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Stephens AR, El-Hassan R, Patel RK. Evaluation of Fluoroscopically Guided Transforaminal Selective Nerve Root Sleeve Injections for Lumbar Spinal Stenosis With Radiculopathy Utilizing Patient Reported Outcome Measurement Information System as an Outcome Measure. Arch Phys Med Rehabil 2024; 105:1458-1463. [PMID: 38430994 DOI: 10.1016/j.apmr.2024.02.720] [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: 09/14/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To evaluate the therapeutic effect of transforaminal selective nerve root sleeve injections (TFSNRIs) in a specific subset of patients with clinical symptoms and presentation consistent with spinal stenosis. DESIGN Retrospective review. SETTING Tertiary academic spine center. PARTICIPANTS A total of 176 patients with radicular leg pain with or without low back pain as well as ≥3 clinical features of spinal stenosis and corroborative radiographic features of spinal stenosis on lumbar spine magnetic resonance imaging without confounding spinal pathology (N=176). INTERVENTIONS Fluoroscopically guided transforaminal selective nerve root sleeve injections. MAIN OUTCOME MEASURES Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) v1.2/v2.0, Pain Interference (PI) v1.1, and PROMIS (D) v1.0 were collected at baseline and post-procedure short term (<3-months) and long-term (6-12 month) follow-up. Statistical analysis comparing baseline and postprocedural PROMIS scores was performed. Differences were compared with previously established minimal clinically important differences in the spine population. RESULTS For patients with spinal stenosis treated with TFSNRI, no statistically significant improvement was observed short- and long-term follow-up in PROMIS PF (P=.97, .77) and PROMIS Depression (P=.86, .85) scores. At short-term follow-up, PROMIS PI scores did significantly improve (P=.01) but the average difference of pre- and post-procedure scores did not reach clinical significance. No significant difference in PROMIS PI was noted at long-term follow-up (.75). CONCLUSIONS Although a statistically significant difference was observed for improvement in pain, in this retrospective study, TFSNRI did not provide clinically significant improvement in patients' function, pain, or depression for lumbar spinal stenosis at short- and long-term follow-up.
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Affiliation(s)
- Andrew R Stephens
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY.
| | - Ramzi El-Hassan
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Rajeev K Patel
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
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Varrassi G, Hanna M, Coaccioli S, Fabrizzi P, Baldini S, Kruljac I, Brotons C, Perrot S. Dexketoprofen Trometamol and Tramadol Hydrochloride Fixed-Dose Combination in Moderate to Severe Acute Low Back Pain: A Phase IV, Randomized, Parallel Group, Placebo, Active-Controlled Study (DANTE). Pain Ther 2024; 13:1007-1022. [PMID: 38922520 PMCID: PMC11255173 DOI: 10.1007/s40122-024-00623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION Dexketoprofen/tramadol 25/75 mg (DKP/TRAM) is a fixed-dose combination of a cyclooxygenase inhibitor and opioid receptor agonist. To better understand the efficacy and safety of DKP/TRAM in the treatment of moderate to severe acute lower back pain (LBP) with or without radiculopathy, we carried out a large explorative phase IV international, multicenter, prospective, randomized, double-blind, parallel group, placebo-controlled study (DANTE). METHODS A total of 538 patients with or without a history of LBP and experiencing acute LPB of moderate to severe intensity [Numerical Rating Scale-Pain Intensity (NRS-PI) score > 5] were randomized 4:4:1:1 to DKP/TRAM 25/75 mg every 8 h (n = 211), tramadol (TRAM) 100 mg (n = 207), placebo-matched DKP/TRAM (n = 59), or placebo-matched TRAM (n = 61). RESULTS The proportion of patients achieving the primary endpoint, defined as the time to first achieve NRS-PI score < 4 or pain intensity reduction ≥ 30% from drug intake up to 8 h after the first dose, was higher in the DKP/TRAM arm than in the placebo group, but the difference was not statistically significant (46.1% vs. 42.6%, respectively; hazard ratio 1.11; 95% confidence interval 0.775, 1.595; p = 0.566). DKP/TRAM achieved superiority over TRAM in total pain relief at 4, 6, and 8 h (p < 0.05). Conversely, in relation to the secondary endpoints, a significantly greater reduction in NRS-PI score was seen with DKP/TRAM versus placebo starting from 1 h, and this reduction remained numerically lower throughout 8 h. Summed pain intensity difference values were also significantly lower at 4, 6, and 8 h with DKP/TRAM compared to TRAM (p < 0.05). Overall, DKP/TRAM was well tolerated. CONCLUSION Although the primary endpoint was not met, secondary efficacy analyses suggest the superiority of DKP/TRAM over placebo and TRAM alone in terms of total pain relief. DKP/TRAM can be considered to be an effective and safe option for the treatment of moderate to severe acute LBP. DANTE STUDY REGISTRATION EudraCT number: 2019-003656-37; ClinicalTrials.gov Identifier: NCT05170841.
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Affiliation(s)
| | - Magdi Hanna
- Analgesics and Pain Research (APR) Ltd, Beckenham, UK
| | | | - Paolo Fabrizzi
- A. Menarini Industrie Farmaceutiche Riunite S.r.l., Florence, Italy
| | - Simone Baldini
- A. Menarini Industrie Farmaceutiche Riunite S.r.l., Florence, Italy
| | - Ivan Kruljac
- Poliklinika SOLMED d.o.o., Preradovićeva ulica 20, 10000, Zagreb, Croatia
| | - Carles Brotons
- Sardenya Primary Health Care Center, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Serge Perrot
- Pain Center, INSERM U987, Hôpital Cochin, University of Paris, Paris, France
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Vengatraman S, Aseer Peter AL, Kannan S. Cross-cultural adaptation, reliability, validity, and psychometric evaluation of the Tamil version STarT back screening tool among low back pain subjects. J Orthop Sci 2024; 29:952-957. [PMID: 37482443 DOI: 10.1016/j.jos.2023.07.004] [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: 12/29/2022] [Revised: 04/20/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The STarT back screening tool helps primary care workers make the initial clinical decision and classify low back pain subjects into subgroups. Currently, the tool is required for stratification/triaging of low back pain and is commonly used in clinical practice, and requires linguistic validation in Tamil. The study aimed to determine the validity and reliability of the Tamil version of the STarT back screening tool. METHODS The baseline measurements include the Tamil version of the STarT back screening tool-, pain severity using the Numeric pain rating Scale (NPRS), disability status using the Tamil version of the Roland Morris Disability Questionnaire (RMDQ), and fear avoidance beliefs using the fear-avoidance beliefs questionnaire (FABQ) - Tamil were obtained. After five days, the retest measures are done to investigate the test-retest reliability. RESULTS The current study showed excellent test-retest reliability of total score (ICC - 0.80) and psychosocial subscore (ICC-0.82) with excellent internal consistency and moderate to high validity with clinical outcomes. CONCLUSION The study concludes that the Tamil version of the STarT Back Screening Questionnaire is a reliable and valid tool that reported good understanding and easy completion by the subject.
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Affiliation(s)
- Srinithi Vengatraman
- Sri Ramachandra Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to Be University), Porur, Chennai, India
| | - Antony Leo Aseer Peter
- Sri Ramachandra Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to Be University), Porur, Chennai, India.
| | - Soundararajan Kannan
- Sri Ramachandra Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to Be University), Porur, Chennai, India
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Cady-McCrea CI, Shaikh HJF, Mannava S, Stone J, Hassanzadeh H, Mesfin A, Molinari RW, Menga EN, Rubery PT, Puvanesarajah V. Depression State Correlates with Functional Recovery Following Elective Lumbar Spine Fusion. World Neurosurg 2024; 187:e107-e114. [PMID: 38616025 DOI: 10.1016/j.wneu.2024.04.039] [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: 01/28/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To determine how depression state impacts postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores and achievement of minimum clinically important difference (MCID) following lumbar fusion. Depression has been shown to negatively impact outcomes following numerous orthopedic surgeries. Situational and major clinical depression can differentially affect postoperative outcomes. METHODS Adult patients undergoing elective 1-3 level lumbar fusion were reviewed. Patients with a formal diagnosis of major depression were classified as "clinically depressed" whereas patients with at least "mild" PROMIS Depression scores in the absence of formal depression diagnosis were deemed "situationally depressed." analysis of variance testing was used to assess differences within and between groups. Multivariate regression was used to identify features associated with the achievement of MCID. RESULTS Two hundred patients were included. The average age was 65.9 ± 12.2 years. 75 patients (37.5%) were nondepressed, 66 patients (33.0%) were clinically depressed, and 59 patients (29.5%) were situationally depressed. Situationally depressed patients had worse preoperative physical function (PF) and pain interference (PI) scores and were more likely to have severe symptoms (P = 0.001, P = 0.001). All groups improved significantly from preoperative baseline scores. All groups met MCID PF at different rates, with highest proportion of situationally depressed reaching this metric (P = 0.03). Rates of achieving MCID PI were not significantly different between groups (P = 0.47). Situational depression was predictive of achieving MCID PF (P = 0.002) but not MCID PI. CONCLUSIONS Our study investigated the relationship between depression and postoperative PROMIS scores and identified situationally depressed patients as having the worst preoperative impairment. Despite this, the situationally depressed cohort had the highest likelihood of achieving MCID PF, suggestive of a bidirectional relationship between lumbar degenerative disease and subclinical, situational depression. These findings may help guide preoperative counseling on expectations, and patient selection.
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Affiliation(s)
- Clarke I Cady-McCrea
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Hashim J F Shaikh
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Sandeep Mannava
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Jonathan Stone
- Department of Neurological Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, Medstar Orthopaedic Institute at Georgetown University Hospital, Washington, DC, USA
| | - Robert W Molinari
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Emmanuel N Menga
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Paul T Rubery
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA.
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Eid L, George M, Hady DAA. Effects of transcutaneous vagus nerve stimulation on chronic low back pain: a systematic review. BMC Musculoskelet Disord 2024; 25:498. [PMID: 38926726 PMCID: PMC11201057 DOI: 10.1186/s12891-024-07569-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) is a frequent disease. It is a critical health concern that can influence functional capacity by restricting living activities. OBJECTIVES The current study is to investigate the effects of transcutaneous vagus nerve stimulation (TVNs) in the management of CLBP. METHODS We searched the databases on Google Scholar, PubMed, Web of Science, Cochrane, and Pedro for randomized clinical trial (RCT) studies published in any language that looked at the effectiveness of TVNs in people with chronic LBP. The inclusion criteria were PICO. Participants in the research were people (≥ 18 years) diagnosed with persistent low back pain for more than 3 months. Study quality was assessed using Cochrane ROB 2. RESULTS Our database search found 1084 RCT. A number of studies that were not necessary for the issue were removed, and the overall outcome was six trials. Risk of bias (ROB) evaluations at the study level (derived from outcomes) are reported. In the six studies, two (33.3%) had an overall uncertain ROB (i.e., some concerns), whereas one (16.7%) had a high overall ROB. Three trials (50%) had a low overall RoB. CONCLUSION There is still no evidence to support the use of transcutaneous vagus nerve stimulation as a viable therapeutic rehabilitation strategy. Therefore, we recommend high-quality trials and long-term follow-up to evaluate disability, quality of life, and pain outcomes in these patients.
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Affiliation(s)
- Lama Eid
- Faculty of Physical Therapy, Deraya University, Minia, Egypt
| | - Mina George
- Faculty of Physical Therapy, Deraya University, Minia, Egypt
| | - Doaa A Abdel Hady
- Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Deraya University, Minia, Egypt.
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Shaikh HJF, Cady-McCrea CI, Menga EN, Haddas R, Molinari RN, Mesfin A, Rubery PT, Puvanesarajah V. Clinical Improvement After Lumbar Fusion: Using PROMIS to Assess Recovery Kinetics. Spine (Phila Pa 1976) 2024; 49:601-608. [PMID: 37163645 DOI: 10.1097/brs.0000000000004709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023]
Abstract
STUDY DESIGN Retrospective review of a single institution cohort. OBJECTIVE The goal of this study is to identify features that predict delayed achievement of minimum clinically important difference (MCID) following elective lumbar spine fusion using Patient-Reported Outcomes Measurement Information System (PROMIS) surveys. SUMMARY OF BACKGROUND DATA Preoperative prediction of delayed recovery following lumbar spine fusion surgery is challenging. While many studies have examined factors impacting the achievement of MCID for patient-reported outcomes in similar cohorts, few studies have assessed predictors of early functional improvement. METHODS We retrospectively reviewed patients undergoing elective one-level posterior lumbar fusion for degenerative pathology. Patients were subdivided into two groups based on achievement of MCID for each respective PROMIS domain either before six months ("early responders") or after six months ("late responders") following surgical intervention. Multivariable logistic regression analysis was used to determine features associated with odds of achieving distribution-based MCID before or after six months follow up. RESULTS 147 patients were included. The average age was 64.3±13.0 years. At final follow-up, 57.1% of patients attained MCID for PI and 72.8% for PF. However, 42 patients (49.4%) reached MCID for PI by six months, compared to 44 patients (41.1%) for PF. Patients with severe symptoms had the highest probability of attaining MCID for PI (OR 10.3; P =0.001) and PF (OR 10.4; P =0.001) Preoperative PROMIS symptomology did not predict early achievement of MCID for PI or PF. Patients who received concomitant iliac crest autograft during their lumbar fusion had increased odds of achieving MCID for PI (OR 8.56; P =0.001) before six months. CONCLUSION Our study demonstrated that the majority of patients achieved MCID following elective one-level lumbar spine fusion at long-term follow-up, although less than half achieved this clinical benchmark for each PROMIS metric by six months. We also found that preoperative impairment was not associated with when patients would achieve MCID. Further prospective investigations are warranted to characterize the trajectory of clinical improvement and identify the risk factors associated with poor outcomes more accurately.
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Affiliation(s)
- Hashim J F Shaikh
- University of Rochester Medical Center, Department of Orthopaedics & Physical Performance, Rochester, NY, USA
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de Andrés Ares J, Eldabe S, Helsen N, Baranidharan G, Barat JL, Bhaskar A, Cassini F, Gillner S, Kallewaard JW, Klessinger S, Mavrocordatos P, Occhigrossi F, Van Zundert J, Huygen F, Stoevelaar H. Radiofrequency for chronic lumbosacral and cervical pain: Results of a consensus study using the RAND/UCLA appropriateness method. Pain Pract 2024. [PMID: 38597223 DOI: 10.1111/papr.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Despite the routine use of radiofrequency (RF) for the treatment of chronic pain in the lumbosacral and cervical region, there remains uncertainty on the most appropriate patient selection criteria. This study aimed to develop appropriateness criteria for RF in relation to relevant patient characteristics, considering RF ablation (RFA) for the treatment of chronic axial pain and pulsed RF (PRF) for the treatment of chronic radicular pain. METHODS The RAND/UCLA Appropriateness Method (RUAM) was used to explore the opinions of a multidisciplinary European panel on the appropriateness of RFA and PRF for a variety of clinical scenarios. Depending on the type of pain (axial or radicular), the expert panel rated the appropriateness of RFA and PRF for a total of 219 clinical scenarios. RESULTS For axial pain in the lumbosacral or cervical region, appropriateness of RFA was determined by the dominant pain trigger and location of tenderness on palpation with higher appropriateness scores if these variables were suggestive of the diagnosis of facet or sacroiliac joint pain. Although the opinions on the appropriateness of PRF for lumbosacral and cervical radicular pain were fairly dispersed, there was agreement that PRF is an appropriate option for well-selected patients with radicular pain due to herniated disc or foraminal stenosis, particularly in the absence of motor deficits. The panel outcomes were embedded in an educational e-health tool that also covers the psychosocial aspects of chronic pain, providing integrated recommendations on the appropriate use of (P)RF interventions for the treatment of chronic axial and radicular pain in the lumbosacral and cervical region. CONCLUSIONS A multidisciplinary European expert panel established patient-specific recommendations that may support the (pre)selection of patients with chronic axial and radicular pain in the lumbosacral and cervical region for either RFA or PRF (accessible via https://rftool.org). Future studies should validate these recommendations by determining their predictive value for the outcomes of (P)RF interventions.
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Affiliation(s)
- Javier de Andrés Ares
- Department of Anesthesiology-Pain Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Nicky Helsen
- Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium
| | | | - Jean-Luc Barat
- Service de Neurochirurgie, Hôpital privé Clairval - Ramsay santé, Marseille, France
| | - Arun Bhaskar
- Pain Management Centre, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Fabrizio Cassini
- SS. Antonio e Biagio e C. Arrigo Hospital, Allesandria, Piedmont, Italy
| | - Sebastian Gillner
- Department of Neurosurgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Jan Willem Kallewaard
- Department of Anaesthesiology and Pain Management, Rijnstate Hospital, Velp, The Netherlands
- Department of Anaesthesiology and Pain Treatment, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | | | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frank Huygen
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Herman Stoevelaar
- Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium
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Igwesi-Chidobe CN, Ifeanyichukwu CN, Okorie JP, Faisal M, Ozumba BC. Prevalence and Biopsychosocial Factors Associated With a Current Episode of Low Back Pain Among Adults With a Previous History of Low Back Pain: A Cross-sectional Study of Market Traders in an African Population. THE JOURNAL OF PAIN 2024:104526. [PMID: 38599267 DOI: 10.1016/j.jpain.2024.104526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 03/12/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
Low back pain (LBP) is the leading cause of years lived with disability globally, with Nigeria having one of the greatest burdens. A current episode of LBP is important in Nigeria, but the associated factors are unknown. This cross-sectional study investigated the prevalence, biomechanical, and psychosocial factors associated with a current episode of LBP among 700 adult market traders with previous LBP in an urban Nigerian population. Descriptive, bivariate, and multivariate analyses were conducted. The prevalence of a current episode of LBP was 76.4%. Factors associated with an increased risk of a current episode of LBP in a decreasing order of importance were exposure to biomechanical factors (aggregate [total] score) (odds ratio [OR] = 1.535; 95% confidence interval [CI] = 1.398-1.685); anxiety (OR = 1.182; 95% CI = 1.089-1.282); fear-avoidance beliefs (physical activity) (OR = 1.139; 95% CI = 1.029-1.261); fear-avoidance beliefs (work) (OR = 1.105; 95% CI = 1.047-1.165); while factors associated with a reduced risk of a current episode of LBP were ability to take breaks in the job in addition to scheduled breaks (OR = .430; 95% CI = .240-.773) and ability to control the order and pace of tasks (OR = .477; 95% CI = .236-.965). Occupational biomechanical and psychosocial factors were associated with a current episode of LBP in logistic regression models explaining 52.7% and 73.1% of the variation in a current episode of LBP. Occupational biomechanical factors, particularly handling large and bulky objects at arm's length and kneeling and squatting, produced the greatest risk of a current episode of LBP. PERSPECTIVE: Occupational biomechanical factors, occupational psychosocial factors, and personal psychosocial factors such as anxiety and fear-avoidance beliefs are associated with a current episode of LBP in Nigeria. Pragmatic public health and occupational health initiatives that modify exposure to these factors may be required in Nigeria.
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Affiliation(s)
- Chinonso Nwamaka Igwesi-Chidobe
- School of Allied Health Professions and Midwifery, Faculty of Health Studies, University of Bradford, Bradford, United Kingdom; Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria.
| | | | - Joshua P Okorie
- Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
| | - Muhammad Faisal
- Biostatistics Unit, Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
| | - Benjamin C Ozumba
- Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria; Faculty of Medicine, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
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Gushcha AO, Sharif S, Zileli M, Oertel J, Zygourakis CC, Yusupova AR. Acute back pain: Clinical and radiologic diagnosis: WFNS spine committee recommendations. World Neurosurg X 2024; 22:100278. [PMID: 38389960 PMCID: PMC10882106 DOI: 10.1016/j.wnsx.2024.100278] [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: 07/28/2023] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
Objective To formulate the most current, evidence-based recommendations for the clinical and radiologic diagnosis of acute low back pain lasting <4 weeks. Methods A systematic literature search in PubMed and Google Scholar databases was performed from 2012 to 2022 using the search terms "acute back pain AND clinical diagnosis" and "acute back pain AND radiologic diagnosis". Screening criteria resulted in a total of 97 papers analyzed. Using the Delphi method and two rounds of voting, the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated ten final consensus statements. Results Ten final consensus statements address the clinical diagnosis of acute LBP, including which clinical conditions cause acute LBP and how we can distinguish between the different causes of LBP, including discogenic, facet joint, sacroiliac joint, and myofascial pain. The most important step for the radiologic diagnosis of acute LBP is to evaluate the necessity of radiologic investigation, as well as its timing and the most appropriate type of imaging modality. Importantly, imaging should not be a routine diagnostic tool, unless red flag signs are present. In fact, routine imaging for acute LBP can actually have a negative effect as it may reveal incidental radiographic findings that exacerbate patient fear and anxiety. Conclusion Overall, the quality of evidence is not high for most of our consensus statements, and further studies are needed to validate the WFNS Spine Committee recommendations on the clinical and radiographic diagnosis of acute LBP.
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Affiliation(s)
- Artem O Gushcha
- Department of Neurosurgery, Research Center of Neurology, Moscow, Russia
| | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrberger Str. 90.5, 66421, Homburg, Saar, Germany
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Adilya R Yusupova
- Department of Neurosurgery, Research Center of Neurology, Moscow, Russia
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Tikhile P, Patil DS, Jaiswal PR. An Integrated Approach to Chronic Low Back Pain: Evaluating the Impact of Consecutive Loop TheraBand Training Combined With Proprioceptive Neuromuscular Facilitation and Conventional Physiotherapy. Cureus 2024; 16:e58632. [PMID: 38770514 PMCID: PMC11103918 DOI: 10.7759/cureus.58632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Chronic low back pain (CLBP) is a prevalent musculoskeletal condition characterized by persistent discomfort in the lumbosacral region lasting beyond 12 weeks. Individuals with CLBP often experience limitations in range of motion and compromised performance of affected body parts. Core muscle weakness/delayed activation and impaired lumbar proprioception are established contributors to CLBP. And influence balance dysfunction in CLBP patients. Exercise therapy is a cornerstone in the management of CLBP, aimed at enhancing muscular endurance, strength, and flexibility of the back muscles and soft tissues. However, the efficacy of exercise interventions depends on various factors including the type, intensity, frequency, and duration of exercises. This case report presents the rehabilitation of a corporate employee with a non-specific CLBP. The rehabilitation goals focused on improving balance, reducing disability, and alleviating pain. An integrated approach combining proprioceptive neuromuscular facilitation (PNF) with Consecutive Loop TheraBand (CLX) (The Hygenic Corporation, Akron, USA) along with traditional physical therapy techniques was implemented. PNF, a well-established technique, was chosen for its effectiveness in reducing disability and LBP while enhancing balance. The integration of PNF alongside conventional physiotherapy resulted in notable improvements, including increased lumbar flexion range following the rehabilitation period. This case underscores the importance of early initiation of comprehensive rehabilitation in CLBP patients to preserve strength, alleviate pain, reduce functional disability, and enhance balance. By addressing both the muscular and proprioceptive aspects of CLBP, this integrated approach aims to optimize outcomes in CLBP management.
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Affiliation(s)
- Priya Tikhile
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepali S Patil
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratik R Jaiswal
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Sofat N, Lambarth A. Can we achieve pain stratification in musculoskeletal conditions? Implications for clinical practice. FRONTIERS IN PAIN RESEARCH 2024; 5:1362757. [PMID: 38524267 PMCID: PMC10958789 DOI: 10.3389/fpain.2024.1362757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
In the last few years there has been an increased appreciation that pain perception in rheumatic and musculoskeletal diseases (RMDs) has several mechanisms which include nociceptive, inflammatory, nociplastic and neuropathic components. Studies in specific patient groups have also demonstrated that the pain experienced by people with specific diagnoses can present with distinctive components over time. For example, the pain observed in rheumatoid arthritis has been widely accepted to be caused by the activation of nociceptors, potentiated by the release of inflammatory mediators, including prostaglandins, leukotrienes and cytokine networks in the joint environment. However, people with RA may also experience nociplastic and neuropathic pain components, particularly when treatments with disease modifying anti-rheumatic drugs (DMARDs) have been implemented and are insufficient to control pain symptoms. In other RMDs, the concept of pain sensitisation or nociplastic pain in driving ongoing pain symptoms e.g. osteoarthritis and fibromyalgia, is becoming increasingly recognised. In this review, we explore the hypothesis that pain has distinct modalities based on clinical, pathophysiological, imaging and genetic factors. The concept of pain stratification in RMD is explored and implications for future management are also discussed.
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Affiliation(s)
- Nidhi Sofat
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Andrew Lambarth
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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Gao F, Hu Q, Chen W, Li J, Qi C, Yan Y, Qian C, Wan M, Ficke J, Zheng J, Cao X. Brain regulates weight bearing bone through PGE2 skeletal interoception: implication of ankle osteoarthritis and pain. Bone Res 2024; 12:16. [PMID: 38443372 PMCID: PMC10914853 DOI: 10.1038/s41413-024-00316-w] [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: 09/04/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
Bone is a mechanosensitive tissue and undergoes constant remodeling to adapt to the mechanical loading environment. However, it is unclear whether the signals of bone cells in response to mechanical stress are processed and interpreted in the brain. In this study, we found that the hypothalamus of the brain regulates bone remodeling and structure by perceiving bone prostaglandin E2 (PGE2) concentration in response to mechanical loading. Bone PGE2 levels are in proportion to their weight bearing. When weight bearing changes in the tail-suspension mice, the PGE2 concentrations in bones change in line with their weight bearing changes. Deletion of cyclooxygenase-2 (COX2) in the osteoblast lineage cells or knockout of receptor 4 (EP4) in sensory nerve blunts bone formation in response to mechanical loading. Moreover, knockout of TrkA in sensory nerve also significantly reduces mechanical load-induced bone formation. Moreover, mechanical loading induces cAMP-response element binding protein (CREB) phosphorylation in the hypothalamic arcuate nucleus (ARC) to inhibit sympathetic tyrosine hydroxylase (TH) expression in the paraventricular nucleus (PVN) for osteogenesis. Finally, we show that elevated PGE2 is associated with ankle osteoarthritis (AOA) and pain. Together, our data demonstrate that in response to mechanical loading, skeletal interoception occurs in the form of hypothalamic processing of PGE2-driven peripheral signaling to maintain physiologic bone homeostasis, while chronically elevated PGE2 can be sensed as pain during AOA and implication of potential treatment.
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Affiliation(s)
- Feng Gao
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Qimiao Hu
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Wenwei Chen
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Jilong Li
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Cheng Qi
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Yiwen Yan
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Cheng Qian
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Mei Wan
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - James Ficke
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Junying Zheng
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Xu Cao
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA.
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA.
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Alves SM, Puentedura EJ, Silva AG. Pain neuroscience education and graded exposure versus Pilates and postural education: A pilot study in an occupational context. Physiother Theory Pract 2024; 40:456-467. [PMID: 36111620 DOI: 10.1080/09593985.2022.2122914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Pain neuroscience education (PNE) and graded exposure have not been explored in occupational settings for low back pain (LBP). AIM To pilot feasibility and assess preliminary effectiveness of PNE and graded exposure for LBP. METHODS A pilot study where workers were randomized to either PNE and graded exposure or Pilates and postural education. Both interventions consisted of weekly individual face-to-face sessions for 8 weeks (a total of 8 sessions). The primary outcome was pain intensity. Secondary outcomes were disability, catastrophizing, fear-avoidance, sleep, endurance of back extensor muscles, and patient's perceived impression of change. RESULTS Seventeen participants entered the PNE and graded exposure group and 20 the Pilates and postural education group. PNE and graded exposure were feasible to implement. Between-group comparisons suggest higher improvements in the PNE group for extensor muscle endurance (p < .001, η2p = .29), pain catastrophizing (p < .001; η2p = .56) and fear-avoidance related to physical activity (p < .001; η2p = .48) and work (p < .001; η2p = .47). In the PNE group, at least 13 (76.5%) participants reported being at least "moderately better" against 6 (30%) participants in the Pilates group. CONCLUSION PNE and graded exposure can be successfully implemented in an occupational context and is potentially more beneficial than Pilates and postural education for extensor muscle endurance, catastrophizing, and fear avoidance and similarly as beneficial for pain intensity and disability. Further studies are needed to confirm these results.
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Affiliation(s)
- Sara M Alves
- Department of Physical Medicine and Rehabilitation, Hospital Center of Vila Nova de Gaia - Espinho, R. Dr. Francisco Sá Carneiro 4400-129, 4430-999, Vila Nova de Gaia, Portugal
| | - Emilio J Puentedura
- Department of Physical Therapy, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Anabela G Silva
- School of Health Sciences and CINTESIS.UA@RISE, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
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Kasem J, Davies MAM, Chainey S, Ronca F. Musculoskeletal complaints in English law enforcement officers: a cross-sectional study. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2024; 30:84-89. [PMID: 37434478 DOI: 10.1080/10803548.2023.2235844] [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] [Indexed: 07/13/2023]
Abstract
Objectives. Musculoskeletal (MSK) complaints are prevalent in law enforcement officers (LEOs), but research that examines their risk factors is limited. This study aimed to identify the self-reported MSK complaint prevalence and perceived causes in LEOs. Methods. The Nordic musculoskeletal questionnaire was used to identify the 12-month and 7-day prevalence of MSK 'trouble' (ache, pain, discomfort) for nine body sites. The perceived cause, participant characteristics and occupational role were reported. Body fat percentage was measured using bioelectrical impedance. Results. Complete submissions of 186 questionnaires were received (80% male, median age 40.6 years, interquartile range 10.1). Eighty-six per cent of officers reported having an MSK complaint in the last 12 months, where lower back, shoulder and neck complaint prevalence was 59.1, 48.4 and 42.5%, respectively. The occupational role was associated with the site and presence of complaints (p < 0.05), where armed officers presented with more shoulder, lower back and hip/thigh complaints. Age, sex and body fat did not impact complaint prevalence. Participants mainly attributed their complaints to occupation equipment or to sport and exercise. Conclusion. MSK complaints were highly prevalent in this cohort, particularly armed officers. Further research is required to establish the impact of these complaints and how they can be mitigated.
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Affiliation(s)
- Judi Kasem
- Institute of Sport, Exercise and Health, University College London, UK
| | | | - Spencer Chainey
- Jill Dando Institute of Security and Crime Science, University College London, UK
| | - Flaminia Ronca
- Institute of Sport, Exercise and Health, University College London, UK
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Tikhile P, Patil DS. Unveiling the Efficacy of Physiotherapy Strategies in Alleviating Low Back Pain: A Comprehensive Review of Interventions and Outcomes. Cureus 2024; 16:e56013. [PMID: 38606230 PMCID: PMC11008921 DOI: 10.7759/cureus.56013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Low back pain (LBP) presents a significant burden globally, affecting individuals of all ages, but it is more common in adults aged 30-60 years old and demographics including race, ethnicity, and socioeconomic status. Physiotherapy interventions are commonly employed to manage LBP due to their non-invasive nature and potential for addressing underlying biomechanical dysfunctions. This comprehensive review aims to evaluate the efficacy of various physiotherapy strategies in alleviating LBP, considering a range of interventions and their associated outcomes. Through a thorough examination of existing literature from January 2017 to October 2023, this review synthesises evidence on the effectiveness of interventions such as manual therapy, exercise therapy, electrotherapy modalities, and education-based approaches. The review also scrutinizes the comparative effectiveness of different physiotherapy modalities and their suitability for specific patient populations, considering factors such as chronicity, severity, and underlying pathology. By critically evaluating the evidence base, this review aims to provide insights into the most effective physiotherapy strategies for alleviating LBP, chronic low back pain (CLBP) and chronic nonspecific low back pain (CNLBP) and guiding clinical practice toward evidence-based interventions. The Visual Analogue Scale and Numerical Pain Rating Scale for pain, Oswestry Disability Index and Roland-Morris Disability Questionnaire for disability, Modified-Modified Schober Test for measurement of lumbar flexion and extension and static and dynamic balance for assessing postural stability and balance were among the measures used to foresee enhancements in pain, disability, balance, and LBP symptoms. Twenty-one studies that fulfilled the criteria for inclusion (aged 20 to 50 years and of both genders) were added to the review. Exercises for core stability, strengthening, orthosis (a medical device designed to support, align, stabilise, or correct musculoskeletal structures and functions), transcutaneous electrical nerve stimulation, heat massage therapy, interferential current (a form of electrical stimulation used in physical therapy), Mulligan's mobilization (a manual therapy technique), low-level laser therapy, and McGill stabilization exercises (core exercises) were among the therapeutic strategies. The McKenzie method (back exercises), ultrasound, sensory-motor training, Swiss ball exercises, and other techniques reduced pain and enhanced strength, balance, and ease of daily activities. Every therapeutic approach has an impact on recovery rates ranging from minimal to maximal. Conventional physical therapy is less effective than most recent advanced techniques like mobilisation and exercises. In summary, the integration of manual techniques, orthoses and alternative intervention strategies with conservative therapeutic approaches can effectively alleviate pain, enhance function and yield better overall outcomes. To get more information about the optimal dosage, therapeutic modalities and long-term effects of these treatments, more admirable research is required. This paper aims to expand the scientific discourse by exploring non-traditional physiotherapy interventions and assessing their efficacy in light of the rigorous standards set forth by the latest WHO guidelines.
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Affiliation(s)
- Priya Tikhile
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Deepali S Patil
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Sanchis-Soler G, Tortosa-Martinez J, Sebastia-Amat S, Chulvi-Medrano I, Cortell-Tormo JM. Is Acute Lower Back Pain Associated with Heart Rate Variability Changes? A Protocol for Systematic Reviews. Healthcare (Basel) 2024; 12:397. [PMID: 38338282 PMCID: PMC10855181 DOI: 10.3390/healthcare12030397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Acute lower back pain (ALBP) is an extremely common musculoskeletal problem. ALBP consists of a sudden onset of short-duration pain in the lower back. However, repeated attacks can make the pain chronic. It can be measured through a self-report scale as well as through physical and physiological evaluations. Heart Rate Variability (HRV) has been used to evaluate the body's response to pain. However, to the best of our knowledge, no clear consensus has been reached regarding the relationship between both variables and on an optimal protocol for ALBP evaluation based on HRV. The objective of this review is to analyze the relationship and effectiveness of HRV as an instrument for measuring ALBP. Furthermore, we consider the influence of different types of interventions in this relationship. The protocol of this review was previously recorded in the International Prospective Register of Systematic Reviews (number CRD42023437160). The PRISMA guidelines for systematic reviews and PubMed, WOS and Scopus databases are employed. Studies with samples of adults with ALBP are included. This study sets out a systematic review protocol to help identify the relationship between HRV and ALBP. Understanding this relationship could help in designing early detection or action protocols that alleviate ALBP.
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Affiliation(s)
- Gema Sanchis-Soler
- Department of General and Specific Didactics, University of Alicante, 03690 San Vicente del Raspeig, Spain; (G.S.-S.); (S.S.-A.); (J.M.C.-T.)
- Health, Physical Activity and Sports Technology (HEALTH-TECH), University of Alicante, 03690 San Vicente del Raspeig, Spain
| | - Juan Tortosa-Martinez
- Department of General and Specific Didactics, University of Alicante, 03690 San Vicente del Raspeig, Spain; (G.S.-S.); (S.S.-A.); (J.M.C.-T.)
- Health, Physical Activity and Sports Technology (HEALTH-TECH), University of Alicante, 03690 San Vicente del Raspeig, Spain
| | - Sergio Sebastia-Amat
- Department of General and Specific Didactics, University of Alicante, 03690 San Vicente del Raspeig, Spain; (G.S.-S.); (S.S.-A.); (J.M.C.-T.)
- Health, Physical Activity and Sports Technology (HEALTH-TECH), University of Alicante, 03690 San Vicente del Raspeig, Spain
| | - Ivan Chulvi-Medrano
- Department of Physical and Sports Education, University of Valencia, 46010 Valencia, Spain;
| | - Juan Manuel Cortell-Tormo
- Department of General and Specific Didactics, University of Alicante, 03690 San Vicente del Raspeig, Spain; (G.S.-S.); (S.S.-A.); (J.M.C.-T.)
- Health, Physical Activity and Sports Technology (HEALTH-TECH), University of Alicante, 03690 San Vicente del Raspeig, Spain
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Thomaz de Aquino Nava G, Mendes Tozim B, Hebling Spinoso D, Baldini Prudencio C, Tavella Navega M. Chronic low back pain and muscle activity in women during the sit-to-stand task: A cross-sectional study. J Bodyw Mov Ther 2024; 37:366-371. [PMID: 38432830 DOI: 10.1016/j.jbmt.2023.11.040] [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: 01/25/2022] [Revised: 07/07/2023] [Accepted: 11/24/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION The ability to stand up and sit down is important. Due to the large number of repetitions of these activities during the day and the demand that the task requires, it is cited as painful in the presence of low back pain (LBP). Individuals with LBP present alterations in muscle activation, however, this statement needs to be verified during everyday situations like the sit-to-stand task (STST). Therefore, the objective was to evaluate the muscle recruitment of women with and without LBP during the STST. METHODS 35 women were evaluated, and allocated into the control group (CG n = 15) and the low back pain group (LBPG n = 20). The protocol consisted of clinical evaluation and the sit-to-stand task (STST). Electromyographic signals of the lumbar multifidus (LM), internal oblique (IO) and external oblique (EO), rectus abdominis (RA), and lumbar iliocostalis (LI) were carried out concomitantly with the STST. To verify normality, the Shapiro-Wilk test was used. For the characterization of the sample, the MANOVA test was chosen and the MANCOVA test was also chosen to compare the characteristics of the participants. RESULTS Regarding the data analysis of the electromyographic signals, higher values were seen in the RA (moments 2 and 3) in the LBPG in the STST. CONCLUSION The present study showed that women with chronic LBP present higher muscle activation of the rectus abdominis in the sit-to-stand task.
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Affiliation(s)
- Guilherme Thomaz de Aquino Nava
- Department of Physical Education, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil.
| | - Beatriz Mendes Tozim
- Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marília, São Paulo, Brazil
| | - Deborah Hebling Spinoso
- Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marília, São Paulo, Brazil
| | - Caroline Baldini Prudencio
- Department of Tocogynecology, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Marcelo Tavella Navega
- Department of Physical Education, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil; Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marília, São Paulo, Brazil
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Shaikh HJF, Cady-McCrea CI, Menga EN, Molinari RW, Mesfin A, Rubery PT, Puvanesarajah V. Socioeconomic disadvantage is correlated with worse PROMIS outcomes following lumbar fusion. Spine J 2024; 24:107-117. [PMID: 37683769 DOI: 10.1016/j.spinee.2023.08.016] [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: 01/22/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND CONTEXT Socioeconomic status (SES) has been associated with differential healthcare outcomes and may be proxied using the area-deprivation index (ADI). Few studies to date have investigated the role of ADI on patient-reported outcomes and clinically meaningful improvement following lumbar spine fusion surgery. PURPOSE The purpose of this study is to investigate the role of SES on lumbar fusion outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) surveys. STUDY DESIGN/SETTING Retrospective review of a single institution cohort. PATIENT SAMPLE About 205 patients who underwent elective one-to-three level posterior lumbar spine fusion. OUTCOME MEASURES Change in PROMIS scores and achievement of minimum clinically important difference (MCID). METHODS Patients 18 years or older undergoing elective one-to-three level lumbar spine fusion secondary to spinal degeneration from January 2015 to September 2021 with minimum one year follow-up were reviewed. ADI was calculated using patient-supplied addresses and patients were grouped into quartiles. Higher ADI values represent worse deprivation. Minimum clinically important difference (MCID) thresholds were calculated using distribution-based methods. Analysis of variance testing was used to assess differences within and between the quartile cohorts. Multivariable regression was used to identify features associated with the achievement of MCID. RESULTS About 205 patients met inclusion and exclusion criteria. The average age of our cohort was 66±12 years. The average time to final follow-up was 23±8 months (range 12-36 months). No differences were observed between preoperative baseline scores amongst the four quartiles. All ADI cohorts showed significant improvement for pain interference (PI) at final follow-up (p<.05), with patients who had the lowest socioeconomic status having the lowest absolute improvement from preoperative baseline physical function (PF) and PI (p=.01). Only those patients who were in the lowest socioeconomic quartile failed to significantly improve for PF at final follow-up (p=.19). There was a significant negative correlation between socioeconomic level and the absolute proportion of patients reaching MCID for PI (p=.04) and PF (p=.03). However, while ADI was a significant predictor of achieving MCID for PI (p=.02), it was nonsignificant for achieving MCID for PF. CONCLUSIONS Our study investigated the influence of ADI on postoperative PROMIS scores and identified a negative correlation between ADI quartile and the proportion of patients reaching MCID. Patients in the worse ADI quartile had lower chances of reaching clinically meaningful improvement in PI. Policies focused on alleviating geographical deprivation may augment clinical outcomes following lumbar surgery.
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Affiliation(s)
- Hashim J F Shaikh
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA
| | - Clarke I Cady-McCrea
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA
| | - Emmanuel N Menga
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA
| | - Robert W Molinari
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA
| | - Addisu Mesfin
- Medstar Orthopaedic Institute, Georgetown University School of Medicine, 3800 Reservoir Rd NW, Washington DC 20007, USA
| | - Paul T Rubery
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA.
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Van den Heuvel SAS, Cohen SPC, de Andrès Ares J, Van Boxem K, Kallewaard JW, Van Zundert J. 3. Pain originating from the lumbar facet joints. Pain Pract 2024; 24:160-176. [PMID: 37640913 DOI: 10.1111/papr.13287] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Pain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well-designed studies, the prevalence is generally between 10% and 20%, increasing with age. METHODS The literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized. RESULTS There are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni- or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non-dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After "red flags" are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation. CONCLUSIONS Well-selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.
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Affiliation(s)
- Sandra A S Van den Heuvel
- Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Steven P C Cohen
- Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Koen Van Boxem
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Willem Kallewaard
- Anesthesiology and Pain Medicine, Rijnstate Ziekenhuis, Velp, The Netherlands
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jan Van Zundert
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Sorkpor SK, Miao H, Moore C, Johnson CM, Maria DMS, Pollonini L, Ahn H. Listening to Remotely Monitored Home-based Preferred Music for Pain in Older Black Adults with Low Back Pain: A Pilot Study of Feasibility and Acceptability. Pain Manag Nurs 2023; 24:e102-e108. [PMID: 37482453 DOI: 10.1016/j.pmn.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/23/2023] [Accepted: 07/02/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Low back pain (LBP) is a complex condition that is widespread among older Black adults. Nonpharmacologic interventions are recommended as first-line therapy, but their use in practice is limited, possibly due to misunderstanding of their analgesic characteristics. AIM To determine the feasibility and acceptability of listening to preferred music at home to relieve pain in older Black adults aged 65 years or older with LBP. METHOD We recruited 20 community-dwelling older adults (≥65 years) with LBP to use noise-isolating headphones to listen to their preferred music for 20 minutes twice daily for four days via the MUSIC CARE® app. Feasibility was determined using enrollment, adherence, and attrition rates, and acceptability was determined using the Treatment Acceptance and Preference (TAP) scale. Average pain scores were self-reported using the Numeric Rating Scale (NRS) after the second intervention of the day. Pain scores were evaluated using paired sample t test and repeated-measures ANOVA. RESULTS Enrollment, adherence, and attrition rates were 95.25%, 100.00%, and 0.00%, respectively. Most participants rated the TAP scale at ≥3, indicating acceptance. Pain scores decreased significantly from baseline (M = 46.90, SD = 21.47) to post-intervention (M = 35.70, SD = 16.57), t (19) = 2.29, p = .03. Repeated measures ANOVA showed a significant decrease in mean pain scores over time [F (2.36, 44.88) = 5.61, p = .004, η2 = .23]. CONCLUSIONS Listening to preferred music for 20 minutes twice a day is a feasible and acceptable intervention that can considerably reduce pain in older Black adults with LBP.
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Affiliation(s)
- Setor K Sorkpor
- College of Nursing, Florida State University, Tallahassee, Florida.
| | - Hongyu Miao
- College of Nursing, Florida State University, Tallahassee, Florida
| | - Carolyn Moore
- School of Music, Sam Houston State University, Huntsville, Texas
| | - Constance M Johnson
- Cizik School of Nursing, University of Texas Health Science Center Houston, Houston, Texas
| | - Diane M Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center Houston, Houston, Texas
| | - Luca Pollonini
- Departments of Engineering Technology, University of Houston, Texas
| | - Hyochol Ahn
- University of Arizona College of Nursing, Tucson, Arizona
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Gao F, Hu Q, Qi C, Wan M, Ficke J, Zheng J, Cao X. Mechanical loading-induced change of bone homeostasis is mediated by PGE2-driven hypothalamic interoception. RESEARCH SQUARE 2023:rs.3.rs-3325498. [PMID: 37790467 PMCID: PMC10543368 DOI: 10.21203/rs.3.rs-3325498/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Bone is a mechanosensitive tissue and undergoes constant remodeling to adapt to the mechanical loading environment. However, it is unclear whether the signals of bone cells in response to mechanical stress are processed and interpreted in the brain. In this study, we found that the hypothalamus of the brain regulates bone remodeling and structure by perceiving bone PGE2 concentration in response to mechanical loading. Bone PGE2 levels are in proportion to their weight bearing. When weight bearing changes in the tail-suspension mice, the PGE2 concentrations in bones change in line with their weight bearing changes. Deletion of Cox2 or Pge2 in the osteoblast lineage cells or knockout Ep4 in sensory nerve blunts bone formation in response to mechanical loading. And sensory denervation also significantly reduces mechanical load-induced bone formation. Moreover, mechanical loading induces CREB phosphorylation in the hypothalamic ARC region to inhibit sympathetic TH expression in the PVN for osteogenesis. Finally, we show that elevated PGE2 is associated with ankle osteoarthritis (AOA) and pain. Together, our data demonstrate that in response to mechanical loading, skeletal interoception occurs in the form of hypothalamic processing of PGE2-driven peripheral signaling to maintain physiologic bone homeostasis, while chronically elevated PGE2 can be sensed as pain during AOA and implication of potential treatment.
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Affiliation(s)
- Feng Gao
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Qimiao Hu
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Cheng Qi
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Mei Wan
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - James Ficke
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Junying Zheng
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Xu Cao
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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Terfe A, Jemal T, Waqkene T. Prevalence of low back pain and its associated factors among traditional cloth weavers in Gulele sub-city, Addis Ababa, Ethiopia. Front Public Health 2023; 11:1181591. [PMID: 37521989 PMCID: PMC10374213 DOI: 10.3389/fpubh.2023.1181591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
The prevalence of work-related musculoskeletal disorders particularly low back pain is significantly high among common informal or small-scale enterprises within developing countries like weaving. However, there is little information on risk factors for low back pain in the informal sector such as the weaving sector in the areas of Addis Ababa as well as in Ethiopia. Therefore this study was aimed to assess the magnitude of low back pain and its associated factors among traditional cloth weavers in the Gulele sub-city, Addis Ababa, Ethiopia. A cross-sectional study with internal comparison was conducted from June 1, 2022, and August 30, 2022. A total of 660 traditional cloth weavers were included in the study by using a systematic random sampling method to select participants in each of cooperatives as well as individual households in 5 woredas in Gulele sub-city. The data was analyzed and managed using SPSS version 20. A multivariate logistic regression analysis was used to control potential confounding factors and to determine the association. Among 660 (100%) respondents, 330 (50%) of them experienced low back pain after starting weaving. Out of the respondents with low back pain through their job career, 291 (44.1%) of them experienced low back pain during the last 12 months. Working greater than 8 h per day (AOR = 4.60, 95%CI: 2.35, 8.87), working with frequent bending (AOR = 3.32, 95%CI: 1.49, 7.40), job stress (AOR = 1.68, 95%CI: 1.18, 2.40) were among factors significantly associated with the occurrence of low back pain. This study has shown a high prevalence of low back pain among traditional cloth weavers which indicates the need for immediate public health action. However, very small improvements in the working condition, weaving tools design, working methods can potentially lead to large benefits.
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Affiliation(s)
- Amare Terfe
- Department of Environmental Health Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Temima Jemal
- Department of Environmental Health Science and Technology, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tolossa Waqkene
- Department of Public Health, Dawo District Health Office, Woliso, Ethiopia
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van der Graaf JW, Kroeze RJ, Buckens CFM, Lessmann N, van Hooff ML. MRI image features with an evident relation to low back pain: a narrative review. 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 2023; 32:1830-1841. [PMID: 36892719 DOI: 10.1007/s00586-023-07602-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/27/2022] [Accepted: 02/11/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Low back pain (LBP) is one of the most prevalent health condition worldwide and responsible for the most years lived with disability, yet the etiology is often unknown. Magnetic resonance imaging (MRI) is frequently used for treatment decision even though it is often inconclusive. There are many different image features that could relate to low back pain. Conversely, multiple etiologies do relate to spinal degeneration but do not actually cause the perceived pain. This narrative review provides an overview of all possible relevant features visible on MRI images and determines their relation to LBP. METHODS We conducted a separate literature search per image feature. All included studies were scored using the GRADE guidelines. Based on the reported results per feature an evidence agreement (EA) score was provided, enabling us to compare the collected evidence of separate image features. The various relations between MRI features and their associated pain mechanisms were evaluated to provide a list of features that are related to LBP. RESULTS All searches combined generated a total of 4472 hits of which 31 articles were included. Features were divided into five different categories:'discogenic', 'neuropathic','osseous', 'facetogenic', and'paraspinal', and discussed separately. CONCLUSION Our research suggests that type I Modic changes, disc degeneration, endplate defects, disc herniation, spinal canal stenosis, nerve compression, and muscle fat infiltration have the highest probability to be related to LBP. These can be used to improve clinical decision-making for patients with LBP based on MRI.
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Affiliation(s)
- Jasper W van der Graaf
- Diagnostic Image Analysis Group, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
- Department of Orthopedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | - Robert Jan Kroeze
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Constantinus F M Buckens
- Department of Medical Imaging, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Nikolas Lessmann
- Diagnostic Image Analysis Group, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Miranda L van Hooff
- Department of Orthopedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
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Brzeszczyńska J, Brzeszczyński F. Benefit of sunlight and melatonin on back pain and inflammation. Bone Joint Res 2023; 12:199-201. [PMID: 37051814 PMCID: PMC10032241 DOI: 10.1302/2046-3758.123.bjr-2023-0026] [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] [Indexed: 03/29/2023] Open
Abstract
Cite this article: Bone Joint Res 2023;12(3):199–201.
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Affiliation(s)
- Joanna Brzeszczyńska
- Department of Cancer Biology and Epigenetics, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
- Joanna Brzeszczyńska. E-mail:
| | - Filip Brzeszczyński
- Department of Endocrine, General and Vascular Surgery, Medical University of Lodz, Lodz, Poland
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Javed S, Perry K, Mach S, Huh B. Case report: Use of peripheral nerve stimulation for treatment of pain from vertebral plana fracture. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1088097. [PMID: 36713642 PMCID: PMC9878588 DOI: 10.3389/fpain.2022.1088097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023]
Abstract
Vertebral plana fractures are a severe form of compression fractures that can cause significant morbidity due to incapacitating pain. Due to the flattening of the vertebrae in a plana fracture, accessing the vertebral body transpedicularly can be difficult, making traditional vertebral augmentation treatment dangerous. These injuries also typically occur in elderly patients with contraindications to invasive procedures. Peripheral nerve stimulation is a relatively new and minimally invasive treatment that uses electrical stimulation to inhibit pain signals from reaching the somatosensory cortex. Our case describes an 80 Year old female with multiple comorbidities and refractory pain due to a vertebral planar fracture successfully treated with a 60 day course of peripheral nerve stimulation as evidenced by over 50% reduction in symptoms and discontinuation of opioid pain medication use.
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Affiliation(s)
- Saba Javed
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, United States
| | - Kenneth Perry
- Department of Anesthesiology, Critical Care and Pain Medicine, University of Texas Health Science Center at Houston, Houston, United States,Correspondence: Kenneth Perry
| | - Steven Mach
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, United States
| | - Billy Huh
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, United States
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Sarvilina IV, Danilov AB. [Comparative analysis of the use of symptomatic slow acting drugs for osteoarthritis containing chondroitin sulfate or affecting its biosynthesis in patients with non-specific low back pain]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:81-96. [PMID: 36719123 DOI: 10.17116/jnevro202312301181] [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: 02/01/2023]
Abstract
OBJECTIVE Retrospective comparative analysis of the use of SYSADOA preparations containing chondroitin sulfate (Chondroguard, 2 ml, 25 amp., glycosaminoglycan-peptide complex, 1 ml 25 amp., bioactive concentrate of small marine fish, 2 ml, 10 amp.) in patients with chronic non-specific low back pain (LBP) of lumbar and sacral localization caused by spondylosis and osteochondrosis of the lumbar spine, at the stage of outpatient care. MATERIAL AND METHODS Data of medical records of patients (n=120; men - 32, women - 88, age - 54.1±7.6 years, duration of disease exacerbation 4.0±1.7 months) with nonspecific LBP were systematized according to the inclusion/exclusion criteria. All patients were divided into 4 groups: Group 1 (n=30) received Chondroguard im., 2 ml every other day, the course of treatment was 25 injections, 25 days; Group 2 (n=30) received glycosaminoglycan-peptide complex on the 1st day - 0.3 ml, on the 2nd day - 0.5 ml, and then 3 times a week for 1 ml, course of treatment - 25 injections, 25 days; Group 3 (n=30) received bioactive concentrate of small marine fish, 2 ml im., every other day, the course of treatment was 10 injections; repeated courses of treatment - after 6 months; Group 4 (n=30) received Amelotex (meloxicam) at a dose of 15 mg once a day for 15 days. All patients of the first 3 groups received Amelotex at a dose of 15 mg with the possibility of reducing the dose to 7.5 mg or completely discontinuing the drug if necessary. Retrospectively, dynamic monitoring was performed in the medical records of outpatients after 50 days and 6 months from the start of therapy according to the following parameters: intensity of pain according to VAS, short form of the McGill pain questionnaire, vital signs of patients (Oswestry Disability Index, version 2.1a [Oswestry Disability Index], and Roland-Morris questionnaire), propensity to chronic pain syndrome according to the STarT Back Screening Tool questionnaire, the presence and severity of comorbid fibromyalgia according to the Fibromyalgia Rapid Screening Tool questionnaire, the level of pain catastrophization according to the Pain Catastrophizing Scale, the severity of comorbid anxiety and depression according to the Hospital Anxiety and Depression Scale, the severity comorbid insomnia (Insomnia Severity Index), quality of life according to the SF-36 scale, the effectiveness of drugs according to the patient on a 5-point scale, the need to take NSAIDs and analgesics, tolerability on a 4-point system. The safety of therapy was monitored using the WHO and Naranjo scales. RESULTS In patients with nonspecific LBP, a greater degree of reduction in the intensity of the pain syndrome, a smaller number of exacerbations of the pain syndrome over 6 months of observation, an improvement in the functional status and life activity, a tendency to a decrease in the severity of anxiety and depression, sleep disturbances and comorbid fibromyalgia, limiting the risk of chronicity and catastrophization of pain, the presence of a structure-modifying effect on IVD and degenerative changes in the facet joints, a significant improvement in the physical and mental components of health, high satisfaction and safety of therapy, which included taking Chondroguard with meloxicam, with a decrease in the need to take the latter by the 50th day observation period compared to other regimens. The effects of Chondroguard and meloxicam turned out to be long-term and were recorded by the 6th month in the absence of Chondroguard, which indicated the preservation of the influence of highly purified cholesterol on the pathogenetic mechanisms of the formation of LBP. CONCLUSION The study allows us to recommend the use of a parenteral form of cholesterol (Chondroguard, CJSC «PharmFirma «Sotex», Russia) for the treatment of nonspecific LBP with moderate or severe pain, chronic relapsing or persistent course, in combination with NSAIDs and their subsequent cancellation or administration on demand.
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Affiliation(s)
- I V Sarvilina
- LLC «Medical Center «Novomedicina», Rostov-on-Don, Russia
| | - A B Danilov
- First Moscow State Medical University named after I.M. Sechenov, Moscow, Russia
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Muacevic A, Adler JR, Haj Ali T, Jibbawi AA, Yehya K, Msheik A. The Benefit of Epidural Transforaminal Injection of Ozone in Comparison With Transforaminal Steroids Injection in the Management of Chronic Low Back Pain in Lebanese Population: One-Year Retrospective Study. Cureus 2023; 15:e34106. [PMID: 36843776 PMCID: PMC9946692 DOI: 10.7759/cureus.34106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/24/2023] Open
Abstract
Background Chronic low back pain (CLBP) is one of the most common complaints affecting the population worldwide including in Lebanon. Until 15 years ago, surgery was the treatment of choice. However, conservative measures are now preferred because of the large number of post-surgical complications, in addition to the many conditions where surgery cannot be performed. Objective The aim of our study is to determine the effectiveness of transformational epidural injection of ozone (TFEOI) in the management of CLBP among the Lebanese population in the Nabatieh area in comparison with patients who received transformational epidural steroid injection (TFESI). Methods A one-year (2016-2017) retrospective study where 100 patients with CLBP were selected from two hospitals (Alnajdah, and Ragheb Harb hospitals) and divided into two groups. Fifty patients were treated with Ozone injections while the other 50 were treated with steroid injections. For each patient, we recorded the type of pain, irradiation, paresthesia, and the type of injection given (steroid or Ozone). We used the patients' files and contacted them via phone calls. The results of this study were reached based on Vas Score and Mac Nab criteria which are subjective questionnaires. Results The study showed that the TFESI was effective for a short duration (86% of results were excellent and good after one month of injection, but they decreased to 16% after six months). On the other hand, TFEOI was effective over both short and long duration (82% excellent and good after one month, 64% excellent and good after six months). Conclusion Results from this study provide that ozone injection has high benefits in the management of CLBP in the Lebanese population.
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Mechanisms behind the Development of Chronic Low Back Pain and Its Neurodegenerative Features. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010084. [PMID: 36676033 PMCID: PMC9862392 DOI: 10.3390/life13010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/11/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
Chronic back pain is complex and there is no guarantee that treating its potential causes will cause the pain to go away. Therefore, rather than attempting to "cure" chronic pain, many clinicians, caregivers and researchers aim to help educate patients about their pain and try to help them live a better quality of life despite their condition. A systematic review has demonstrated that patient education has a large effect on pain and pain related disability when done in conjunction with treatments. Therefore, understanding and updating our current state of knowledge of the pathophysiology of back pain is important in educating patients as well as guiding the development of novel therapeutics. Growing evidence suggests that back pain causes morphological changes in the central nervous system and that these changes have significant overlap with those seen in common neurodegenerative disorders. These similarities in mechanisms may explain the associations between chronic low back pain and cognitive decline and brain fog. The neurodegenerative underpinnings of chronic low back pain demonstrate a new layer of understanding for this condition, which may help inspire new strategies in pain education and management, as well as potentially improve current treatment.
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Proinflammatory profile in the skin of Parkinson's disease patients with and without pain. PLoS One 2022; 17:e0276564. [PMID: 36301901 PMCID: PMC9612575 DOI: 10.1371/journal.pone.0276564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background Pain is a common non-motor symptom of Parkinson`s disease (PD), however, its pathomechanism remains elusive. Objective We aimed to investigate the local gene expression of selected proinflammatory mediators in patients with PD and correlated our data with patients`pain phenotype. Methods We recruited 30 patients with PD and 30 healthy controls. Pain intensity of patients was assessed using the Numeric Rating Scale (NRS) and patients were stratified into PD pain (NRS≥4) and PD No Pain (NRS<4) subgroups. Skin punch biopsies were immunoassayed for protein-gene product 9.5 as a pan-neuronal marker and intraepidermal nerve fiber density (IEFND). Quantitative real-time polymerase chain reaction (qRT-PCR) analysis was performed to assess the gene expression of inflammatory mediators in the skin compared to controls. Results Patients with PD had lower distal IENFD compared to healthy controls. In skin samples, IL-2 (p<0.001) and TNF-α (p<0.01) were expressed higher in PD patients compared to controls. IL-1β (p<0.05) was expressed higher in the PD pain group compared to healthy controls. PD patients with pain receiving analgesics had a lower expression of TNF-α (p<0.05) in the skin compared to those not receiving treatment. Conclusions Our data suggest the occurrence of a local, peripheral inflammatory response in the skin in PD, but do not support this being a relevant factor contributing to pain in PD.
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Lin F, Zhou Z, Li Z, Shan B, Zhou Z, Sun Y, Zhou X. Utility of a fulcrum for positioning support during flexion-extension radiographs for assessment of lumbar instability in patients with degenerative lumbar spondylolisthesis. J Neurosurg Spine 2022; 37:535-540. [PMID: 35523252 DOI: 10.3171/2022.3.spine22192] [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: 02/10/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors investigated a new standardized technique for evaluating lumbar stability in lumbar lateral flexion-extension (LFE) radiographs. For patients with lumbar spondylolisthesis, a three-part fulcrum with a support platform that included a semiarc leaning tool with armrests, a lifting platform for height adjustment, and a base for stability were used. Standard functional radiographs were used for comparison to determine whether adequate flexion-extension was acquired through use of the fulcrum method. METHODS A total of 67 consecutive patients diagnosed with L4-5 degenerative lumbar spondylolisthesis were enrolled in the study. The authors analyzed LFE radiographs taken with the patient supported by a fulcrum (LFEF) and without a fulcrum. Sagittal translation (ST), segmental angulation (SA), posterior opening (PO), change in lumbar lordosis (CLL), and lumbar instability (LI) were measured for comparison using functional radiographs. RESULTS The average value of SA was 5.76° ± 3.72° in LFE and 9.96° ± 4.00° in LFEF radiographs, with a significant difference between them (p < 0.05). ST and PO were also significantly greater in LFEF than in LFE. The detection rate of instability was 10.4% in LFE and 31.3% in LFEF, and the difference was significant. The CLL was 27.31° ± 11.96° in LFE and 37.07° ± 12.963.16° in LFEF, with a significant difference between these values (p < 0.05). CONCLUSIONS Compared with traditional LFE radiographs, the LFEF radiographs significantly improved the detection rate of LI. In addition, this method may reduce patient discomfort during the process of obtaining radiographs.
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Affiliation(s)
| | | | - Zhiwei Li
- 2Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Selective Nerve Root Block in Treatment of Lumbar Radiculopathy: A Narrative Review. SURGERIES 2022. [DOI: 10.3390/surgeries3030028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Selective Nerve Root Block (SNRB) is a precise local injection technique that can be utilised to target a particular inflamed nerve root causing lumbar radiculopathy for both diagnostic and therapeutic purposes. Usually, for SNRB to be therapeutic, a combination of a local anaesthetic agent and a steroid is injected under imaging guidance, whereas for diagnostic purposes, just the local anaesthetic agent is injected. While the ideal treatment strategy is to relieve the nerve root from its compressing pathology, local injection of steroids targeted at the affected nerve root can also be attempted to reduce inflammation and thus achieve pain relief. Although the general principle for administering an SNRB remains largely the same across the field, there are differences in techniques depending on the region and level of the spine that is targeted. Moreover, drug combinations utilised by clinicians vary based on preference. The proven benefits of SNRBs largely outweigh their risks, and the procedure is deemed safe and well tolerated in a majority of patients. In this narrative, we explore the existing literature and seek to provide a comprehensive understanding of SNRB as a treatment for lumbar radiculopathy, its indications, techniques, outcomes, and complications.
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The effectiveness of pregabalin with or without agomelatine in the treatment of chronic low back pain: a double-blind, placebo-controlled, randomized clinical trial. BMC Pharmacol Toxicol 2022; 23:70. [PMID: 36104745 PMCID: PMC9476640 DOI: 10.1186/s40360-022-00612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/27/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although various pharmacological and nonpharmacological treatments are available for the chronic low back pain (CLBP), there is no consensus on the best optimal treatment for this condition. This study aimed to investigate the efficacy of co-administration of pregabalin and agomelatine versus pregabalin with placebo to treat CLBP.
Methods
Forty-six CLBP patients without the surgical indication referred to the outpatient orthopedic clinic of Rasoul-e-Akram Hospital, Tehran, Iran, were randomly divided into two study groups: Group A [pregabalin (75 mg twice per day) + placebo] and Group B [pregabalin (75 mg twice per day) + agomelatine (25 mg per night)]. Patients were evaluated at weeks 0, 4, and 8. Outcome measures were the Persian versions of the Brief Pain Inventory (BPI) interference scale, Roland-Morris Disability Questionnaire (RMDQ), The Hospital Anxiety and Depression Scale (HADS), 36-Item Short Form Survey (SF-36), and General Health Questionnaire-28 (GHQ-28) were used.
Results
At weeks 4 and 8 after the intervention, all evaluated measures showed significant improvement in both study groups (P < 0.01). The mean improvement of GHQ-28 was 3.7 ± 1.22 in group A and 13.1 ± 4.71 in group B. This difference was statistically significant (P = 0.003). Other outcomes did not vary substantially between the two research groups. Agomelatine treatment was well tolerated, with no significant adverse effects seen in patients. Liver tests of all patients were routine during the study period. Major adverse effect was not seen in any patient. The prevalence of Minor side effects was not significantly different between two study groups.
Conclusion
Compared with the pregabalin and placebo, co-administration of pregabalin and agomelatine had no added effect on improving pain scores in CLBP patients. However, the patients’ general health was significantly improved after the combined administration of pregabalin and agomelatine.
Trial registration
The study protocol was registered in the Iranian Registry of Clinical Trials before starting the study (NO.IRCT20200620047852N1, Registration date: 23/06/2020).
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Varrassi G, Hanna M, Coaccioli S, Suada M, Perrot S. DANTE Study: The First Randomized, Double-Blind, Placebo and Active-Controlled, Parallel Arm Group Study Evaluating the Analgesic Efficacy and Safety of Dexketoprofen TrometAmol aNd Tramadol Hydrochloride Oral FixEd Dose Combination on Moderate to Severe Acute Pain in Patients with Acute Low Back Pain-Rationale and Design. Pain Ther 2022; 11:1055-1070. [PMID: 35788976 PMCID: PMC9314501 DOI: 10.1007/s40122-022-00407-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/14/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Despite a wide range of treatment approaches and the availability of treatment recommendations or guidelines, no consensus on the most effective pharmacological therapy of low back pain (LBP) has been reached yet. Therefore, additional clinical evidence, particularly if built upon a rigorous clinical trial design, an evidence-based medication choice, and broader inclusion criteria better acknowledging the heterogeneity and intrinsic variability of LBP is needed. The DANTE study has been designed to comprehensively assess the analgesic efficacy and tolerability of dexketoprofen/tramadol (DKP/TRAM) 75/25 mg in a large cohort of patients with moderate to severe acute LBP. METHODS The DANTE study is a phase IV, multicenter, randomized, double-blind, double-dummy parallel group, placebo, and active controlled study. The DANTE study encompasses a single-dose phase (day 1, t0-t8h) and a multiple-dose phase (from t8h to 8 h after intake of last dose at day 5). The DANTE study population includes patients naïve to LBP or patients with previous history of LBP experiencing a new episode of moderate to severe intensity with or without radiculopathy. The clinical phase of the DANTE study started in September 2020 and the anticipated completion date is April 2022. PLANNED OUTCOMES The primary endpoint is the time to first achieve a numeric rating scale-pain intensity (NRS-PI) score of < 4 or a pain intensity reduction ≥ 30% from drug intake up to 8 h after the first dose (t8h). Secondary objectives aim are: (1) to evaluate the analgesic efficacy of TRAM/DKP 75/25 mg versus TRAM 100 mg after the first dose; (2) to evaluate the analgesic efficacy of TRAM/DKP 75/25 mg versus TRAM 100 mg after the multiple doses (from t8h until day 5, multiple dose); and (3) to assess the safety and tolerability of the TRAM/DKP 75/25 mg fixed combination after single and multiple doses. DANTE STUDY REGISTRATION EudraCT number: 2019-003656-37.
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Affiliation(s)
| | - Magdi Hanna
- Analgesics and Pain Research (APR) Ltd, Beckenham, UK
| | | | - Meto Suada
- grid.417562.30000 0004 1757 5468Global Medical Affairs, Menarini, Florence, Italy
| | - Serge Perrot
- grid.508487.60000 0004 7885 7602Pain Center, INSERM U987, Hôpital Cochin, University of Paris, Paris, France
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Soteropoulos C, Pergolizzi J, Nagarakanti S, Gharibo C. Peripheral Nerve Stimulation for Treatment of Cluneal Neuropathy Case Study. Cureus 2022; 14:e28033. [PMID: 36120219 PMCID: PMC9473452 DOI: 10.7759/cureus.28033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
Chronic low back pain is a prevalent and sometimes debilitating condition. This case report describes a 69-year-old female presenting with axial spine pain. The pain was inadequately controlled by opioids as she was treated unsuccessfully with hydrocodone and remained to have the pain between 7/10 and 10/10. Peripheral neural stimulation (PNS) was trialed and then used to control her pain. PNS is a device-based treatment option that appears effective in a subset of patients. It has been effectively used to treat many different chronic pain syndromes. The patient responded well to the treatment, with her pain intensity going down to between 2/10 and 5/10 on the same scale. She was able to discontinue her use of opioids. PNS can be a safe and effective treatment in patients who have not responded well to pharmacologic analgesia.
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Naznin RA, Moniruzzaman M, Sumi SA, Benzir M, Jahan I, Ahmad R, Haque M. Sacralization of Coccygeal Vertebra: A Descriptive Observational Study in Bangladesh. Cureus 2022; 14:e27496. [PMID: 35919212 PMCID: PMC9339143 DOI: 10.7759/cureus.27496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background: In the sacrococcygeal region, anatomical variation is due to the sacralization of the coccygeal vertebra, which is the due union of/fusion of the fifth sacral with the first coccygeal vertebra of five couples of sacral foramina under-detected or asymptomatic beyond radiological assessment. That is why it is challenging to know the cause of coccydynia, caudal block failure, the difficult second stage of labor, and perineal tears. The present study aims to improve knowledge about the anatomical variation of sacralization of the coccygeal vertebra. Additionally, to find the prevalence of sacralization of coccygeal vertebra in Sylhet, Bangladesh. Methods: This study was performed on 60 parched, totally calcified, typical sacra of mature-age individuals of undetermined sexes, fulfilling the inclusion criteria from the bone bank of the osteology museum of the Department of Anatomy, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh, from July 2017 to June 2018. Sex determination of the collected unknown sacra was conducted using discriminant function analysis. It was found that 50% (30) were male and 50% (30%) were female. The unpaired t-tests and chi-square were utilized to determine the statistical significance. Results: Out of 60 sacra, eight (13.33%) samples presented with sacralization. This study found that males had significantly higher straight (p=0.05) and curved (p=0.05) lengths of sacrococcygeal vertebrae. The sacrococcygeal curvature index (SCI) showed statistically significant (p=0.05) differences between the sexes. Conclusion: Sacralization may exert an impact on the caudal block. It could extend the second stage of the labor process with perineal tears. Therefore, knowledge about the anatomical variation of the coccygeal vertebra is essential.
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Aguilar-Ferrándiz ME, Matarán-Peñarrocha GA, Tapia-Haro RM, Castellote-Caballero Y, Martí-García C, Castro-Sánchez AM. Effects of a supervised exercise program in addition to electrical stimulation or kinesio taping in low back pain: a randomized controlled trial. Sci Rep 2022; 12:11430. [PMID: 35794120 PMCID: PMC9259681 DOI: 10.1038/s41598-022-14154-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/02/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractChronic low back pain it is one of the most common health problems worldwide. Usually is accompanied by a complex set of symptoms and generates significant direct and indirect socioeconomic and health costs. From a therapeutic point of view, there are a wide variety of methods to address the treatment of this pathology, however, these therapies have not been shown definitive efficacy. To investigate the effect of a mixed treatment with exercise and electrical stimulation versus exercise and kinesio taping in patients with non-specific chronic low back pain. A total of 58 patients participated in this single-blinded randomised clinical trial. Participants were assigned to the exercises- kinesio taping group, or exercises- analgesic current group, both received 12 treatment sessions. Disability, fear of movement, anxiety, depression, sleeps quality, pain, lower limb mechanosensitivity and pressure-pain thresholds were recorded at baseline and after 4 weeks of treatment. The 2 × 2 mixed analysis of covariance test showed statistically significant differences between groups for pain (P = 0.046). Pair-wise comparisons with baseline demonstrated significant differences for both groups in pain (P ≤ 0.001), disability (P ≤ 0.001), pressure-pain thresholds (P ≤ 0.044), lower limb mechanosensitivity, (P ≤ 0.047), anxiety (P ≤ 0.001), depression (P ≤ 0.001) and sleep quality (P ≤ 0.010). Patients with chronic low back pain who received a combined treatment of exercises and kinesio taping or analgesic current showed an improvement in pain, disability, anxiety, depression and sleep pattern. Moreover, exercises combined with electrotherapy produces greater improvements over these variables.Trial registration: NCT02812459.
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Importance of Matrix Cues on Intervertebral Disc Development, Degeneration, and Regeneration. Int J Mol Sci 2022; 23:ijms23136915. [PMID: 35805921 PMCID: PMC9266338 DOI: 10.3390/ijms23136915] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 01/25/2023] Open
Abstract
Back pain is one of the leading causes of disability worldwide and is frequently caused by degeneration of the intervertebral discs. The discs’ development, homeostasis, and degeneration are driven by a complex series of biochemical and physical extracellular matrix cues produced by and transmitted to native cells. Thus, understanding the roles of different cues is essential for designing effective cellular and regenerative therapies. Omics technologies have helped identify many new matrix cues; however, comparatively few matrix molecules have thus far been incorporated into tissue engineered models. These include collagen type I and type II, laminins, glycosaminoglycans, and their biomimetic analogues. Modern biofabrication techniques, such as 3D bioprinting, are also enabling the spatial patterning of matrix molecules and growth factors to direct regional effects. These techniques should now be applied to biochemically, physically, and structurally relevant disc models incorporating disc and stem cells to investigate the drivers of healthy cell phenotype and differentiation. Such research will inform the development of efficacious regenerative therapies and improved clinical outcomes.
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Syrett M, Reed NR, Reed WR, Richey ML, Frolov A, Little JW. Sex-Related Pain Behavioral Differences following Unilateral NGF Injections in a Rat Model of Low Back Pain. BIOLOGY 2022; 11:biology11060924. [PMID: 35741445 PMCID: PMC9219698 DOI: 10.3390/biology11060924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/16/2022]
Abstract
Low back pain (LBP) is a globally prevalent and costly societal problem with multifactorial etiologies and incompletely understood pathophysiological mechanisms. To address such shortcomings regarding the role of neurotrophins in the underlying mechanisms of pain, an LBP model was developed in rats involving two unilateral intramuscular injections of nerve growth factor (NGF) into deep trunk muscles. To date, behavioral investigations of this NGF-LBP model have been limited, especially as it pertains to female pain behaviors. This study compared mechanical sensitivity to noxious (hyperalgesia) and non-noxious (hypersensitivity) stimuli in control and NGF-injected male and female rats through pain resolution. Although the baseline testing revealed no differences between males and females, NGF-injected females demonstrated prolonged ipsilateral deep trunk mechanical hyperalgesia that resolved seven days later than males. Moreover, females showed bilateral trunk mechanical sensitivity to noxious and non-noxious stimuli compared to only ipsilateral behaviors in males. Sex differences were also observed in the severity of behavioral responses, with females displaying greater mean differences from baseline at several timepoints. Overall, these NGF-LBP behavioral findings mirror some of the sex differences reported in the clinical presentation of LBP and accentuate the translatability of this NGF-LBP model. Future studies using this LBP-NGF model could help to elucidate the neurobiological mechanisms responsible for the development, severity, and/or resolution of muscular LBP as well as to provide insights into the processes governing the transition from acute to chronic LBP.
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Affiliation(s)
- Michael Syrett
- Saint Louis University School of Medicine, 1402 South Grand Blvd., Saint Louis, MO 63104, USA; (M.S.); (N.R.R.); (M.L.R.); (A.F.)
| | - Nicholas R. Reed
- Saint Louis University School of Medicine, 1402 South Grand Blvd., Saint Louis, MO 63104, USA; (M.S.); (N.R.R.); (M.L.R.); (A.F.)
| | - William R. Reed
- Department of Physical Therapy, University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL 35294, USA;
| | - Madison L. Richey
- Saint Louis University School of Medicine, 1402 South Grand Blvd., Saint Louis, MO 63104, USA; (M.S.); (N.R.R.); (M.L.R.); (A.F.)
| | - Andrey Frolov
- Saint Louis University School of Medicine, 1402 South Grand Blvd., Saint Louis, MO 63104, USA; (M.S.); (N.R.R.); (M.L.R.); (A.F.)
| | - Joshua W. Little
- Saint Louis University School of Medicine, 1402 South Grand Blvd., Saint Louis, MO 63104, USA; (M.S.); (N.R.R.); (M.L.R.); (A.F.)
- Correspondence:
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Parisien M, Lima LV, Dagostino C, El-Hachem N, Drury GL, Grant AV, Huising J, Verma V, Meloto CB, Silva JR, Dutra GGS, Markova T, Dang H, Tessier PA, Slade GD, Nackley AG, Ghasemlou N, Mogil JS, Allegri M, Diatchenko L. Acute inflammatory response via neutrophil activation protects against the development of chronic pain. Sci Transl Med 2022; 14:eabj9954. [PMID: 35544595 DOI: 10.1126/scitranslmed.abj9954] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The transition from acute to chronic pain is critically important but not well understood. Here, we investigated the pathophysiological mechanisms underlying the transition from acute to chronic low back pain (LBP) and performed transcriptome-wide analysis in peripheral immune cells of 98 participants with acute LBP, followed for 3 months. Transcriptomic changes were compared between patients whose LBP was resolved at 3 months with those whose LBP persisted. We found thousands of dynamic transcriptional changes over 3 months in LBP participants with resolved pain but none in those with persistent pain. Transient neutrophil-driven up-regulation of inflammatory responses was protective against the transition to chronic pain. In mouse pain assays, early treatment with a steroid or nonsteroidal anti-inflammatory drug (NSAID) also led to prolonged pain despite being analgesic in the short term; such a prolongation was not observed with other analgesics. Depletion of neutrophils delayed resolution of pain in mice, whereas peripheral injection of neutrophils themselves, or S100A8/A9 proteins normally released by neutrophils, prevented the development of long-lasting pain induced by an anti-inflammatory drug. Analysis of pain trajectories of human subjects reporting acute back pain in the UK Biobank identified elevated risk of pain persistence for subjects taking NSAIDs. Thus, despite analgesic efficacy at early time points, the management of acute inflammation may be counterproductive for long-term outcomes of LBP sufferers.
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Affiliation(s)
- Marc Parisien
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Lucas V Lima
- Department of Psychology, Faculty of Science, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Concetta Dagostino
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Nehme El-Hachem
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Gillian L Drury
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Audrey V Grant
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Jonathan Huising
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen 6525, Netherlands
| | - Vivek Verma
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Carolina B Meloto
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Jaqueline R Silva
- Departments of Anesthesiology and Perioperative Medicine and Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Gabrielle G S Dutra
- Department of Psychology, Faculty of Science, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Teodora Markova
- Department of Psychology, Faculty of Science, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Hong Dang
- Cystic Fibrosis Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Philippe A Tessier
- Department of Microbiology and Immunology, Faculty of Medicine, Laval University, Quebec City, Quebec G1V 0A6, Canada
| | - Gary D Slade
- Center for Pain Research and Innovation, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Andrea G Nackley
- Center for Translational Pain Medicine and Departments of Anesthesiology and Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Nader Ghasemlou
- Departments of Anesthesiology and Perioperative Medicine and Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Jeffrey S Mogil
- Department of Psychology, Faculty of Science, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Massimo Allegri
- Pain Therapy Service, Policlinico of Monza Hospital, Monza 20900, Italy.,Pain Management and Neuromodulation Centre, Ensemble Hospitalier de la Côte, Morges 1110, Switzerland
| | - Luda Diatchenko
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1G1, Canada
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Georgopoulos V, Akin-Akinyosoye K, Smith S, McWilliams DF, Hendrick P, Walsh DA. An observational study of centrally facilitated pain in individuals with chronic low back pain. Pain Rep 2022; 7:e1003. [PMID: 35441119 PMCID: PMC9012603 DOI: 10.1097/pr9.0000000000001003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/05/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Central pain facilitation can hinder recovery in people with chronic low back pain (CLBP). Objectives The objective of this observational study was to investigate whether indices of centrally facilitated pain are associated with pain outcomes in a hospital-based cohort of individuals with CLBP undertaking a pain management programme. Methods Participants provided self-report and pain sensitivity data at baseline (n = 97) and again 3 months (n = 87) after a cognitive behavioural therapy-based group intervention including physiotherapy. Indices of centrally facilitated pain were pressure pain detection threshold, temporal summation and conditioned pain modulation at the forearm, Widespread Pain Index (WPI) classified using a body manikin, and a Central Mechanisms Trait (CMT) factor derived from 8 self-reported characteristics of anxiety, depression, neuropathic pain, fatigue, cognitive dysfunction, pain distribution, catastrophizing, and sleep. Pain severity was a composite factor derived from Numerical Rating Scales. Cross-sectional and longitudinal regression models were adjusted for age and sex. Results Baseline CMT and WPI each was associated with higher pain severity (CMT: r = 0.50, P < 0.001; WPI: r = 0.21, P = 0.04) at baseline and at 3 months (CMT: r = 0.38, P < 0.001; WPI: r = 0.24, P = 0.02). High baseline CMT remained significantly associated with pain at 3 months after additional adjustment for baseline pain (β = 2.45, P = 0.04, R 2 = 0.25, P < 0.0001). Quantitative sensory testing indices of pain hypersensitivity were not significantly associated with pain outcomes at baseline or at 3 months. Conclusion Central mechanisms beyond those captured by quantitative sensory testing are associated with poor CLBP outcome and might be targets for improved therapy.
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Affiliation(s)
- Vasileios Georgopoulos
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham BRC, University of Nottingham, Nottingham, United Kingdom
| | - Kehinde Akin-Akinyosoye
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
| | - Stephanie Smith
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
| | - Daniel F. McWilliams
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
| | - Paul Hendrick
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- Physiotherapy, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - David A. Walsh
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham BRC, University of Nottingham, Nottingham, United Kingdom
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Allegri M, Incerti M, Eldabe S. A better comprehension of anatomy and clinical diagnosis to better treat cervical and low back pain after "failed back surgery". Minerva Anestesiol 2022; 88:220-222. [PMID: 35410104 DOI: 10.23736/s0375-9393.22.16428-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Massimo Allegri
- Department of Pain Therapy, Ensemble Hospitalier de la Côte, Morges, Switzerland - massimo.allegriehc.vd.ch.,Service of Pain Therapy, Monza Polyclinic Hospital, Monza, Italy - massimo.allegriehc.vd.ch
| | - Michele Incerti
- Department of Neurosurgery, Monza Polyclinic Hospital, Monza, Italy
| | - Sam Eldabe
- Department of Pain Therapy, Ensemble Hospitalier de la Côte, Morges, Switzerland.,Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
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Heo M, Yun J, Kim H, Lee SS, Park S. Optimization of a lumbar interspinous fixation device for the lumbar spine with degenerative disc disease. PLoS One 2022; 17:e0265926. [PMID: 35390024 PMCID: PMC8989208 DOI: 10.1371/journal.pone.0265926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
Interspinous spacer devices used in interspinous fixation surgery remove soft tissues in the lumbar spine, such as ligaments and muscles and may cause degenerative diseases in adjacent segments its stiffness is higher than that of the lumbar spine. Therefore, this study aimed to structurally and kinematically optimize a lumbar interspinous fixation device (LIFD) using a full lumbar finite element model that allows for minimally invasive surgery, after which the normal behavior of the lumbar spine is not affected. The proposed healthy and degenerative lumbar spine models reflect the physiological characteristics of the lumbar spine in the human body. The optimum number of spring turns and spring wire diameter in the LIFD were selected as 3 mm and 2 turns, respectively—from a dynamic range of motion (ROM) perspective rather than a structural maximum stress perspective—by applying a 7.5 N∙m extension moment and 500 N follower load to the LIFD-inserted lumbar spine model. As the spring wire diameter in the LIFD increased, the maximum stress generated in the LIFD increased, and the ROM decreased. Further, as the number of spring turns decreased, both the maximum stress and ROM of the LIFD increased. When the optimized LIFD was inserted into a degenerative lumbar spine model with a degenerative disc, the facet joint force of the L3-L4 lumbar segment was reduced by 56%–98% in extension, lateral bending, and axial rotation. These results suggest that the optimized device can strengthen the stability of the lumbar spine that has undergone interspinous fixation surgery and reduce the risk of degenerative diseases at the adjacent lumbar segments.
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Affiliation(s)
- Minhyeok Heo
- School of Mechanical Engineering, Pusan National University, Busan, Republic of Korea (South Korea)
| | - Jihwan Yun
- School of Mechanical Engineering, Pusan National University, Busan, Republic of Korea (South Korea)
| | - Hanjong Kim
- School of Mechanical Engineering, Pusan National University, Busan, Republic of Korea (South Korea)
| | - Sang-Soo Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea (South Korea)
| | - Seonghun Park
- School of Mechanical Engineering, Pusan National University, Busan, Republic of Korea (South Korea)
- * E-mail:
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YERLİKAYA M, SARACOGLU İ. The attitudes and beliefs of physiotherapists, family physicians and physiatrists concerning chronic low back pain. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1015826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ricci M, Mulone A, Elena N, Vecchini E, Valentini R, Gelmini M. Use of a non-medicated plaster in chronic lumbar back pain: a randomized controlled trial. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022260. [PMID: 36043965 PMCID: PMC9534234 DOI: 10.23750/abm.v93i4.12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The latest technology on far infrared radiations reflects the radiations emitted by the human body and induces an antalgic and anti-inflammatory effect without active ingredients. Our primary aim was to assess pain level modifications throughout the treatment period with two different types of patches, compared to a placebo. As secondary aims, we focused on addressing patients' quality of life and range of motion changes with each patch. METHODS We assessed 54 patients with chronic lumbar back pain treated with FIT Therapy (far infrared technology) patch. Three different types of FIT Therapy patches (F4, F3, and placebo) were used according to the different power of action and patients allocated in a randomized fashion into the 3 arms of the study. Every single patient was assessed during the study using the VAS pain scale, the Roland Morris Disability Questionnaire for quality of life, and ROM for a total of 14 days. RESULTS Only the F4 patch group significantly reduced pain level at T14 compared to the placebo group (p<0.05). Meanwhile, F3 showed only a non-significant decrease compared to placebo (p=0.254). In terms of lifestyle improvements, both F3 and F4 recorded a decrease on the RMDQ of 4 and 6 points, respectively. CONCLUSIONS Currently, we still need further studies with longer follow-up to consider the FIT Therapy patches F4 a valid alternative as a "non-medicated pain relief", but it proved to have a role in alleviating painful symptoms and improving function in chronic lumbar back pain without adverse events.
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Abuzeid Atta Elmannan A, AlHindi HA, AlBaltan RI, AlSaif MS, Almazyad NS, Alzurayer RK, Al-Rumayh S. Non-specific Low Back Pain Among Nurses in Qassim, Saudi Arabia. Cureus 2021; 13:e19594. [PMID: 34926063 PMCID: PMC8672921 DOI: 10.7759/cureus.19594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Non-specific low back pain (LBP) is a complex and multifactorial health problem. Evidence has shown that LBP is an important occupational hazard and nurses are particularly at high risk. While several studies have addressed the prevalence of LBP worldwide, the prevalence of LBP in Saudi Arabia remains unclear. In this study, we aimed to estimate the prevalence and associated factors of LBP among nurses in the Qassim region, Saudi Arabia. Methods This was a multicenter cross-sectional study carried out in four major public hospitals in the Qassim region. A total of 323 nurses were recruited through a two-stage sampling method. A previously validated questionnaire was used to gather data. The main outcome measures were; LBP prevalence during working life, demographic factors, lifestyle factors, work-related factors, and psychological factors. Multivariable logistic regression analysis was used to determine factors independently associated with LBP. Results The study showed that LBP prevalence was 65.6% (n=212). Over one-third of the study, participants sought treatment for LBP (n=82, 38.7%). Age and the type of ward were found significantly associated with LBP [adjusted odds ratios (aOR): 0.39; 95% confidence interval (CI): 0.19, 0.77; p value=0.007] & (aOR: 0.36; 95% CI: 0.15, 0.86; p-value =0.02), respectively. However, gender, working hours, number of patients, stress, and smoking were not identified as LBP risk factors in this study. Conclusion The findings of this study suggest that LBP is a highly prevalent occupational health problem among nurses in Qassim. Young nurses 20-30 years are more likely to suffer from LBP, while nurses working in the general surgery wards have a lower risk for LBP in this study. On-the-job training is essential particularly for new and young nurses on proper body mechanics when mobilizing patients or lifting heavy equipment. In addition, there is a need for evidence-based interventions to improve the workplace environment for nurses in hospitals in order to lower LBP prevalence.
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Affiliation(s)
| | - Hajar A AlHindi
- Medicine, College of Medicine, Qassim University, Alrass, SAU
| | - Reema I AlBaltan
- Family and Community Medicine, College of Medicine, Qassim University, Buraidah, SAU
| | - Mariah S AlSaif
- Family and Community Medicine, College of Medicine, Qassim University, Alrass, SAU
| | - Nouf S Almazyad
- Medicine, College of Medicine, Qassim University, Buraidah, SAU
| | | | - Shouq Al-Rumayh
- Medical Intern, College of Medicine, Qassim University, Buraidah, SAU
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Rubio-Haro R, De Andrés-Serrano C, Noriega González DC, Bordes-García C, DE Andrés J. Adjacent segment syndrome after failed back surgery: biomechanics, diagnosis, and treatment. Minerva Anestesiol 2021; 88:282-292. [PMID: 34709016 DOI: 10.23736/s0375-9393.21.15939-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The adjacent segment syndrome is defined as the changes in the adjacent structures of an operated spinal level that produce symptoms of pain and disability, which worsen the quality of life of a patient. Pain management specialists must be aware of these biomechanical changes brought by spinal surgeries, as well as of the symptoms associated with pain after surgery, to reach an appropriate diagnosis and provide an adequate treatment. Specialized pain literature contains few reports on specific management of patients using the terms "adjacent segment syndrome, degeneration or disease"; most of the literature comes from surgical journals. It is necessary to perform studies with a population sample comprising patients with adjacent segment syndrome after spinal surgery, since almost all treatments applied in this group are extrapolated from those used in patients with pain originating in the same area but who have not previously undergon spine surgery. Therefore, we consider necessary for pain physicians to understand the underlying biomechanics, promote the diagnosis of this condition, and analyze possible treatments in patients with adjacent segment disease to alleviate their pain and improve their quality of life.
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Affiliation(s)
- Ruben Rubio-Haro
- Anesthesia, Critical Care and Pain Management Department, Valencia University General Hospital, Valencia, Spain -
| | - Carmen De Andrés-Serrano
- Multidisciplinary Pain Clinic, Vithas Virgen del Consuelo Hospital, Carrer de Callosa d'En Sarrià, Valencia, Spain
| | - David C Noriega González
- Column Unit Section, Orthopedic Surgery Service, University Clinic Hospital of Valladolid, Valladolid, Spain
| | - Clara Bordes-García
- Anesthesia Critical Care and Pain Management Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Jose DE Andrés
- Anesthesia Critical Care and Pain Management Department, Valencia University General Hospital, Valencia University Medical School, Valencia, Spain
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Santra D, Goswami S, Mandal JK, Basu SK. Low back pain expert systems: Clinical resolution through probabilistic considerations and poset. Artif Intell Med 2021; 120:102163. [PMID: 34629151 DOI: 10.1016/j.artmed.2021.102163] [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: 11/08/2020] [Revised: 07/22/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Proper diagnosis of Low Back Pain (LBP) is quite challenging in especially the developing countries like India. Though some developed countries prepared guidelines for evaluation of LBP with tests to detect psychological overlay, implementation of the recommendations becomes quite difficult in regular clinical practice, and different specialties of medicine offer different modes of management. Aiming at offering an expert-level diagnosis for the patients having LBP, this paper uses Artificial Intelligence (AI) to derive a clinically justified and highly sensitive LBP resolution technique. MATERIALS AND METHODS The paper considers exhaustive knowledge for different LBP disorders (classified based on different pain generators), which have been represented using lattice structures to ensure completeness, non-redundancy, and optimality in the design of knowledge base. Further the representational enhancement of the knowledge has been done through construction of a hierarchical network, called RuleNet, using the concept of partially-ordered set (poset) with respect to the subset equality (⊆) relation. With implicit incorporation of probability within the knowledge, the RuleNet is used to derive reliable resolution logic along with effective resolution of uncertainties during clinical decision making. RESULTS The proposed methodology has been validated with clinical records of seventy seven LBP patients accessed from the database of ESI Hospital Sealdah, India over a period of one year from 2018 to 2019. Achieving 83% sensitivity of the proposed technique, the pain experts at the hospital find the design clinically satisfactory. The inferred outcomes have also been found to be homogeneous with the actual or original diagnosis. DISCUSSIONS The proposed approach achieves the clinical and computational efficiency by limiting the shortcomings of the existing methodologies for AI-based LBP diagnosis. While computational efficiency (with respect to both time and space complexity) is ensured by inferring clinical decisions through optimal processing of the knowledge items using poset, the clinical acceptability has been ascertained reaching to the most-likely diagnostic outcomes through probabilistic resolution of clinical uncertainties. CONCLUSION The derived resolution technique, when embedded in LBP medical expert systems, would provide a fast, reliable, and affordable healthcare solution for this ailment to a wider range of general population suffering from LBP. The proposed scheme would significantly reduce the controversies and confusion in LBP treatment, and cut down the cost of unnecessary or inappropriate treatment and referral.
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Affiliation(s)
- Debarpita Santra
- Department of Computer Science and Engineering, Faculty of Engineering, Technology and Management, University of Kalyani, Block C, Nadia, Kalyani, West Bengal PIN - 741245, India.
| | - Subrata Goswami
- ESI Institute of Pain Management, ESI Hospital Sealdah premises, 301/3 Acharya Prafulla Chandra Road, Kolkata, 700009, West Bengal, India
| | - Jyotsna Kumar Mandal
- Department of Computer Science and Engineering, Faculty of Engineering, Technology and Management, University of Kalyani, Block C, Nadia, Kalyani, West Bengal PIN - 741245, India
| | - Swapan Kumar Basu
- Department of Computer Science, Institute of Science, Banaras Hindu University, Varanasi, 221005, Uttar Pradesh, India
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Prevalence of Self-Reported Work-Related Lower Back Pain and Its Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:6633271. [PMID: 34603457 PMCID: PMC8486508 DOI: 10.1155/2021/6633271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 08/02/2021] [Accepted: 08/24/2021] [Indexed: 11/21/2022]
Abstract
Introduction Low back pain is the commonest musculoskeletal disorder affecting every socioeconomic group of the world's population. The lifetime risk of developing low back pain is about 60%–80%. The pooled prevalence and associated factors of low back pain have not yet been determined in Ethiopia. Thus, this study was aimed at assessing the overall prevalence of low back pain and its associated factors in Ethiopia. Methods A systematic search of PubMed, Scopus, Science Direct, and Google Scholar for observational studies reporting data on the prevalence and associated factors of low back pain was conducted. Relevant data were extracted with a standardized data extraction excel form. Stata 14 was employed for the meta-analysis. Heterogeneity was assessed by Cochran's Q test and I2 values of a forest plot. Publication bias was checked using a funnel plot and Egger's test. A random-effects model was used in the analysis. Result A total of thirty-two studies were included for the systematic review. Twenty-four and sixteen studies were used to pool the overall low back pain prevalence and associated factors, respectively. The overall pooled annual prevalence of low back pain in Ethiopia was estimated to be 54.05% (95% CI: 48.14–59.96). Age, sex, body mass index, work experience, working hours, lack of safety training, awkward working posture, work shift, prolonged standing, lifting heavy objects, sleeping disturbance, history of back trauma, previous medical history of musculoskeletal disorder, and lack of adequate rest interval at work were significantly associated with low back pain. Conclusion The current systematic review and meta-analysis revealed a higher prevalence of lower back pain in Ethiopia. Most of the low back pain epidemiological studies conducted in Ethiopia focused on specific occupational settings, making pooling of data and comparison with other countries challenging. Thus, further general population studies are recommended.
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Pelled G, Salas MM, Han P, Gill HE, Lautenschlager KA, Lai TT, Shawver CM, Hoch MB, Goff BJ, Betts AM, Zhou Z, Lynch C, Schroeder G, Bez M, Maya MM, Bresee C, Gazit Z, McCallin JP, Gazit D, Li D. Intradiscal quantitative chemical exchange saturation transfer MRI signal correlates with discogenic pain in human patients. Sci Rep 2021; 11:19195. [PMID: 34584114 PMCID: PMC8478892 DOI: 10.1038/s41598-021-97672-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/22/2021] [Indexed: 12/13/2022] Open
Abstract
Low back pain (LBP) is often a result of a degenerative process in the intervertebral disc. The precise origin of discogenic pain is diagnosed by the invasive procedure of provocative discography (PD). Previously, we developed quantitative chemical exchange saturation transfer (qCEST) magnetic resonance imaging (MRI) to detect pH as a biomarker for discogenic pain. Based on these findings we initiated a clinical study with the goal to evaluate the correlation between qCEST values and PD results in LBP patients. Twenty five volunteers with chronic low back pain were subjected to T2-weighted (T2w) and qCEST MRI scans followed by PD. A total of 72 discs were analyzed. The average qCEST signal value of painful discs was significantly higher than non-painful discs (p = 0.012). The ratio between qCEST and normalized T2w was found to be significantly higher in painful discs compared to non-painful discs (p = 0.0022). A receiver operating characteristics (ROC) analysis indicated that qCEST/T2w ratio could be used to differentiate between painful and non-painful discs with 78% sensitivity and 81% specificity. The results of the study suggest that qCEST could be used for the diagnosis of discogenic pain, in conjunction with the commonly used T2w scan.
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Affiliation(s)
- Gadi Pelled
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Margaux M Salas
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- 59th Medical Wing Air Force, San Antonio, TX, 78236, USA
| | - Pei Han
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Biomedical Research Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Howard E Gill
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Karl A Lautenschlager
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Tristan T Lai
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Cameron M Shawver
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Matthew B Hoch
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Brandon J Goff
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Aaron M Betts
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Zhengwei Zhou
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Biomedical Research Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Cody Lynch
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Biomedical Research Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Grant Schroeder
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Maxim Bez
- Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
| | - Marcel M Maya
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Catherine Bresee
- Biostatistics and Bioinformatics Research Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Zulma Gazit
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - John P McCallin
- Division of Pain Management, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX, 78234, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Dan Gazit
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Faculty of Dental Medicine, Hebrew University, 91120, Jerusalem, Israel
| | - Debiao Li
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Biomedical Research Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, 90095, USA
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Axially Loaded Magnetic Resonance Imaging Identification of the Factors Associated with Low Back-Related Leg Pain. J Clin Med 2021; 10:jcm10173884. [PMID: 34501338 PMCID: PMC8432049 DOI: 10.3390/jcm10173884] [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: 05/07/2021] [Revised: 07/21/2021] [Accepted: 08/25/2021] [Indexed: 02/07/2023] Open
Abstract
This retrospective observational study was conducted to identify factors associated with low back-related leg pain (LBLP) using axially loaded magnetic resonance imaging (AL-MRI). Ninety patients with low back pain (LBP) underwent AL-MRI of the lumbar spine. A visual analog scale and patient pain drawings were used to evaluate pain intensity and location and determine LBLP cases. The values of AL-MRI findings were analyzed using a logistic regression model with a binary dependent variable equal to one for low back-related leg pain and zero otherwise. Logistic regression results suggested that intervertebral joint effusion (odds ratio (OR) = 4.58; p = 0.035), atypical ligamenta flava (OR = 5.77; p = 0.003), and edema of the lumbar intervertebral joint (OR = 6.41; p = 0.003) were more likely to be present in LBLP patients. Advanced disc degeneration (p = 0.009) and synovial cysts (p = 0.004) were less frequently observed in LBLP cases. According to the AL-MRI examinations, the odds of having LBLP are more likely if facet effusion, abnormal ligamenta flava, and lumbar facet joint edema are present on imaging than if not. The assessment of lumbar spine morphology in axial loaded MRI adds value to the potential understanding of LBLP, but further longitudinal and loaded–unloaded comparative studies are required to determine the role of acute dynamic changes and instability in LBLP development.
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