immediately and for 12 h, reducing perceived pain and sustaining improvement thereafter. This highlights the potential of Tape with Magnetic Particles in managing chronic low back pain associated with scar tissue.
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Affiliation(s)
- Francisco J Molina-Payá
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, Elche Campus, Elx, Alicante, Comunitat Valenciana, Spain
| | - Eleuterio A. Sánchez Romero
- Department of Rehabilitation, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), Madrid, Spain
- Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute-Segovia de Arana (IDIPHISA), Majadahonda, Spain
| | - Samuel Fernández-Carnero
- Department of Rehabilitation, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Universidad de Alcalá, Facultad de Enfermería y Fisioterapia, Departamento Fisioterapia, Grupo de Investigación en Fisioterapia y Dolor, Alcalá de Henares, Spain
| | - Yolanda Noguera-Iturbe
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, Elche Campus, Elx, Alicante, Comunitat Valenciana, Spain
| | - Francisco Selva-Sarzo
- Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Department of Physiotherapy, University of Valencia, Valencia, Spain
- Department of Physiotherapy, University of Valencia, Master of Permanent Training in Assessment, Physiotherapy and Performance in Sport, Valencia, Spain
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Wang W, Pan D, Liu Q, Chen X, Wang S. L-Carnitine in the Treatment of Psychiatric and Neurological Manifestations: A Systematic Review. Nutrients 2024; 16:1232. [PMID: 38674921 PMCID: PMC11055039 DOI: 10.3390/nu16081232] [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: 03/21/2024] [Revised: 04/13/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE L-carnitine (LC), a vital nutritional supplement, plays a crucial role in myocardial health and exhibits significant cardioprotective effects. LC, being the principal constituent of clinical-grade supplements, finds extensive application in the recovery and treatment of diverse cardiovascular and cerebrovascular disorders. However, controversies persist regarding the utilization of LC in nervous system diseases, with varying effects observed across numerous mental and neurological disorders. This article primarily aims to gather and analyze database information to comprehensively summarize the therapeutic potential of LC in patients suffering from nervous system diseases while providing valuable references for further research. METHODS A comprehensive search was conducted in PubMed, Web Of Science, Embase, Ovid Medline, Cochrane Library and Clinicaltrials.gov databases. The literature pertaining to the impact of LC supplementation on neurological or psychiatric disorders in patients was reviewed up until November 2023. No language or temporal restrictions were imposed on the search. RESULTS A total of 1479 articles were retrieved, and after the removal of duplicates through both automated and manual exclusion processes, 962 articles remained. Subsequently, a meticulous re-screening led to the identification of 60 relevant articles. Among these, there were 12 publications focusing on hepatic encephalopathy (HE), while neurodegenerative diseases (NDs) and peripheral nervous system diseases (PNSDs) were represented by 9 and 6 articles, respectively. Additionally, stroke was addressed in five publications, whereas Raynaud's syndrome (RS) and cognitive disorder (CD) each had three dedicated studies. Furthermore, migraine, depression, and amyotrophic lateral sclerosis (ALS) each accounted for two publications. Lastly, one article was found for other symptoms under investigation. CONCLUSION In summary, LC has demonstrated favorable therapeutic effects in the management of HE, Alzheimer's disease (AD), carpal tunnel syndrome (CTS), CD, migraine, neurofibromatosis (NF), PNSDs, RS, and stroke. However, its efficacy appears to be relatively limited in conditions such as ALS, ataxia, attention deficit hyperactivity disorder (ADHD), depression, chronic fatigue syndrome (CFS), Down syndrome (DS), and sciatica.
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Affiliation(s)
- Wenbo Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China; (W.W.); (D.P.); (X.C.)
| | - Da Pan
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China; (W.W.); (D.P.); (X.C.)
| | - Qi Liu
- Department of Public Health, School of Medicine, Xizang Minzu University, Xianyang 712082, China;
| | - Xiangjun Chen
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China; (W.W.); (D.P.); (X.C.)
- Department of Public Health, School of Medicine, Xizang Minzu University, Xianyang 712082, China;
| | - Shaokang Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China; (W.W.); (D.P.); (X.C.)
- Department of Public Health, School of Medicine, Xizang Minzu University, Xianyang 712082, China;
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Li W, Djuric N, Cobbaert C, Vleggeert-Lankamp CLA. Modic Changes in the Lumbar Spine: Exploring Their Association with Abdominal Aortic Calcification as a Potential Indicator of Systemic Atherosclerosis. World Neurosurg 2024; 184:e503-e510. [PMID: 38310947 DOI: 10.1016/j.wneu.2024.01.157] [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: 09/07/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND This was a cross-sectional study on the correlation between abdominal aortic calcification (AAC) and Modic changes (MC). Little is known regarding the etiology of MC in the lumbar spine. Currently, insufficient vascularization of the endplate has been proposed to contribute to the appearance of MC. Our objective was to investigate whether AAC, a marker for a poor vascular status, is associated with MC in patients suffering from degenerative disc disease. METHODS Radiologic images of patients (n = 130) suffering from degenerative lumbar disc disease were reviewed. Type and severity of MC were assessed using magnetic resonance images, and severity of AAC was evaluated using computed tomography images or fluoroscopy. Both items were dichotomized into minimal and relevant grades. The correlation between them was studied using Spearman's correlation test, with age as a covariate. RESULTS Of the patients, 113 (87%) demonstrated MC (31% type I, 63% type II, and 6% type III) (55% relevant grade), and 68% had AAC (44% relevant grade). Spearman statistical analysis revealed that AAC was correlated with age (P < 0.001), whereas MC were not (P = 0.142). AAC severity was significantly correlated with MC, remaining so after age adjustment (P < 0.05). While MC type I lacked correlation with AAC, MC type II were significantly correlated with AAC (0.288, P = 0.015); however, this association lost significance after adjusting for age (P = 0.057). CONCLUSIONS AAC and MC (mainly MC type II) are associated, indicating that reduced blood supply or even a poor systemic vascularization status due to atherosclerotic disease may play a role in the formation of MC. Future studies focusing on the etiology of MC should pay more attention to patients' vascular status and determinants of abdominal aorta calcification.
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Affiliation(s)
- Wensen Li
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden, Netherlands.
| | - Niek Djuric
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden, Netherlands
| | - Christa Cobbaert
- Department of Clinical Chemistry, Leiden University Medical Center, Leiden, Netherlands
| | - Carmen L A Vleggeert-Lankamp
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden, Netherlands; Spaarne Gasthuis, Haarlem/Hoofddorp, Leiden, Netherlands
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Nasir A, Afridi OK, Ullah S, Khan H, Bai Q. Mitigation of sciatica injury-induced neuropathic pain through active metabolites derived from medicinal plants. Pharmacol Res 2024; 200:107076. [PMID: 38237646 DOI: 10.1016/j.phrs.2024.107076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
Sciatica characterized by irritation, inflammation, and compression of the lower back nerve, is considered one of the most common back ailments globally. Currently, the therapeutic regimens for sciatica are experiencing a paradigm shift from the conventional pharmacological approach toward exploring potent phytochemicals from medicinal plants. There is a dire need to identify novel phytochemicals with anti-neuropathic potential. This review aimed to identify the potent phytochemicals from diverse medicinal plants capable of alleviating neuropathic pain associated with sciatica. This review describes the pathophysiology of sciatic nerve pain, its cellular mechanisms, and the pharmacological potential of various plants and phytochemicals using animal-based models of sciatic nerve injury-induced pain. Extensive searches across databases such as Medline, PubMed, Web of Science, Scopus, ScienceDirect, and Google Scholar were conducted. The findings highlights 39 families including Lamiaceae, Asteraceae, Fabaceae, and Apocyanaceae and Cucurbitaceae, effectively treating sciatic nerve injury-induced pain. Flavonoids made up 53% constituents, phenols and terpenoids made up 15%, alkaloids made up 13%, and glycosides made up 6% to be used in neuorpathic pain. Phytochemicals derived from various medicinal plants can serve as potential therapeutic targets for both acute and chronic sciatic injury-induced neuropathic pain.
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Affiliation(s)
- Abdul Nasir
- Department of Anesthesiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Medical Research Center, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Sami Ullah
- Department of Biochemistry, Abdul Wali Khan University, Mardan, Pakistan
| | - Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University Mardan, Pakistan.
| | - Qian Bai
- Department of Anesthesiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Medical Research Center, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Ryf C, Hofstetter L, Clack L, Hincapié CA. Involving patients and clinicians in the development of a randomised clinical trial protocol to assess spinal manual therapy versus nerve root injection for patients with lumbar radiculopathy: a patient and public involvement project to inform the SALuBRITY trial design. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:8. [PMID: 38229190 DOI: 10.1186/s40900-023-00536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Spinal manual therapy and corticosteroid nerve root injection are commonly used to treat patients with lumbar radiculopathy. The SALuBRITY trial-a two parallel group, double sham controlled, randomised clinical trial-is being developed to compare their effectiveness. By gathering patients' and clinicians' perspectives and involving them in discussions related to the trial research question and objectives, proposed trial recruitment processes, methods, and outcome measures, we aimed to improve the relevance and quality of the SALuBRITY trial. METHODS We involved patients with lived experience of lumbar radiculopathy (n = 5) and primary care clinicians (n = 4) with experience in the treatment of these patients. Involvement activities included an initial kick-off event to introduce the project, establishing a shared purpose statement, and empowering patient and clinician advisors for their involvement, followed by semi-structured group and individual interviews, and questionnaires to evaluate the experience throughout the project. RESULTS Both patient and clinician advisors endorsed the significance and relevance of the trial's objectives. Patients assessed the proposed trial methods as acceptable within the context of a trusting patient-clinician relationship. A trial recruitment and enrolment target time of up to five days was regarded as acceptable, although patients with chronic radiculopathy may need more time to consider their trial participation decision. All advisors reached consensus on the acceptability of a medication washout phase of 12- to 24-h before pain outcome measurement, with the inclusion of a rescue medication protocol. Both advisory groups preferred leg pain over back pain as the primary clinical outcome, with patient advisors advocating for personalized primary pain localization. Furthermore, patients requested expanding the pain, enjoyment, and general activity scale with peak pain intensity, rather than average pain alone. Patient and clinician advisors evaluated their engagement in clinical research as meaningful and impactful. CONCLUSION Patient and public involvement resulted in important and relevant considerations for the SALuBRITY trial, spanning all research phases. These findings hold promise for enhancing the trial's quality and relevance and improving its translation into clinical practice.
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Affiliation(s)
- Corina Ryf
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Léonie Hofstetter
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Head of Musculoskeletal Epidemiology Research, Epidemiology, Biostatistics and Prevention Institute (EBPI) & University Spine Centre Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
- Head of Musculoskeletal Epidemiology Research, Epidemiology, Biostatistics and Prevention Institute (EBPI) & University Spine Centre Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
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Gerling MC, Baker M, Stanton E, Chaladoff E, Buser Z. Nerve root retraction time during lumbar endoscopic discectomy: association with new onset radiculitis, a post-operative neurologic complication. 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 2024; 33:126-132. [PMID: 37747545 DOI: 10.1007/s00586-023-07952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE To evaluate the relationship between nerve root retraction time, post-operative radiculitis and patient reported outcomes. METHODS Patients who underwent single- or multi-level lumbar discectomy between 2020 and 2022 for lumbar disk herniations were prospectively followed with pre-operative, interoperative and post-operative variables including radiculitis and patient reported outcomes including VAS, ODI and CAT domains Pain interference, Pain intensity and Physical function. Intraoperative nerve root retraction time was recorded. Paired sample two-tailed t-test and multivariate regression were utilized with p < 0.05 being significant. RESULTS A total of 157 patients who underwent single- or multi-level endoscopic lumbar discectomy. Average patient age was 44 years, and 64% were male patients. Nerve retraction time ranged from 4 to 15 min. Eighteen percent reported new radiculitis at 2-weeks post-operatively. In patients with new-onset radiculitis 79.2% reported significantly worse VAS leg at 2 weeks post-operative (4.2 vs. 8.3, p < 0.001) compared to 12.5% who had improved VAS leg (9.3 vs. 7, p = 0.1181). Patients with radiculitis and worse VAS scores had substantially longer nerve retraction time (13.8 ± 7.5 min) than patients with improved VAS leg (6.7 ± 1.2 min). At 6 months, patients with longer nerve retraction time had no significant improvement in the ODI or CAT compared to the baseline. CONCLUSIONS This is the first study in discectomy literature to show that new onset radiculitis and poorer outcomes in VAS leg correlate with longer nerve retraction time at early and later time points.
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Affiliation(s)
- Michael C Gerling
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, 94 9th Street, Unit 1-222, Brooklyn, NY, 11215, USA
| | | | - Eloise Stanton
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | | | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA.
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, 94 9th Street, Unit 1-222, Brooklyn, NY, 11215, USA.
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12
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Ingber RS. Iliopsoas trigger point dry needling and therapeutic stretching in the treatment of a series of six consecutive patients presenting with acute lumbar radiculitis and foot drop. J Bodyw Mov Ther 2023; 36:1-4. [PMID: 37949544 DOI: 10.1016/j.jbmt.2023.04.073] [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: 04/21/2020] [Revised: 08/12/2021] [Accepted: 04/15/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate the clinical results, number of treatments administered and the cost of care of a series of six consecutive patients presenting with acute lumbar radiculitis and a foot drop treated with iliopsoas myofascial treatments. METHOD A retrospective chart review of the results of iliopsoas myofascial treatments for acute lumbar radiculitis in six consecutive patients presenting with acute sciatic pain and ipsilateral foot drop. RESULTS Five of six (83%) patients with acute lumbar radiculitis and foot drop responded without need for surgical decompression. In responders, heel walk returned in 2, 3, 10, 13 and 32 weeks after initiating treatment. The patients received an average of 6.7 trigger point dry needling treatments (range 3-14) and 9.5 physical therapy sessions (range 3-16). The average cost of the medical care, based upon the rate of $125 for trigger points and $75 for physical therapy, was $1691.66 (range $693.75-2712.50). CONCLUSIONS Iliopsoas myofascial treatments achieved an acceptable, risk-free, relatively inexpensive method of management in the non-surgical care of these six patients presenting with severe, acute lumbar radiculitis.
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Thoomes E, Falla D, Cleland JA, Fernández-de-Las-Peñas C, Gallina A, de Graaf M. Conservative management for lumbar radiculopathy based on the stage of the disorder: a Delphi study. Disabil Rehabil 2023; 45:3539-3548. [PMID: 36205564 DOI: 10.1080/09638288.2022.2130448] [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: 05/17/2022] [Accepted: 09/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Conservative management of lumbar radiculopathy (LR) is the first treatment option. To date, systematic reviews and clinical practice guidelines have not considered the most appropriate timing of management. This study aimed to establish consensus on effective conservative treatment modalities across different stages (i.e., acute, sub-acute, or chronic) of LR. MATERIALS AND METHODS Through an iterative multistage Delphi process, experts rated agreement with proposed treatment modalities across stages of LR and could suggest additional treatment modalities. The agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round. RESULTS Fourteen panelists produced a consensus list of effective treatment modalities across stages of LR. Acute stage management should focus on providing patients with information about the condition including pain education, individualized physical activity, and directional preference exercises, supported with NSAIDs. In the sub-acute stage, strength training and neurodynamic mobilization could be added and transforaminal/epidural injections considered. In the chronic stage, spinal manipulative therapy, specific exercise, and function-specific physical training should be combined with individualized vocational, ergonomic and postural advice. CONCLUSIONS Experts agree effectiveness of interventions differs through the evolution of LR.IMPLICATIONS FOR REHABILITATIONTo date clinical guideline for conservative management of lumbar radiculopathy do not consider the evolution of the condition.Acute stage management of lumbar radiculopathy should focus on providing information about the condition and support individualized physical activity with pain medication.Sub-acute management should add neurodynamic mobilization to strength training, while transforaminal and/or epidural injections could be considered.Chronic stage management should consider spinal manipulative therapy and focus on restoring personalized functional capacity.
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Affiliation(s)
- Erik Thoomes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
- Research Department, Fysio-Experts, Hazerswoude, Netherlands
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
| | - Joshua A Cleland
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Alessio Gallina
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
| | - Marloes de Graaf
- Research Department, Fysio-Experts, Hazerswoude, Netherlands
- Department of Manual Therapy, Breederode University of Applied Science, Rotterdam, Netherlands
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14
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Bansal P, Vatkar AJ, Baburaj V, Kumar V, Dhatt SS. Effect of obesity on results of endoscopic versus open lumbar discectomy: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:5589-5601. [PMID: 37041263 DOI: 10.1007/s00402-023-04870-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 04/02/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Lumbar disc herniation in obese individuals poses unique surgical challenges which can influence outcomes in such patients. Limited studies are available evaluating the results of discectomy in obese persons. The aim of this review was to compare outcomes in obese and non-obese individuals; and to analyse whether approach to surgery had a bearing on these outcomes. METHODS The literature search was conducted on four databases (PubMed, Medline, EMBASE, and CINAHL) and PRISMA guidelines were followed. After screening by the authors, eight studies were shortlisted from which data were extracted and analysed. Comparative analysis was done for lumbar discectomy (microdiscectomy or minimally invasive vs. endoscopic technique) between obese and non-obese groups from the six comparative studies in our review. Pooled estimates and subgroup analysis was done to ascertain the effect of surgical approach on outcomes. RESULTS Eight studies published between 2007 and 2021 were included. Mean age of study cohort was 39.05 years. Mean operative time was significantly shorter in the non-obese group mean difference of 15.1 min (95% CI - 0.24 to 30.5). On subgroup analysis, obese individuals operated via endoscopic approach had significantly decreased operative time as compared to open approach. Blood loss and complication rates were also lower in the non-obese groups, but not statistically significant. CONCLUSION Significantly less mean operative time was seen in non-obese individuals and when obese patients were operated via endoscopic approach. This difference between obese and non-obese groups was significantly more in the open subgroup as compared to the endoscopic subgroup. No significant differences in blood loss, mean improvement in VAS score, recurrence rate, complication rate and length of hospital stay was found between obese and non-obese patients as well as between endoscopic versus open lumbar discectomy within the obese subgroup. The learning curve associated with endoscopy makes it a challenging procedure.
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Affiliation(s)
- Parth Bansal
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | | | | | - Vishal Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, India.
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15
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Çelen ZE, Onay T. The Relationship Between Bone Mineral Density and Lumbar Disc Herniation in Postmenopausal Women. Cureus 2023; 15:e44156. [PMID: 37753050 PMCID: PMC10519149 DOI: 10.7759/cureus.44156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION In previous studies, the relationship between BMD (bone mineral density) and LDH (lumbar disc herniation) has been investigated in young people, except for postmenopausal women. The aim of this study was to evaluate this association in postmenopausal women. METHODS A cross-sectional analysis of 545 consecutive postmenopausal women was performed at a single center. The study included patients aged 45 to 85 with low back pain. Age, weight, height, L1-L4 BMD, L1-L4 T-score, L1-L4 Z-score, femoral neck BMD, femoral neck T-score, and femoral neck Z-score of patients were collected. MRI scans were assessed for the diagnosis of LDH. To explore the impact of the number of herniated segments, patients with LDH were further divided into single-level and multi-level LDH groups. RESULTS Five hundred and thirteen postmenopausal women were included in the final analysis. The mean age of the patients was 61.3±8.6 years in the LDH group and 58.4±7.8 years in the non-LDH group (p=0.001). The LDH group had higher lumbar (p<0.001) and femoral neck (p<0.05) BMD, T, and Z-scores than the non-LDH group. In binary logistic regression analysis, age, lumbar, and femoral neck BMD were significantly associated with LDH (p<0.001, p=0.03, and p=0.040, respectively). Patients with multi-level herniation had significantly higher rates of obesity (BMI ≥30) compared to patients with single-level herniation (58.0% vs. 47.0%; p=0.031). However, in terms of obesity rates, the LDH group and the non-LDH group were statistically similar (53.9% vs. 54.2%; p=0.961). There was no association between the single and multi-level herniation groups in terms of L1-4 and femoral neck BMD (p=0.760 and 0.435, respectively). CONCLUSION Higher lumbar bone mineral density and higher femoral neck bone mineral densities were found to be associated with lumber disc herniation in postmenopausal women with low back pain. These results suggest that bone mineral density assessment may be useful in clinical practice to determine which patients are at higher risk of lumbar disc herniation.
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Affiliation(s)
- Zekeriya Ersin Çelen
- Department of Orthopaedic Surgery and Traumatology, Yalova Training and Research Hospital, Yalova, TUR
| | - Tolga Onay
- Department of Orthopaedic Surgery and Traumatology, Göztepe Training and Research Hospital, İstanbul, TUR
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16
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Lanier VM, Lohse KR, Hooker QL, Francois SJ, van Dillen LR. Treatment preference changes after exposure to treatment in adults with chronic low back pain. PM R 2023; 15:817-827. [PMID: 36106673 PMCID: PMC10014477 DOI: 10.1002/pmrj.12897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/17/2022] [Accepted: 08/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients' pretreatment preferences can influence outcomes of nonpharmacologic treatments for musculoskeletal pain. Less is known about how patients' treatment preferences change following exposure to treatment. OBJECTIVE To examine the effect of exposure to treatment and change in disability and pain on treatment preference ratings of two exercise-based treatments for people with chronic low back pain (LBP). DESIGN Secondary analysis of a subsample of participants from a randomized clinical trial. SETTING Academic research setting. PARTICIPANTS Individuals with chronic LBP (n = 83). INTERVENTIONS 6 weekly sessions of motor skill training (MST) or strength and flexibility exercise (SFE). MAIN OUTCOME MEASURES Prior to treatment, participants completed a treatment preference assessment measure (TPA) describing MST and SFE. Participants rated four attributes (effectiveness, acceptability/logicality, suitability/appropriateness, convenience) of each treatment on a 5-point Likert scale (0-4) with higher scores indicating higher ratings. An overall preference rating was calculated as the mean of the attribute ratings. The TPA was administered 12 months post treatment to reassess participants' ratings of the treatment they received. RESULTS Participants who received MST rated their preference for MST higher 12 months post treatment and participants who received SFE rated their preference for SFE lower. Smaller improvements (to worsening) in pain were associated with a reduction in preference ratings in the SFE group, whereas the MST group generally increased their ratings regardless of pain. Changes in disability were not related to changes in preference ratings. CONCLUSIONS Participants changed their preference ratings of two exercise-based treatments for LBP after exposure to the treatment. Participants who received the less familiar MST viewed this treatment more favorably 12 months post treatment, and this change was less contingent on changes in disability/pain than for participants in the SFE group. Assessing preference ratings at various times during treatment is crucial to understand a person's preference for and perceptions of a treatment.
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Affiliation(s)
- Vanessa M Lanier
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Quenten L Hooker
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sara J Francois
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Linda R van Dillen
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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17
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Nabi MH, Hawlader MDH, Naz F, Siddiquea SR, Hasan M, Hossian M, Dalal K. Low back pain among professional bus drivers: a cross-sectional study from Bangladesh. BMC Public Health 2023; 23:1172. [PMID: 37331993 DOI: 10.1186/s12889-023-16018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a common condition contributing to impaired quality of life among professional vehicle drivers. Our study aimed to assess LBP prevalence and associated factors among professional bus drivers in Bangladesh. METHODS A cross-sectional study was conducted among 368 professional bus drivers using a semi-structured questionnaire. A Nordic Musculoskeletal Questionnaire (NMQ) subscale was used to measure LBP. Multivariable logistic regression analysis was used to identify the factors associated with LBP. RESULTS In the last month, 127 (34.51%) participants reported experiencing pain or discomfort in the lower backside. Multivariable logistic regression analysis showed that age of more than 40 years (adjusted odds ratio (aOR): 2.07, 95% confidence interval (CI): 1.14 to 3.75), the income of more than 15,000 BDT per month (aOR: 1.91, 95% CI: 1.11 to 3.26), work duration more than ten years (aOR: 2.53, 95% CI: 1.12 to 5.70), working more than 15 days per month (aOR: 1.93, 95% CI: 1.02 to 3.65), working more than 10 h per day (aOR: 2.46, 95% CI: 1.05 to 5.75), poor condition of the driving seat (aOR: 1.80, 95% CI: 1.08 to 3.02), current smoking habit (aOR: 9.71, 95% CI: 1.25 to 75.15), illicit substances use (aOR: 1.97, 95% CI: 1.11 to 3.48), and four hours or less sleeping time per day (aOR: 1.83, 95% CI: 1.09 to 3.06) were positively associated with LBP. CONCLUSION The high burden of LBP among the participants calls for a focus on this vulnerable group's occupational health and safety, with particular emphasis on implementing standard measures.
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Affiliation(s)
| | | | - Farah Naz
- Department of Physiology, Green Life Medical College, Dhaka, 1205, Bangladesh
| | | | - Mehedi Hasan
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Mosharop Hossian
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Koustuv Dalal
- School of Health Sciences, Division of Public Health Science, Mid Sweden University, Sundsvall, Sweden.
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18
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Stover JD, Trone MAR, Weston J, Lewis C, Levis H, Philippi M, Zeidan M, Lawrence B, Bowles RD. Therapeutic TNF-alpha Delivery After CRISPR Receptor Modulation in the Intervertebral Disc. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.31.542947. [PMID: 37398456 PMCID: PMC10312567 DOI: 10.1101/2023.05.31.542947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Low back pain (LBP) ranks among the leading causes of disability worldwide and generates a tremendous socioeconomic cost. Disc degeneration, a leading contributor to LBP, can be characterized by the breakdown of the extracellular matrix of the intervertebral disc (IVD), disc height loss, and inflammation. The inflammatory cytokine TNF-α has multiple pathways and has been implicated as a primary mediator of disc degeneration. We tested our ability to regulate the multiple TNF-α inflammatory signaling pathways in vivo utilizing CRISPR receptor modulation to slow the progression of disc degeneration in rats. Sprague-Dawley rats were treated with CRISPRi-based epigenome-editing therapeutics targeting TNFR1 and showed a decrease in behavioral pain in a disc degeneration model. Surprisingly, while treatment with the vectors alone was therapeutic, TNF-α injection itself became therapeutic after TNFR1 modulation. These results suggest direct inflammatory receptor modulation, to harness beneficial inflammatory signaling pathways, as a potent strategy for treating disc degeneration.
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19
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Li YX, Xiong J, Zhang Z, Liao K, Zhou XH, Li J, Xiang J, Xu LL. Research Trends of the Research and Development of Acupuncture and Moxibustion Therapy on Lumbar Disc Herniation: A Bibliometric Analysis. J Pain Res 2023; 16:1835-1853. [PMID: 37284329 PMCID: PMC10239644 DOI: 10.2147/jpr.s400362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Background Acupuncture and moxibustion has been applied worldwide in the treatment of various pain diseases including lumbar disc herniation (LDH) and other pain, However, there has been no bibliometric analysis on this aspect in the past five years. Therefore, this study was carried out for finding research trends and fronts in this field using Citespace and VOSviewer. Methods Publications about acupuncture therapy for LDH were extracted from the Web of Science database and PubMed with an unlimited time frame. A bibliometric analysis and visualization of results was conducted using CiteSpace 6.1.R3 and VOSviewer 1.6.18 on the information of the annual publication, countries, journals, institutions, authors, references, and keywords. Results A total of 127 publications were included, and the number of publications had increased noticeably over the past 30 years and reached a peak in the past 3 years. The most productive country with the most publications was China, whose Medical University was the institution with the highest volume of publications. The most productive author was Chen Rixin, while the most-cited author was Kreiner DS. Chinese Acupuncture and Moxibustion was the journal with the most publications, and Spine Journal was the most frequently cited journal. In cited references, an article published in The New England Journal of Medicine by Deyo RA had the most citations and the highest centrality. Of the keywords, the five most frequently used keywords include lumbar disc herniation, acupuncture, low back pain, intervertebral disc displacement, and management. Conclusion Acupuncture and moxibustion can help to relieve symptoms in patients. However, this field is in the early stages of development and requires more high-quality research studies and international collaborations. In addition, exploring the effectiveness and mechanism of acupuncture for LDH is the hot trend in the future.
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Affiliation(s)
- Yu-Xin Li
- Graduate School, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China
| | - Jun Xiong
- College of Acupuncture and Massage, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China
| | - Zheng Zhang
- College of Acupuncture and Massage, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China
| | - Kai Liao
- College of Acupuncture and Massage, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China
| | - Xiao-Hong Zhou
- College of Acupuncture and Massage, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China
| | - Jun Li
- College of Acupuncture and Massage, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China
| | - Jie Xiang
- College of Acupuncture and Massage, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China
| | - Ling-Ling Xu
- College of Acupuncture and Massage, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China
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20
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Zhang AS, Xu A, Ansari K, Hardacker K, Anderson G, Alsoof D, Daniels AH. Lumbar Disc Herniation: Diagnosis and Management. Am J Med 2023:S0002-9343(23)00252-8. [PMID: 37072094 DOI: 10.1016/j.amjmed.2023.03.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 04/20/2023]
Abstract
Lumbar disc herniations are common causes of lower back, neurological dysfunction, and buttock/leg pain. Herniation refers to the displacement of the nucleus pulposus of the intervertebral disc through the annulus fibrosus, thereby causing pressure on the neural elements. The sequalae of lumbar disc herniations range in severity from mild low back and buttock pain to severe cases of inability to ambulate and cauda equina syndrome. Diagnosis is achieved with a thorough history and physical along with advanced imaging. Treatment plans are dictated by corresponding patient symptoms and exam findings with their imaging. Most patients can experience relief with non-surgical measures. However, if symptoms persist or worsen, surgery may be appropriate.
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Affiliation(s)
- Andrew S Zhang
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA; Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Andrew Xu
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kashif Ansari
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kyle Hardacker
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - George Anderson
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Daniel Alsoof
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Park SC, Kang MS, Yang JH, Kim TH. Assessment and nonsurgical management of low back pain: a narrative review. Korean J Intern Med 2023; 38:16-26. [PMID: 36420562 PMCID: PMC9816685 DOI: 10.3904/kjim.2022.250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022] Open
Abstract
Low back pain (LBP) is a common condition that affects people of all ages and income levels worldwide. The etiology of LBP may be mechanical, neuropathic, systemic, referred visceral, or secondary to other causes. Despite numerous studies, the diagnosis and management of LBP remain challenging due to the complex biomechanics of the spine and confounding factors, such as trivial degenerative imaging findings irrelevant to symptoms and psychological and emotional factors. However, it is imperative to identify the crucial signs ("red flags") indicating a serious underlying condition. While many recent guidelines emphasize non-pharmacologic management approaches, such as education, reassurance, and physical and psychological care, as the first option, LBP patients in many countries, including South Korea, are prescribed medications. Multidisciplinary rehabilitation combined with prudent use of medications is required in patients unresponsive to first-line therapy. The development of practical guidelines apposite for South Korea is needed with multidisciplinary discussion.
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Affiliation(s)
- Sung Cheol Park
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Min-Seok Kang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Tae-Hoon Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul,
Korea
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22
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Predictive Factors for Poor Outcome following Chemonucleolysis with Condoliase in Lumbar Disc Herniation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121868. [PMID: 36557070 PMCID: PMC9781337 DOI: 10.3390/medicina58121868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Condoliase, a chondroitin sulfate ABC endolyase, is a novel and minimally invasive chemonucleolytic drug for lumbar disc herniation. Despite the growing number of treatments for lumbar disc herniation, the predicting factors for poor outcomes following treatment remain unclear. The aim of this study was to determine the predictive factors for unsuccessful clinical outcome following condoliase therapy. Material and Methods: We performed a retrospective single-center analysis of 101 patients who underwent chemonucleolysis with condoliase from January 2019 to December 2021. Patients were divided into good outcome (i.e., favorable outcome) and poor outcome (i.e., requiring additional surgical treatment) groups. Patient demographics and imaging findings were collected. Clinical outcomes were evaluated using the numerical rating scale and Japanese Orthopaedic Association scores at baseline and at 1- and 3-month follow-up. Pretreatment indicators for additional surgery were compared between the 2 groups. Results: There was a significant difference in baseline leg numbness between the good outcome and poor outcome groups (6.27 ± 1.90 vs. 4.42 ± 2.90, respectively; p = 0.033). Of the 101 included patients, 32 received a preoperative computed tomography scan. In those patients, the presence of calcification or ossification in disc hernia occurred more often in the poor outcome group (61.5% vs. 5.3%, respectively; p < 0.001; odds ratio = 22.242; p = 0.014). Receiver-operating characteristics curve analysis for accompanying calcification or ossification showed an area under the curve of 0.858 (95% confidence interval, 0.715−1.000; p = 0.001). Conclusions: Calcified or ossified disc herniation may be useful predictors of unsuccessful treatment in patients with condoliase administration.
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AZAK BOZAN A, ÖZCAN S, KILINÇ M, IŞIK SEÇ M, ÖNAL SA. Lomber Disk Hernisinde Disk Restorasyon Hidrojel İmplant (Gelstixtm) Kullandığımız Hastalarda Sonuçlar: Retrospektif Kohort Çalışması. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1175483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Introduction: The aim of this study is evaluting the results of disc restoration hidrogel implanted (GelstixTM) lomber disc hernia patients.
Material-Method: Patients suffered from chronic back pain diagnosed lumber disc hernia who were admitted to Firat University Algology Clinic and treated with disc restoration hidrogel between January 2013 – January 2014 were evaluated. Cases were evaluated for demografic characteristics, magnetic resistance imaging findings, preoperative and postoperative VAS, complications, side effects and patients satisfaction after prosedure.
Results: Of the operated 62 patients were 25 male (40,3%) and 37 female (59,7%). Mean age of all patients was 49,18±14,18 years, mean age of female patients was 50,81±13,37 years and mean age of male patients was 46,76±15,27 years. Mean duration of pain in female and male patients was 37,81±37,92 months and 25,36±33,58 months, respectively. Preoperative and postoperatif VAS scores of female and male patients were 8,24±1,09 and 7,88±1,01 and 3,56±2,11 and 3,76±2,17, respectively. Of the 62 patients suffered from 16 right leg pain (25,8%), 20 left leg pain (32,3%), 26 bilateral lower limb pain (41,9%). Of 62 patients 31 had no additional disorders (50%), 12 had cardiac disorders (19,4%), 3 had (4,8%) respiratory disorders, 7 had endocrine disorders (11,3%), 4 had both endocrine and cardiac disorders (6,5%), 2 had both cardiac and respiratory disorders (3,2%), 1 had both endocrine and respiratory disorders (1,6%), and 2 had both endocrine, cardiac and respiratory disorders (3,2%). Of the 62 patients 25 had bulging (40,3%), 5 had protrusion (8,1%), 4 had narrowed neural foramen (6,5%), 18 had bulging +narrowed neural foramen (29%), 3 had narrowed neural foramen + protrusion (4,8%) and 7 had bulging + protrusion (11,3%). Thirteen patients hadn’t had previous therapy (20,97%), transforaminal steroid injection was applied to 29 patients (46,77%) and medical threapy (such as NSAID, miyorelactants) was applied to 20 (32,26%). Levels of complaints were 2 at L2-L3 (3,2%), 17 at L3-L4 (27,4%), 28 at L4-L5 (45,2%) and 15 at L5-S1 (24,2%). Without L2-L3 level other operated levels had significant difference between preropeative VAS scores and postoperative VAS scores. The number of unsatissfied patients was 9 (14,5%), moderated satisfied patients number 16(25,8%),good satisfied patients number was 16 (25,8%), and perfectly satisfied patients number was 21 (33,9%).
Conclusion: Disc restoration hidrogel is a safe minimal invasive technique with satisfactory results, low complication rates and low side effect risk especially in young and middle aged patients.
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Ghandour S, Pazarlis K, Lewin S, Isaksson P, Försth P, Persson C. An ex-vivo model for the biomechanical assessment of cement discoplasty. Front Bioeng Biotechnol 2022; 10:939717. [PMID: 36118564 PMCID: PMC9478659 DOI: 10.3389/fbioe.2022.939717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/27/2022] [Indexed: 12/05/2022] Open
Abstract
Percutaneous Cement Discoplasty (PCD) is a surgical technique developed to relieve pain in patients with advanced degenerative disc disease characterized by a vacuum phenomenon. It has been hypothesized that injecting bone cement into the disc improves the overall stability of the spinal segment. However, there is limited knowledge on the biomechanics of the spine postoperatively and a lack of models to assess the effect of PCD ex-vivo. This study aimed to develop a biomechanical model to study PCD in a repeatable and clinically relevant manner. Eleven ovine functional spinal units were dissected and tested under compression in three conditions: healthy, injured and treated. Injury was induced by a papain buffer and the treatment was conducted using PMMA cement. Each sample was scanned with micro-computed tomography (CT) and segmented for the three conditions. Similar cement volumes (in %) were injected in the ovine samples compared to volumes measured on clinical PCD CT images. Anterior and posterior disc heights decreased on average by 22.5% and 23.9% after injury. After treatment, the anterior and posterior disc height was restored on average to 98.5% and 83.6%, respectively, of their original healthy height. Compression testing showed a similar stiffness behavior between samples in the same group. A decrease of 51.5% in segment stiffness was found after injury, as expected. The following PCD treatment was found to result in a restoration of stiffness—showing only a difference of 5% in comparison to the uninjured state. The developed ex-vivo model gave an adequate representation of the clinical vacuum phenomena in terms of volume, and a repeatable mechanical response between samples. Discoplasty treatment was found to give a restoration in stiffness after injury. The data presented confirm the effectiveness of the PCD procedure in terms of restoration of axial stiffness in the spinal segment. The model can be used in the future to test more complex loading scenarios, novel materials, and different surgical techniques.
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Affiliation(s)
- Salim Ghandour
- Division of Biomedical Engineering, Department of Materials Science and Engineering, Uppsala University, Uppsala, Sweden
| | - Konstantinos Pazarlis
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
- Stockholm Spine Center, Stockholm, Sweden
| | - Susanne Lewin
- Division of Biomedical Engineering, Department of Materials Science and Engineering, Uppsala University, Uppsala, Sweden
| | - Per Isaksson
- Division of Applied Mechanics, Department of Materials Science and Engineering, Uppsala University, Uppsala, Sweden
| | - Peter Försth
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Cecilia Persson
- Division of Biomedical Engineering, Department of Materials Science and Engineering, Uppsala University, Uppsala, Sweden
- *Correspondence: Cecilia Persson,
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Hershkovich O, Mor Y, Lotan R. Intravenous Corticosteroid Therapy for Acute Lumbar Radicular Pain. J Clin Med 2022; 11:jcm11175127. [PMID: 36079057 PMCID: PMC9457254 DOI: 10.3390/jcm11175127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction: The efficacy of pharmacological interventions for acute lumbar radicular pain (ALRP) is limited, and systemic steroid use remains controversial. We evaluated the effectiveness and tolerance of systemic steroid use in a cohort of patients with ALRP. Methods: A retrospective cohort of 56 patients (including 24 females) were admitted with intractable ALRP resistance to conservative treatment of NSAIDs and opiates between the years 2016 and 2018. Medical records were studied for demographics, physical examination findings, Visual Analogue Score (VAS), IV steroids side effects, and recent imaging findings. All patients received a daily dose of IV 24 mg Dexamethasone until discharge, SNRB, or surgery. Results: The average IV steroid treatment was 3.9 (±2.8) days, with most patients showing significant pain relief allowing discharge (69.7%). SNRB was required in 19.6% and surgical intervention in 10.7% within the same admission. Multivariate analysis did not find any parameter to predict treatment failure (age, gender, motor/sensory deficit, CT/MRI findings). The motor deficit, positive straight leg raising (SLR), and dural sac compression on CT were higher in the intervention group but did not reach statistical significance. One patient required discontinuation of IV steroids due to elevated blood pressure. Conclusions: Despite the insufficient evidence in the literature, IV steroid treatment is still a viable option in ALRP treatment, with pain relief allowing discharge in 70% of patients and a low complication rate. Our study found daily 24 mg IV dexamethasone for ALRP to be an effective treatment and helpful in most patients admitted. This study supports the common practice used by spine units.
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Affiliation(s)
- Oded Hershkovich
- Department of Orthopedic Surgery, Wolfson Medical Center, Ha-Lokhamim St. 62, Holon 5822012, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3-5028383; Fax: +972-3-5028774
| | - Yaakov Mor
- Department of Orthopedic Surgery, Wolfson Medical Center, Ha-Lokhamim St. 62, Holon 5822012, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Raphael Lotan
- Department of Orthopedic Surgery, Wolfson Medical Center, Ha-Lokhamim St. 62, Holon 5822012, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Huang F, Xiao Z, Zhan X, Zeng P, Zhao S, Guo R, Tian Q, Fan Z, Wu S. Tuina combined with Adjuvant therapy for lumbar disc herniation: A network meta-analysis. Complement Ther Clin Pract 2022; 49:101627. [PMID: 35849972 DOI: 10.1016/j.ctcp.2022.101627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/16/2022] [Accepted: 06/26/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To directly or indirectly compare the effectiveness and pain relief of TN combined with different treatments for lumbar disc herniation (LDH). METHODS The Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), Wanfang data, Chinese Biomedical Literature database (CBM), Chinese Scientific Journal Database (VIP), PubMed, Embase, Cochrane library, and Web of Science were searched from inception to July 2020. Only full texts of randomized controlled trials (RCTs) that make comparisons between Tuina and Tuina combined with other methods were included. We extracted trial data and assessed the risk of bias by two reviewers independently. We pooled continuous data in standard mean differences (SMDs) and binary data in risk ratios (RRs), and provided 95% confidence intervals. The primary outcomes were the effectiveness rate. The secondary outcome was pain measurements including visual analog scale (VAS) scores. RESULTS Forty-four trials which included 4741 participants and 16 kinds of interventions were selected in our study. Tuina combined with Acupuncture was the most frequently investigated intervention. Five (31%) kindnesces (SMDs) and binary data in risk ratios (RRs), and provided 95% confidence intervals. The primary outcomes were the effectiveness rate. The secondary outcome was pain measurements including visual analog scale (VAS) scores. RESULTS Forty-four trials of treatments among 15 increased the healing rate more significantly compared with Tuina(TN), including Tuian combined with Traction and formula(TN + TRA + FM), Tuina combined with formula(TN + FM), Tuina combined with Traction and Acupuncture(ACU + TN + TRA), Tuian combined with Traction(TN + TRA), Tuina combined with Electroacupuncture(EA + TN), Tuina combined with the warm needle(TN + WN), Tuina combined with Acupuncture(ACU + TN). Seven treatments including Tuina combined with Electroacupuncture(EA + TN), Tuian combined with Traction and formula(TN + TRA + FM), Tuina combined with Acupuncture(ACU + TN), Tuina combined with formula(TN + FM), Acupuncture(ACU), Tuian combined with Traction(TN + TRA), Tuina combined with the warm needle(TN + WN) had better effects in reducing pain intensity compared with Tuina, range from 0.01 (95%Crl 0-0.08) for EA + TN to 0.30 (95%Crl 0.20-0.45) for TN + WN. CONCLUSIONS According to the comprehensive review, Tuina combined with Traction and formula(TN + TRA + FM) seemed to be the most recommendable treatment which is more affordable and effective. However, all the available evidence was of low quality, so more high-quality studies are expected to confirm the effectiveness. REGISTRATION NUMBER PROSPERO CRD42020193068.
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Affiliation(s)
- Fan Huang
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Zhaoxun Xiao
- Department of Anatomy and Histology & Embryology, Faculty of Basic Medical Science, Kunming Medical University, 1168 West Chunrong Road, Kunming, 650500, Yunnan, China
| | - Xiaoxuan Zhan
- Department of Rehabilitation Medicine, Affiliated Haikou Hospital of Central South University Xiangya School of Medicine, Haikou, 570208, Hainan, China
| | - Ping Zeng
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Siyi Zhao
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Rusong Guo
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Qiang Tian
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Zhiyong Fan
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
| | - Shan Wu
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
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Stepanov IA, Beloborodov VA, Sorokovikov VA. [A validated new classification for intervertebral disk degeneration]. Khirurgiia (Mosk) 2022:72-79. [PMID: 35658139 DOI: 10.17116/hirurgia202206172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop a new validated classification of intervertebral disc degeneration. MATERIAL AND METHODS A retrospective observational single-center study included medical records of patients with and without degenerative disease of lumbar intervertebral discs. The interval values of apparent diffusion coefficient (ADC) of intervertebral discs were grouped into degeneration classes. RESULTS The study included medical records of 100 patients. A quantitative analysis of data showed that mean ADC has a significant correlation with severity of lumbosacral disc degeneration according to classification by Pfirrmann et al. Lumbar intervertebral discs with degeneration grade 3-4 were less homogeneous compared to grade 2-3. Among discs with degeneration grade 4, mean ADC was significantly higher in case of hernia (p=0.01). Conversely, mean ADC was significantly higher in the absence of hernia for discs grade 3 (p=0.04). Combination of all data is presented as original classification of lumbosacral disc degeneration based on mean ADC. CONCLUSION The developed classification can be recommended for radiologists, neurologists and neurosurgeons.
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Affiliation(s)
- I A Stepanov
- Irkutsk State Medical University, Irkutsk, Russia.,Kharlampiev Clinic, Irkutsk, Russia.,Irkutsk Research Center of Surgery and Traumatology, Irkutsk, Russia
| | | | - V A Sorokovikov
- Irkutsk Research Center of Surgery and Traumatology, Irkutsk, Russia
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Sherman KJ, Wellman RD, Jones SM, Lewis CC. Interest in Mindfulness Training for Chronic Low-Back Pain: Results from a Vignette-driven, Web-based Survey of Patients. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:484-496. [PMID: 35352963 PMCID: PMC9232229 DOI: 10.1089/jicm.2021.0427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Mindfulness-based stress reduction (MBSR) has been found effective for improving chronic low-back pain (cLBP). However, little data exist regarding how attractive this technique is to Americans as a therapy for cLBP. Design: Survey of randomly selected persons with cLBP. Settings/Location: Respondents were recruited from Kaiser Permanente Washington and one-time surveys were completed online. Patients: Adults 18-80 years of age with cLBP. Surveys: The study was conducted between December 2019 and August 2020. Outcome measures: The survey described an evidence-based classic MBSR course and then asked respondents about their sociodemographic characteristics, their current back pain, previous back pain treatments, behavioral risk factors for back pain, and four outcomes indicative of intention to engage in MBSR. Results: Four-hundred fifty-seven respondents completed the survey. Respondents were primarily women, white, educated, and with back pain for more than 5 years. About half had previously used a mind-body therapy for their pain. Overall, they reported moderate to high intention to try mindfulness classes and practice at home (median of 5 with 50% of the observations between 4 and 6, and 5.7, 50% of the observations between 4.3 and 6.3, respectively, on a 7-point scale). They reported a willingness to spend a median of 3 h/week learning mindfulness and 3.5 h/week practicing mindfulness techniques (for both outcomes, 50% of the respondents reported between 2 and 5 h). Few patient characteristics predicted intention to engage in MBSR, with no variable predicting all outcomes. The magnitude of the effect associated with significant predictors was small. Conclusion: Classic MBSR appealed to many survey respondents, in that they reported high interest in learning MBSR and intention to practice at home. The amount of time they reported being willing to spend learning MBSR and practicing at home is consistent with the time commitment in the original course.
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Affiliation(s)
- Karen J. Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Address correspondence to: Karen J. Sherman, PhD, Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA
| | - Robert D. Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | | | - Cara C. Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Li WS, Yan Q, Cong L. Comparison of Endoscopic Discectomy Versus Non-Endoscopic Discectomy for Symptomatic Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1012-1026. [PMID: 34402320 PMCID: PMC9344526 DOI: 10.1177/21925682211020696] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The authors aimed to systematically compare the effectiveness and safety of endoscopic discectomy (ED) with non-endoscopic discectomy (NED) for treatment of symptomatic lumbar disc herniation (LDH). METHODS A systematic search was performed on PubMed, EMBASE, the Cochrane Library and China National Knowledge Infrastructure for randomized controlled trial from inception until August 13, 2020. Trials which investigated multiple operative approaches on lumbar disc herniation were identified without language restrictions. RESULTS In total, 25 trials involving 2258 patients with symptomatic LDH were included. Twenty trials performed the comparison between ED and NED. Five trials performed the comparison between percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID). The operative time of micro-endoscopic discectomy (MED) was longer than open discectomy (OD). The length of hospital stay of percutaneous endoscopic lumbar discectomy (PELD) was shorter than fenestration discectomy (FD). Significant differences in intraoperative blood loss volumes were found between PELD with FD and MED with OD. The complication rate of PELD was lower than FD (PELD: 4.3%; FD: 14.6%) and the complication rate of full-endoscopic discectomy (FE) was lower than microscopic discectomy (MD) (FE: 13.4%; MD: 32.1%). CONCLUSIONS PELD and FE have the advantage of limiting intraoperative damages. ED and NED can be both considered sufficient to achieve good clinical outcomes. PETD and PEID are able to achieve similar results but the learning curve of PETD was steeper. More independent high-quality RCTs with sufficiently large sample sizes performing cost-effectiveness analyzes are needed.
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Affiliation(s)
- Wei-Shang Li
- Department of Orthopedic Surgery, The
First Hospital of China Medical University, Shenyang, People’s Republic of
China
| | - Qi Yan
- Departments of Surgery, University of
Texas Health San Antonio, San Antonio, TX, USA
| | - Lin Cong
- Department of Orthopedic Surgery, The
First Hospital of China Medical University, Shenyang, People’s Republic of
China,Lin Cong, Department of Orthopedic Surgery,
The First Hospital of China Medical University, No.155 Nanjing Bei Street,
Heping District, Shenyang City, Liaoning Province 110001, People’s Republic of
China.
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The Effect of Melatonin on Radicular Pain in a Rat Model of Lumbar Disc Herniation. Spine (Phila Pa 1976) 2022; 47:754-763. [PMID: 35102121 DOI: 10.1097/brs.0000000000004329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Controlled, randomized, animal study. OBJECTIVE To investigate the effect of melatonin and its receptors on radicular pain and the possible mechanisms. SUMMARY OF BACKGROUND DATA Lumbar disc herniation (LDH) may induce radicular pain, but the mechanism is not clear and therapeutic effect is still poor. Previously we report central sensitization meaning potentiation of spinal nociceptive synaptic transmission is the critical cause of radicular pain. Melatonin (Mel) has been reported to promote hippocampal synaptic transmission and thus improve learning ability. But the effect of Mel on spinal synaptic transmission and radicular pain are not clear. METHODS Rat LDH model was induced by autologous nucleus pulposus (NP) implantation. Melatonin was delivered intraperitoneally four times a day, from day 1 to day 3 after surgery. Melatonin receptor agonist and antagonists were delivered intrathecally for 3 days as well. Mechanical and thermal pain thresholds were assessed by von Frey filaments and hotplate test respectively. Electrophysiological recording was employed for survey C-fiber evoked field potentials. The protein level of N- methyl-D-aspartate submit 2A (NR2A), NR2B, melatonin receptor 1 (MT1), and receptor 2 (MT2) was evaluated by western blotting. Spinal expression of calcitonin gene related peptides (CGRP), isolectin b4 (IB4), and neurofilament-200 (NF200) was displayed by immunofluorescence staining. RESULTS Melatonin significantly increased mechanical and thermal pain thresholds, lasting at least to day 5 after surgery. Melatonin decreased C-fiber evoked field potentials; decreased spinal NR2B protein level; reduced spinal CGRP, and IB4 expression. MT2 was upregulated after NP implantation and was co-localized with neuron and microglia. MT2 receptor agonist simulated the effect of Mel, and both MT receptor broadspectrum antagonist and MT2 specific antagonist abolished the effect of MT2 receptor agonist. CONCLUSION Melatonin alleviates radicular pain from LDH by inhibiting central sensitization via binding with its receptor 2, decreasing spinal CGRP, IB4, and NR2B expression.
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Andersen MØ, Ernst C, Rasmussen J, Ankjær T, Carreon LY. Predictive Factors of Successful Return to Work Following Discectomy. Global Spine J 2022; 12:627-630. [PMID: 32969278 PMCID: PMC9109552 DOI: 10.1177/2192568220960399] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVE To identify modifiable factors associated with successful return to work 12 weeks following discectomy. Lumbar disc herniation is a common cause of sciatica and sick leave. This presents an economic burden to the individual and the society. METHODS Data from DaneSpine on a consecutive cohort of patients operated due to lumbar disc herniation during a 3-year period was identified and merged with data from the Ministry of Employment's register on public welfare payments. Data on welfare payments 2 years prior to the date of operation and 1 year postoperative was included. Patients were considered to be on sick leave if they received welfare payments for the week. Patients are considered to have returned to work if they did not receive public welfare payments for a 4-week period. RESULTS Of 1134 patients meeting inclusion criteria, 98.5% had complete preoperative surgical data available. Postoperatively, 79.1% of the patients returned to the work within 12 weeks. Physically demanding jobs, low preoperative EQ5D score, and long duration of sick leave prior to surgery were associated negatively with return to work at 12 weeks. CONCLUSION The results of this study indicate that patients who have a longer duration of sick leave have a physically demanding job and are in a poor health are more likely not to return to work by 12 weeks after surgery for lumbar disc herniation. Future studies are needed to determine if earlier referral to a surgeon leads to an earlier return to work.
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Affiliation(s)
- Mikkel Ø. Andersen
- Lillebaelt Hospital, Middelfart,
Denmark,Mikkel Andersen, Sector for Spine Surgery
and Research, Lillebaelt Hospital, Østre Hougvej 55, 5500 Middelfart, Denmark.
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32
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Zhang S, Chen Y, Ren R, Jiang S, Cao Y, Li Y. Quantitative study on the biomechanical mechanism of sacroiliac joint subluxation: A finite element study. J Orthop Res 2022; 40:1223-1235. [PMID: 34185334 DOI: 10.1002/jor.25132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/21/2021] [Accepted: 06/24/2021] [Indexed: 02/04/2023]
Abstract
The biomechanical mechanism of sacroiliac joint pain caused by sacroiliac joint subluxation is still unclear. And the purpose of this study is to elucidate the mechanism. In the present study, a finite element model of female lumbar spine-pelvis-femur was established. To simulate the sacroiliac joint subluxation quantitatively, the left ilium was shifted ±1, ±2, and ±3 mm along each axis, respectively. The stress and strain of articular surfaces and ligaments between the sacroiliac joint subluxation model and the normal model were compared. When the left ilium shifted along the positive direction of the X/Y/Z axis, the stress on most articular surfaces of the sacroiliac joint increased, of which the stress on the iliac surface of the right sacroiliac joint increased most obviously. The stress and strain of the ligaments increased most obviously when the left ilium shifted along the Y-axis, of which the left sacrospinous ligament increased the most, followed by the right sacrospinous ligament and right long posterior sacroiliac ligament. While the left long posterior sacroiliac ligament decreased the most, followed by the left short posterior sacroiliac ligament. The present study suggests that when the sacroiliac joint subluxation happens, even a slight shift, different biomechanical changes of different ligaments around the sacroiliac joint will happen. This may lead to an abnormal proprioceptive sensation of the ligaments, resulting in stress imbalance of the sacroiliac joint, and finally resulting in sacroiliac joint pain.
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Affiliation(s)
- Shaoqun Zhang
- Traditional Chinese Medical Orthopedics Department, Shenzhen Traditional Chinese Medicine Hospital, The fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yili Chen
- Traumatology Department, Wang Jing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Ruxia Ren
- Pharmacy Department, The Seventh Affiliated Hospital, Sun Yat-sen Universtiy, Shenzhen, China
| | - Shunwan Jiang
- Traditional Chinese Medical Orthopedics Department, Shenzhen Traditional Chinese Medicine Hospital, The fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yafei Cao
- Traditional Chinese Medical Orthopedics Department, Shenzhen Traditional Chinese Medicine Hospital, The fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yikai Li
- Traditional Chinese Medical Orthopedics Department, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
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Ryf C, Hofstetter L, Clack L, Puhan MA, Hincapié CA. Involving patients and clinicians in a pilot randomised clinical trial of spinal manual therapy versus nerve root injection for lumbar radiculopathy: protocol of a patient and public involvement project. BMJ Open 2022; 12:e057881. [PMID: 35470195 PMCID: PMC9039412 DOI: 10.1136/bmjopen-2021-057881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION A patient and public involvement (PPI) project will be embedded within the SALuBRITY pilot trial, a two parallel group, double sham controlled, randomised clinical trial. The study aims to compare the effectiveness of spinal manual therapy and corticosteroid nerve root injections, two methods commonly used to treat patients with lumbar radiculopathy. We aim to gather patients' and clinicians' perspectives and involve them in decisions related to the research question and objectives, proposed trial recruitment processes and methods, and proposed outcome measures. METHODS AND ANALYSIS A small group of patients with lived experience of lumbar radiculopathy and primary care clinicians with experience in the treatment of patients with lumbar radiculopathy are involved. An initial kickoff event will prepare and empower the advisors for involvement in the project, followed by semistructured patient group and one-on-one clinician interviews. We will follow the Critical Outcomes of Research Engagement framework for assessing the impact of patient engagement in research. We will summarise and feedback PPI content to the patient and clinician advisors during a member-checking process to ensure accurate interpretation of patient and clinician inputs. Inductive and deductive thematic analysis will be used for the qualitative analysis of the interviews. Two surveys will be completed at different points along the trial to track the advisors' and researchers' experiences over the course of the PPI project. Any modifications to the SALuBRITY trial methods due to PPI inputs will be thoroughly documented and recorded in an impact log. ETHICS AND DISSEMINATION The independent research ethics committee of Canton Zurich confirmed that ethical approval for this PPI subproject was not required. PPI results will be disseminated in a peer-reviewed journal and presented at conferences.
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Affiliation(s)
- Corina Ryf
- Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland
| | - Léonie Hofstetter
- Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Cesar A Hincapié
- Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
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34
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Asano H, Plonka D, Weeger J. Effectiveness of Acupuncture for Nonspecific Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Med Acupunct 2022; 34:96-106. [PMID: 35509875 PMCID: PMC9057891 DOI: 10.1089/acu.2021.0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective This systematic review and meta-analysis assess the effectiveness of acupuncture as an adjunct to standard therapy in the management of nonspecific chronic low back pain (NScLBP), compared with standard therapy alone. Methods A systematic literature search of full-text articles of randomized controlled trials in the date range of 2000-2020, utilizing PubMed and EBSCO databases, was performed to evaluate the efficacy of acupuncture treatment for nonspecific chronic lower back pain. The outcomes of interest were pain intensity and disability. The methodological quality of each study was evaluated using Cochrane risk-of-bias criteria. The studies were combined using meta-analysis when statistical pooling of data was possible. Results This systematic review included 5 studies of which 4 were included in the meta-analysis. Acupuncture as an adjunct to standard therapy had clinically meaningful reduction in self-reported pain at post-treatment (mean difference = -1.04 [95% confidence interval (CI), -1.59 to -0.49], P < 0.001, I 2 = 46.1%) and at intermediate term (mean difference = -0.82 [95% CI, -1.13 to -0.50], P < 0.001, I 2 = 0%), compared with standard care. Levels of disability showed similar clinically meaningful reduction at post-treatment and intermediate term. Conclusion Both the systematic review and meta-analysis demonstrate that acupuncture as an adjunct to standard therapy is a safe and effective method in reducing pain and disability among adults with NScLBP.
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Affiliation(s)
- Hitomi Asano
- Emperor's College of Traditional Oriental Medicine, Santa Monica, CA, USA
| | - Derek Plonka
- Emperor's College of Traditional Oriental Medicine, Santa Monica, CA, USA
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Ariel E, Levkovitz Y, Goor-Aryeh I, Motti R. The effects of TENS, interferential stimulation, and combined interferential stimulation and pulsed ultrasound on patients with disc herniation-induced radicular pain. J Back Musculoskelet Rehabil 2022; 35:363-371. [PMID: 34180407 DOI: 10.3233/bmr-200302] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Electrotherapy is part of a physician's toolbox for treating various musculoskeletal conditions, including radicular pain, but the preferred modality is yet unclear. OBJECTIVE To compare the short-term efficacy of three electrotherapeutic modalities in relieving lumbar disc herniation (LDH)-induced radicular pain. METHODS Fourteen patients with LDH-induced radicular pain attended a single session of electrotherapy, which included four 10-min consecutive treatments: transcutaneous electrical nerve stimulation (TENS), interferential (IF) stimulation, a combined treatment with pulsed ultrasound and IF current (CTPI), and a sham control. Treatments were randomized and the straight leg raise (SLR) degree was measured immediately before and after each treatment. RESULTS Each of the three active modalities significantly improved the SLR score. The most prominent improvement was observed in the CTPI condition, followed by IF and, finally, TENS. The sham stimulation did not affect the SLR scores. CONCLUSIONS A single session with either TENS, IF current or CTPI is sufficient to improve the range of motion and degree of radicular pain associated with LDH. CTPI appears to be the most effective modality of the three, possibly due to greater penetration efficiency of the induced current. The effects of a long-term treatment schedule are yet to be identified.
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Affiliation(s)
- Efrat Ariel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Itay Goor-Aryeh
- Pain Clinic, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Ratmansky Motti
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pain Clinic, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
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36
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A Preliminary Study on the Equivalence between Standing Back-Extension and Superman Training in Lumbar Multifidus Exercise. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3677831. [PMID: 35371286 PMCID: PMC8967528 DOI: 10.1155/2022/3677831] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022]
Abstract
Objective. To explore the equivalence of an easier and more convenient lumbar multifidus (LM) muscle exercise pattern among standing back-extension, static standing, and superman training. Methods. A total of 26 healthy young volunteers were enrolled, including 14 males and 12 females, aged from 22 to 44 years with an average of
years. Ultrasonography was used to measure the thickness of the left LM of the transverse process of the L5 vertebra during static standing, static prone decubitus, standing back-extension, and prone superman training. In this study, measurement data were expressed as
and compared using the
-test. Results. The left LM thickness of the L5 vertebra was
cm during static standing and
cm during static prone decubitus, showing no statistical difference between the two groups (
). The left LM thickness of the L5 vertebra was
cm during standing back-extension and
cm during the prone superman training, indicating no statistical difference between the two groups (
). Conclusions. There is no significant statistical difference in the LM thickness between static standing and static prone decubitus and between standing back-extension and prone superman training, indicating the equivalence of the two methods in LM exercise, providing a simpler and easier way for clinical exercise of lumbodorsal muscles.
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37
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Bronfort G, Maiers M, Schulz C, Leininger B, Westrom K, Angstman G, Evans R. Multidisciplinary integrative care versus chiropractic care for low back pain: a randomized clinical trial. Chiropr Man Therap 2022; 30:10. [PMID: 35232482 PMCID: PMC8886833 DOI: 10.1186/s12998-022-00419-3] [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: 09/30/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is influenced by interrelated biological, psychological, and social factors, however current back pain management is largely dominated by one-size fits all unimodal treatments. Team based models with multiple provider types from complementary professional disciplines is one way of integrating therapies to address patients' needs more comprehensively. METHODS This parallel group randomized clinical trial conducted from May 2007 to August 2010 aimed to evaluate the relative clinical effectiveness of 12 weeks of monodisciplinary chiropractic care (CC), versus multidisciplinary integrative care (IC), for adults with sub-acute and chronic LBP. The primary outcome was pain intensity and secondary outcomes were disability, improvement, medication use, quality of life, satisfaction, frequency of symptoms, missed work or reduced activities days, fear avoidance beliefs, self-efficacy, pain coping strategies and kinesiophobia measured at baseline and 4, 12, 26 and 52 weeks. Linear mixed models were used to analyze outcomes. RESULTS 201 participants were enrolled. The largest reductions in pain intensity occurred at the end of treatment and were 43% for CC and 47% for IC. The primary analysis found IC to be significantly superior to CC over the 1-year period (P = 0.02). The long-term profile for pain intensity which included data from weeks 4 through 52, showed a significant advantage of 0.5 for IC over CC (95% CI 0.1 to 0.9; P = 0.02; 0 to 10 scale). The short-term profile (weeks 4 to 12) favored IC by 0.4, but was not statistically significant (95% CI - 0.02 to 0.9; P = 0.06). There was also a significant advantage over the long term for IC in some secondary measures (disability, improvement, satisfaction and low back symptom frequency), but not for others (medication use, quality of life, leg symptom frequency, fear avoidance beliefs, self-efficacy, active pain coping, and kinesiophobia). Importantly, no serious adverse events resulted from either of the interventions. CONCLUSIONS Participants in the IC group tended to have better outcomes than the CC group, however the magnitude of the group differences was relatively small. Given the resources required to successfully implement multidisciplinary integrative care teams, they may not be worthwhile, compared to monodisciplinary approaches like chiropractic care, for treating LBP. Trial registration NCT00567333.
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Affiliation(s)
- Gert Bronfort
- University of Minnesota, Mayo Building C504, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Michele Maiers
- Northwestern Health Sciences University, 2501 W. 84th Street, Bloomington, MN, 55431, USA
| | - Craig Schulz
- University of Minnesota, Mayo Building C504, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Brent Leininger
- University of Minnesota, Mayo Building C504, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Kristine Westrom
- University of Minnesota, Mayo Building C504, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Greg Angstman
- St. Elizabeth's Medical Center-Wabasha, 1000 1st Dr NW, Austin, MN, USA
| | - Roni Evans
- University of Minnesota, Mayo Building C504, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
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38
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Hooker QL, Lanier VM, Roles K, van Dillen LR. Motor skill training versus strength and flexibility exercise in people with chronic low back pain: Preplanned analysis of effects on kinematics during a functional activity. Clin Biomech (Bristol, Avon) 2022; 92:105570. [PMID: 35045374 PMCID: PMC8985120 DOI: 10.1016/j.clinbiomech.2021.105570] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND People with chronic low back pain display the altered movement pattern where the lumbar spine moves more readily into its available range of motion relative to other joints. A logical approach to treatment, therefore, would be to improve this pattern during functional activities. METHODS 154 participants were randomized to receive 6 weeks of motor skill training or strength and flexibility exercise. Participants in the motor skill training group received person-specific training to modify their altered movement pattern during functional activities. Participants in the strength and flexibility group received exercises for trunk strength and trunk and lower-limb flexibility. At baseline, post-treatment and 6-months after treatment participants performed a test of picking up an object using their preferred pattern. Three-dimensional marker co-ordinate data were collected. A mixed-model repeated measures analysis of variance was used to examine the treatment group and time effects. FINDINGS Motor skill training: Baseline early excursion values [mean (confidence interval)] were as follows: knee = 11.1°(8.0,4.1), hip = 21.2°(19.2,23.1), lumbar = 11.3°(10.4,12.3). From baseline to post-treatment significant improvements in early excursion included: knee = +18.6°(15.4,21.8), hip = +10.8°(8.8,12.8), and lumbar = -2.0°(-0.1,-4.0). There were no significant changes from post-treatment to 6-month follow-up. Strength and flexibility exercise: Baseline early excursion values were as follows: knee = 8.9°(5.8,11.9), hip = 20.8°(18.9,22.8), and lumbar = 11.2°(10.3,12.2) early excursion. There were no significant changes for knee, hip, and lumbar early excursion. INTERPRETATION Motor skill training was more effective than strength and flexibility exercise at changing and maintaining change to the altered movement pattern during a functional activity test of picking up an object.
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Affiliation(s)
- Quenten L. Hooker
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Vanessa M. Lanier
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, United States,Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Kristen Roles
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Linda R. van Dillen
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, United States,Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, United States
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39
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Beloborodov VA, Stepanov IA. [Risk factors of unsatisfactory outcomes after percutaneous laser decompression of lumbar intervertebral discs]. Khirurgiia (Mosk) 2022:15-22. [PMID: 35080822 DOI: 10.17116/hirurgia202201115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the risk factors of unsatisfactory clinical results after percutaneous laser decompression of the lumbar intervertebral disc (PLDD). MATERIAL AND METHODS A retrospective observational single-center study included medical records of patients who underwent lumbar PLDD for degenerative spine disease. We analyzed clinical and instrumental parameters potentially affecting the results of lumbar PLDD. RESULTS Clinical study included 82 patients who underwent PLDD for lumbar intervertebral disc degenerative disease. Mean postoperative follow-up period was 30.8±13.3 months. In 22 (26%) patients, unsatisfactory clinical outcomes were observed. According to binary logistic regression model, comorbidities (p=0.03), duration of disease over 12 months (p=0.03), low preoperative quality of life according to ODI score (more than 50%) (p=0.04), high body mass index (over 25 kg/m2) (p=0.02), severe intervertebral disc (p=0.04) and facet joint degeneration (p=0.01) and intervertebral disc height decrease more than 50% (p=0.01) were significantly associated with unsatisfactory clinical outcomes after lumbar PLDD for degenerative spine disease. CONCLUSION Identification of these risk factors of unsatisfactory clinical outcomes is important stage of preoperative preparation in patients scheduled for lumbar PLDD.
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Affiliation(s)
| | - I A Stepanov
- Irkutsk State Medical University, Irkutsk, Russia.,Kharlampiev Hospital, Irkutsk, Russia
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40
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Jones SMW, Sherman KJ, Bermet Z, Palazzo LG, Lewis CC. Theory of Planned Behavior and Mindfulness Intentions in Chronic Low Back Pain. Mindfulness (N Y) 2022; 13:3145-3152. [PMID: 36408120 PMCID: PMC9648996 DOI: 10.1007/s12671-022-02022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/12/2022]
Abstract
Objectives Theory of planned of behavior (TPB) constructs have been linked to health behavior intentions. Intentions to try mindfulness-based stress reduction (MBSR), a first-line therapy for chronic low back pain (cLBP), have been less studied. This study aimed to identify which TPB constructs could inform strategies to improve adoption of MBSR. Methods People with cLBP (n = 457) read a description of MBSR then completed survey items assessing TPB constructs: attitudes, norms, self-efficacy, perceived control, and intentions to try MBSR training. Results Structural equation modeling showed self-efficacy/control (coefficient: 0.564), norms (0.245), and attitudes (0.131) were all positively associated with intentions to try mindfulness trainings. Conclusions Results suggest self-efficacy/control may be the most strongly related TPB construct with intentions to try MBSR. Dissemination of MBSR for cLBP could focus on adapting the intervention to increase accessibility and improving available resources to overcome logistical barriers (online formats, drop-in classes). Supplementary Information The online version contains supplementary material available at 10.1007/s12671-022-02022-2.
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Affiliation(s)
- Salene M. W. Jones
- Fred Hutchinson Cancer Research Center, Kaiser Permanente Washington Health Research Institute, University of Washington, 1100 Fairview Ave N, Seattle, WA 98109 USA
| | - Karen J. Sherman
- Fred Hutchinson Cancer Research Center, Kaiser Permanente Washington Health Research Institute, University of Washington, 1100 Fairview Ave N, Seattle, WA 98109 USA
| | - Zoe Bermet
- University of Washington, Seattle, WA USA
| | - Lorella G. Palazzo
- Fred Hutchinson Cancer Research Center, Kaiser Permanente Washington Health Research Institute, University of Washington, 1100 Fairview Ave N, Seattle, WA 98109 USA
| | - Cara C. Lewis
- Fred Hutchinson Cancer Research Center, Kaiser Permanente Washington Health Research Institute, University of Washington, 1100 Fairview Ave N, Seattle, WA 98109 USA
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41
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Margiana R, Alawiyah K, Ima K, Fitriana R, Widodo AR, Wibowo TD. Improvement of Walking Analysis using the Sciatic Function Index for Sciatic Nerve Function in Injured Rat Model Treated with Low-Intensity Aerobics. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Sciatica is a disease of the peripheral nerves. Sciatica indicates that there is damage to the peripheral nerves in the sciatic nerves. Factors that can affect this disease include gender, posture, parity, age, genetic factors, and occupation. Some of the pathophysiological conditions of sciatica include the pathology of the intervertebral disc, dorsal root, and sciatic nerve itself. The results of standard therapy with surgery have not been effective and very expensive. Therefore, research on therapy in sciatica cases still needs to be done and evaluated. Physical exercise treatment (aerobic] is necessary for this therapy in sciatica cases due to promote the function of peripheral nerves.
AIM: This study aimed to determine the effect of aerobic exercise treatment on peripheral nerve injury and its relationship to walking function during injury-induced peripheral nerve regeneration.
METHODS: This study was an experimental study with a post-test. he study sample consisted of Male Sprague-Dawley rats with an age of about 2-3 months divided into three groups. Control group was conducted by surgery without clamping/injuring the peripheral nerves. The treatment for second group (P1) was clamping/injury of peripheral nerve and given the treatment of physical exercise with aerobics. The treatment for third group (P2) was clamping/injury of peripheral nerve and not given the treatment of physical exercise with aerobics. The intensity of giving physical exercise treatment with aerobic that is carried out is for 42 days. Nerve functional evaluation was carried out using the sciatic function index (SFI) method. Histological staining for sciatic was used hematoxylin-Eosin (HE) staining and immunohistochemistry with Growth Associated Protein 43 (GAP43) [Bioss, bs-0154R] and S100 antibody [ab52642]. This research was approved by Animal Ethics Committee of University of Indonesia protocol (No.19-07-0852).
RESULTS: There was a significant change between the 7th and 14th days (p<0.001; paired t-test) in the P1 treatment. Improvement in nerve function was found on the 14th day after being given aerobic treatment. This is indicated by the data average change in SFI scores on days 7 and 4 was from -144 to 34. This data is also supported by footprint changes for injured hindfoot data.
CONCLUSION: Low intensity aerobics treatment improve the walking function and nerve function in sciatic nerve injury on day 14. This is due to the effect of physical exercise on the injured sciatic nerve.
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Urquhart DM, Rosenfeld JV, van Tulder M, Wluka AE, Leder K, Cheng AC, Forbes AB, Chan P, O'Sullivan R, Liew S, Cicuttini FM. Is antibiotic treatment effective in the management of chronic low back pain with disc herniation? Study protocol for a randomised controlled trial. Trials 2021; 22:759. [PMID: 34717722 PMCID: PMC8557614 DOI: 10.1186/s13063-021-05728-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background There has been immense interest and debate regarding the effectiveness of antibiotic treatment for chronic low back pain. Two randomised controlled trials have examined the efficacy of antibiotics for chronic low back pain with disc herniation and Modic changes, but have reported conflicting results. The aim of this double-blind, randomised, placebo-controlled trial is to determine the efficacy of antibiotic treatment in a broader patient subgroup of chronic low back pain with disc herniation and investigate whether the presence of Modic changes predicts response to antibiotic therapy. Methods One hundred and seventy individuals with chronic low back pain will be recruited through hospital and private medical and allied health clinics; advertising in national, community and social media; and posting of flyers in community locations. They will be randomly allocated to receive either amoxicillin-clavulanate (500 mg/125 mg) twice per day for 90 days or placebo. The primary outcome measure of pain intensity will be assessed using the Low Back Pain Rating scale and a 100-mm visual analogue scale at 12 months. Secondary measures of self-reported low back disability and work absence and hindrance will also be examined, and an economic analysis will be conducted. Intention-to-treat analyses will be performed. Discussion There is uncertainty about whether antibiotic treatment is effective for chronic low back pain and, if effective, which patient subgroup is most likely to respond. We will conduct a clinical trial to investigate the efficacy of antibiotics compared with placebo in individuals with chronic low back pain and a disc herniation. Our findings will provide high-quality evidence to assist in answering these questions. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12615000958583. Registered on 11 September 2015 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05728-1.
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Affiliation(s)
- Donna M Urquhart
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, 3004, Australia.
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, Alfred Hospital, Melbourne, VIC, 3004, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Maurits van Tulder
- Department of Human Movement Sciences, Faculty Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, 1081, HV, Amsterdam, The Netherlands
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Allen C Cheng
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Andrew B Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Patrick Chan
- Department of Neurosurgery, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Richard O'Sullivan
- MRI Department, Healthcare Imaging Services, Epworth Hospital, Richmond, VIC, 3121, Australia
| | - Susan Liew
- Department of Orthopaedic Surgery, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, 3004, Australia
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Oliveira CB, Hamilton M, Traeger A, Buchbinder R, Richards B, Rogan E, Maher CG, Machado GC. Do patients with acute low back pain in emergency departments have more severe symptoms than those in general practice? A systematic review with meta-analysis. PAIN MEDICINE 2021; 23:614-624. [PMID: 34480571 DOI: 10.1093/pm/pnab260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/10/2021] [Accepted: 08/14/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION There is a common belief that patients presenting to emergency departments have more severe pain levels and functional limitations than those in general practice. The aim of this systematic review was to compare pain and disability levels of patients with acute low back pain presenting to general practice versus those presenting to emergency departments. METHODS Electronic searches were conducted in MEDLINE, EMBASE and CINAHL from inception to February 2019. Observational studies including patients with acute non-specific low back pain presenting to emergency departments and/or general practice were eligible. Pain and/or disability scores expressed on a 0-100 scale were the primary outcomes. Risk of bias was evaluated using a validated tool for observational studies and the overall quality of evidence was assessed using GRADE. Meta-analysis using random effects and meta-regression were used to test for differences between the two settings. RESULTS We included 12 records reporting results for 10 unique studies with a total of 6,999 participants from general practice (n = 6) and emergency departments (n = 4). There was low quality evidence (downgraded for indirectness and inconsistency) that patients presenting to emergency departments had higher pain scores than those in general practice with a mean difference of 17.3 points (95%CI: 8.8 to 25.9 on a 0-100 scale). Similarly, there was low quality evidence (downgraded for indirectness and inconsistency) that patients presenting to emergency departments had higher disability scores than those in general practice (mean difference: 21.7, 95%CI: 4.6 to 38.7 on a 0-100 scale). CONCLUSION Patients with acute non-specific low back pain presenting to emergency departments may report higher levels of pain and disability than those seen in general practice. PROSPERO REGISTRATION NUMBER CRD42017076806.
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Affiliation(s)
- Crystian B Oliveira
- Physical Therapy Department, Faculty of Science and Technology, Sao Paulo State University, Presidente Prudente, Sao Paulo, Brazil.,Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil.,Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
| | - Melanie Hamilton
- Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
| | - Adrian Traeger
- Institute for Musculoskeletal Health, Sydney, New South Wales, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bethan Richards
- Institute for Musculoskeletal Health, Sydney, New South Wales, Australia.,Rheumatology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Eileen Rogan
- Emergency Department, Canterbury Hospital, Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney, New South Wales, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, Sydney, New South Wales, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Vaughan SA, Torres K, Kaye R. RESUME-1: a Phase III study of tolperisone in the treatment of painful, acute muscle spasms of the back. Pain Manag 2021; 12:25-33. [PMID: 34192885 DOI: 10.2217/pmt-2021-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Tolperisone is a nonopioid, centrally acting muscle relaxant in clinical development in the USA for the treatment of symptoms associated with acute, painful muscles spasms of the back. CLN-301, RESUME-1, is a 14-day double-blind, randomized, placebo-controlled, parallel-group Phase III study of the efficacy and safety of tolperisone administered orally three-times daily in 1000 male and female subjects at approximately 70 clinical sites in the USA experiencing back pain due to or associated with muscle spasm of acute onset. Tolperisone is a promising therapeutic for managing acute, painful muscle spasms of the back as it appears to lack the off-target CNS effects often seen with conventional skeletal muscle relaxants. Clinical Trials Registration: NCT04671082.
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Affiliation(s)
| | - Kayla Torres
- Neurana Pharmaceuticals, Inc., San Diego, CA 92122, USA
| | - Randall Kaye
- Neurana Pharmaceuticals, Inc., San Diego, CA 92122, USA
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45
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Abstract
In all levels of disc herniations the absolute surgical indications include deteriorating neurological deficits with myelopathy or cauda equina syndrome. However, this review summarized the relative indications for surgery in each level. In cervical disc herniation (CDH), the indications for surgery consist of six months of persisting symptoms, not responding to conservative treatment. However, high-quality studies are lacking, and a randomized controlled trial is now underway to clarify the indications. In thoracic disc herniation (TDH), the indications for surgery comprise failure of conservative measures and/or worsening neurological symptoms. Moreover, giant calcified thoracic disc herniations or myelopathy signs on magnetic resonance imaging, even in the absence of neurological symptoms, may benefit from surgical treatment as a preventive measure. In lumbar disc herniation (LDH), the indications for surgery include imaging confirmation of LDH, consistent with clinical findings, and failure to improve after six weeks of conservative care.
Cite this article: EFORT Open Rev 2021;6:526-530. DOI: 10.1302/2058-5241.6.210020
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Affiliation(s)
- Wai Weng Yoon
- Spinal Surgery Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.,Centre for Spinal Surgery, Queens Medical Centre, Nottingham University NHS Trust, Nottingham, UK
| | - Jonathan Koch
- Centre for Spinal Surgery, Queens Medical Centre, Nottingham University NHS Trust, Nottingham, UK
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Tieppo Francio V, Sherwood D, Twohey E, Barndt B, Pagan-Rosado R, Eubanks J, Sayed D. Developments in Minimally Invasive Surgical Options for Vertebral Pain: Basivertebral Nerve Ablation - A Narrative Review. J Pain Res 2021; 14:1887-1907. [PMID: 34188535 PMCID: PMC8236249 DOI: 10.2147/jpr.s287275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022] Open
Abstract
Historically, intervertebral disc degeneration has been the etiological target of chronic low back pain; however, disc degeneration is not necessarily directly associated with pain, and many other anatomical structures are potential etiologies. The vertebral endplates have been postulated to be a source of vertebral pain, where these endplates become particularly susceptible to increased expression of nociceptors and inflammatory proliferation carried by the basivertebral nerve (BVN), expressed on diagnostic imaging as Modic changes. This is useful diagnostic information that can help physicians to phenotype a subset of low back pain, which is known as vertebral pain, in order to directly target interventions, such as BVN ablation, to this significant pain generator. Therefore, this review describes the safety, efficacy, and the rationale behind the use of BVN ablation, a minimally invasive spinal intervention, for the treatment of vertebral pain. Our current literature review of available up-to-date publications utilizing BVN ablation in the treatment of vertebral pain suggests that there is limited, but moderate-quality evidence that this is an effective intervention for reduction of disability and improvement in function, at short- and long-term follow-up, in addition to limited moderate-quality evidence that BVN RFA is superior to conservative care for pain reduction, at least at 3-month follow-up. Our review concluded that there is a highly clinical and statistically significant treatment effect of BVN ablation for vertebral pain with clinically meaningful benefits in pain reduction, functional improvements, opioid dose reduction, and improved quality of life. There were no reported device-related patient deaths or serious AEs based on the available literature. BVN ablation is a safe, well-tolerated and clinically beneficial intervention for vertebral pain, when proper patient selection and surgical/procedural techniques are applied.
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Affiliation(s)
- Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - David Sherwood
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric Twohey
- Gundersen Health System Transitional, La Crosse, WI, USA
| | - Brandon Barndt
- Department of Physical Medicine and Rehabilitation, Temple University and Moss Rehabilitation, Philadelphia, PA, USA
| | - Robert Pagan-Rosado
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - James Eubanks
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dawood Sayed
- Department of Anesthesiology, The University of Kansas Medical Center, Kansas City, KS, USA
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Jess MA, Hamilton S, Ryan C, Wellburn S, Alexanders J, Spence D, Martin D. Exploring the origin of pain subclassification, with emphasis on low back pain: a scoping review. JBI Evid Synth 2021; 19:308-340. [PMID: 32881730 DOI: 10.11124/jbisrir-d-19-00383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review aimed to explore the different working definitions for the duration of acute, subacute, and chronic pain, with emphasis on low back pain, and to establish where these definitions originated and the rationale provided for the time frames used. INTRODUCTION From a global perspective, low back pain is a major social and economic problem. One of the most commonly used methods to stratify and manage low back pain is the traditional duration-based classification (acute, subacute, and chronic). Where these time points lie to differentiate these transitions continues to be debated within the scientific community, which may engender a degree of heterogeneity in study findings. Therefore, applying these findings to clinical practice may be somewhat challenging. This review encapsulates the historical origins of the different duration categories to provide an understanding of how these variations were derived. INCLUSION CRITERIA Studies that included participants with low back pain were the focus of this review. Sources that included children or other specific pain pathologies, such as cancer pain, were excluded. The main concept of interest was that the publication proposed an original definition of the duration of acute, subacute, or chronic low back pain. All study designs were included provided they gave a rationale for the duration that they used. METHODS The following databases were searched: MEDLINE, Embase, CINAHL, and PsycINFO, from the inception of each database until September 18, 2019. This review was limited to studies published in English. Two independent reviewers screened the retrieved articles against the eligibility criteria. Additional studies were searched from the reference lists of studies to find the original source. Some original sources overlapped with general pain duration literature. This led to a deviation from the scoping review protocol, which originally intended to focus on definitions of low back pain duration only. Data extraction was undertaken using a charting table developed specifically for the review objectives. The findings were presented using narrative synthesis. RESULTS Nineteen records were included in this review, and comprised three book chapters, four review articles, four articles that arose following pain expert group discussions, seven primary research studies, and a spinal guideline. Data were extracted from the included studies and categorized into four themes based on the origin of the classification of the duration. The themes included i) work/employment setting, ii) empirical studies, iii) expert reasoning, and iv) pathophysiological explanation. CONCLUSIONS This scoping review compiled the existing literature on the working definitions of the duration of acute, subacute, and chronic low back pain and found a wide variation. These ranged from seven days, 14 days, and seven weeks for the acute and subacute transition points, and seven weeks to three years for chronic low back pain. The duration definitions specifically referring to the general pain literature focused on three and/or six months for the transition to chronic. Better integration of reasoning between the identified themes could facilitate the establishment of more ideal duration definitions in the future. Although inconclusive, the definition most commonly cited, with most consensus, was three months for the transition to chronic low back pain.
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Affiliation(s)
- Mary-Anne Jess
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Sharon Hamilton
- School of Health and Social Care, Teesside University, Middlesbrough, UK.,Teesside Centre for Evidence-Informed Practice: A JBI Affiliated Group, Middlesbrough, UK
| | - Cormac Ryan
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Shaun Wellburn
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Jenny Alexanders
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Daniel Spence
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Denis Martin
- School of Health and Social Care, Teesside University, Middlesbrough, UK
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Acupuncture alleviates chronic pain and comorbid conditions in a mouse model of neuropathic pain: the involvement of DNA methylation in the prefrontal cortex. Pain 2021; 162:514-530. [PMID: 32796318 PMCID: PMC7808350 DOI: 10.1097/j.pain.0000000000002031] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022]
Abstract
ABSTRACT Chronic pain reduces life quality and is an important clinical problem associated with emotional and cognitive dysfunction. Epigenetic regulation of DNA methylation is involved in the induction of abnormal behaviors and pathological gene expression. We examined whether acupuncture can restore epigenetic changes caused by chronic pain, and identified the underlying mechanisms in neuropathic pain mice. Acupuncture treatment for 6 months (3 days/week) improved mechanical/cold allodynia and the emotional/cognitive dysfunction caused by left partial sciatic nerve ligation (PSNL)-induced neuropathic pain. The effects of acupuncture were associated with global DNA methylation recovery in the prefrontal cortex (PFC). Analysis of DNA methylation patterns in PFC indicated that 1364 overlapping genes among 4442 and 4416 methylated genes in the PSNL vs sham and PSNL vs acupuncture points groups, respectively, were highly associated with the DNA methylation process. Acupuncture restored the reduced expression of 5-methylcytosine, methyl-cytosine-phospho-guanine binding protein 2, and DNA methyltransferase family enzymes induced by PSNL in PFC. Methylation levels of Nr4a1 and Chkb associated with mitochondrial dysfunction were decreased in PFC of the PSNL mice, and increased by acupuncture. By contrast, high expression of Nr4a1 and Chkb mRNA in PSNL mice decreased after acupuncture. We also found that acupuncture inhibited the expression of Ras pathway-related genes such as Rasgrp1 and Rassf1. Finally, the expression of Nr4a1, Rasgrp1, Rassf1, and Chkb mRNA increased in the neuronal cells treated with Mecp2 small interfering RNA. These results suggest that acupuncture can relieve chronic pain-induced comorbid conditions by altering DNA methylation of Nr4a1, Rasgrp1, Rassf1, and Chkb in the PFC.
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Radnovich R, Heinz J, Ambrose C, Stannard E, Lissin D. Repeat Epidural Injections of SP-102 (Dexamethasone Sodium Phosphate Injectable Gel) in Subjects with Lumbosacral Radiculopathy. J Pain Res 2021; 14:1231-1239. [PMID: 33981160 PMCID: PMC8107054 DOI: 10.2147/jpr.s303282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/01/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose SP-102 is a novel epidural steroid injection (ESI) formulation of 10 mg dexamethasone sodium phosphate in a viscous gel solution. Repeat dosing of ESIs is possible if required for pain relief, but with consideration of hypothalamic–pituitary–adrenal (HPA) axis suppression from prolonged systemic exposure. This phase I/II study investigated the effect of initial and repeat SP-102 injections on HPA suppression and analgesia. Methods Subjects with lumbosacral radiculopathy received an initial epidural SP-102 injection (T1) on day 1, followed by a repeat injection (T2) on ≥28 days later. To determine HPA suppression, area under the effect curve over 28 days and maximum change from baseline were calculated for cortisol, glucose levels, and white blood cell (WBC) count. Equivalent effect on HPA suppression of T1 relative to T2 was determined if the 90% CIs for ratios of these measures were within 80%–125%. The effect of repeat injections on leg and back pain was also assessed. Results Based on the responder analysis, all subjects had achieved a cortisol response by day 3 after initial injection and by day 2 after repeat injection. The repeat injection had similar effects on glucose levels and WBC count to the initial injection. Pain scores decreased after each injection and remained low for the 28-day follow-up, with some evidence of improved analgesic effect of the second dose compared with the first. There were no serious adverse events or discontinuations due to adverse events. Conclusion The lack of cumulative effect and rapid resolution of HPA suppression following repeated SP-102 dosing suggests that consideration of HPA pharmacodynamics is not clinically relevant when making decisions regarding repeat dosing. SP-102 ESIs provided prolonged pain relief, with preliminary evidence of greater efficacy after repeat injection. A phase III trial is ongoing. Clinical Trial Identifier ClinicalTrials.gov: NCT03613662.
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Affiliation(s)
| | | | - Chris Ambrose
- Global Research and Development, Scilex Pharmaceuticals Inc, Palo Alto, CA, USA
| | - Elizabeth Stannard
- Global Research and Development, Scilex Pharmaceuticals Inc, Palo Alto, CA, USA
| | - Dmitri Lissin
- Global Research and Development, Scilex Pharmaceuticals Inc, Palo Alto, CA, USA
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Consistent differences in lumbar spine alignment between low back pain subgroups and genders during clinical and functional activity sitting tests. Musculoskelet Sci Pract 2021; 52:102336. [PMID: 33548765 PMCID: PMC8918047 DOI: 10.1016/j.msksp.2021.102336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Subgroups of people with low back pain display differences in their lumbar alignment during tests from a clinical examination. However, it is unknown if subgroups display the same patterns during a functional activity test and if gender influences subgroup-related differences. OBJECTIVES Test if differences in lumbar alignment between two LBP subgroups are 1) present during a functional activity test of preferred sitting and 2) independent of gender. DESIGN Cross-sectional. METHOD 154 participants with chronic low back pain were classified based on the Movement System Impairment Classification System by a physical therapist. Participants performed a functional activity test of preferred sitting and clinical tests of maximum flexed and extended sitting. 3D marker co-ordinate data were collected. Sagittal plane lumbar alignment, indexed by lumbar curvature angle, was calculated. A three-way mixed effect analysis of variance was used to examine effects of test, subgroup, gender, subgroup × test, gender × test and subgroup × gender. RESULTS/FINDINGS The lumbar rotation with extension subgroup [LCA = -8.0° (-9.5,-6.5)] displayed a more extended lumbar alignment than lumbar rotation [LCA = -5.9° (-7.4,-4.4)]. Women [LCA = -10.7° (-12.3,-9.2)] displayed a more extended lumbar alignment than men [LCA = -3.2° (-4.7,-1.7)]. There was a significant gender × test interaction (p = 0.01). The subgroup × test (p = 0.99) and subgroup × gender (p = 0.76) interactions were not significant. CONCLUSIONS LBP subgroup differences in lumbar alignment are present during preferred sitting. Gender-related differences in lumbar alignment are not driving subgroup differences. These findings highlight the need to use patient-specific clinical characteristics to guide treatment of a functional activity of preferred sitting limited due to low back pain.
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