Randomized study of the impact of a therapeutic education program on patients suffering from chronic low-back pain who are treated with transcutaneous electrical nerve stimulation

The effectiveness of Kinesio taping and conventional physical therapy in the management of chronic low back pain: a randomized clinical trial

OBJECTIVE

The objective of the study was to find out the effectiveness of Kinesio taping (KT) and conventional physical therapy (CPT) such as transcutaneous electrical nerve stimulation and supervised exercise therapy and CPT alone in chronic low back pain (CLBP) patients.

METHODS

This randomized clinical trial conducted between June 2019 and December 2020, who were randomly assigned to two groups: the experimental group (KT with CPT) and the control group (CPT only). The following outcomes were measured at baseline and at the second and sixth weeks: pain using the Numerical Pain Rating Scale, lumbar flexion range of motion (ROM) by the modified Schober's method, and functional disability using the Oswestry Disability Index. Treatment effects were investigated using separate 2 × 3 mixed-model analyses of variance (ANOVAs).

RESULTS

A total of 60 male adults with CLBP were included in this study. The experimental group showed a greater decrease in pain than the control group after 2 week of intervention (mean between-group difference 1.97 (95%CI 1.64-2.29). This was maintained during a 6-week follow-up of 2.71 (95%CI 2.54-2.87). At 2 weeks, the experimental group had a significantly greater improvement in disability, by 13.45 (95%CI 11.98-14.91). This effect was significant at the 6-week follow-up of 14.10 (95%CI 13.11-15.08). Similarly, lumbar flexion ROM was significantly better at the 2-week - 2.7 (95%CI -3.15- - 2.42) and 6-week follow-ups -3.9 (95%CI - 4.42- - 3.49).

CONCLUSION

The study concluded that Kinesio taping with conventional physical therapy reduces pain and disability and improves lumbar flexion range of motion after 2 and 6 weeks of application.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05173948. Key Points • This is the first clinical study found the short-term clinical effectiveness of Kinesio taping and conventional physical therapy in the management of chronic low back pain. • This study found a new clinical evidence that Kinesio taping and conventional physical therapy provides better short-term outcomes in chronic low back pain. • These reports helpful for the clinicians and physical therapists to prevent and treat the symptoms and consequences of chronic low back pain in an effective manner.

Characterising the Features of 381 Clinical Studies Evaluating Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief: A Secondary Analysis of the Meta-TENS Study to Improve Future Research

Background and Objectives: Characterising the features of methodologies, clinical attributes and intervention protocols, of studies is valuable to advise directions for research and practice. This article reports the findings of a secondary analysis of the features from studies screened as part of a large systematic review of TENS (the meta-TENS study). Materials and Methods: A descriptive analysis was performed on information associated with methodology, sample populations and intervention protocols from 381 randomised controlled trials (24,532 participants) evaluating TENS delivered at a strong comfortable intensity at the painful site in adults with pain, irrespective of diagnosis. Results: Studies were conducted in 43 countries commonly using parallel group design (n = 334) and one comparator group (n = 231). Mean ± standard deviation (SD) study sample size (64.05 ± 58.29 participants) and TENS group size (27.67 ± 21.90 participants) were small, with only 13 of 381 studies having 100 participants or more in the TENS group. Most TENS interventions were ‘high frequency’ (>10 pps, n = 276) and using 100 Hz (109/353 reports that stated a pulse frequency value). Of 476 comparator groups, 54.2% were active treatments (i.e., analgesic medication(s), exercise, manual therapies and electrophysical agents). Of 202 placebo comparator groups, 155 used a TENS device that did not deliver currents. At least 216 of 383 study groups were able to access other treatments whilst receiving TENS. Only 136 out of 381 reports included a statement about adverse events. Conclusions: Clinical studies on TENS are dominated by small parallel group evaluations of high frequency TENS that are often contaminated by concurrent treatment(s). Study reports tended focus on physiological and clinical implications rather than the veracity of methodology and findings. Previously published criteria for designing and reporting TENS studies were neglected and this should be corrected in future research using insights gleaned from this analysis.

Foundational Research Could Improve Future Transcutaneous Electrical Nerve Stimulation Evaluations

Background and objectives: There is a lack of good quality evidence regarding the effectiveness of transcutaneous electrical nerve stimulation (TENS) for chronic musculoskeletal pain, including chronic low back pain. High quality randomised controlled trials (RCTs) have been called for to establish effectiveness over and above placebo and some guidance has already been offered regarding the design of such trials. This article expands the discussion regarding the design of future TENS trials. There is qualitative evidence of the complexity of TENS as an intervention which should be considered in future TENS evaluations. This complexity includes multiple benefits reported by patients, depending on their chosen contexts of TENS use. The ideal content and delivery of support for patients to optimise TENS use also lacks consensus. There is no evidence that a TENS education package has been designed to support the complex set of behaviours and choices which experienced users suggest are required to optimise TENS benefits. Finally, clinical and research outcomes have not been contextualised and related to the specific strategies of use. Conclusions: We suggest that research is required to develop consensus about the content and delivery of training in TENS use for patients who live with pain, informed by the experience of patients, clinicians, and researchers. Once a consensus about the content of TENS training has been reached, there is then a need to develop a TENS training course (TTC) based on this content. An effective and acceptable TTC is needed to develop the knowledge and skills required to optimise TENS use, supporting patients to build confidence in using TENS in everyday life situations with the aim of reducing the impact of chronic pain on function and quality of life. Further research is required to extend the evidence base regarding appropriate, contextualised TENS patient-reported outcomes.

A Comprehensive Review of Over the Counter Treatment for Chronic Low Back Pain

PURPOSE OF THE REVIEW

Chronic low back pain (CLBP) is a major contributor to societal disease burden and years lived with disability. Nonspecific low back pain (LBP) is attributed to physical and psychosocial factors, including lifestyle factors, obesity, and depression. Mechanical low back pain occurs related to repeated trauma to or overuse of the spine, intervertebral disks, and surrounding tissues. This causes disc herniation, vertebral compression fractures, lumbar spondylosis, spondylolisthesis, and lumbosacral muscle strain.

RECENT FINDINGS

A systematic review of relevant literature was conducted. CENTRAL, MEDLINE, EMBASE, PubMed, and two clinical trials registry databases up to 24 June 2015 were included in this review. Search terms included: low back pain, over the counter, non-steroidal anti-inflammatory (NSAID), CLBP, ibuprofen, naproxen, acetaminophen, disk herniation, lumbar spondylosis, vertebral compression fractures, spondylolisthesis, and lumbosacral muscle strain. Over-the-counter analgesics are the most frequently used first-line medication for LBP, and current guidelines indicate that over-the-counter medications should be the first prescribed treatment for non-specific LBP. Current literature suggests that NSAIDs and acetaminophen as well as antidepressants, muscle relaxants, and opioids are effective treatments for CLBP. Recent randomized controlled trials also evaluate the benefit of buprenorphine, tramadol, and strong opioids such as oxycodone. This systematic review discusses current evidence pertaining to non-prescription treatment options for chronic low back pain.