Associated Risk Factors with Low Back Pain in White-Collar Workers-A Cross-Sectional Study

Predicting Treatment Outcomes in Patients with Low Back Pain Using Gene Signature-Based Machine Learning Models

INTRODUCTION

Low back pain (LBP) is a significant global health burden, with variable treatment outcomes and an unclear underlying molecular mechanism. Effective prediction of treatment responses remains a challenge. In this study, we aimed to develop gene signature-based machine learning models using transcriptomic data from peripheral immune cells to predict treatment outcomes in patients with LBP.

METHODS

The transcriptomic data of patients with LBP from peripheral immune cells were retrieved from the GEO database. Patients with LBP were recruited, and treatment outcomes were assessed after 3 months. Patients were classified into two groups: those with resolved pain and those with persistent pain. Differentially expressed genes (DEGs) between the two groups were identified through bioinformatic analysis. Key genes were selected using five machine learning models, including Lasso, Elastic Net, Random Forest, SVM, and GBM. These key genes were then used to train 45 machine learning models by combining nine different algorithms: Logistic Regression, K-Nearest Neighbors, Support Vector Machine, Decision Tree, Random Forest, Gradient Boosting Machine, Multilayer Perceptron, Naive Bayes, and Linear Discriminant Analysis. Five-fold cross-validation was employed to ensure robust model evaluation and minimize overfitting. In each fold, the dataset was split into training and validation sets, with model performance assessed using multiple metrics including accuracy, precision, recall, and F1 score. The final model performance was reported as the mean and standard deviation across all five folds, providing a more reliable estimate of the models' ability to predict LBP treatment outcomes using gene expression data from peripheral immune cells.

RESULTS

A total of 61 DEGs were identified between patients with resolved and persistent pain. From these genes, 45 machine learning models were constructed using different combinations of feature selection methods and classification algorithms. The Elastic Net with Logistic Regression achieved the highest accuracy of 88.7% ± 8.0% (mean ± standard deviation), followed closely by Elastic Net with Linear Discriminant Analysis (88.7% ± 7.5%) and Lasso with Multilayer Perceptron (87.7% ± 6.7%). Overall, 15 models demonstrated robust performance with accuracy > 80%, suggesting the reliability of our machine learning approach in predicting LBP treatment outcomes. The SHapley Additive exPlanations (SHAP) method was used to visualize the contribution of core genes to model performance, highlighting their roles in predicting treatment outcomes.

CONCLUSION

The study demonstrates the potential of using transcriptomic data from peripheral immune cells and machine learning models to predict treatment outcomes in patients with LBP. The identification of key genes and the high accuracy of certain models provide a basis for future personalized treatment strategies in LBP management. Visualizing gene importance with SHAP adds interpretability to the predictive models, enhancing their clinical relevance.

Factors associated with pain-related functional interference in people with chronic low back pain enrolled in a physical exercise programme: the role of pain, sleep, and quality of life

OBJECTIVE

To identify the factors associated with the pain-related functional interference level in people with chronic low back pain.

DESIGN

Cross-sectional.

SUBJECTS/PATIENTS

Chronic low back pain patients.

METHODS

Sociodemographic data, pain intensity, pain-related functional interference, physical functioning and fitness, sleep quality, anxiety and depression, social support, and health-related quality of life were recorded. Descriptive and bivariate analyses were performed. A linear regression model was carried out to identify the factors associated with the pain-related functional interference level.

RESULTS

99 participants were involved (mean age: 54.37 SD: 12.44; women: 67.7%). 37.4%, 27.3%, and 35.4% were classified into low, moderate, and high pain-related functional interference level groups, respectively. Higher pain-related functional interference was associated with higher pain intensity (β: 0.724; p = 0.026), worse sleep quality (β: 0.077; p = 0.012), worse quality of life (physical (β: -0.539; p < 0.001) and mental (β: -0.289; p < 0.001), and lower consumption of weak opioids (β: -3.408; p = 0.037).

CONCLUSION

Beyond the pain experience and intensity among people with chronic low back pain, several biopsychosocial factors associated with this condition has been identified. Furthermore, higher pain intensity, worse sleep quality, worse quality of life, and weak opioids' consumption have been related to the pain-related functional interference of this population.

Quantitative sensory testing and exercise-induced hypoalgesia protocols in low back pain: A scoping review

A significant driver of pain in individuals with low back pain (LBP) is alterations to endogenous pain modulation (EPM). EPM can be measured using quantitative sensory testing (QST), however; there are inconsistencies in the way QST has been implemented across the low back pain literature. The objective of this scoping review was to summarize protocols used to assess EPM using QST (pain pressure threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM)) or exercise-induced hypoalgesia (EIH) in LBP. Databases Medline, Embase, CINAHL and AMED were searched on June 15, 2023, for articles that used QST or EIH protocols in LBP populations. Data was extracted on participants, study design, setting and details on QST and EIH protocols. Of the 221 studies included in the review, 196 used PPT, 62 used TS and 60 used CPM; only 5 studies investigated EIH. For all QST, there was high variability in the type of equipment, timing, trials, and testing location with many studies not reporting this information. There were 4 testing modalities used for TS, and 7 different test stimuli, and 3 different conditioning stimuli used across the studies for CPM. For CPM and EIH, PPT was the most common testing modality. There were 4 types of exercises used across the 5 EIH studies. This scoping review provides a summary of QST and EIH protocols in LBP that may be used as a guide for assessment in future studies. These results demonstrate a need for the development of standardized protocols and reporting guidelines. PERSPECTIVE: This article presents a summary of measures used to assess EPM in LBP. The results show the wide variability of protocols used in the literature. Future research should focus on creating standardized protocols, reporting guidelines and providing more guidance for researchers in selecting appropriate tests for their research questions.

Impact of Standing and Sitting Postures on Spinal Curvature and Muscle Mechanical Properties in Young Women: A Photogrammetric and MyotonPro Analysis

BACKGROUND This study aimed to evaluate the effect of standing and sitting positions on spinal curvatures evaluated using projection moire and muscle tone and stiffness using the MyotonPRO hand-held device in young women. MATERIAL AND METHODS Thirty-three healthy women, aged 21 to 23 years, volunteered in the study. We used the projection moire method to examine spinal curvatures in both positions and the MyotonPRO device to measure the tone and stiffness of muscles in 3 regions. We evaluated the effects of positions (standing vs sitting), regions (cervical, thoracic, and lumbar), and side factor (right vs left) using multivariate analysis. RESULTS The sitting position significantly decreased the lumbosacral and thoracolumbar angles (P<0.001), but had no effect on the superior thoracic angle. Muscle tension and stiffness were the highest (P<0.001) in the cervical region and did not differ between positions (P>0.05) in this region. We found significantly higher muscle tone and stiffness in the thoracic and lumbar regions during sitting than during standing (P<0.001). There was symmetry in the muscle tone and the stiffness between the right and left sides of the spine. CONCLUSIONS The sitting posture decreased lumbosacral and thoracolumbar angles but increased muscle tension and stiffness in the lumbar and thoracic regions only. The symmetry of muscle tone and transverse stiffness in both positions was the normative value. This study provides insight into the adaptive physiological changes in spinal curvature and muscle mechanical properties in young women and serves as an important reference point for clinical studies of women.

Frontal Plane Body Posture as a Predictor of Musculoskeletal Injuries in Amateur Athletes: A Comprehensive Study of 89 Participants Over 12 Months

BACKGROUND This study aimed to evaluate frontal plane body posture parameters as injury risk factors during physical activity in the previous 12 months. MATERIAL AND METHODS The study sample consisted of 41 males aged 21.3±1.1 years old and 48 females aged 20.8±0.6. To evaluate body posture, we assessed differences in the height of the acromion process (SSA) and differences in the height of the shoulder blades (LSAS), differences in the distance of the lower angles of the shoulder blades and spine (LSPD), differences in the height of the posterior superior iliac spine (PSIS), and the maximum deflection of spinous process line from the line C7-S1 (PTA). The Injury History Questionnaire was used for injury data collection from the previous 12 months. The parameters were assessed for their ability to distinguish between injured and non-injured individuals using the receiver operating characteristic (ROC) method. RESULTS The results suggest that LSPD is a significantly (P=0.028) better predictor of injury than other body posture parameters. The cut-off points for risk of injury based on the assessed body posture parameters demonstrated a diagnostic accuracy higher than chance, except for LSAS and PTA (AUC >0.5). In addition, there were no sex differences in the predictive potential of detecting injuries between males and females. CONCLUSIONS The LSPD has the greatest predictive value for musculoskeletal injuries. Our results suggest that body posture parameters, irrespective of sex, independently influence injury risk, emphasizing the need for preventive strategies targeting athletes' trunk and shoulder regions.

Pressure Pain Threshold Protocols With Pressure Algometer in Patients With Low Back Pain: A Systematic Review With Meta-Analysis

OBJECTIVE

The pressure pain threshold is commonly employed to assess pain in various conditions. Despite its widespread use, the measurement of pressure pain thresholds is not consistently described across studies. Therefore, this review aimed to systematically examine the evidence regarding the assessment of pressure pain thresholds in patients with low back pain, including the protocols and body sites employed.

METHODS

Six databases were systematically screened from their earliest records to May 2023 to identify studies utilizing pressure pain thresholds. Eligibility screening was conducted for the identified studies, and the included studies underwent appraisal using the appropriate tool corresponding to their study design.

RESULTS

Upon categorizing based on the type of pain, we included 5 studies involving acute low back pain and 43 studies with chronic pain. The meta-analysis was conducted to compare subjects with and without pain, revealing no significant difference for the paraspinal region (SMD = -4.19, 95%CI = -11.7 to 3.32, z = -1.09, p = .27), piriformis (SMD = -1.24, 95%CI = -4.25 to 1.76, z = -0.81, p = .42) and quadratus lumborum musculature (SMD = -0.37, 95%CI = -1.35 to 0.60, z = -0.75, p = .45).

CONCLUSION

The paraspinal and gluteal musculature are the most frequently evaluated. Concerning the protocols for assessment, no consensus was identified. However, studies that assessed chronic low back pain typically adhered to a similar approach regarding the number of measures and a constant increase in pressure.

Residents of Mountainous Areas Have a Higher Low Back Pain Prevalence Than Flat Areas of Chongqing, China: A Cross-Sectional Study

Background and Purpose

Epidemiological studies on low back pain in residents living in mountainous areas are scarce. The study was aimed at investigating the prevalence and associated factors of low back pain in Chongqing, relatively impoverished mountainous areas of China.

Materials and Methods

This was a cross-sectional study conducted at selected community or village health service centers in Chongqing over a 2-month period (May 2021 to June 2021), which included adults of Chongqing aged >18 years with or without low back pain (N=1820) chosen by stratified, cluster-sampling. Associated factors of low back pain including sociodemographic characteristics, lifestyle, and occupational features were collected, along with medical history, Oswestry Disability Questionnaire (ODI), and Numerical Rating Scale (NRS) of patients with low back pain, and carried out for at least 20 minutes per respondent. Univariate and multivariate logistic regression models were utilized for statistical analysis.

Results

Overall, 30.5% of 1704 respondents presented with low back pain, with 26.3% living in flat areas and 35.6% in mountainous areas. The associated factors of low back pain were mountainous area residence (OR 1.4, 95% CI 1.1-1.8), advanced age (OR 1.8, 95% CI 1.3-2.5 for those aged 45-59 years, OR 2.3, 95% CI 1.6-3.4 for those aged 60-74 years, and OR 2.1, 95% CI 1.2-3.6 for those aged ≥75 years), married or remarried (OR 1.9, 95% CI 1.1-3.2), divorced or widowed (OR 2.7, 95% CI 14-5.4), moderate labor intensity (OR 1.4, 95% CI 1.1-1.8), frequent stoop (OR 1.6, 95% CI 1.1-2.4), and depressed mood (OR 1.6, 95% CI 1.2-2.1). Residents in the mountainous areas had a higher score on Oswestry Disability Questionnaire (8.3 [SD 6.3] vs 6.2 [SD 4.3]) than those in flat areas.

Conclusion

Mountainous areas in Chongqing had higher prevalence of low back pain as 35.6%, compared with 26.3% in flat areas, with more severe dysfunction in low back pain patients. Multifactorial analysis found that the factors associated with low back pain in Chongqing residents included mountain residence, labor intensity, stoop, psychological factors and frequency of exercise.

Current Concept of Quantitative Sensory Testing and Pressure Pain Threshold in Neck/Shoulder and Low Back Pain

In recent years, several published articles have shown that quantitative sensory testing (QST) and pressure pain threshold (PPT) are useful in the analysis of neck/shoulder and low back pain. A valid reference for normal PPT values might be helpful for the clinical diagnosis of abnormal tenderness or muscle pain. However, there have been no reliable references for PPT values of neck/shoulder and back pain because the data vary depending on the devices used, the measurement units, and the area examined. In this article, we review previously published PPT articles on neck/shoulder and low back pain, discuss the measurement properties of PPT, and summarize the current data on PPT values in patients with chronic pain and healthy volunteers. We also reveal previous issues related to PPT evaluation and discuss the future of PPT assessment for widespread use in general clinics. We outline QST and PPT measurements and what kinds of perceptions can be quantified with the PPT. Ninety-seven articles were selected in the present review, in which we focused on the normative values and abnormal values in volunteers/patients with neck/shoulder and low back pain. We conducted our search of articles using PubMed and Medline, a medical database. We used a combination of “Pressure pain threshold” and “Neck shoulder pain” or “Back pain” as search terms and searched articles from 1 January 2000 to 1 June 2022. From the data extracted, we revealed the PPT values in healthy control subjects and patients with neck/shoulder and low back pain. This database could serve as a benchmark for future research with pressure algometers for the wide use of PPT assessment in clinics.

Differences and Correlations of Anxiety, Sleep Quality, and Pressure-Pain Threshold between Patients with Chronic Low Back Pain and Asymptomatic People

Background. Chronic low back pain (CLBP) is a clinically common and expensive disease. Patients frequently take sick leaves because of pain and dysfunction, and their unpleasant life and work experiences cause psychological depression and anxiety and affect their quality of life. Sleep disturbance is a common problem among patients with low back pain (LBP) with more than 50% complaining about poor sleep quality. This study aimed to explore the correlations between anxiety, sleep quality, and pressure-pain threshold (PPT) and their differences between patients with CLBP and asymptomatic people. Methods. Forty patients with CLBP and 40 asymptomatic people were recruited. Relevant data, including State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, and PPT, were individually and independently collected by blinded physiotherapists with a practicing certificate and then statistically analyzed. An independent sample t-test was used to determine the intergroup differences between patients with CLBP and asymptomatic populations. Pearson correlation coefficient was employed for correlation analysis. Results. The CLBP group had significantly higher anxiety scores (41.64 ± 9.88 vs. 36.69 ± 8.31; t = −2.496, $p=0.015$ ) than the asymptomatic group. A significant difference was found in the total score of the Pittsburgh Sleep Quality Index (6.41 ± 2.43 vs. 5.09 ± 2.18; t = −2.628, $p=0.010$ ) but not in the trait anxiety (44.00 ± 7.83 vs. 42.67 ± 9.51; t = −0.695, $p=0.489$ ) of the two groups. State−Trait Anxiety Inventory showed a low to moderate negative correlation with PPT. No remarkable correlation was observed between Pittsburgh Sleep Quality Index and PPT. Conclusions. Patients with CLBP showed considerably worse state anxiety and sleep quality than asymptomatic people; however, no substantial difference in PPT was found between the two groups. The results suggest that in clinical practice, the focus should include pain and related social and psychological factors. CLBP treatment could be considered from multiple perspectives and disciplines.This trial is registered with Chinese Clinical Trial Registry (Trial registration: ChiCTR-TRC-13003701).