Electrical stimulation for chronic non-specific low back pain in a working-age population: a 12-week double blinded randomized controlled trial

The effects of dynamic neuromuscular stabilization approach on clinical outcomes in older patients with chronic nonspecific low back pain: a randomized, controlled clinical trial

OBJECTIVE

We aimed to examine the effects of Dynamic Neuromuscular Stabilization (DNS) approach in older patients with chronic non-specific low back pain (CNSLBP).

METHODS

A total of 72 participants with CNSLBP were assigned to either the experimental group (n = 36) or control group (n = 36) in this randomized study. A conventional physiotherapy program was administered to the participants in the control group for 3 days per week for a total of 6 weeks. In addition to the conventional program, DNS exercise protocol was performed for 3 days per week for 6 weeks for the participants in the experimental group. While quality of movements and exercise capacity were our primary outcomes, functional balance and quality of life constituted our secondary outcomes. The participants were assessed both at baseline and post-treatment.

RESULTS

The improvement in a deep squat, in-line lunge, hurdle step, shoulder flexibility, rotary trunk stability, total Functional Movement Screening score, and Timed-up and Go Test score was greater in the experimental group (p<.05). The improvement was similar in both groups in terms of the rest of outcome measures.

DISCUSSION

This study demonstrated the effectiveness of the DNS approach on some functional movement patterns and functional balance performance in older patients with CNSLBP.

The effect of transcutaneous electrical nerve stimulation on pain and electrical stimulation muscle thickness in patients with non-specific chronic low back pain-based ultrasonographic evaluation

Aim: The existing mechanisms of transcutaneous electrical nerve stimulation (TENS) focuses more on the effect of neural tissue. This study investigated the effect of TENS on the thickness of the erector spinae muscles and reducing pain. Patients & methods: 56 individuals with low back pain participated in this single-blind, pre/post-test study. For 2 weeks, participants underwent ten sessions of TENS. The ultrasound evaluations examined the thickness of the erector spinae muscle, and the visual analog scale measured the severity of low back pain. Results: There was a decrease in pain score and muscle thickness after the interventions (p ≤ 0.004). There was also a strong correlation between reducing pain and decreasing muscle thickness (R = 0.709; p = 0.000). Conclusion: Following TENS in the lumbar, in addition to reducing pain, the thickness of the erector spinae muscles also decreased. Clinical Trial Registration: IRCT20200423047173N1 (ClinicalTrials.gov).

Clinical and Quality of Life Benefits for End-Stage Workers' Compensation Chronic Pain Claimants following H-Wave® Device Stimulation: A Retrospective Observational Study with Mean 2-Year Follow-Up

Previously promising short-term H-Wave^® device stimulation (HWDS) outcomes prompted this retrospective cohort study of the longer-term effects on legacy workers' compensation chronic pain claimants. A detailed chart-review of 157 consecutive claimants undergoing a 30-day HWDS trial (single pain management practice) from February 2018 to November 2019 compiled data on pain, restoration of function, quality of life (QoL), and polypharmacy reduction into a summary spreadsheet for an independent statistical analysis. Non-beneficial trials in 64 (40.8%) ended HWDS use, while 19 (12.1%) trial success charts lacked adequate data for assessing critical outcomes. Of the 74 final treatment study group charts, missing data points were removed for a statistical analysis. Pain chronicity was 7.8 years with 21.6 ± 12.2 months mean follow-up. Mean pain reduction was 35%, with 89% reporting functional improvement. Opioid consumption decreased in 48.8% of users and 41.5% completely stopped; polypharmacy decreased in 36.8% and 24.4% stopped. Zero adverse events were reported and those who still worked usually continued working. An overall positive experience occurred in 66.2% (p < 0.0001), while longer chronicity portended the risk of trial or treatment failure. Positive outcomes in reducing pain, opioid/polypharmacy, and anxiety/depression, while improving function/QoL, occurred in these challenging chronic pain injury claimants. Level of evidence: III.

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.

Effect of Neural Mobilization Exercises in Patients With Low Back-Related Leg Pain With Peripheral Nerve Sensitization: A Prospective, Controlled Trial

Objective

The aim of this study was to investigate the short-term effect of slider and tensioner exercises on pain and range of motion (ROM) of straight leg raise (SLR) and slump tests in patients with low back-related leg pain with peripheral nerve sensitization.

Methods

In this prospective, controlled trial, 51 patients with low back-related leg pain with peripheral nerve sensitization were divided into 3 treatment groups: slider (slider neural mobilization exercise + transcutaneous electric nerve stimulation [TENS]), tensioner (tensioner neural mobilization exercise + TENS), and control (only TENS). Each patient received 6 sessions over 2 weeks. The following outcomes were measured at baseline and after the first, third, and sixth sessions: visual analog scale (VAS) for pain and ROM of SLR and slump tests were performed for the symptomatic side.

Results

Compared with controls, patients receiving the slider and tensioner exercises showed a greater decrease in pain at the third and sixth sessions (mean difference: ≥1.54 cm; 95% CI, 0.1-3.9). There was a significant difference in the ROM of the SLR test between the slider and controls at only the sixth session (mean difference: 16.7°; 95% CI, -29.2 to -4.3). Patients in the slider and tensioner groups demonstrated greater improvements in the ROM of slump test at all sessions compared with controls (mean difference: ≥12.5°; 95% CI, -32.1 to -6.4). There were no significant differences between the slider and tensioner groups in any outcome at any session.

Conclusion

Patients in both slider and tensioner neural mobilization exercise groups demonstrated improvements in pain and ROM in patients with low back-related leg pain with peripheral nerve sensitization compared to those in the control group.

Heart Rate Variability Monitoring during Interferential Current Application in the Lower Back Area: A Cross-Sectional Study

Vasovagal reactions may occur occasionally during electrical stimulation using interferential current (IFC). The purpose of this study was to examine variations in autonomic activity during the application of IFC in asymptomatic participants by analysis of their heart rate variability (HRV). Seventy-three male volunteers were randomly assigned to a placebo group (n = 36; HRV was documented for 10 min, both at rest and during a placebo intervention) and an intervention group (n = 37; HRV was documented for 10 min in two conditions labelled as (1) rest and (2) application of IFC technique on the lumbar segment). The diameters of the Poincaré plot (SD1, SD2), stress score (SS), and the ratio between sympathetic and parasympathetic activity (S/PS) were measured. After interventions, differences amongst the placebo group and the IFC group were found in SD2 (p < 0.001), SS (p = 0.01) and S/PS ratio (p = 0.003). The IFC technique was associated with increased parasympathetic modulation, which could induce a vasovagal reaction. Monitorization of adverse reactions should be implemented during the application of IFC technique. HRV indicators might have a part in prevention of vasovagal reactions. Further studies in patients with lumbar pain are needed to explore possible differences in HRV responses due to the presence of chronic pain.

Protocol based management of common sports injuries by integrated approach of Sandhi Marmabhighata - An open labeled clinical trial

Background

Sports injuries are the second most common type of accident after domestic (3.7%) and occupational accidents (3.1%). There is an average annual estimate of 8.6 million sports and recreational related injury incidents with an age-adjusted rate of 34.1 per 1000 populations. Common sports injuries are musculoskeletal injuries i.e. Sprains, Strains, Joint injuries, soft tissue injury (STI). The sports injury in Ayurveda can be co-related within dissimilar facets of trauma related ailments.

Objective

To evaluate the efficacy of a protocol-based management of common sports injuries using an integrated approach.

Materials and methods

Integration of Ayurveda and Physiotherapy procedures was done and phase wise treatment was framed. Total 30 patients of age between 10 and 60 years ful-filling the inclusion criteria were selected for the present study. The patients were treated with Phase wise protocol consisting of three phase’s i.e. Inflammatory (1–5 days), Stabilization and recovery (6–10 days), Muscle strengthening (11–17 days). Assessments were done through various variables like pain, tenderness, swelling, local temperature, manual muscle testing (MMT) and range of motion (ROM) at different time points.

Statistical analysis

Wilcoxon matched pair test was used to assess within group results for subjective parameters and paired t-test (Dependent t-test) was used to assess for objective parameters.

Result

The study showed that integrated treatment approach has given significant results in the parameters like pain, loss of function, tenderness, local temperature, MMT and ROM.

Conclusion

Phase wise management through integrated protocol is effective in the management of common sports injuries.

Effect of pulsed electromagnetic field on nonspecific low back pain patients: a randomized controlled trial

BACKGROUND

Further research on pulsed electromagnetic field (PEMF) effects on the different conditions of low back pain was warranted due to lack of studies in this area.

OBJECTIVES

To investigate the effects of pulsed electromagnetic field therapy with 50Hz frequency, with low intensity of 20Gauss compared to conventional non-invasive treatment modalities in patients with chronic non-specific low back pain.

METHODS

Design - A prospective, randomized, patient-blinded, controlled trial. Setting - The study was conducted at Outpatient Physiotherapy Clinic in Cairo, Egypt. The study was conducted between May 2015 and September 2016. Participants - Fifty participants with non-specific low back pain enrolled into experimental and control groups. Interventions - The experimental group received the Conventional physical therapy Protocol as well as magnetic field, while the control group received the same Conventional physical therapy and sham electromagnetic field. Both groups received 12 sessions over 4 weeks' period. Outcome measures - Primary outcome measures was pain intensity while the secondary outcome measures were disability and lumbar range of motion - ROM. There were no adverse events occurred during the study.

RESULTS

Fifty participants with non-specific low back pain (control group n=25; experimental group n=25) were randomized. There were significant between-group differences in pain scores (mean difference - MD 1.52; 95%CI -0.34 to 3.35), function disability (MD 8.14; 95%CI 6.5 to 9.96), Range of Motion (ROM) of lumbar flexion (MD -1.27; 95%CI -1.09 to -1.45), ROM of lumbar extension (MD -1.1; 95%CI -0.97 to -1.23), ROM of lumbar right side bending (MD 8.2; 95%CI 6.56 to 9.84) and ROM of lumbar left side bending (MD 10.4; 95%CI 8.81 to 11.99) in favour of the experimental group.

CONCLUSION

Adding pulsed electromagnetic field to Conventional physical therapy Protocol yields superior clinical improvement in pain, functional disability, and lumbar ROM in patients with non-specific low back pain than Conventional physical therapy alone.

Psychosocial Factors Related to Lateral and Medial Epicondylitis: Results From Pooled Study Analyses

OBJECTIVE

The goal is to assess the relationships between psychosocial factors and both medial and lateral epicondylitis after adjustment for personal and job physical exposures.

METHODS

One thousand eight hundred twenty-four participants were included in pooled analyses. Ten psychosocial factors were assessed.

RESULTS

One hundred twenty-one (6.6%) and 34 (1.9%) participants have lateral and medial epicondylitis, respectively. Nine psychosocial factors assessed had significant trends or associations with lateral epicondylitis, the largest of which was between physical exhaustion after work and lateral epicondylitis with and odds ratio of 7.04 (95% confidence interval = 2.02 to 24.51). Eight psychosocial factors had significant trends or relationships with medial epicondylitis, with the largest being between mental exhaustion after work with an odds ratio of 6.51 (95% confidence interval = 1.57 to 27.04).

CONCLUSIONS

The breadth and strength of these associations after adjustment for confounding factors demonstrate meaningful relationships that need to be further investigated in prospective analyses.

Effect of interferential current therapy on pain perception and disability level in subjects with chronic low back pain: a randomized controlled trial

Objective:

To assess the short-term efficacy of transregional interferential current therapy on pain perception and disability level in chronic non-specific low back pain.

Design:

A randomized, single-blinded (the assessor collecting the outcome data was blinded), controlled trial.

Setting:

A private physiotherapy research clinic.

Subjects:

A total of 64 individuals, 20 men and 44 women, mean (SD) age was 51 years (11.93), with low back pain of more than three months, with or without pain radiating to the lower extremities above the knee, were distributed into a control ( n = 20) or an experimental group ( n = 44). A 2:1 randomization ratio was used in favour of the latter.

Interventions:

A transregional interferential current electrotherapy protocol was performed for participants in the experimental group, while the control group underwent a ‘usual care’ treatment (massage, mobilization and soft-tissue techniques). All subjects received up to 10 treatment sessions of 25 minutes over a two-week period, and completed the intervention and follow-up evaluations.

Outcome measures:

Self-perceived pain was assessed with a Visual Analogue Scale. Secondary measure included the Oswestry Low Back Disability Index. Evaluations were collected at baseline and after the intervention protocol.

Results:

Significant between-group differences were found for interferential current therapy on pain perception ( p = 0.032) and disability level ( p = 0.002). The observed differences in the between-group mean changes were of 11.34 mm (1.77/20.91) and 13.38 points (4.97/21.78), respectively.

Conclusions:

A two-week transregional interferential current treatment has shown significant short-term efficacy, when compared with a ‘usual care’ protocol, on self-perceived pain and functionality in subjects with chronic low back pain.

Effect of Fixed Versus Adjusted Transcutaneous Electrical Nerve Stimulation Amplitude on Chronic Mechanical Low Back Pain

OBJECTIVES

This study aimed to investigate the effect of adjusting pulse amplitude of transcutaneous electrical nerve stimulation versus fixed pulse amplitude in treatment of chronic mechanical low back pain.

DESIGN

Randomized clinical trial.

SETTING

El-sahel Teaching Hospital, Egypt.

PARTICIPANTS

Forty-five patients with chronic low back pain assigned to three equal groups. Their ages ranged from 20 to 50 years.

INTERVENTION

The three groups received the same exercise program. Group A received transcutaneous electrical nerve stimulation with fixed pulse amplitude for 40 minutes. Group B received transcutaneous electrical nerve stimulation with adjusted pulse amplitude for 40 minutes, with the pulse amplitude adjusted every 5 minutes. Group C received exercises only. Treatment sessions were applied three times per week for 4 weeks for the three groups.

OUTCOME MEASURES

A visual analogue scale was used to assess pain severity, the Oswestry Disability Index was used to assess functional level, and a dual inclinometer was used to measure lumbar range of motion. Evaluations were performed before and after treatment.

RESULTS

Visual analogue scale, Oswestry Disability Index, and back range of motion significantly differed between the two groups that received transcutaneous electrical nerve stimulation and the control group and did not significantly differ between fixed and adjusted pulse amplitude of transcutaneous electrical nerve stimulation.

CONCLUSION

Adjusting pulse amplitude of transcutaneous electrical nerve stimulation does not produce a difference in the effect of transcutaneous electrical nerve stimulation used to treat chronic low back pain.

Monochromatic Infrared Photo Energy Versus Low Level Laser Therapy in Chronic Low Back Pain

INTRODUCTION

Low back pain (LBP) is the most common musculoskeletal disease. Monochromatic infrared photo energy (MIPE) and low level laser therapy (LLLT) are light modalities used to reduce pain and increase blood flow. The aim of this study was to compare the effects of the MIPE and LLLT in reducing functional disability and pain as well as improving lumbar range of motion (ROM) in patients with chronic LBP.

METHODS

Seventy participants with LBP completed the program and were randomly assigned into 2 groups. Group 1 (n = 35) received MIPE and therapeutic exercises. Group 2 (n = 35) received LLLT and therapeutic exercises. Both groups received 2 visits per week for 6 weeks. Outcome measures were functional rating index (FRI), visual analogue scale (VAS) and modified-modified Schober test at baseline and after 6 weeks.

RESULTS

There were statistically significant improvements in functional disability, pain and lumbar ROM (P < .05) in each group. However, no significant differences were recorded between the groups (P > .05).

CONCLUSION

Therefore, MIPE and LLLT may play a role in treating chronic LBP and there are no differences between the two modalities in improving functional disability, pain and lumbar ROM in patients with chronic LBP.

Associations between Distal Upper Extremity Job Physical Factors and Psychosocial Measures in a Pooled Study

Introduction. There is an increasing body of literature relating musculoskeletal diseases to both job physical exposures and psychosocial outcomes. Relationships between job physical exposure measures and psychosocial factors have not been well examined or quantified. These exploratory analyses evaluate relationships between quantified exposures and psychosocial outcomes. Methods. Individualized quantification of duration, repetition, and force and composite scores of the Strain Index (SI) and the Threshold Limit Value for Hand Activity Level (TLV for HAL) were compared to 10 psychosocial measures. Relationships and predicted probabilities were assessed using ordered logistic regression. Analyses were adjusted for age, BMI, and gender. Results and Discussion. Among 1834 study participants there were multiple statistically significant relationships. In general, as duration, repetition, and force increased, psychosocial factors worsened. However, general health and mental exhaustion improved with increasing job exposures. Depression was most strongly associated with increased repetition, while physical exhaustion was most strongly associated with increased force. SI and TLV for HAL were significantly related to multiple psychosocial factors. These relationships persisted after adjustment for strong confounders. Conclusion. This study quantified multiple associations between job physical exposures and occupational and nonoccupational psychosocial factors. Further research is needed to quantify the impacts on occupational health outcomes.

Effects of transcutaneous electrical nerve stimulation on pain in patients with spinal cord injury: a randomized controlled trial

[Purpose] To investigate the effects of transcutaneous electrical nerve stimulation (TENS) on pain in patients with spinal cord injury. [Subjects and Methods] Fifty-two spinal cord injury patients with central pain were randomly allocated into two groups TENS and control with 26 subjects per group. The patients in TENS and control groups were treated with TENS and sham TENS for 20 min (three times a week) for 12 consecutive weeks, respectively. The two group’s pain was assessed using visual analog scale (VAS) and the McGill Pain Questionnaire (including pain rating index-total, pain rating index-affective, pain rating index-sensory, present pain intensity, and number of words chosen) before and after the treatment. [Results] After the intervention, we found significant differences in VAS, pain rating index-total, pain rating index-affective, pain rating index-sensory, present pain intensity, and number of words chosen between the TENS group and the control group. [Conclusion] Our results suggest that TENS effectively decreases pain in patients with spinal cord injury.