Self-Treatment of Chronic Low Back Pain Based on a Rapid and Objective Sacroiliac Asymmetry Test: A Pilot Study

Effects of Conventional Exercises on Lower Back Pain and/or Pelvic Girdle Pain in Pregnancy: A Systematic Review and Meta-Analysis

Pregnant women frequently complain of low back discomfort associated with their pregnancies. On their quality of life, it could have a detrimental effect. Pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) are associated with substantial direct and indirect expenditures. Evidence addressing strategies to treat and prevent these illnesses needs to be clarified. This review aimed to examine the connection between exercise, LBP, and PGP. To find relevant studies (in the English language) that matched the inclusion and exclusion criteria, a systematic search of peer-reviewed literature was carried out using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Scopus, the Web of Science, Pub Med, and ClinicalTrials.Gov. The publishing window was limited to the previous 10 years (2012-2022). Utilizing Review Manager version 5.4 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen), the results were examined. JADAD ratings were used to evaluate the quality of the included studies. To analyze the endpoints, the mean, standard mean difference (SMD), and 95% confidence intervals (CI) were determined. We chose 16 randomized controlled trials (RCTs) that included 1885 pregnant individuals with pelvic girdle and/or lower back discomfort. The combined data showed that the exercise group had lower VAS scores than the control group. The final result, however, did not significantly differ. Most of the studies had high JADAD scores, ranging from 3 to 5 points. Lower back pain and/or pelvic girdle discomfort during pregnancy are not influenced by exercise; however, women who are provided with a regular exercise program appear to manage the condition effectively with improved functional status.

Factors Associated With Repeat Emergency Department Visits for Low Back Pain

Background Low back pain represents 2-3% of Emergency Department (ED) visits. In this study, we aimed to identify patient and treatment-related variables that contributed to repeat visits to the ED for low back pain within a 12-month period. Methodology We conducted a retrospective review of adult patients presenting to the ED of one hospital over a two-year period with the primary diagnosis of low back pain. The primary outcome included return to the ED within 12 months with the same complaint, and the secondary outcome included return to the ED within 30 days or six months. Results A total of 793 patients met the inclusion criteria. The rate of return to the ED with the same complaint within 30 days, six months, and 12 months of the first visit was 7%, 11%, and 14%, respectively. Patients who received opioids at discharge were more likely to return within 12 months (68% vs. 55%; p = 0.0075) and six months (68% vs. 56%; p = 0.0184) compared to those who did not receive opioids at discharge. Undergoing an X-ray decreased the odds of a 30-day return visit by 70% (p = 0.0067), and by 59% within 12 months (p = 0.0032). Receiving opioids at discharge also doubled the odds of return within 12 months (odds ratio = 2.030, p = 0.0183), while receiving nonsteroidal anti-inflammatory drugs (NSAIDs) reduced the odds by 60% (p = 0.0028). Conclusions Patients who received opioids at discharge were more likely to have a return visit for low back pain within six and 12 months. Patients who underwent X-rays at the index visit and were prescribed NSAIDs at discharge were less likely to return to the ED for low back pain.

Chronic Low Back Pain Forced Me to Search for and Find Pain Solutions: An Autobiographical Case Report

Lifelong, pregnancy-induced low back pain forced me to search for solutions to the problem of pain. Currently, low back pain is often diagnosed as “nonspecific” and, as a result, a multitude of tests and poorly effective, at times side effect-laden or habit-forming treatments are recommended. My quest for relief took me to first diagnose my pain as coming from the sacroiliac joints, then to prolotherapy, the first treatment which brought me prolonged relief. I then learned how to perform prolotherapy. In 2009, when I undertook a randomized controlled study of dextrose prolotherapy for rotator cuff tendinopathy, I restricted my practice to treating pain.

As low back pain was a large part of my practice, I sought new ways to examine the sacroiliac joints. I conducted a consecutive patient data collection which suggested that over three-quarters of those with low back pain suffer from displaced sacroiliac joints. In a further randomized controlled study, I found that the two-minute corrective exercise I derived from this test provided immediate relief to 90% of those using it.

With Dr. John Clark Lyftogt I discovered the safety and effectiveness of 5% dextrose perineural injections to provide immediate pain relief to any area supplied by a nerve I could reach with my needle. As I was treating many diabetics with peripheral neuropathy, I shifted my perineural injection material to 5% mannitol, which may be as effective, with less exposure to dextrose as a potential benefit for diabetics.

As most people dislike injections, a pharmacist and I developed a mannitol-containing topical cream for pain relief. We compared a base cream to the same cream with mannitol on lips pretreated with capsaicin cream which made them burn. By 10 minutes the probability the two creams were as effective in relieving the burn was less than 0.001 in favor of mannitol. When given to 235 patients with a total of 289 different painful conditions, we found that it provided 53% relief in an average of 16 minutes with a median of four hours duration.

Now retired, after 55 years of medical practice, I love to relieve the pain of friends and fellow hikers using exercise and cream. Searching for and finding solutions to chronic pain has enriched my life and that of many others.