Chronic Low Back Pain: Prevalence, Impact on Quality of Life, and Predictors of Future Disability

Duloxetine for individuals with chronic back pain: A systematic review and meta‑analysis of randomized controlled trials

The current study aimed to assess the efficacy of duloxetine in reducing pain and improving the quality of life of individuals with chronic low back pain (CLBP). An extensive literature search was conducted to identify relevant studies that examined the efficacy of duloxetine in CLBP management. The primary objective of the present study was to assess the role of duloxetine use on pain levels, as well as improvements in quality of life, using validated instruments. The results were synthesized using a random-effects model. A total of 8 studies were included in the analysis. Duloxetine demonstrated clear benefits in pain reduction, evidenced by improvements across multiple scales including the visual analogue scale, brief pain inventory-interference (BPI), BPI-severity, weekly worst pain over 24 hours and Roland-Morris Disability Questionnaire scores. Quality of life improved with duloxetine treatment, as indicated by the 36-item short form survey (SF-36). However, there was no significant impact on the physical function component of SF-36. The present study provides evidence to affirm the efficacy of duloxetine in treating CLBP. Further research is required to validate these findings and to establish whether combining duloxetine with other CLBP treatments yields superior outcomes.

Association between dietary intake of flavonoids and chronic low back pain: a cross-sectional study

Aim

The purpose of this study was to explore the association between flavonoids intake and chronic low back pain (CLBP).

Methods

This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey. Dietary flavonoids intake was assessed using a two-day recall questionnaire on dietary intake. CLBP was defined based of self-reported question. Weighted univariate and multivariate logistic regression models were performed to evaluate the relationship between flavonoids intake and CLBP. Additionally, subgroup analyses were conducted based on age, sedentary behavior time, arthritis, depression, and sleep disorder.

Results

A total of 3,136 adults were included, and 460 participants developed CLBP. After adjusting confounders, compared with the lowest total flavonoids intake tertile (reference group), flavonoids intake with highest tertile (>170 mg) was associated with reduced odds of CLBP [odds ratio (OR) =0.74, 95% confidence interval (CI): 0.57-0.95]. This relationship of flavonoids intake with CLBP remained statistically significant among participants aged ≥45 years (OR = 0.52, 95%CI: 0.35-0.76), with sedentary behavior time of >3 h (OR = 0.60, 95%CI: 0.41-0.86), with arthritis (OR = 0.51, 95%CI: 0.29-0.90), depression (OR = 0.48, 95%CI: 0.24-0.98), and sleep disorder (OR = 0.27, 95%CI: 0.12-0.60).

Conclusion

Higher flavonoids intake was found to be negatively associated with the likelihood of CLBP. For the general adult population, consuming foods rich in flavonoids may be linked to a reduced risk of CLBP.

Effective Management of McKenzie Derangement VI With Urge Urinary Incontinence Through Surgical Intervention and Customized Physiotherapy: A Case Report

Urge incontinence, often linked to prolapsed intervertebral disc (PIVD) due to nerve compression, involves sudden, involuntary urine leakage. Management includes behavioral therapy, bladder training, and pelvic floor muscle training (PFMT) to strengthen pelvic muscles and regulate voiding, effectively reducing symptoms and improving quality of life. A 40-year-old female patient presented with chief complaints of lower back pain radiating down the right lower limb below the knee, accompanied by a right-sided listing. Based on the McKenzie classification, she was diagnosed with McKenzie derangement VI, characterized by unilateral/asymmetrical pain across the L4-L5 region, radiating pain below the knee, and the presence of deformity, specifically trunk deviation away from the painful side that is the right side. Additionally, she reported experiencing urge urinary incontinence. Following surgery, she experienced significant reductions in pain and urinary incontinence, improved posture, and an enhanced quality of life. Surgical decompression and spinal fixation effectively alleviated neural compression and instability at the L4-L5 and L5-S1 levels. At the same time, the phased physiotherapy approach facilitated recovery through pain management, neuromuscular re-education, and functional restoration. Preoperative assessments such as the modified Schober's test, visual analogue scale (VAS), Revised Oswestry Disability Index (RODI), sciatica bothersome index, revised urinary incontinence scale (RUIS), and Michigan incontinence symptom index (MISI) were essential in guiding the rehabilitation process and measuring progress. The integration of these multidisciplinary interventions underscores the importance of a comprehensive treatment plan in achieving positive outcomes for PIVD, despite the potential for complications such as chronic pain and disability.

Reducing Chronic Spine Pain in an Adult Male by Decreasing Lumbar Scoliosis and Increasing Cervical Lordosis Using Chiropractic BioPhysics® Protocols: A 26-Month Follow-Up Case Report

We present a case report of a patient suffering from chronic low back pain (CLBP) and chronic non-specific neck pain (CNSNP), both of which were caused and complicated by a physically demanding occupation, a history of mixed martial arts, and lumbar scoliosis. Improvements in patient-reported outcomes (PROs) and radiographic findings were observed following conservative spine rehabilitation. The patient, a 34-year-old male, had experienced chronic spine pain, particularly CLBP and CNSNP, for several years. He reported severe pain and increasing disability after a recent neck injury sustained while practicing jiu-jitsu. Radicular pain, along with numbness and tingling, was noted in the right upper extremity, extending to the first three digits, and there were also altered sensations and temperature changes in both feet. He described sharp, pinching mid-back pain and worsening disability due to the persistent pain, which led him to seek manual manipulative chiropractic spine therapy, though he reported little benefit from it. The patient had relied on over-the-counter pain medications for many years without achieving long-term pain and disability relief, and these medications were no longer used following treatment. Chiropractic BioPhysics® (CBP®) spinal structural rehabilitation protocols were used to improve coronal and sagittal balance, as well as paraspinal muscular strength, addressing posture, mobility, and related aspects. These protocols include postural exercises, postural Mirror Image® traction, and postural spinal manipulative therapy. All PROs improved, with a near resolution of all initial symptoms of chronic spine pain. Outcomes measured included disability indices and health-related quality of life (HRQoL) indicators. Radiographic parameter improvements were significant, demonstrating improved coronal and sagittal balance as a result of the treatment. Following 30 in-office treatments, administered three times per week for 10 weeks, initial outcomes were reassessed. The patient then received 13 in-office treatments periodically over one year, and all initial outcomes were repeated. The improvements remained stable over time. A 26-month follow-up found that the improvements were sustained over a very long period without additional treatment after the 13-month examination. Chronic spine pain, specifically CLBP and CNSNP, is a significant source of suffering and contributes substantially to the global burden of disease. Improvement in HRQoLs, PROs, and objective spine parameters are desirable clinical outcomes. Our case report documents objective improvement in lumbar scoliosis and spine pain, which is rare in conservative studies. This successful treatment of chronic pain with long-term follow-up contributes to the growing evidence supporting conservative, non-surgical treatments for CNSNP and CLBP. Successful management of chronic spine pain was observed in a patient undergoing CBP® treatment. The treatment was designed to address abnormal sagittal and coronal postural balance and radiographic abnormalities indicating spinal misalignment and reassess progress in PROs, as well as objective and subjective HRQoL measures, both following treatment and 13 months later. However, larger studies are needed to draw firm conclusions regarding the efficacy of this treatment for chronic pain.

A controlled clinical trial investigating the effects of stretching and compression exercises on electromyography of calf muscles in chronic LBP patients with a deep gluteal syndrome

BACKGROUND

In deep gluteal syndrome (DGS), the piriformis muscle could impinge the sciatic nerve. The FAIR (flexion adduction internal rotation) test is a provocation test used to identify sciatic nerve irritation caused by this muscle. Compression and stretching exercises are usually prescribed to treat this syndrome. The aim of this study was to compare the effects of these two treatments on surface electromyography (sEMG) of the gastrocnemius and tibialis anterior in patients with low back pain (LBP) and DGS.

MATERIALS AND METHODS

Forty-five participants were allocated to three groups of stretching exercise, compression or control. In addition to 15 min of heat and 15 min of electrical nerve stimulation for pain relief, participants in the compression exercise (CE) group received self-compression exercise, those in the stretching exercise (SE) group received self-stretching exercise and those in the control group received no extra interventions. For the two intervention groups, three sets of two minutes of exercise with two minutes of rest in between were applied. The sEMG amplitude values of the gastrocnemius and tibialis anterior muscles of the affected buttock side of any one group while performing the FAIR test were compared to the others. Pain and disability were assessed and the changes were compared between the two groups.

RESULTS

After the intervention period, no group demonstrated a change in the sEMG of the gastrocnemius or tibialis anterior muscles (p > 0.05). There was no difference in the change in this variable between groups (Mean difference (95% CI) of gastrocnemius was ranged over= -4.04 to 7.72 (-19.44 to 23.14); p = 0.603); (Mean difference (95% CI) of tibialis anterior muscles was ranged from - 2.44 to -6.43 (-18.28 to 9.31); p = 0.550).; Pain and disability also decreased significantly in all three study groups (p < 0.05). However, only the disability of patients who performed stretching exercises improved compared to the compression exercise group (Mean difference (95% CI) = -12.62 (-20.41 to -4.38); p = 0.009).

CONCLUSION

Neither stretching nor compression exercises altered the sEMG of the gastrocnemius and tibialis anterior muscles in patients with DGS. Furthermore, performing stretching exercises improved disability compared to the other interventions.

TRIAL REGISTRATION

The trial was retrospectively registered in the Iranian Registry of Clinical Trials ( www.irct.ir ) on 10/01/2017 as IRCT201604178035N4. URL of the record: https://en.irct.ir/trial/8473 .