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Heuch I, Heuch I, Hagen K, Storheim K, Zwart JA. Menopausal hormone therapy, oral contraceptives and risk of chronic low back pain: the HUNT Study. BMC Musculoskelet Disord 2023; 24:84. [PMID: 36721124 PMCID: PMC9887847 DOI: 10.1186/s12891-023-06184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are indications that use of menopausal hormone therapy (MHT) and oral contraceptives (OC) increases the risk of low back pain (LBP), with higher oestrogen levels involved in the underlying mechanisms. The purpose of the present study was to investigate associations between use of systemic MHT or OC and risk of chronic LBP in a large population-based data set. METHODS Data were obtained from two surveys in the Trøndelag Health Study in Norway, HUNT2 (1995-1997) and HUNT3 (2006-2008). A cross-sectional study of association between use of systemic MHT and prevalence of chronic LBP comprised 12,974 women aged 40-69 years in HUNT2, with 4007 women reporting chronic LBP. A cohort study involving MHT comprised 6007 women without chronic LBP at baseline in HUNT2, and after 11 years 1245 women reported chronic LBP at follow-up in HUNT3. The cross-sectional study of association with use of OC included 23,593 women aged 20-69 years in HUNT2, with 6085 women reporting chronic LBP. The corresponding cohort study included 10,586 women without chronic LBP at baseline in HUNT2, of whom 2084 women reported chronic LBP in HUNT3. Risk of chronic LBP was examined in both study designs in generalised linear models with adjustment for potential confounders. RESULTS In the cohort study, current users of systemic MHT at baseline showed a greater risk of chronic LBP (relative risk (RR) 1.30; 95% CI: 1.14-1.49; compared with never users). The risk increased according to duration of MHT use (P for linear trend = 0.003). Known users of systemic MHT based exclusively on oestrogen experienced the highest risk (RR 1.49; 95% CI: 1.16-1.91), but an increased risk was also seen among known users of oestrogen-progestin combination MHT (RR 1.35; 95% CI: 1.16-1.57). A slight increase in risk of chronic LBP was found in the cohort study among former users of OC (RR 1.17; 95% CI: 1.06-1.30; compared with never users). CONCLUSIONS Long-lasting use of systemic MHT, in particular therapy based on oestrogen only, is associated with greater risk of chronic LBP. Having been a user of OC most likely entails a minor increase in risk.
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Affiliation(s)
- Ingrid Heuch
- grid.55325.340000 0004 0389 8485Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Nydalen, P.O. Box 4956, N-0424 Oslo, Norway
| | - Ivar Heuch
- grid.7914.b0000 0004 1936 7443Department of Mathematics, University of Bergen, Bergen, Norway
| | - Knut Hagen
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Clinical Research Unit Central Norway, St. Olavs Hospital, Trondheim, Norway
| | - Kjersti Storheim
- grid.55325.340000 0004 0389 8485Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Nydalen, P.O. Box 4956, N-0424 Oslo, Norway ,grid.412414.60000 0000 9151 4445Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - John-Anker Zwart
- grid.55325.340000 0004 0389 8485Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Nydalen, P.O. Box 4956, N-0424 Oslo, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway
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Brain-specific genes contribute to chronic but not to acute back pain. Pain Rep 2022; 7:e1018. [PMID: 35975136 PMCID: PMC9371560 DOI: 10.1097/pr9.0000000000001018] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/20/2022] [Accepted: 05/20/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Back pain is the leading cause of disability worldwide. Although most back pain cases are acute, 20% of acute pain patients experience chronic back pain symptoms. It is unclear whether acute pain and chronic pain have similar or distinct underlying genetic mechanisms. Objectives To characterize the molecular and cellular pathways contributing to acute and chronic pain states. Methods Cross-sectional observational genome-wide association study. Results A total of 375,158 individuals from the UK Biobank cohort were included in the discovery of genome-wide association study. Of those, 70,633 (19%) and 32,209 (9%) individuals met the definition of chronic and acute back pain, respectively. A total of 355 single nucleotide polymorphism grouped into 13 loci reached the genome-wide significance threshold (5x10-8) for chronic back pain, but none for acute. Of these, 7 loci were replicated in the Nord-Trøndelag Health Study (HUNT) cohort (19,760 chronic low back pain cases and 28,674 pain-free controls). Single nucleotide polymorphism heritability was 4.6% (P=1.4x10-78) for chronic back pain and 0.81% (P=1.4x10-8) for acute back pain. Similar differences in heritability estimates between acute and chronic back pain were found in the HUNT cohort: 3.4% (P=0.0011) and 0.6% (P=0.851), respectively. Pathway analyses, tissue-specific heritability enrichment analyses, and epigenetic characterization suggest a substantial genetic contribution to chronic but not acute back pain from the loci predominantly expressed in the central nervous system. Conclusion Chronic back pain is substantially more heritable than acute back pain. This heritability is mostly attributed to genes expressed in the brain.
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Sipko T, Glibowski E. Immediate Effects of Single-Session Proprioceptive Neuromuscular Facilitation Exercises on the Sit-to-Stand Strategy in Patients With Chronic Lumbar Spinal Disc Disease: A Preliminary Study. J Manipulative Physiol Ther 2022. [DOI: 10.1016/j.jmpt.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Efficacy of invasive laser acupuncture in treating chronic non-specific low back pain: A randomized controlled trial. PLoS One 2022; 17:e0269282. [PMID: 35639723 PMCID: PMC9154191 DOI: 10.1371/journal.pone.0269282] [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: 02/03/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022] Open
Abstract
This study aimed to provide preliminary evidence for the efficacy of invasive laser acupuncture (ILA) for chronic non-specific low back pain (CNLBP). This was a single-center, randomized, patient and assessor-blinded, placebo-controlled, parallel-arm, clinical trial with a 1:1:1 allocation ratio that included a full analysis set. Forty-five participants with CNLBP were randomly assigned to the control group (sham laser), 650 group (650 nm-wavelength ILA), or 830 group (830 nm-wavelength ILA) (n = 15/group). All participants received ILA for 10 min, followed by electroacupuncture for 10 min on the same day. The treatment was performed once per day, twice per week for 4 weeks at bilateral BL23, BL24, BL25, and GB30. The primary outcome was the among-group difference of changes in the visual analog scale (VAS) scores at intervention endpoint (week 4). The secondary outcomes were the among-group difference of changes in VAS at 4 weeks after intervention completion (week 8), those in the Korean version of the Oswestry Disability Index (ODI) and the European Quality of Life Five-Dimension- Five-Level (EQ-5D-5L) at intervention endpoint (week 4) and 4 weeks after intervention completion (week 8). The VAS scores of the 650 group decreased significantly compared with those of the control group (p = 0.047; week 4 vs. week 0). The ODI scores of the 650 group (p = 0.018, week 4 vs. week 0; p = 0.006, week 8 vs. week 0) and 830 group (p = 0.014, week 4 vs. week 0) decreased significantly compared with those of the control group. There was no adverse event related to ILA and no significant difference in changes in vital signs among the three groups. The 650 group showed significant improvements in pain intensity and functional disability. The 830 group showed significant improvements in functional disability. Therefore, ILA therapy at 650 nm and 830 nm wavelengths can be used to treat CNLBP.
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Kasapovic A, Schwetje D, Ali T, Jaenisch M, Gathen M, Bornemann R, Abdallah H, Vieweg U. First clinical results of a novel minimally-invasive fusion system for the sacroiliac joint. Technol Health Care 2022; 30:1139-1145. [PMID: 35342065 DOI: 10.3233/thc-213348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sacroiliac joint (SIJ) painful dysfunction is a common source of low back pain (LBP). Several surgical treatment options for SIJ fusion were described. A promising treatment option with demonstrated clinical improvement is the minimally-invasive SIJ fusion. OBJECTIVE The aim of this case study was to document the effectiveness and safety of the new SIJ system (Torpedo®) over a period of 6 months after the minimally invasive implantation. METHODS Patients with failed conservative treatment of painful SIJ dysfunction were enrolled successively in two centers. The Diagnosis was made by positive response to SIJ-injection with local anesthetic and at least by two positive SIJ provocation tests. The Torpedo® Implant system was used for the implantation. This workpiece made of titanium alloy is characterized by a helical profile geometry (CST: chronical spinal turn) with a hydrophilic surface. The evaluated endpoints LBP and grade of disability were assessed using a 0-10 numerical rating scale (NRS), and Oswestry Disability Index (ODI) preoperatively and at one, three and six months postoperatively. RESULTS 15 patients (10 female, 5 male; mean age 59 ± 13 years) were operated on one after the other. The pain intensity decreased in all 15 patients. After 6 months, a decrease in the median values of 70% (quartiles 1-3: 65-79%) was calculated. The median values of the Oswestry Disability Index after 6 months were 62% (quartiles 1-3: 53-67) lower than before the operation. Before surgery, 13 patients (87%) were taking opioids for pain management. Six months after the operation, opioids were only needed by 3 patients (20%). Implant malpositioning was not detected on plain radiograph. No surgical site infections or perioperative complications occurred. CONCLUSIONS The clinical improvement in early follow up and the absence of surgery related complications demonstrate a high grade of device-related safety and effectiveness of the treatment with a novel minimally-invasive SIJ fusion system.
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Affiliation(s)
- Adnan Kasapovic
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Desirée Schwetje
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Thaer Ali
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Max Jaenisch
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Martin Gathen
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Rahel Bornemann
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Hany Abdallah
- Department of Orthopaedic and Spine Surgery, Wadi al Neel Military, Hospital, Cairo, Egypt
| | - Uwe Vieweg
- Department of Spine Surgery, Sana Hospital Rummelsberg, Schwarzenbruck, Germany
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Scott-Young M, Lee SM(S, Nielsen D, Rathbone E, Rackham M, Hing W. Comparison of Mid- to Long-term Follow-up of Patient-reported Outcomes Measures After Single-level Lumbar Total Disc Arthroplasty, Multi-level Lumbar Total Disc Arthroplasty, and the Lumbar Hybrid Procedure for the Treatment of Degenerative Disc Disease. Spine (Phila Pa 1976) 2022; 47:377-386. [PMID: 34559766 PMCID: PMC8815823 DOI: 10.1097/brs.0000000000004253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE The aim of this article is to compare the mid- to long-term patient-reported outcome measures (PROMs) between single-level total disc arthroplasty (TDA), multi-level TDA, and hybrid constructs (combination of TDA and anterior lumbar interbody fusion [ALIF] across multiple levels) for symptomatic degenerative disc disease (DDD). SUMMARY OF BACKGROUND DATA The treatment of single-level DDD is well documented using TDA. However, there is still a paucity of published evidence regarding long-term outcomes on multi-level TDA and hybrid constructs for the treatment of multi-level DDD, as well as lack of long-term comparisons regarding treatment of single-level DDD and multi-level DDD. METHODS A total of 950 patients underwent surgery for single-level or multi-level DDD between July 1998 and February 2012 with single-level TDA (n = 211), multi-level TDA (n = 122), or hybrid construct (n = 617). Visual Analog Score for the back (VAS-B) and leg (VAS-L) were recorded, along with the Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ). RESULTS All PROMs in all groups showed statistically and clinically significant improvements (P < 0.005) in pain and function that is well above the corresponding minimum clinically important difference (MCID) and exceeds literature thresholds for substantial clinical benefit (SCB). Unadjusted analyses show that there were no statistically significant differences in the change scores between the surgery groups for VAS back and leg pain, and RMDQ up to 8 years' follow-up. Adjusted analyses showed the ODI improvement score for the single group was 2.2 points better (95% confidence interval [CI]: 0.6-3.9, P = 0.009) than in the hybrid group. The RMDQ change score was better in the hybrid group than in the multi-level group by 1.1 points (95% CI: 0.4-1.9, P = 0.003) at 6 months and a further 0.4 point at 2 years (95% CI: 0.1-0.8, P = 0.011). CONCLUSION In the setting of meticulous preoperative evaluation in establishing a precision diagnosis, clinically and statistically equivalent results can be achieved when treating symptomatic DDD through single-level TDA, multi-level TDA, and hybrid constructs. These results are sustained at mid- to long-term follow-up.Level of Evidence: 3.
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Affiliation(s)
- Matthew Scott-Young
- Gold Coast Spine, Gold Coast, Queensland, Australia
- Faculty of Health Science & Medicine, Bond University, Gold Coast, Queensland, Australia
| | | | - David Nielsen
- Department of Orthopedic Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Evelyne Rathbone
- Faculty of Health Science & Medicine, Bond University, Gold Coast, Queensland, Australia
| | | | - Wayne Hing
- Faculty of Health Science & Medicine, Bond University, Gold Coast, Queensland, Australia
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Heuch I, Heuch I, Hagen K, Storheim K, Zwart JA. Does the risk of chronic low back pain depend on age at menarche or menopause? A population-based cross-sectional and cohort study: the Trøndelag Health Study. BMJ Open 2022; 12:e055118. [PMID: 35210341 PMCID: PMC8883263 DOI: 10.1136/bmjopen-2021-055118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE In most population-based studies of low back pain (LBP), women have a higher risk than men, possibly reflecting hormonal influences. The aim of this study was to explore associations between age at menarche and menopause and risk of chronic LBP. DESIGN Population-based cross-sectional and cohort study designs. SETTING The HUNT2 and HUNT3 medical surveys of the entire population of Nord-Trøndelag County in Norway. MAIN OUTCOME MEASURE Prevalence or risk of chronic LBP, defined as LBP persisting at least 3 months continuously during last year. PARTICIPANTS Associations between age at menarche and prevalence of chronic LBP were examined in cross-sectional data from HUNT2, comprising 27 697 women aged 20-69 years, with 7300 women reporting LBP. The corresponding cohort data included 11 659 women without LBP at baseline in HUNT2, with 2353 women reporting LBP at follow-up 11 years later in HUNT3. Cross-sectional data on age at menopause or premenopausal status included 11 332 women aged 40-69 years, with 3439 women reporting chronic LBP. Corresponding cohort data included 7893 women without LBP at baseline, of whom 1100 developed LBP. METHODS Associations between age at menarche or menopause and risk of chronic LBP were examined by generalised linear modelling. RESULTS A U-shaped association was indicated between age at menarche and risk of chronic LBP, both in the cross-sectional and cohort studies. Age at menarche ≤11 years was associated with an increased risk of chronic LBP, with a relative risk of 1.32 (95% CI 1.15 to 1.52), compared with age 14 years at menarche, after relevant adjustments. Corresponding cross-sectional crude absolute risks were 32% and 25%, respectively. No association was established between age at menopause and risk of LBP. Being premenopausal had no influence on risk. CONCLUSIONS In contrast to results for age at menopause, the association with age at menarche suggests that hormonal factors affect the risk of LBP.
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Affiliation(s)
- Ingrid Heuch
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Research Unit Central Norway, St Olavs University Hospital, Trondheim, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - John-Anker Zwart
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Division of Clinical Neuroscience, Faculty of Medicine, University of Oslo, Oslo, Norway
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Rialet-Micoulau J, Lucas V, Demoulin C, Pitance L. Misconceptions of physical therapists and medical doctors regarding the impact of lifting a light load on low back pain. Braz J Phys Ther 2022; 26:100385. [PMID: 35063698 PMCID: PMC8784290 DOI: 10.1016/j.bjpt.2021.100385] [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: 01/07/2021] [Revised: 10/28/2021] [Accepted: 12/17/2021] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND A common misconception about low back pain (LBP) is that the spine is weak and that lumbar flexion should be avoided. Because the beliefs of health-care professionals (HCPs) influence patients, it is important to understand the attitudes of health care professionals towards LBP and lifting. OBJECTIVES To assess and compare the perceptions of different categories of HCPs regarding the safety of specific movement strategies used to lift a light load, and their beliefs regarding back pain. The secondary aim was to determine whether certain factors influenced the beliefs of HCPs. METHODS Data were collected via an electronic survey. Student and qualified physical therapists (PTs), medical students, and general practitioner (GP) trainees were included. The questionnaire included eight photographs, depicting eight different strategies to lift a light load. Respondents were requested to select the strategy(s) they considered as "unsafe" to use for asymptomatic people with a previous history of LBP and people with chronic LBP. Beliefs and attitudes towards LBP were evaluated using the Back Pain Attitudes Questionnaire (Back-PAQ). RESULTS Questionnaires from 1005 participants were included. Seventy percent of qualified PTs considered none of the strategies as harmful (versus 32% of PT students, 9% of GP trainees and 1% of medical students). Qualified PTs had higher Back-PAQ scores (mean ± SD: 13.6 ± 5.5) than PT students (8.7 ± 5.7), GP trainees (5.9 ± 5.9) and medical students (4.1 ± 5.2), indicating less misconceptions regarding LBP. Having LBP negatively influenced beliefs while taking a pain education course positively influenced beliefs. CONCLUSION Misconceptions regarding LBP and the harmfulness of lifting a light load with a rounded back remain common among HCPs, particularly medical doctors.
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Affiliation(s)
- Joséphine Rialet-Micoulau
- Clinical Research Institute, Neuro-musculo-skeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium
| | - Valoris Lucas
- Clinical Research Institute, Neuro-musculo-skeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium
| | - Christophe Demoulin
- Clinical Research Institute, Neuro-musculo-skeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium; Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium
| | - Laurent Pitance
- Clinical Research Institute, Neuro-musculo-skeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium; Oral and Maxillofacial Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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Kallan SZ, Oakley PA, Harrison DE. Reduction of lumbar hyperlordosis in a pediatric: a Chiropractic Biophysics<sup>®</sup> case report. J Phys Ther Sci 2022; 34:646-650. [PMID: 36118660 PMCID: PMC9444519 DOI: 10.1589/jpts.34.646] [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: 05/17/2022] [Accepted: 06/18/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To demonstrate the reduction of lumbar hyperlordosis, sacral base angle and
anterior thoracic translation posture in an 11-year-old female. [Participant and Methods]
A pediatric patient presented with lumbar hyperlordosis and underwent Chiropractic
BioPhysics® treatment protocols to reduce her spinal deformity and correlated
symptoms. Symptoms included thoracolumbar, hip, knee and ankle pains and lower extremity
weakness. Radiographs confirmed lumbar hyperlordosis, increased sacral base angle and a
forward translated thoracic posture. Spinal traction as well as corrective exercises and
spinal manipulative therapy was performed over an 11-month period. [Results] After 57
treatments, there was a 13.4° reduction in L1-L5 lordosis, an 11.8° reduction in sacral
base angle and a 13.8 mm reduction in anterior thoracic translation. The improved
structural changes correlated with improved symptoms. [Conclusion] Lumbar hyperlordosis
can be reduced in pediatric patients presenting with hyperlordosis and associated
symptomatology. Routine radiography may be warranted in the diagnosis of lumbar spine
deformities in pediatrics. Further research into the non-surgical reduction of lumbar
spine hyperlordosis is needed.
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Williams RJ, Tryfonidou MA, Snuggs JW, Le Maitre CL. Cell sources proposed for nucleus pulposus regeneration. JOR Spine 2021; 4:e1175. [PMID: 35005441 PMCID: PMC8717099 DOI: 10.1002/jsp2.1175] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022] Open
Abstract
Lower back pain (LBP) occurs in 80% of adults in their lifetime; resulting in LBP being one of the biggest causes of disability worldwide. Chronic LBP has been linked to the degeneration of the intervertebral disc (IVD). The current treatments for chronic back pain only provide alleviation of symptoms through pain relief, tissue removal, or spinal fusion; none of which target regenerating the degenerate IVD. As nucleus pulposus (NP) degeneration is thought to represent a key initiation site of IVD degeneration, cell therapy that specifically targets the restoration of the NP has been reviewed here. A literature search to quantitatively assess all cell types used in NP regeneration was undertaken. With key cell sources: NP cells; annulus fibrosus cells; notochordal cells; chondrocytes; bone marrow mesenchymal stromal cells; adipose-derived stromal cells; and induced pluripotent stem cells extensively analyzed for their regenerative potential of the NP. This review highlights: accessibility; expansion capability in vitro; cell survival in an IVD environment; regenerative potential; and safety for these key potential cell sources. In conclusion, while several potential cell sources have been proposed, iPSC may provide the most promising regenerative potential.
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Affiliation(s)
- Rebecca J. Williams
- Biomedical Research Centre, BiosciencesSheffield Hallam UniversitySheffieldUK
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
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[Minimally invasive arthrodesis of the sacroiliac joint (SIJ)]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 34:98-108. [PMID: 34661704 DOI: 10.1007/s00064-021-00738-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Pain reduction and improvement in quality of life with sacroiliac joint (SIJ) fusion. INDICATIONS Chronic SIJ-associated pain; positive response to SIJ injection with local anesthetic; positive SIJ provocation tests; failed conservative therapy over 6 months. CONTRAINDICATIONS Non-SIJ-associated pain; tumor/infection/unstable fracture in the implantation area; malformations; tumor or osteolysis of the sacrum or ilium bone; active infection at the implantation site; allergy to metal components; secondary gain from illness, request for a pension; inadequately treated osteoporosis. SURGICAL TECHNIQUE Transarticular placement of Kirschner's wires through the SI joint via minimally invasive lateral approach. Guided preparation of implant site over Kirschner's wires and implantation of 3 triangular, transarticular titanium implants for SIJ fusion. POSTOPERATIVE MANAGEMENT Deep vein thrombosis prophylaxis. 3 weeks partial weight-bearing and then moving on to full weight-bearing. X‑ray controls at defined intervals. Physiotherapy. RESULTS We enrolled 26 patients who were followed up over the period of 4 years. The evaluated endpoints were low back pain on the visual analog scale (VAS 0-10), grade of disability with the Oswestry Disability Index (ODI) and quality of life with the EuroQOL-5D. At 4 years, mean low back pain improved compared to preoperative (VAS preoperative 8.4, VAS 4 years postoperative 4.6). Mean improvements in ODI (ODI preoperative 58.1, ODI 4 years postoperative 32.1) and EQ-5D (preoperative 0.5, after 4 years 0.7) could be evaluated over the long-term period of 4 years. Satisfaction rates were high and the proportion of subjects taking opioids decreased at the 4‑year follow-up (preoperative 82%, postoperative 39%). Implant loosening could not be detected on plain radiograph.
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Diagnostic Accuracy of Clusters of Pain Provocation Tests for Detecting Sacroiliac Joint Pain: Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2021; 51:422-431. [PMID: 34210160 DOI: 10.2519/jospt.2021.10469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the diagnostic test accuracy of pain provocation tests for the sacroiliac joint. DESIGN Systematic review of diagnostic test accuracy. LITERATURE SEARCH Seven electronic databases and reference lists of included studies and previous reviews were searched. STUDY SELECTION CRITERIA Studies investigating the diagnostic accuracy of clusters of clinical tests for sacroiliac joint pain were included. DATA SYNTHESIS Bivariate random-effects meta-analysis was employed. Risk of bias and applicability concerns were assessed using the revised Quality Assessment of Diagnostic Accuracy Studies tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to judge credibility of evidence. RESULTS From 2195 records identified in the search, 5 studies were included that assessed clusters of pain provocation tests for the sacroiliac joint. The estimated positive likelihood ratio was 2.13 (95% confidence interval [CI]: 1.2, 3.9), the negative likelihood ratio was 0.33 (95% CI: 0.11, 0.72), and the diagnostic odds ratio was 9.01 (95% CI: 1.72, 28.4). The GRADE ratings for the outcomes were of very low certainty. Assuming a point prevalence of sacroiliac joint pain of 20%, we calculated a positive posterior probability of 35% (95% CI: 32%, 37%) and negative posterior probability of 8% (95% CI: 6%, 10%). CONCLUSION A positive result on a sacroiliac joint pain provocation test cluster gives the clinician 35% certainty of having correctly identified sacroiliac joint pain. Clusters of pain provocation tests for the sacroiliac joint do not provide sufficient diagnostic accuracy for ruling in the sacroiliac joint as the source of pain. Clinicians can rule out the sacroiliac joint as the source of pain with more confidence: the negative posttest probability indicates that the clinician can conclude with 92% certainty that a negative test result is correct. J Orthop Sports Phys Ther 2021;51(9):422-431. Epub 1 Jul 2021. doi:10.2519/jospt.2021.10469.
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Jess MA, Hamilton S, Ryan C, Wellburn S, Alexanders J, Spence D, Martin D. Exploring the origin of pain subclassification, with emphasis on low back pain: a scoping review. JBI Evid Synth 2021; 19:308-340. [PMID: 32881730 DOI: 10.11124/jbisrir-d-19-00383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review aimed to explore the different working definitions for the duration of acute, subacute, and chronic pain, with emphasis on low back pain, and to establish where these definitions originated and the rationale provided for the time frames used. INTRODUCTION From a global perspective, low back pain is a major social and economic problem. One of the most commonly used methods to stratify and manage low back pain is the traditional duration-based classification (acute, subacute, and chronic). Where these time points lie to differentiate these transitions continues to be debated within the scientific community, which may engender a degree of heterogeneity in study findings. Therefore, applying these findings to clinical practice may be somewhat challenging. This review encapsulates the historical origins of the different duration categories to provide an understanding of how these variations were derived. INCLUSION CRITERIA Studies that included participants with low back pain were the focus of this review. Sources that included children or other specific pain pathologies, such as cancer pain, were excluded. The main concept of interest was that the publication proposed an original definition of the duration of acute, subacute, or chronic low back pain. All study designs were included provided they gave a rationale for the duration that they used. METHODS The following databases were searched: MEDLINE, Embase, CINAHL, and PsycINFO, from the inception of each database until September 18, 2019. This review was limited to studies published in English. Two independent reviewers screened the retrieved articles against the eligibility criteria. Additional studies were searched from the reference lists of studies to find the original source. Some original sources overlapped with general pain duration literature. This led to a deviation from the scoping review protocol, which originally intended to focus on definitions of low back pain duration only. Data extraction was undertaken using a charting table developed specifically for the review objectives. The findings were presented using narrative synthesis. RESULTS Nineteen records were included in this review, and comprised three book chapters, four review articles, four articles that arose following pain expert group discussions, seven primary research studies, and a spinal guideline. Data were extracted from the included studies and categorized into four themes based on the origin of the classification of the duration. The themes included i) work/employment setting, ii) empirical studies, iii) expert reasoning, and iv) pathophysiological explanation. CONCLUSIONS This scoping review compiled the existing literature on the working definitions of the duration of acute, subacute, and chronic low back pain and found a wide variation. These ranged from seven days, 14 days, and seven weeks for the acute and subacute transition points, and seven weeks to three years for chronic low back pain. The duration definitions specifically referring to the general pain literature focused on three and/or six months for the transition to chronic. Better integration of reasoning between the identified themes could facilitate the establishment of more ideal duration definitions in the future. Although inconclusive, the definition most commonly cited, with most consensus, was three months for the transition to chronic low back pain.
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Affiliation(s)
- Mary-Anne Jess
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Sharon Hamilton
- School of Health and Social Care, Teesside University, Middlesbrough, UK.,Teesside Centre for Evidence-Informed Practice: A JBI Affiliated Group, Middlesbrough, UK
| | - Cormac Ryan
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Shaun Wellburn
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Jenny Alexanders
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Daniel Spence
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Denis Martin
- School of Health and Social Care, Teesside University, Middlesbrough, UK
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Adnan R, Van Oosterwijck J, Danneels L, Willems T, Meeus M, Crombez G, Goubert D. Differences in psychological factors, disability and fatigue according to the grade of chronification in non-specific low back pain patients: A cross-sectional study. J Back Musculoskelet Rehabil 2021; 33:919-930. [PMID: 33016899 DOI: 10.3233/bmr-191548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Differences in pain processing, muscle structure and function have been reported in patients with low back pain (LBP) with different grades of pain chronicity. OBJECTIVE The present study aims to examine differences in psychological factors, disability and subjective fatigue between subgroups of LBP based on their chronification grade. METHODS Twenty-one healthy controls (HC) and 54 LBP patients (categorized based on the grades of chronicity into recurrent LBP (RLBP), non-continuous chronic LBP (CLBP), or continuous (CLBP)) filled out a set of self-reporting questionnaires. RESULTS The Hospital Anxiety and Depression Scale (HADS) and Multidimensional Pain Inventory (MPI) scores indicated that anxiety, pain severity, pain interference and affective distress were lower in HC and RLBP compared to non-continuous CLBP. Anxiety scores were higher in non-continuous CLBP compared to RLBP, continuous CLBP and HC. The Pain Catastrophizing Scale for Helplessness (PSCH) was higher in non-continuous CLBP compared to HC. The Survey of Pain Attitudes (SOPA) showed no differences in adaptive and maladaptive behaviors across the groups. The Pain Disability Index (PDI) measured a higher disability in both CLBP groups compared to HC. Moreover, the Rolland Morris Disability Questionnaire (RMDQ) showed higher levels of disability in continuous CLBP compared to non-continuous CLBP, RLBP and HC. The Checklist Individual Strength (CIS) revealed that patients with non-continuous CLBP were affected to a higher extent by severe fatigue compared to continuous CLBP, RLBP and HC (subjective fatigue, concentration and physical activity). For all tests, a significance level of 0.05 was used. CONCLUSIONS RLBP patients are more disabled than HC, but have a tendency towards a general positive psychological state of mind. Non-continuous CLBP patients would most likely present a negative psychological mindset, become more disabled and have prolonged fatigue complaints. Finally, the continuous CLBP patients are characterized by more negative attitudes and believes on pain, enhanced disability and interference of pain in their daily lives.
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Affiliation(s)
- Rahmat Adnan
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Malaysia
| | - Jessica Van Oosterwijck
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Research Foundation - Flanders (FWO), Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Lieven Danneels
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Tine Willems
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Mira Meeus
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Geert Crombez
- Department of Experimental - Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Belgium
| | - Dorien Goubert
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
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15
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Rehman Y, Ferguson H, Bozek A, Blair J, Allison A, Johnston R. Dropout associated with osteopathic manual treatment for chronic noncancerous pain in randomized controlled trials. J Osteopath Med 2021; 121:417-428. [PMID: 33721921 DOI: 10.1515/jom-2020-0240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT Reviews exploring harm outcomes such as adverse effects (AE), all cause dropouts (ACD), dropouts due to inefficacy, and dropouts due to AE associated with osteopathic manipulative treatment (OMT) or osteopathic manual therapy (OMTh) are scant. OBJECTIVES To explore the overall AE, ACD, dropouts due to inefficacy, and AE in chronic noncancerous pain (CNCP) patients receiving OMTh through a systematic review of previous literature. METHODS For this systematic review and meta-analysis, the authors searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), EMCare, and Allied and Complementary Medicine Database (AMED), and Ostmed.Dr, as well as the bibliographical references of previous systematic reviews evaluating OMTh for pain severity, disability, quality of life, and return to work outcomes. Randomized controlled trials with CNCP patients 18 years or older with OMTh as an active or combination intervention and the presence of a control or combination group were eligible for inclusion. In this sub-study of a previous, larger systematic review, 11 studies (n=1,015) reported data that allowed the authors to perform meta-analyses on ACD and dropouts due to AE. The risk of bias (ROB) was assessed with the Cochrane ROB tool and the quality of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS The pooled analysis showed that ACD was not significantly different for visceral OMTh (vOMTh) vs. OMTh control (odds ratio [OR]=2.66 [95% confidence interval [[CI]], 0.28, 24.93]) or for OMTh vs. standard care (OR=1.26 [95% CI, 0.84, 1.89]; I2=0%). Single study analysis showed that OMTh results were nonsignificant in comparison with chemonucleolysis, gabapentin, and exercise. OMTh in combination with gabapentin (vs. gabapentin alone) and OMTh in combination with exercise (vs. exercise alone) showed nonsignificant ACD. Dropouts due to AE were not significantly different, but the results could not be pooled due to an insufficient number of studies. CONCLUSIONS Most articles did not explicitly report AEs, ACD rates, or dropouts due to AEs and inefficacy. The limited data available on dropouts showed that OMTh was well tolerated compared with control interventions, and that the ACD and dropouts due to AEs were not significantly different than comparators. Future trials should focus on explicit reporting of dropouts along with beneficial outcomes to provide a better understanding of OMTh efficacy.
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Affiliation(s)
- Yasir Rehman
- Department of Health Research Methodology, Department of Health Research Methods, Evidence, and Impact, The Michael G. DeGroote Institute for Pain Research and Care, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada.,Department of Medical Sciences at Canadian Academy of Osteopathy, Hamilton, ON, Canada
| | - Hannah Ferguson
- Department of Medical Sciences at Canadian Academy of Osteopathy, Hamilton, ON, Canada
| | - Adelina Bozek
- Department of Medical Sciences at Canadian Academy of Osteopathy, Hamilton, ON, Canada
| | - Joshua Blair
- Department of Medical Sciences at Canadian Academy of Osteopathy, Hamilton, ON, Canada
| | - Ashley Allison
- Department of Medical Sciences at Canadian Academy of Osteopathy, Hamilton, ON, Canada
| | - Robert Johnston
- Department of Medical Sciences at Canadian Academy of Osteopathy, Hamilton, ON, Canada
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16
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Peng YC, Hsu CY, Tang WT. Deficits in the Star Excursion Balance Test and Golf Performance in Elite Golfers with Chronic Low Back Pain. JOURNAL OF SPORTS SCIENCE AND MEDICINE 2021; 20:229-236. [PMID: 34211315 DOI: 10.52082/jssm.2021.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/16/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to investigate whether low-handicap elite golfers with chronic low back pain (CLBP) exhibit deficits in dynamic postural control and whether CLBP affects golfers in terms of their golf swing parameters. A total of fifteen Division 1 college golfers were recruited as participants. Of these, six of whom experienced CLBP, while the remaining participants were healthy. In this study, CLBP was defined as experiencing chronic pain symptoms for more than six months. The Star Excursion Balance Test (SEBT) was administered to examine dynamic posture control in both groups. The TrackMan Golf Launch Monitor Simulator was used to collect data on the performance parameters of the swing of the participants. The results for both feet in the medial, lateral, posterior, posteromedial, and posterolateral directions indicated that the CLBP group scored lower than the control group. However, the CLBP group scored higher for the right foot in the anterolateral direction. The parameters for the club speed and ball carry of the CLBP group were lower than those of the control group. Further, the CLBP group exhibited a more upright swing plane relative to the control group. Taken together, our findings suggest that SEBT may be feasible and highly accessible to assess golf swing performance of elite players with CLBP.
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Affiliation(s)
- Yi-Chien Peng
- Physical Education Office, National Cheng Kung University (NCKU), Taiwan.,Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University (NTSU), Taiwan
| | - Chung-Yuan Hsu
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University (NTSU), Taiwan.,Division of Chinese Acupuncture and Traumatology, Center of Traditional Chinese Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Tzu Tang
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University (NTSU), Taiwan
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17
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Kanakarajan S, Fernando K, Dharmavaram S, Galley HF. Sensory mapping of lumbar facet joint pain: a feasibility study. Br J Pain 2021; 15:64-68. [PMID: 33633853 DOI: 10.1177/2049463719886890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the feasibility of sensory mapping of lumbar facet joint pain in patients scheduled to undergo radiofrequency (RF) denervation. Design Prospective cohort study. Setting University teaching hospital. Subjects A total of 15 participants listed for RF denervation of lumbar facet joint. Method After written informed consent, participants were recruited to the study. Participants completed a pain diagram prior to their procedure. After successful image-guided placement of RF cannulas, the sensory detection threshold using 50 Hz stimulation was obtained, followed by application of suprathreshold stimulation. Participants mapped their stimulated area in comparison to their pre-procedure pain diagram. Results All 15 participants had previously undergone diagnostic blocks. All participants were able to report either pain or paraesthesia during suprathreshold stimulation. In total, 14 out of 15 participants reported complete coverage of their usual painful area with suprathreshold stimulation of nerves scheduled for RF denervation. In one of the participants, an area of upper lumbar pain was not covered during suprathreshold stimulation. Nearly two-thirds of the participants (n = 9), reported either pain or paraesthesia, outside their normal painful area during suprathreshold stimulation. A total of 71 nerves were scheduled for RF denervation. Sensory electrical stimulation was successfully achieved in 68 out of 71 nerves (96%). The average sensory detection threshold was found to be 0.3 V while the suprathreshold stimulation was 0.6 V. Conclusion Lumbar facet joint pain can be mapped using suprathreshold sensory stimulation, which has the potential to introduce objectivity during RF denervation.
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18
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Kim JH, Na CS, Park GC, Lee JS. Effects of different wavelengths of invasive laser acupuncture on chronic non-specific low back pain: a study protocol for a pilot randomized controlled trial. Trials 2021; 22:118. [PMID: 33546748 PMCID: PMC7863497 DOI: 10.1186/s13063-021-05038-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 01/09/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chronic non-specific low back pain (CLBP) is a common musculoskeletal disorder for which patients seek complementary and alternative medical treatments, including laser acupuncture (LA). Invasive LA (ILA) involves the simultaneous application of invasive acupuncture treatment at acupoints and focused laser irradiation. The efficacy of ILA for CLBP remains controversial owing to the insufficient clinical trial data. We intend to obtain basic data regarding the efficacy and safety of ILA for CLBP by comparing the effects of different wavelengths of ILA on CLBP. METHODS This will be a prospective, patient-blinded, parallel-arm, single-center (DongShin University Gwangju Korean Medicine Hospital, Republic of Korea), pilot randomized controlled clinical trial. Forty-five participants with CLBP will be randomized in equal numbers into the control, 650-nm ILA (650 ILA), or 830-nm ILA (830 ILA) group. The control group will receive sham ILA for 10 min and real electroacupuncture (EA) for 10 min. The 650 and 830 ILA groups will receive real ILA (i.e., 650 ILA group, 650-nm wavelength; 830 ILA group, 830-nm wavelength) for 10 min and real EA for 10 min once/day, twice a week for 4 weeks, at bilateral Shenshu (BL23), Qihaishu (BL24), Dachangshu (BL25), and Huantiao (GB30). The primary outcome will be an improvement in pain intensity assessed using the visual analog scale. Scores in the Korean version of the Oswestry Disability Index and the European Quality of Life Five Dimension Five Level scale will be recorded as secondary outcome measures. All scores will be recorded at baseline (before intervention), 4 weeks after the first intervention (at the end of the intervention), and 4 weeks after completion of the intervention. DISCUSSION The study is expected to provide preliminary evidence regarding the efficacy, safety, and usefulness of ILA for the treatment of CLBP. TRIAL REGISTRATION This trial was registered with the Clinical Research Information Service (registration No. KCT0004610 ; http://cris.nih.go.kr ). Registered on 7 January 2020.
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Affiliation(s)
- Jae-Hong Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, DongShin University, 185 Gunjae-ro, Naju City, 58245 Republic of Korea
- Clinical Research Center, DongShin University Gwangju Korean Medicine Hospital, 141 Wolsan-ro, Nam-gu, Gwangju City, 61619 Republic of Korea
| | - Chang-Su Na
- Department of Acupoint and Meridian, College of Korean Medicine, DongShin University, 185 Gunjae-ro, Naju City, 58245 Republic of Korea
| | - Gwang-Cheon Park
- Clinical Research Center, DongShin University Gwangju Korean Medicine Hospital, 141 Wolsan-ro, Nam-gu, Gwangju City, 61619 Republic of Korea
| | - Jeong-Soon Lee
- Department of Nursing, Christian College of Nursing, 6 Baekseo-ro 70 beon-gil, Nam-gu, Gwangju City, 61662 Republic of Korea
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19
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Rehman Y, Ferguson H, Bozek A, Blair J, Allison A, Johnston R. Osteopathic Manual Treatment for Pain Severity, Functional Improvement, and Return to Work in Patients With Chronic Pain. J Osteopath Med 2020; 120:888-906. [PMID: 32946545 DOI: 10.7556/jaoa.2020.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Context Chronic non-cancer pain (CNCP) is associated with disability, poor quality of life (QOL), and failure to return to work (RTW). Osteopathic manipulative treatment (OMT) or osteopathic manual therapy (OMTh) are increasingly offered to patients with CNCP; however, the existing systematic reviews and meta-analyses in the literature that explore the effectiveness of OMTh have major limitations. Objective To systematically evaluate the quality of evidence documenting the effectiveness of OMTh for patients with CNCP using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and to evaluate the efficacy of OMTh in patients with CNCP through a meta-analysis of pooled data from previous studies. Methods We searched online the databases Ovid, MEDLINE, Embase, OSTMED.DR, EMCare, Allied and Complementary Medicine Database (AMED), Physiotherapy Evidence Database (PEDro), and Cochrane Central Register of Controlled Trials (CENTRAL), as well as the bibliographic references of previous systematic review articles evaluating OMTh for pain severity, disability, QOL, or RTW outcomes. Eligibility included randomized controlled trials methodology, CNCP patients 18 years or older, use of previously validated assessment tools, use of OMTh as an active or combination intervention, and presence of a control or comparison group. We pooled studies based on the homogeneity between OMT comparator treatment and outcomes. Risk of bias was assessed with the Cochrane risk of bias tool and the quality of evidence was determined with GRADE. Results Sixteen randomized controlled trials (n=1158 patients) were eligible for data extraction. Moderate quality evidence showed that OMTh vs. standard care was significantly associated with a reduction in pain [standardized mean difference (95% CI)=[-.37 (-.58, -.17)] and disability [-.28 (-.46, -.10)], as well as improved QOL [.67 (.29, 1.05)]. Moderate quality evidence showed that OMTh plus exercise vs. exercise only was significantly associated with reduction in pain severity [-1.25 (-1.67, -.83)] and disability [-1.15 (-1.57, -.74)]. Moderate quality evidence showed that using visceral OMTh vs. general OMTh was significantly associated with reduction in pain severity [-.74 (-1.09, -.39)] and disability [-.52 (-.91, -.13)]. In comparison to physiotherapy, gabapentin, and OMTh plus gabapentin, OMTh did not show any significant effect for any of the outcomes. OMTh vs. standard care did not show significant improvement in RTW at 12 weeks, although the effect was significant at 8 weeks after OMTh. Conclusion Moderate quality evidence suggests that OMTh is effective for CNCP patients. There was a significant association between visceral OMTh and reduced pain severity and disability. More robust, high-quality randomized controlled trials with larger sample sizes are required to further explore the effectiveness of the OMTh in the management of CNCP.
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20
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Rondanelli M, Fossari F, Vecchio V, Gasparri C, Peroni G, Spadaccini D, Riva A, Petrangolini G, Iannello G, Nichetti M, Infantino V, Perna S. Clinical trials on pain lowering effect of ginger: A narrative review. Phytother Res 2020; 34:2843-2856. [PMID: 32436242 PMCID: PMC7754412 DOI: 10.1002/ptr.6730] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 04/08/2020] [Accepted: 04/23/2020] [Indexed: 01/01/2023]
Abstract
Ginger has a pain-reducing effect and it can modulate pain through various mechanisms: inhibition of prostaglandins via the COX and LOX-pathways, antioxidant activity, inibition of the transcription factor nf-kB, or acting as agonist of vanilloid nociceptor. This narrative review summarizes the last 10-year of randomized controlled trials (RCTs), in which ginger was traditionally used as a pain reliever for dysmenorrhea, delayed onset muscle soreness (DOMS), osteoarthritis (AO), chronic low back pain (CLBP), and migraine. Regarding dysmenorrhea, six eligible studies suggest a promising effect of oral ginger. As concerned with DOMS, the four eligible RCTs suggested a reduction of inflammation after oral and topical ginger administration. Regarding knee AO, nine RCTs agree in stating that oral and topical use of ginger seems to be effective against pain, while other did not find significant differences. One RCT considered the use of ginger in migraine and suggested its beneficial activity. Finally, one RCT evaluated the effects of Swedish massage with aromatic ginger oil on CLBP demonstrated a reduction in pain. The use of ginger for its pain lowering effect is safe and promising, even though more studies are needed to create a consensus about the dosage of ginger useful for long-term therapy.
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Affiliation(s)
- Mariangela Rondanelli
- IRCCS Mondino FoundationPaviaItaly
- Department of Public Health, Experimental and Forensic MedicineUniversity of PaviaPaviaItaly
| | - Federica Fossari
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”University of PaviaPaviaItaly
| | - Viviana Vecchio
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”University of PaviaPaviaItaly
| | - Clara Gasparri
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”University of PaviaPaviaItaly
| | - Gabriella Peroni
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”University of PaviaPaviaItaly
| | - Daniele Spadaccini
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”University of PaviaPaviaItaly
| | | | | | - Giancarlo Iannello
- General ManagementAzienda di Servizi alla Persona “Istituto Santa Margherita”PaviaItaly
| | - Mara Nichetti
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”University of PaviaPaviaItaly
| | - Vittoria Infantino
- Department of Biomedical Science and Human OncologyUniversity of Bari Aldo MoroBariItaly
| | - Simone Perna
- Department of Biology, College of ScienceUniversity of BahrainZallaqBahrain
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21
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Heuch I, Heuch I, Hagen K, Storheim K, Zwart JA. Associations between the number of children, age at childbirths and prevalence of chronic low back pain: the Nord-Trøndelag Health Study. BMC Public Health 2020; 20:1556. [PMID: 33059635 PMCID: PMC7565361 DOI: 10.1186/s12889-020-09480-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/31/2020] [Indexed: 12/02/2022] Open
Abstract
Background Associations between childbirths and subsequent risk of low back pain (LBP) have not been clarified. Changes in sex hormone levels or lumbar posture during pregnancy may have an impact on LBP later in life. The purpose of this study was to explore associations between the number of childbirths, age at childbirths and prevalence of chronic LBP in a general population of women. Methods Data were obtained from the Norwegian community-based Nord-Trøndelag Health Study, HUNT2 (1995–1997). Women aged 20–69 years indicated whether they suffered from chronic LBP, defined as LBP persisting at least 3 months continuously during last year. Information about LBP was collected from 3936 women who had experienced no childbirths, 3143 women who had delivered one child only and 20,584 women who had delivered 2 or more children. Of these, 7339 women reported chronic LBP. The 595 women who were pregnant when information was collected were considered separately, regardless of previous births, with 80 women reporting chronic LBP. Associations with prevalence of chronic LBP were examined by generalised linear modelling with adjustment for potential confounders in a cross-sectional design. Results Women who had delivered one child only showed a higher prevalence of chronic LBP than women with no childbirths (prevalence ratio (PR) 1.11; 95% CI: 1.01–1.22). Among women with one or more childbirths, no overall change in prevalence could be demonstrated with an increasing number of children in analyses adjusted for age at first delivery. In women with at least two childbirths, an age less than 20 years at first childbirth was associated with an increased prevalence of chronic LBP (PR 1.36; 95% CI: 1.25–1.49; compared with age 25–29 years). No association was observed between age at last delivery and chronic LBP. The lowest prevalence of chronic LBP was found among women who were currently pregnant (PR 0.80; 95% CI: 0.63–1.00; compared with women with no childbirths). Conclusions Having experienced at least one childbirth seems to be associated with a higher prevalence of chronic LBP later in life. A young age at first childbirth is also associated with a long-lasting increased prevalence.
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Affiliation(s)
- Ingrid Heuch
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, P.O. Box 4956, Nydalen, N-0424, Oslo, Norway.
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Research Unit Central Norway, St. Olavs Hospital, Trondheim, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Ullevål, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - John-Anker Zwart
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, P.O. Box 4956, Nydalen, N-0424, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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22
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Hadzimuratovic B, Mittelbach A, Bahrami A, Zwerina J, Kocijan R. Confluent abscesses in autochthonous back muscles after spinal injections : A case report and narrative review of the literature on low back pain and spinal injections. Wien Med Wochenschr 2020; 172:247-255. [PMID: 32748365 DOI: 10.1007/s10354-020-00773-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/01/2020] [Indexed: 12/13/2022]
Abstract
Injection therapy is a frequently used method for the treatment of subacute and chronic low back pain (LBP) despite scant evidence for its effectiveness. To date there are relatively few studies comparing this method with other treatments. Moreover, there are many possible side effects associated with injection therapies, some of which are potentially life threatening. We present the case of a 59-year-old woman admitted to the emergency department with confluent abscess formations of autochthonous back muscles and staphylococcal sepsis caused by injection therapy performed by a general practitioner for LBP. The findings of this case report emphasize a careful selection of patients for this type of treatment and a multidisciplinary approach to treatment of LBP.
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Affiliation(s)
- Benjamin Hadzimuratovic
- Ludwig Boltzmann Institute of Osteology, I. Medizinische Abteilung, Mein Hanusch-Krankenhaus, Heinrich Collin-Straße 30, 1140, Vienna, Austria
| | - Andreas Mittelbach
- Institut für Physikalische Medizin und Rehabilitation, Mein Hanusch-Krankenhaus, Heinrich Collin-Straße 30, 1140, Vienna, Austria
| | - Arian Bahrami
- Zentralröntgeninstitut mit Fachbereich Nuklearmedizin, I. Medizinische Abteilung, Mein Hanusch-Krankenhaus, Heinrich Collin-Straße 30, 1140, Vienna, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology, I. Medizinische Abteilung, Mein Hanusch-Krankenhaus, Heinrich Collin-Straße 30, 1140, Vienna, Austria
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology, I. Medizinische Abteilung, Mein Hanusch-Krankenhaus, Heinrich Collin-Straße 30, 1140, Vienna, Austria.
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De Andrés Ares J, Gilsanz F. Randomized Pragmatic Pilot Trial Comparing Perpendicular Thin Electrode Versus Parallel Thick Electrode Approaches for Lumbar Medial Branch Neurotomy in Facetogenic Low Back Pain. Pain Pract 2020; 20:889-907. [DOI: 10.1111/papr.12928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022]
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Effects of 10-weeks strength training programme on pain intensity, muscle endurance and kinesophobia in patients with non-specific low back pain. TURKISH JOURNAL OF KINESIOLOGY 2020. [DOI: 10.31459/turkjkin.686739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Patient-Reported Outcome Measures After Multilevel Lumbar Total Disc Arthroplasty for the Treatment of Multilevel Degenerative Disc Disease. Spine (Phila Pa 1976) 2020; 45:18-25. [PMID: 31425431 DOI: 10.1097/brs.0000000000003201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case series OBJECTIVE.: The aim of this study was to assess the patient-reported outcome measures (PROMs) and patient satisfaction of multilevel lumbar total disc arthroplasty (TDA) for symptomatic multilevel degenerative disc disease (MLDDD). SUMMARY OF BACKGROUND DATA TDA has been shown to be safe and effective for the treatment of symptomatic single level degenerative disc disease. There is minimal PROMs data on the mid- to long-term outcomes of multilevel TDA constructs. METHODS Prospectively collected PROMs were analyzed from patients receiving multilevel TDA for symptomatic MLDDD. Data were collected preoperatively and postoperatively at 3, 6, and 12 months, then yearly. PROMs included patient satisfaction, Visual Analog Score back and leg, Oswestry Disability Index, and Roland-Morris Disability Questionnaire. RESULTS One hundred twenty-two patients (77 men, 45 women) who had preoperative and at least 24-month follow-up data were included. The average age was 42 ± 8.2 years (range 21-61) and mean follow-up 7.8 years (range 2-10). The majority received two-level TDA, except two patients (1.6%) who received three-level TDA. The two- to three-level TDA's were at the levels L3-4, L4-5, and L5-S1, whereas most two levels (n = 110, 90.2%) were at L4-5 and L5-S1; the remainder (n = 10, 8.2%) being at L3-4 and L4-5. Implants used were Charité (DePuy Spine, Raynham, MA) in 119 patients (240 levels) and InMotion (DePuy Spine) in 3 patients (6 levels). Improvement in pain and disability scores were both clinically and statistically significant (P < 0.001), and this improvement was sustained in those patients over the course of their follow-up. Ninety-two percent of patients reported good or excellent satisfaction with treatment at final review. CONCLUSION Multilevel TDA constructs for MLDDD demonstrate favorable and sustained clinical outcomes at mid- to long-term follow-up. LEVEL OF EVIDENCE 4.
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Onafowokan OO, Fine NF, Brooks F, Stokes OM, Briggs TWR, Hutton M. Multiple injections for low back pain: What’s the future? 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 2020; 29:564-578. [DOI: 10.1007/s00586-019-06258-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/04/2019] [Accepted: 12/16/2019] [Indexed: 12/28/2022]
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Relationship Between Pain Alleviation and Disease-specific Health-related Quality of Life Measures in Patients With Chronic Low Back Pain Receiving Duloxetine: Exploratory Post Hoc Analysis of a Japanese Phase 3 Randomized Study. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:JAAOSGlobal-D-18-00086. [PMID: 31875196 PMCID: PMC6903819 DOI: 10.5435/jaaosglobal-d-18-00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This post hoc analysis of a Japanese phase 3 randomized study (ClinicalTrials.gov identifier: NCT01855919) investigated relationships between pain severity (assessed by the Brief Pain Inventory [BPI]) and disease-specific health-related quality of life (assessed by the 24-item Roland-Morris Disability Questionnaire [RDQ-24]) in duloxetine-treated patients with chronic low back pain (CLBP).
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Valenzuela-Pascual F, García-Martínez E, Molina-Luque F, Soler-González J, Blanco-Blanco J, Rubí-Carnacea F, Climent-Sanz C, Briones-Vozmediano E. Patients’ and primary healthcare professionals’ perceptions regarding chronic low back pain and its management in Spain: a qualitative study. Disabil Rehabil 2019; 43:2568-2577. [DOI: 10.1080/09638288.2019.1705923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Fran Valenzuela-Pascual
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | | | - Fidel Molina-Luque
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Department of Geography and Sociology, University of Lleida, Lleida, Spain
| | - Jorge Soler-González
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Department of Medicine, University of Lleida, Lleida, Spain
- Catalan Health Institute, Lleida, Spain
| | - Joan Blanco-Blanco
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Francesc Rubí-Carnacea
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Carolina Climent-Sanz
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Erica Briones-Vozmediano
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
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Oakley PA, Ehsani NN, Harrison DE. Non-surgical reduction of lumbar hyperlordosis, forward sagittal balance and sacral tilt to relieve low back pain by Chiropractic BioPhysics ® methods: a case report. J Phys Ther Sci 2019; 31:860-864. [PMID: 31645820 PMCID: PMC6801353 DOI: 10.1589/jpts.31.860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/27/2019] [Indexed: 12/19/2022] Open
Abstract
[Purpose] To present the reduction of both lumbar spine hyperlordosis and anterior sagittal balance in a symptomatic patient as treated by Chiropractic BioPhysics® technique. [Participant and Methods] A 46 year old reported with low back and hip pains for six years. Oswestry disability index scored 28%. Radiographic assessment revealed pronounced anterior sagittal balance with lumbar hyperlordosis. The patient was treated by Chiropractic BioPhysics technique to reverse the spinal deformity subluxation via mirror image corrective exercises and spinal traction, as well as spinal manipulative therapy. [Results] Assessments after 36 and 74 treatments corresponding to the 4-month and 13-month check-ups demonstrated a continuous structural improvement in lumbar spine biomechanical parameters. There was a near complete resolution in low back and hip pains with an Oswestry score of 4%. [Conclusion] This case documents the reduction of lumbar spine hyperlordosis and forward sagittal balance by contemporary spine rehabilitation methods. It is essential to screen spinal subluxation patterns via standing radiography which obviously, as demonstrated in this case determines treatment approach as most low back pain patients present with lumbar hypolordosis. Routine initial and repeat radiography is safe in the screening and monitoring of treatment efficacy and is the standard for evidence-based, patient-centred structural rehabilitation.
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Heuch I, Heuch I, Hagen K, Sørgjerd EP, Åsvold BO, Zwart JA. Does diabetes influence the probability of experiencing chronic low back pain? A population-based cohort study: the Nord-Trøndelag Health Study. BMJ Open 2019; 9:e031692. [PMID: 31515434 PMCID: PMC6747649 DOI: 10.1136/bmjopen-2019-031692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Low back pain (LBP) is a major problem in modern society and it is important to study possible risk factors for this disorder. People with diabetes are often affected by LBP, but whether diabetes represents a risk factor for LBP has not been studied in detail. The aim of this study was to explore the association between diabetes and subsequent risk of chronic LBP. DESIGN An 11-year follow-up study. SETTING The Nord-Trøndelag Health Study (HUNT2; 1995-1997) and HUNT3 (2006-2008) surveys of Nord-Trøndelag County in Norway. MAIN OUTCOME MEASURE Chronic LBP, defined as LBP persisting at least 3 months continuously during the last year. PARTICIPANTS A total of 18 972 persons without chronic LBP at baseline in HUNT2, and 6802 persons who reported chronic LBP at baseline in HUNT2. METHODS Associations between diabetes and risk of chronic LBP among individuals aged 30-69 years were examined by generalised linear modelling. RESULTS Men without chronic LBP at baseline showed a significant association between diabetes and risk of chronic LBP (relative risk (RR) 1.43, 95% CI 1.04 to 1.96, p=0.043). In women, no association was found (RR 1.01, 95% CI 0.69 to 1.48, p=0.98). No association could be established between diabetes and recurrence or persistence of chronic LBP after 11 years in either sex. CONCLUSIONS Men with a diagnosis of diabetes may have a higher risk of subsequently experiencing chronic LBP.
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Affiliation(s)
- Ingrid Heuch
- Division of Clinical Neuroscience, Department of Research, Innovation and Education, Oslo University Hospital, Oslo, Norway
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Headaches, St Olavs University Hospital, Trondheim, Norway
| | - Elin Pettersen Sørgjerd
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Endocrinology, St Olavs University Hospital, Trondheim, Norway
| | - John-Anker Zwart
- Division of Clinical Neuroscience, Department of Research, Innovation and Education, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Bai R, Li C, Xiao Y, Sharma M, Zhang F, Zhao Y. Effectiveness of spa therapy for patients with chronic low back pain: An updated systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17092. [PMID: 31517832 PMCID: PMC6750337 DOI: 10.1097/md.0000000000017092] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/09/2019] [Accepted: 08/16/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a major health problem around the world. Two previous meta-analyses showed that the spa therapy has a positive effect on reducing pain among patients with LBP based on studies published before 2006 and studies published between 2006 and 2013. In recent years, more studies reported the effect of spa therapy on treating chronic low back pain (CLBP). Our study aimed to update the meta-analysis of randomized controlled trials (RCTs) about the effect of spa therapy on treating CLBP and to examine the effect of spa therapy based on different interventions. METHODS PubMed, Embase, Web of Science, and Cochrane Library were searched until May 2018 to identify RCTs about spa therapy among patients with CLBP. Summary effect estimates were calculated by using a random-effects model. The quality of each eligible study was evaluated by Jadad checklist. RESULTS Twelve studies met the inclusion criteria for the systematic review and were included in meta-analysis. There was a significant decrease in pain based on visual analogue scale (VAS) (mean difference [MD] 16.07, 95% confidence interval [CI] [9.57, 22.57], P < .00001, I = 88%, n = 966), and lumbar spine function in Oswestry disability index (ODI) (MD 7.12, 95% CI [3.77, 10.47], P < .00001, I = 87%, n = 468) comparing spa therapy group to control group. Methodological assessment for included studies showed that the study's quality is associated with lacking blinding. CONCLUSION This updated meta-analysis confirmed that spa therapy can benefit pain reliving and improve lumbar spine function among patients with CLBP. Physiotherapy of subgroup analysis indicated that it can improve lumbar spine function. However, these conclusions should be treated with caution due to limited studies. More high-quality RCTs with double-blind design, larger sample size, and longer follow-up should be employed to improve the validity of study results.
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Affiliation(s)
- Ruixue Bai
- School of Public Health and Management
- Research Center for Medicine and Social Development
- Innovation Center for Social Risk Governance in Health
- Health Management (Physical Examination) Center, The Second Affiliated Hospital, Chongqing Medical University, Chongqing
| | - Chihua Li
- Zhengzhou Central Hospital Affiliated to Zhengzhou University, Henan, China
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Yangxue Xiao
- School of Public Health and Management
- Research Center for Medicine and Social Development
- Innovation Center for Social Risk Governance in Health
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, Jackson State University, Jackson, MS
| | - Fan Zhang
- School of Public Health and Management
- Research Center for Medicine and Social Development
- Innovation Center for Social Risk Governance in Health
| | - Yong Zhao
- School of Public Health and Management
- Research Center for Medicine and Social Development
- Innovation Center for Social Risk Governance in Health
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Letizia Mauro G, Lauricella L, Vecchio M, Tomasello S, Scaturro D. Efficacy and tolerability of a fixed dose combination of cortex phospholipid liposomes and cyanocobalamin for intramuscular use in peripheral neuropathies. Minerva Med 2019; 110:455-463. [PMID: 31368292 DOI: 10.23736/s0026-4806.19.06068-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Peripheral neuropathies are frequently encountered in clinical practice and are associated with a major impairment in quality of life. However, their management remains poor, and current therapies are often burdened with major side effects and can present poor efficacy on pain and functionality. Therefore, it has been suggested that the combination of two or more different drugs may improve analgesic efficacy and reduce side effects. Tricortin® 1000 is formulated with 12 mg of Brain cortex phospholipid liposomes + 1000 µg of Cyanocobalamin injectable solution (PL+CNCbl) for intramuscular use and is indicated in the treatment of poly-algo-neuropathic syndromes. This combination exerts a marked neurotrophic action by promoting the synthesis of endogenous phospholipids; moreover, the peculiar formulation optimizes the delivery of CNCbl which has analgesic and neurotrophic action. This paper discusses the pharmacotherapy of peripheral neuropathies, including low-back pain, neck pain, postherpetic neuropathy (PHN) and focuses on the fixed dose combination PL+CNCbl clinical efficacy in association with other treatments or in monotherapy.
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Affiliation(s)
- Giulia Letizia Mauro
- Department of Surgery, Oncology, and Stomatology, University of Palermo, Palermo, Italy -
| | - Lorenza Lauricella
- Department of Surgery, Oncology, and Stomatology, University of Palermo, Palermo, Italy
| | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | - Dalila Scaturro
- Department of Surgery, Oncology, and Stomatology, University of Palermo, Palermo, Italy
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Goubert D, Meeus M, Willems T, De Pauw R, Coppieters I, Crombez G, Danneels L. The association between back muscle characteristics and pressure pain sensitivity in low back pain patients. Scand J Pain 2019; 18:281-293. [PMID: 29794309 DOI: 10.1515/sjpain-2017-0142] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/24/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Some low back pain (LBP) patients recover after every pain episode whereas others develop chronicity. Research indicates that the amount of atrophy and fat infiltration differs between patients with LBP. Also enhanced pain sensitivity is present only in a subgroup of LBP patients. The relationship between pain sensitivity and muscular deformations in LBP, is however unexplored. This study examined the association between pressure pain sensitivity and the structural characteristics of the lumbar muscles in three different groups of non-specific LBP patients. METHODS This cross-sectional study examined the total cross-sectional area (CSA), fat CSA, muscle CSA and muscle fat index (MFI) of the lumbar multifidus (MF) and erector spinae (ES) at level L4 by magnetic resonance imaging in 54 patients with non-specific LBP (23 recurrent LBP, 15 non-continuous chronic LBP and 16 continuous chronic LBP). Pressure pain thresholds were measured at four locations (lower back, neck, hand and leg) by a manual pressure algometer and combined into one "pain sensitivity" variable. As a primary outcome measure, the association between pain sensitivity and muscle structure characteristics was investigated by multiple independent general linear regression models. Secondly, the influence of body mass index (BMI) and age on muscle characteristics was examined. RESULTS A positive association was found between pain sensitivity and the total CSA of the MF (p=0.006) and ES (p=0.001), and the muscle CSA of the MF (p=0.003) and ES (p=0.001), irrespective of the LBP group. No association was found between pain sensitivity and fat CSA or MFI (p>0.01). Furthermore, a positive association was found between BMI and the fat CSA of the MF (p=0.004) and ES (p=0.006), and the MFI of the MF (p<0.01) and ES (p=0.003). Finally, a positive association was found between age with the fat CSA of the MF (p=0.008) but not with the fat CSA of the ES (p>0.01), nor the MFI of the MF (p>0.01) and ES (p>0.01). CONCLUSIONS A higher pain sensitivity is associated with a smaller total and muscle CSA in the lumbar MF and ES, and vice versa, but results are independent from the LBP subgroup. On the other hand, the amount of fat infiltration in the lumbar muscles is not associated with pain sensitivity. Instead, a higher BMI is associated with more lumbar fat infiltration. Finally, older patients with LBP are associated with higher fat infiltration in the MF but not in the ES muscle. IMPLICATIONS These results imply that reconditioning muscular tissues might possibly decrease the pain sensitivity of LBP patients. Vice versa, therapy focusing on enhancement of pain sensitivity might also positively influence the CSA and that way contribute to the recovery of LBP. Furthermore, the amount of lumbar muscle fat seems not susceptible to pain sensitivity or vice versa, but instead a decrease in BMI might decrease the fat infiltration in the lumbar muscles and therefore improve the muscle structure quality in LBP. These hypothesis apply for all non-specific LBP patients, despite the type of LBP.
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Affiliation(s)
- Dorien Goubert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent Campus Heymans (UZ) 3 B3, Corneel Heymanslaan 10, Ghent, Belgium, Phone: +3293325374, Fax: +32 9 332 38 11; andPain in Motion International Research Group
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium;Pain in Motion International Research Group.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tine Willems
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Robby De Pauw
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Iris Coppieters
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; andPain in Motion International Research Group
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Baillie L, Bacon CJ, Hewitt CM, Moran RW. Predictors of functional improvement in people with chronic low back pain following a graded Pilates-based exercise programme. J Bodyw Mov Ther 2019; 23:211-218. [PMID: 30691755 DOI: 10.1016/j.jbmt.2018.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 03/31/2018] [Accepted: 05/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have investigated subgroups of patients with low back pain (LBP) most likely to benefit from Pilates or movement control exercises, but none have determined prognostic factors specifically for chronic LBP. This prospective cohort study aimed to determine predictors of change in disability in people with chronic LBP following a Pilates-based exercise programme and reports summarised integrated prediction statistics to aid clinical utility for determination of subgroups likely to benefit or not benefit from treatment. METHODS Healthy adults (n = 55) with non-specific chronic LBP undertook a graded 6-week programme involving two 1-hour Pilates sessions/week (1 mat and 1 equipment-based) led in small groups by a trained Pilates instructor. Predictors of change in Patient-Specific Functional Scale (PSFS) were identified through regression analysis and used to develop clinical prediction statistics. RESULTS Clinically important improvement (n = 14 of 48 analysed) was predicted by four variables: gradual rather than sudden onset of LBP, PSFS <3.7 points, absence of aberrant motions on forward bending, and body mass index >24.5 kg/m2. Presence of ≥3 improved probability of success from 29% to 73%. Failure to improve (n = 18) was predicted by three variables: sudden onset of low back pain, patient-specific functional score ≥3.7, and difference between left and right active straight leg raise >7°. Presence of all three increased probability of failure from 38% to 80%. CONCLUSIONS A combination of five, easily measured variables were able to predict disability outcome following a graded programme of Pilates-based exercises in people with chronic LBP. Two common movement deficits were inversely related to positive changes in function which may call into question the structural mechanism of improvements observed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12616001588482.
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Affiliation(s)
- Leyla Baillie
- Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
| | | | - Claire M Hewitt
- Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
| | - Robert W Moran
- Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
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Zati A, Cavazzuti L, Colori BCM, Benedetti MG. Deep heating therapy via MF radiowaves versus superficial heating therapy in the treatment of nonspecific chronic low back pain: A double blind randomized trial. J Back Musculoskelet Rehabil 2019; 31:963-971. [PMID: 30103299 DOI: 10.3233/bmr-170944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nonspecific Chronic Low Back Pain (CLBP) is a condition difficult to treat due to multiple etiopathogenesis and there is wide consensus on the multidisciplinary approach. In physiotherapy, the Medium Frequencies (MF) diathermy has recently been introduced but without enough evidence of effectiveness. OBJECTIVE To explore the effects of a deep heating therapy (DHT) produced by a MF diathermy for the treatment of CLBP compared with a superficial heating therapy (SHT). The study was a double blind randomized trial. METHODS Forty-nine patients affected by CLBP were randomly subdivided in 2 groups and treated with either DHT (450 KHz) or SHT via electric resistance applying the same instrument on the lumbar spine. NRS (Numerical Rating Scale) for pain and ODI (Oswestry Disability Index) for disability were used as outcome measures. The follow up was: T1, 15 days (end of the therapy); T2, 30 days; T3, 45 days after T0. RESULTS Both therapies were effective in reducing pain throughout the follow up with greater improvement in DHT group at T1. DHT resulted to have a higher efficacy with respect to SHT in reducing disability (ODI) throughout all follow ups. CONCLUSION This study provides evidence of the positive effects of MF radio waves diathermy in the treatment of CLBP.
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Wang Y, Freedman L, Buck M, Bohorquez J, Rutkove SB, Keel J. Electrical Impedance Myography for Assessing Paraspinal Muscles of Patients with Low Back Pain. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2019; 10:103-109. [PMID: 33584890 PMCID: PMC7851978 DOI: 10.2478/joeb-2019-0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Indexed: 06/12/2023]
Abstract
The objective of this study was to determine the potential value of electrical impedance myography (EIM) for assessing lumbosacral paraspinal muscle (LPM) condition in lower back pain (LBP) patients. Standard methods for assessing the condition of LPMs, such as magnetic resonance imaging, are inconvenient and expensive. One tool that could be useful for this purpose is electrical impedance myography (EIM) a technique that can be performed rapidly at the bedside. After undergoing a screening history and examination, subjects were studied with the mView EIM device (Myolex, Inc, Boston). Bilateral LPMs were measured three times each and the two closest sets of measurements averaged on each side. Data analysis included non-parametric two-group comparisons between healthy subjects and back pain patients, receiver-operating curve analyses, and correlation analyses to age and body mass index. A total of 86 healthy individuals (median age (interquartile range) (IQR), 45.5 years (30.3-56.0 years), 42 men, 44 women) and 47 LBP (median age 51.0 year (39.5-57.5) years, 21 men, 26 women) were enrolled. Median EIM 100kHz phase was lower in the LBP patients (9.3°(IQR 8.4°-10.6°) versus 11.4°(IQR 9.4°-13.0°), p = 0.0007). Significantly increased normalized side-to-side differences were present for all three EIM variables (e.g., median 100 kHz phase 0.15 (IQR 0.07-0.31 in LBP patients versus 0.09 (IQR 0.04-0.17) in healthy individuals). A significant correlation between 100 kHz EIM phase and reactance was found with age (Rspearman=-0.46, P=0.0002 and Rspearman=-0.440, P=0.0003) but not for resistance. This study provides early evidence supporting that EIM has the potential to serve as a useful tool for evaluating the condition of LPMs.
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Affiliation(s)
- Yun Wang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University Beijing, China
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | | | | | - Seward B. Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - John Keel
- Emory Orthopaedics/Spine Center, Emory University, Atlanta, USA
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Weiner MT, Oakley PA, Dennis AK, Shapiro DA, Harrison DE. Increasing the cervical and lumbar lordosis is possible despite overt osteoarthritis and spinal stenosis using extension traction to relieve low back and leg pain in a 66-year-old surgical candidate: a CBP ® case report. J Phys Ther Sci 2018; 30:1364-1369. [PMID: 30464366 PMCID: PMC6220102 DOI: 10.1589/jpts.30.1364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/02/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To present the case of the dramatic relief of low back pain, leg pain and
disability in an older female with osteoarthritis, lumbar spinal stenosis and hypolordosis
of the cervical and lumbar spine. [Participant and Methods] A 66-year-old female presented
with chronic low back pain, right leg pain, numbness and weakness. Despite being
recommended for surgery, the patient sought alternative treatment. The patient was treated
with Chiropractic BioPhysics® rehabilitation of the spine with the objective to
increase the lumbar and cervical lordoses. Cervical and lumbar extension exercises and
traction were performed as well as spinal manipulation. Treatment was performed
approximately three times per week for 6.5 months. [Results] Re-assessment after treatment
demonstrated significant reduction of low back pain, leg pain and other health
improvements. X-rays showed structural improvements in the cervical and lumbar spine
despite advanced osteoarthritis. [Conclusion] Lumbar and cervical hypolordosis subluxation
may be increased in those with spinal deformity caused symptoms, despite the presence of
osteoarthritis and degenerative stenosis of the spine. Spinal x-rays as used in the
assessment and monitoring of patients being treated with contemporary spinal
rehabilitation methods are not harmful and should be used for routine screening
purposes.
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Oakley PA, Jaeger JO, Brown JE, Polatis TA, Clarke JG, Whittler CD, Harrison DE. The CBP ® mirror image ® approach to reducing thoracic hyperkyphosis: a retrospective case series of 10 patients. J Phys Ther Sci 2018; 30:1039-1045. [PMID: 30154597 PMCID: PMC6110211 DOI: 10.1589/jpts.30.1039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To present a case series demonstrating the reduction of thoracic hyperkyphosis
by the Chiropractic BioPhysics® multimodal rehabilitation program.
[Participants and Methods] Ten randomly selected files and corresponding radiographs were
chosen from recent clinic archives of patients who were treated for thoracic
hyperkyphosis. All patients were treated by CBP mirror image® thoracic
extension traction and exercises, as well as spinal manipulative therapy. [Results]
Results demonstrated an average reduction in hyperkyphosis of 11.3° over an average of 25
treatments, over an average of 9 weeks. Patients also experienced a reduction in pain
levels and disability ratings. [Conclusion] Postural hyperkyphosis is a serious
progressive deformity that is related to a plethora of symptoms, syndromes, and early
death. Thoracic hyperkyphosis may be reduced/corrected by posture-specific, thoracic
extension protocols including mirror image extension traction and exercises, as well as
spinal manipulation as part of the CBP multi-modal rehabilitation program.
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Affiliation(s)
- Paul A Oakley
- Private Practice: 11A-1100 Gorham Street, Newmarket, ON, L3Y 8Y8, Canada
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Butler S. Effects of the excitatory amino acid transporter subtype 2 (EAAT-2) transporter inducer ceftriaxone (an antibiotic) on different pain modalities in rat. Scand J Pain 2018; 2:130-131. [PMID: 29913738 DOI: 10.1016/j.sjpain.2011.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Stephen Butler
- Uppsala University Hospital, Pain Center, Uppsala, Sweden
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Park TSW, Kuo A, Smith MT. Chronic low back pain: a mini-review on pharmacological management and pathophysiological insights from clinical and pre-clinical data. Inflammopharmacology 2018; 26:10.1007/s10787-018-0493-x. [PMID: 29754321 DOI: 10.1007/s10787-018-0493-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/01/2018] [Indexed: 12/19/2022]
Abstract
Globally, low back pain (LBP) is one of the most common health problems affecting humans. The lifetime prevalence of non-specific LBP is approximately 84%, with the chronic prevalence at about 23%. Chronic LBP in humans is defined as LBP that persists for more than 12 weeks without a significant pain improvement. Although there are numerous evidence-based guidelines on the management of acute LBP, this is not the case for chronic LBP, which is regarded as particularly difficult to treat. Research aimed at discovering new drug treatments for alleviation of chronic mechanical LBP is lacking due to the paucity of knowledge on the pathobiology of this condition, despite its high morbidity in the affected adult population. For a debilitating condition such as chronic LBP, it is necessary to assess the sustained effects of pharmacotherapy of various agents spanning months to years. Although many rodent models of mechanical LBP have been developed to mimic the human condition, some of the major shortcomings of many of these models are (1) the presence of a concurrent neuropathic component that develops secondary to posterior intervertebral disc puncture, (2) severe model phenotype, and/or (3) use of behavioural endpoints that have yet to be validated for pain. Hence, there is a great, unmet need for research aimed at discovering new biological targets in rodent models of chronic mechanical LBP for use in drug discovery programs as a means to potentially produce new highly effective and well-tolerated analgesic agents to improve relief of chronic LBP. On a cautionary note, it must be borne in mind that because humans and rats display orthograde and pronograde postures, respectively, the different mechanical forces on their spines add to the difficulty in translation of promising rodent data to humans.
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Affiliation(s)
- Thomas S W Park
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4072, Australia
- UQ Centre for Clinical Research, Faculty of Medicine, Steele Building, St Lucia Campus, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Andy Kuo
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Maree T Smith
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4072, Australia.
- School of Pharmacy, Pharmacy Australia Centre of Excellence, Faculty of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia.
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Perron M, Gendron C, Langevin P, Leblond J, Roos M, Roy JS. Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain. BMC Musculoskelet Disord 2018; 19:95. [PMID: 29606114 PMCID: PMC5879551 DOI: 10.1186/s12891-018-2022-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 03/23/2018] [Indexed: 12/13/2022] Open
Abstract
Background Low back pain (LBP) encompasses heterogeneous patients unlikely to respond to a unique treatment. Identifying sub-groups of LBP may help to improve treatment outcomes. This is a hypothesis-setting study designed to create a clinical prediction rule (CPR) that will predict favorable outcomes in soldiers with sub-acute and chronic LBP participating in a multi-station exercise program. Methods Military members with LBP participated in a supervised program comprising 7 stations each consisting of exercises of increasing difficulty. Demographic, impairment and disability data were collected at baseline. The modified Oswestry Disability Index (ODI) was administered at baseline and following the 6-week program. An improvement of 50% in the initial ODI score was considered the reference standard to determine a favorable outcome. Univariate associations with favorable outcome were tested using chi-square or paired t-tests. Variables that showed between-group (favorable/unfavorable) differences were entered into a logistic regression after determining the sampling adequacy. Finally, continuous variables were dichotomized and the sensitivity, specificity and positive and negative likelihood ratios were determined for the model and for each variable. Results A sample of 85 participants was included in analyses. Five variables contributed to prediction of a favorable outcome: no pain in lying down (p = 0.017), no use of antidepressants (p = 0.061), FABQ work score < 22.5 (p = 0.061), fewer than 5 physiotherapy sessions before entering the program (p = 0.144) and less than 6 months’ work restriction (p = 0.161). This model yielded a sensitivity of 0.78, specificity of 0.80, LR+ of 3.88, and LR- of 0.28. A 77.5% probability of favorable outcome can be predicted by the presence of more than three of the five variables, while an 80% probability of unfavorable outcome can be expected if only three or fewer variables are present. Conclusion The use of prognostic factors may guide clinicians in identifying soldiers with LBP most likely to have a favorable outcome. Further validation studies are needed to determine if the variables identified in our study are treatment effect modifiers that can predict success following participation in the multi-station exercise program. Trial registration ClinicalTrials.gov Identifier: NCT03464877 registered retrospectively on 14 March 2018. Electronic supplementary material The online version of this article (10.1186/s12891-018-2022-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marc Perron
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Local 4445, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada.
| | - Chantal Gendron
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Local 4445, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada.,Canadian Forces Health Services Group, Valcartier Garison, Quebec City, Canada
| | - Pierre Langevin
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Local 4445, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada.,Physio Interactive, Quebec City, Canada
| | - Jean Leblond
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada
| | - Marianne Roos
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Local 4445, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Local 4445, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada
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Clinical classification criteria for nonspecific low back pain: A Delphi-survey of clinical experts. Musculoskelet Sci Pract 2018; 34:66-76. [PMID: 29367122 DOI: 10.1016/j.msksp.2018.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/14/2017] [Accepted: 01/05/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Nonspecific low back pain (NSLBP) is a common problem. Attempts have been made to classify NSLBP patients into homogenous subgroups. Classification systems based on identifying the underlying mechanism(s) driving the disorder are clinically useful to guide specific interventions. OBJECTIVE To establish consensus among experts regarding clinical criteria suggestive of a dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns (DPs) in NSLBP patients. STUDY DESIGN A 2-phase sequential design of a focus group and Delphi-study. METHODS A focus group with 10 academic experts was organized to elaborate on the different DPs discernible in LBP patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 DPs resulting from the focus group. RESULTS Fifteen musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating LBP patients completed the Delphi-survey. Respectively, 34 (response rate, 100.0%), 20 (58.8%) and 15 (44.12%) respondents replied to rounds 1, 2 and 3. Twenty-two 'articular', 20 'myofascial', 21 'neural', 18 'central' and 11 'sensorimotor control' criteria reached a predefined ≥80% consensus level. For example, after round 2, 85.0% of the Delphi-experts agreed to identify 'referred pain below the knee' as a subjective examination criterion suggestive for a predominant 'neural DP'. CONCLUSION These indicators suggestive of a clinical dominance of the proposed DPs could help clinicians to assess and diagnose NSLBP patients. Future reliability and validity testing is needed to determine how these criteria may help to improve physical therapy outcome for NSLBP patients.
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Heuch I, Heuch I, Hagen K, Sørgjerd EP, Åsvold BO, Zwart JA. Is chronic low back pain a risk factor for diabetes? The Nord-Trøndelag Health Study. BMJ Open Diabetes Res Care 2018; 6:e000569. [PMID: 30397493 PMCID: PMC6203062 DOI: 10.1136/bmjdrc-2018-000569] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/22/2018] [Accepted: 09/29/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the risk of diabetes associated with the presence or absence of chronic low back pain, considering both cross-sectional and cohort data. RESEARCH DESIGN AND METHODS Analyses were based on the Norwegian HUNT2 and HUNT3 surveys of Nord-Trøndelag County. The prevalence of diabetes was compared in groups with and without chronic low back pain among 45 157 participants aged 30-69 years. Associations between low back pain at baseline and risk of diabetes were examined in an 11-year follow-up of 30 380 individuals with no baseline diagnosis of diabetes. The comorbidity between diabetes and low back pain was assessed at the end of follow-up. All analyses were carried out considering generalized linear models incorporating adjustment for other relevant risk factors. RESULTS Cross-sectional analyses did not reveal any association between low back pain and diabetes. With adjustment for age, body mass index, physical activity and smoking, the cohort study of women showed a significant association between low back pain at baseline and risk of diabetes (RR 1.30; 95% CI 1.09 to 1.54, p=0.003). The association differed between age groups (p=0.015), with a stronger association in relatively young women. In men, no association was found in the whole age range (RR 1.02; 95% CI 0.86 to 1.21, p=0.82). No association was observed between diabetes and chronic low back pain at the end of follow-up. CONCLUSION Among younger women, those with chronic low back pain may have an increased risk of diabetes.
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Affiliation(s)
- Ingrid Heuch
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Elin Pettersen Sørgjerd
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - John-Anker Zwart
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Deckers K, De Smedt K, Mitchell B, Vivian D, Russo M, Georgius P, Green M, Vieceli J, Eldabe S, Gulve A, van Buyten JP, Smet I, Mehta V, Ramaswamy S, Baranidharan G, Sullivan R, Gassin R, Rathmell J, Gilligan C. New Therapy for Refractory Chronic Mechanical Low Back Pain-Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial. Neuromodulation 2017; 21:48-55. [PMID: 29244235 PMCID: PMC5814827 DOI: 10.1111/ner.12741] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/06/2017] [Accepted: 11/02/2017] [Indexed: 12/28/2022]
Abstract
Objectives The purpose of the international multicenter prospective single arm clinical trial was to evaluate restorative neurostimulation eliciting episodic contraction of the lumbar multifidus for treatment of chronic mechanical low back pain (CMLBP) in patients who have failed conventional therapy and are not candidates for surgery or spinal cord stimulation (SCS). Materials and Methods Fifty‐three subjects were implanted with a neurostimulator (ReActiv8, Mainstay Medical Limited, Dublin, Ireland). Leads were positioned bilaterally with electrodes close to the medial branch of the L2 dorsal ramus nerve. The primary outcome measure was low back pain evaluated on a 10‐Point Numerical Rating Scale (NRS). Responders were defined as subjects with an improvement of at least the Minimal Clinically Important Difference (MCID) of ≥2‐point in low back pain NRS without a clinically meaningful increase in LBP medications at 90 days. Secondary outcome measures included Oswestry Disability Index (ODI) and Quality of Life (QoL; EQ‐5D). Results For 53 subjects with an average duration of CLBP of 14 years and average NRS of 7 and for whom no other therapies had provided satisfactory pain relief, the responder rate was 58%. The percentage of subjects at 90 days, six months, and one year with ≥MCID improvement in single day NRS was 63%, 61%, and 57%, respectively. Percentage of subjects with ≥MCID improvement in ODI was 52%, 57%, and 60% while those with ≥MCID improvement in EQ‐5D was 88%, 82%, and 81%. There were no unanticipated adverse events (AEs) or serious AEs related to the device, procedure, or therapy. The initial surgical approach led to a risk of lead fracture, which was mitigated by a modification to the surgical approach. Conclusions Electrical stimulation to elicit episodic lumbar multifidus contraction is a new treatment option for CMLBP. Results demonstrate clinically important, statistically significant, and lasting improvement in pain, disability, and QoL.
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Affiliation(s)
| | | | - Bruce Mitchell
- Monash Clinical Research Pty Ltd, Clayton, VIC, Australia
| | - David Vivian
- Monash Clinical Research Pty Ltd, Clayton, VIC, Australia
| | - Marc Russo
- Hunter Pain Clinic, Broadmeadow, NSW, Australia
| | - Peter Georgius
- Sunshine Coast Clinical Research, Noosa Heads, QLD, Australia
| | - Matthew Green
- Pain Medicine of South Australia, Welland, SA, Australia
| | - John Vieceli
- Pain Medicine of South Australia, Welland, SA, Australia
| | - Sam Eldabe
- The James Cook University Hospital, Middlesbrough, UK
| | - Ashish Gulve
- The James Cook University Hospital, Middlesbrough, UK
| | | | - Iris Smet
- Algemeen Ziekenhuis Nikolaas, Sint-Niklaas, Belgium
| | | | | | | | | | | | - James Rathmell
- Brigham and Women's Healthcare, Harvard Medical School, Boston, MA, USA
| | - Chris Gilligan
- Brigham and Women's Healthcare, Harvard Medical School, Boston, MA, USA
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Oakley PA, Harrison DE. Lumbar extension traction alleviates symptoms and facilitates healing of disc herniation/sequestration in 6-weeks, following failed treatment from three previous chiropractors: a CBP ® case report with an 8 year follow-up. J Phys Ther Sci 2017; 29:2051-2057. [PMID: 29200655 PMCID: PMC5702845 DOI: 10.1589/jpts.29.2051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/23/2017] [Indexed: 12/28/2022] Open
Abstract
[Purpose] To present the outcome of a patient, having sciatica and MRI-verified disc
herniation/sequestration who underwent Chiropractic BioPhysics®
(CBP®) protocol designed to improve the lumbar lordosis. [Subject and
Methods] A 56-year-old male suffered from chronic low back pain and recent sciatica due to
lumbar disc herniation despite being under continuous care from three previous
chiropractors. Radiographic analysis revealed a lumbar hypolordosis and MRI confirmed disc
herniation and sequestration at L4–L5. Generalized decreased lumbar range of motion and
multiple positive orthopedic and neurologic tests were present. [Results] After 26
treatments of CBP lumbar extension traction over 9-weeks a total reduction of the disc
herniation and sequestration occurred with concomitant improvement in neurologic symptoms.
Continuing maintenance treatments, an 8 year follow-up shows no relapse of condition and
patient remained in good health. [Conclusion] A patient with lumbar disc
herniation/sequestration was successfully treated with CBP technique procedures including
lumbar extension traction that achieved a significant healing of herniation and
significant reduction in symptoms not obtained following traditional chiropractic
procedures alone. The quick reduction in lumbar disc herniation would appear to be related
to a segmental disc unloading force produced during extension traction procedures for
increasing the lumbar curvature.
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Goubert D, De Pauw R, Meeus M, Willems T, Cagnie B, Schouppe S, Van Oosterwijck J, Dhondt E, Danneels L. Lumbar muscle structure and function in chronic versus recurrent low back pain: a cross-sectional study. Spine J 2017; 17:1285-1296. [PMID: 28456669 DOI: 10.1016/j.spinee.2017.04.025] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/23/2017] [Accepted: 04/24/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Heterogeneity exists within the low back pain (LBP) population. Some patients recover after every pain episode, whereas others suffer daily from LBP complaints. Until now, studies rarely make a distinction between recurrent low back pain (RLBP) and chronic low back pain (CLBP), although both are characterized by a different clinical picture. Clinical experiences also indicate that heterogeneity exists within the CLBP population. Muscle degeneration, like atrophy, fat infiltration, alterations in muscle fiber type, and altered muscle activity, compromises proper biomechanics and motion of the spinal units in LBP patients. The amount of alterations in muscle structure and muscle function of the paraspinal muscles might be related to the recurrence or chronicity of LBP. PURPOSE The aim of this experimental study is to evaluate differences in muscle structure (cross-sectional area and lean muscle fat index) and muscle activity of the multifidus (MF) and erector spinae (ES) during trunk extension, in patients with RLBP, non-continuous CLBP, and continuous CLBP. STUDY DESIGN AND SETTING This cross-sectional study took place in the university hospital of Ghent, Belgium. Muscle structure characteristics and muscle activity were assessed by magnetic resonance imaging (MRI). PATIENT SAMPLE Fifty-five adults with non-specific LBP (24 RLBP in remission, 15 non-continuous CLBP, 16 continuous CLBP) participated in this study. OUTCOME MEASURES Total cross-sectional area, muscle cross-sectional area, fat cross-sectional area, lean muscle fat index, T2-rest and T2-shift were assessed. METHODS A T1-weighted Dixon MRI scan was used to evaluate spinal muscle cross-sectional area and fat infiltration in the lumbar MF and ES. Muscle functional MRI was used to evaluate the muscle activity of the lumbar MF and ES during a lumbar extension exercise. Before and after the exercise, a pain assessment was performed. This study was supported by grants from the Special Research Fund of Ghent University (DEF12/AOP/022) without potential conflict of interest-associated biases in the text of the paper. RESULTS Fat cross-sectional area and lean muscle fat index were significantly higher in MF and ES in continuous CLBP compared with non-continuous CLBP and RLBP (p<.05). No differencesbetween groups were found for total cross-sectional area and muscle cross-sectional area in MF or ES (p>.05). Also, no significant differences between groups for T2-rest were established. T2-shift, however, was significantly lower in MF and ES in RLBP compared with, respectively, non-continuous CLBP and continuous CLBP (p<.05). CONCLUSIONS These results indicate a higher amount of fat infiltration in the lumbar muscles, in the absence of clear atrophy, in continuous CLBP compared with RLBP. A lower metabolic activity of the lumbar muscles was seen in RLBP replicating a relative lower intensity in contractions performed by the lumbar muscles in RLBP compared with non-continuous and continuous CLBP. In conclusion, RLBP differs from continuous CLBP for both muscle structure and muscle function, whereas non-continuous CLBP seems comparable with RLBP for lumbar muscle structure and with continuous CLBP for lumbar muscle function. These results underline the differences in muscle structure and muscle function between different LBP populations.
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Affiliation(s)
- Dorien Goubert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium; Pain in Motion Research Group, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Boulevard de la Plaine 2, 1050 Ixelles, Belgium
| | - Robby De Pauw
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium; Pain in Motion Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Prinsstraat 13, 2000 Antwerpen, Belgium
| | - Tine Willems
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium
| | - Stijn Schouppe
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium
| | - Jessica Van Oosterwijck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Prinsstraat 13, 2000 Antwerpen, Belgium
| | - Evy Dhondt
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium.
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Schnelle C, Messerschmidt S, Minford EJ, Greenaway-Twist K, Szramka M, Masiorski M, Sheldrake M, Jones M. Esoteric Connective Tissue Therapy for chronic low back pain to reduce pain, and improve functionality and general well-being compared with physiotherapy: study protocol for a randomised controlled trial. Trials 2017; 18:328. [PMID: 28716108 PMCID: PMC5513109 DOI: 10.1186/s13063-017-2055-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 06/08/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Low back pain causes more global disability than any other condition. Once the acute pain becomes chronic, about two-thirds of sufferers will not fully recover after 1-2 years. There is a paucity of effective treatments for non-specific, chronic low back pain. It has been noted that low back pain is associated with changes in the connective tissue in the affected area, and a very low-impact treatment, Esoteric Connective Tissue Therapy (ECTT), has been developed to restore flexibility in connective tissue. ECTT uses patterns of very small, circular movements, to the legs, arms, spine, sacrum and head, which anecdotally are effective in pain relief. In an unpublished single-arm phase I/II trial with chronic pain patients, ECTT showed a 56% reduction in pain after five treatments and 45% and 54% improvements at 6 months and 7-9 years of follow-up respectively. METHODS The aim of this randomised controlled trial is to compare ECTT with physiotherapy for reducing pain and improving physical function and physical and mental well-being in patients with chronic low back pain. The trial will be held at two hospitals in Vietnam. One hundred participants with chronic low back pain greater than or equal to 40/100 on the visual analogue scale will be recruited and randomised to either ECTT or physiotherapy. Four weekly treatments will be provided by two experienced ECTT practitioners (Treatment Group, 40 minutes each) and hospital-employed physiotherapy nurses (Control Group, 50 minutes). The primary outcomes will be changes in pain, physical function per the Quebec Pain Functionality Questionnaire and physical and mental well-being recorded by the Short Form Health Survey (SF-36), with mixed modelling used as the primary statistical tool because the data are longitudinal. Initial follow-up will be at either 4 or 8 months, with a second follow-up after 12 months. DISCUSSION The trial design has important strengths, because it is to be conducted in hospitals under medical supervision, because ECTT is to be compared with a standard therapy and because the assessor and analyst are to be blinded. The findings from this trial will provide evidence of the efficacy of ECTT for chronic low back pain compared with standard physiotherapy treatment. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12616001196437 . Registered on 30 August 2016.
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Affiliation(s)
- Christoph Schnelle
- School of Public Health, University of Queensland, Herston Road, Herston, QLD Australia
| | | | - Eunice J. Minford
- Department of Surgery, Antrim Area Hospital, 45 Bush Rd, Antrim, BT41 2RL UK
- Queen’s University Belfast, University Rd, Belfast, BT7 1NN UK
| | | | | | | | | | - Mark Jones
- School of Public Health, University of Queensland, Herston Road, Herston, QLD Australia
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Heuch I, Heuch I, Hagen K, Zwart JA. Physical activity level at work and risk of chronic low back pain: A follow-up in the Nord-Trøndelag Health Study. PLoS One 2017; 12:e0175086. [PMID: 28394896 PMCID: PMC5386240 DOI: 10.1371/journal.pone.0175086] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/20/2017] [Indexed: 11/18/2022] Open
Abstract
Background Physical activity in leisure time seems to reduce the risk of low back pain, but it is not known whether occupational activity, as recorded in a representative working population, produces a higher or lower risk. Objective To study associations between physical activity level at work and risk of chronic low back pain. Methods Associations were examined in a Norwegian prospective study using data from the HUNT2 and HUNT3 surveys carried out in the whole county of Nord-Trøndelag. Participants were 7580 women and 7335 men who supplied information about physical activity level at work. Levels considered were sedentary work, work involving walking but no heavy lifting, work involving walking and heavy lifting, and particularly strenuous physical work. Nobody in the cohort was affected by chronic low back pain at baseline. After 11 years, participants reported whether they suffered from chronic low back pain. Generalized linear modelling with adjustment for potential confounders was applied to assess associations with risk factors. Results In age-adjusted analyses both women and men showed statistically significant associations between physical activity at work and risk of chronic low back pain, suggesting positive relationships. For particularly strenuous physical work the relative risk of chronic low back pain was 1.30 (95% CI: 1.00–1.71) in women and 1.36 (95% CI 1.17–1.59) in men, compared to sedentary work. Women still showed a general association with activity level after adjustment for education, leisure time physical activity, BMI, smoking and occupational category. In men, the higher risk was only maintained for particularly strenuous work. Conclusion In this cohort, women had a higher risk of chronic low back pain with work involving walking and heavy lifting or particularly strenuous work, compared to sedentary work. Men participating in particularly strenuous work also experienced a higher risk of chronic low back pain.
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Affiliation(s)
- Ingrid Heuch
- Department of Neurology and FORMI, Oslo University Hospital, Oslo, Norway
- * E-mail:
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Knut Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian National Headache Centre, Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - John-Anker Zwart
- Department of Neurology and FORMI, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Atkinson L, Zacest A. Surgical management of low back pain. Med J Aust 2017; 204:299-300. [PMID: 27125798 DOI: 10.5694/mja16.00038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/03/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | - Andrew Zacest
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, SA
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Effectiveness of Tai Chi for Chronic Musculoskeletal Pain Conditions: Updated Systematic Review and Meta-Analysis. Phys Ther 2017; 97:227-238. [PMID: 27634919 DOI: 10.2522/ptj.20160246] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/31/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tai chi is recommended for musculoskeletal conditions; however, the evidence for its clinical effectiveness is uncertain. PURPOSE The aim of this study was to determine whether tai chi is beneficial for clinical outcomes in people with musculoskeletal pain. DATA SOURCES Seven databases were searched: Embase, PEDro, AMED, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Central Register of Controlled Trials. STUDY SELECTION Randomized controlled trials of tai chi for people with a chronic musculoskeletal condition were included. DATA EXTRACTION Two reviewers extracted data and rated risk of bias. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were calculated for individual trials and pooled effect sizes were calculated using a random-effects model. DATA SYNTHESIS Fifteen studies were identified; these studies included people with osteoarthritis (80%), back pain (13%), and headache (7%). Using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach, moderate-quality evidence was found that tai chi was more effective than no treatment or usual care at short term on pain (SMD=-0.66 [95% CI=-0.85, -0.48]) and disability (SMD=-0.66 [95% CI=-0.85, -0.46]). The evidence for other outcomes was of low or very low quality and there was little information regarding long-term effects. Thus, although the number of publications in this area has increased, the rigor has not, hindering physical therapists' ability to provide reliable recommendations for clinical practice. LIMITATIONS The evidence provided in this review is limited by trials with small sample sizes, low methodological quality, and lack of long-term assessment. CONCLUSIONS In order for tai chi to be recommended as an effective intervention, more high-quality trials with large sample sizes assessing tai chi versus other evidence-based treatments at short term and at long term are needed.
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