An Additional Effect of Electro-Acupuncture on Unspecified Chronic Low Back Pain Among University Employees in Al-kharj, Saudi Arabia: A Randomized Controlled Study

To determine the effect of a series of electro-acupuncture (EA) treatment in conjunction with exercise on the pain, disability, and functional improvement scores of patients with chronic low-back pain (LBP). A blinded prospective randomized controlled study. A total of 52 patients were randomly allocated to an exercise group (n = 26) or an exercise plus EA group (n = 26) and treated for 12 sessions. Numerical Rating Scale (NRS), Aberdeen LBP scale, lumbar spinal active range of movement (AROM), and the isokinetic strength were assessed by a blinded observer. Repeated measures analysis of variance (R-ANOVA) with factors of group and time was used to compare the outcomes between the two groups at baseline (before treatment), immediately after treatment, 1-month follow-up, and 3-month follow-up. The level of significance was set at p = 0.05. Significantly better scores in the NRS and Aberdeen LBP scale were found in the exercise plus EA group immediately after treatment and at 1-month follow-up. Higher scores were also seen at 3-month follow-up. No significant differences were observed in spinal AROM and isokinetic trunk concentric strength between the two groups at any stage of follow-up. This study provides additional data on the potential role of EA in the treatment of LBP, and indicates that the combination of EA and back exercise might be an effective option in the treatment of pain and disability associated with chronic LBP.

BackgroundThere is evidence that core stabilisation, strength and endurance training contribute to reduce low back pain in the general population. However, we are not aware of the effect of these...

Osteopathic physicians are trained to treat patients with musculoskeletal symptoms, to treat somatic dysfunction with osteopathic manipulative treatment (OMT), and to avoid unnecessarily prescribing drugs such as opioids. It is also generally believed that osteopathic physicians provide a unique patient-centered approach to medical care that involves effective communication and empathy. Such training and characteristics of osteopathic medical care (OMC) may enhance clinical outcomes among patients with chronic pain. The objectives of this study were to measure and compare the process and longitudinal outcomes of chronic low back pain (CLBP) treatment provided by osteopathic and allopathic physicians and to identify mediators of the treatment effects of OMC. This retrospective cohort study was conducted utilizing adult participants with CLBP within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from April 2016 through December 2022. Participants having an osteopathic or allopathic physician for at least 1month prior to registry enrollment were included and followed at quarterly intervals for up to 12months. Physician communication and physician empathy were measured at registry enrollment. Opioid prescribing and effectiveness and safety outcomes were measured at registry enrollment and for up to 12months and were analyzed with generalized estimating equations to compare participants treated by osteopathic vs. allopathic physicians. Multiple mediator models, including physician communication, physician empathy, opioid prescribing, and OMT, with covariate adjustments, were utilized to identify mediators of OMC treatment effects. A total of 1,079 participants and 4,779 registry encounters were studied. The mean (SD) age of participants at enrollment was 52.9 (13.2) years, 796 (73.8 %) were female, and 167 (15.5 %) reported having an osteopathic physician. The mean physician communication score for osteopathic physicians was 71.2 (95 % CI, 67.6-74.7) vs. 66.2 (95 % CI, 64.8-67.7) for allopathic physicians (p=0.01). The respective mean scores for physician empathy were 41.6 (95 % CI, 39.9-43.2) vs. 38.3 (95 % CI, 37.6-39.1) (p<0.001). There was no significant difference in opioid prescribing for low back pain between osteopathic and allopathic physicians. Although participants treated by osteopathic physicians reported less severe nausea and vomiting as adverse events potentially attributable to opioids in a multivariable model, neither result was clinically relevant. OMC was associated with statistically significant and clinically relevant outcomes pertaining to low back pain intensity, physical function, and health-related quality of life (HRQOL) over 12months. Physician empathy was a significant mediator of OMC treatment effects in each of the three outcome domains; however, physician communication, opioid prescribing, and OMT were not mediators. The study findings indicate that osteopathic physicians provide a patient-centered approach to CLBP treatment, particularly involving empathy, that yields significant and clinically relevant outcomes pertaining to low back pain intensity, physical function, and HRQOL over 12months of follow-up.

Background/Aims: Multifidus muscle is an important contributor to low back pain as it atrophies and is inhibited during the first episode of low back pain. This study aims to compare the effectiveness of lumbar stabilisation exercise with treadmill walking on multifidus muscle activation, pain intensity and functional disability among people with chronic mechanical low back pain. Methods: Individuals with chronic mechanical low back pain were randomised into two groups: Group 1 (n=25) performed lumbar stabilisation exercises following the McGill protocol; and Group 2 (n=25) followed the modified Bruce treadmill walking protocol. Participants walked or exercised three times a week for 8 weeks. Pain intensity (measured using a visual analogue scale), functional disability (using the Oswestry Disability Index Questionnaire) and amplitude of multifidus muscle activation (using a surface electromyography machine) were assessed at baseline and at the end of week 8. Data were analysed using descriptive statistics, paired and independent t-tests at α≤0.05. Findings: There were no significant differences between the groups' anthropometric and clinical characteristics at baseline. Both groups demonstrated significant reductions in pain intensity and functional disability and increases in multifidus muscle activation at the end of the study (all P&lt;0.05). Group 1 had lower pain intensity (2.60 ± 0.48 vs 4.50 ± 0.12) and functional disability (24.20 ± 4.06 vs 40.00 ± 10.56) and significantly higher multifidus muscle activation levels (40.00 ± 4.16 vs 26.95 ± 4.04; P&lt;0.05) than Group 2 at the end of week 8. Conclusions: Lumbar stabilisation exercises are more effective than treadmill walking exercises in activating the multifidus muscle, reducing pain intensity and functional disability in individuals with chronic mechanical low back pain.

Research background. Chronic nonspecifc low back pain is one of the most widespread health problems in modern society. Massage together with oils is commonly used for low back pain. However, no studies are available on the effect of classical massage with different oils on functional state and pain in patients with chronic low back pain. The aim of this research was to determine the effects of classical massage with different oils on patients with chronic nonspecifc low back pain. Methods. This study included 14 women. They were randomly assigned into two groups. The experimental group received classical massage using oil of natural components and the control group received massage with Vaseline oil. All participants received seven massage sessions, one session lasted 20 min. Pain intensity (VAS scale), functional disability level (Oswestry Low Back Disability Questionnaire) and measurement of spine flexion range of motion (Modifed Shober test) were evaluated before and after intervention. Results. Both groups showed signifcant improvements in pain intensity (p &lt; 0.05). Massage with oil of natural components was more effective then massage with Vaseline oil in reducing pain (p &lt; 0.05). Functional disability decreased in both groups (p &lt; 0.05), but no signifcant difference was found between groups. The range of motion changes were not signifcant after intervention in two groups. Conclusions. Classical massage with oil of natural components and classical massage with Vaseline oil were found to be effective in relieving pain and decreasing functional disability in patients with chronic low back pain. Massage with oil of natural components was more effective than massage with Vaseline oil in reducing pain.Keywords: chronic nonspecifc low back pain, classical massage, oil.

BackgroundPrevious studies have shown that acupuncture and electroacupuncture (EA) are effective in the treatment of patients with low back pain. However, there is little evidence to support the use of one intervention over the other. The aim of this study is to compare the effect of acupuncture and electroacupuncture in the treatment of pain and disability in patients with chronic nonspecific low back pain.Methods/designThe study design is a randomized controlled trial. Patients with nonspecific chronic low back pain of more than three months duration are recruited at Rehabilitation Center of Taboao da Serra - SP (Brazil). After examination, sixty-six patients will be randomized into one of two groups: acupuncture group (AG) (n = 33) and electroacupuncture group (EG) (n = 33). Interventions will last one hour, and will happen twice a week for 6 weeks. The primary clinical outcomes will be pain intensity as measured and functional disability. Secondary outcomes: quality of pain, quality of life. perception of the overall effect, depressive state, flexibility and kinesiophobia. All the outcomes will be assessed will be assessed at baseline, at treatment end, and three months after treatment end. Significance level will be determined at the 5 % level. Results of this trial will help clarify the value of acupuncture and electroacupuncture as a treatment for chronic low back pain and if they are different.DiscussionResults of this trial will help clarify the value of acupuncture needling and electroacupuncture stimulation of specific points on the body as a treatment for chronic low back pain.Trial RegistrationClinicaltrials.gov: NCT02039037. Register October 30, 2013.

Background Chronic mechanical low back pain is a common clinical condition encountered by physical therapists. It has a mechanical origin that lasts more than 3 months. Aim The aim of this study was to investigate the effects of the suboccipital muscle inhibition technique on pain intensity, range of motion (ROM), and functional disability in patients with chronic mechanical low back pain. Patients and methods Thirty female patients with a mean age of 23.8±0.86 years who had chronic mechanical low back pain were randomly assigned to two equal groups. Group A received exercise training (stretching and strengthening) and the suboccipital muscle inhibition treatment for five consecutive sessions. Group B received only exercise training (stretching and strengthening) for five consecutive sessions. Both groups were assessed using the visual analog scale for pain intensity, Modified–Modified Schober’s test for ROM of lumbar flexion and extension, and the Oswestary functional disability questionnaire for functional disability. Patients were assessed before and after treatment. Results The results of this study showed that there were significant improvements in pain, ROM in the lumbar region (flexion and extension), and functional disability in both groups A and B (P Conclusion It was concluded that the suboccipital muscle inhibition technique combined with exercises have better clinical effects than exercises alone in patients with chronic mechanical low back pain.

Background: Chronic low back pain (CLBP) is a prevalent condition affecting a significant portion of the global population, leading to decreased quality of life and increased healthcare utilization. Previous research has identified manual therapies, such as the Muscle Energy Technique (MET) and the Bowen Technique, as potential interventions for reducing pain and improving functional outcomes in patients with CLBP. These techniques focus on reducing muscular tightness and improving flexibility, which are often implicated in the etiology of low back pain. Objective: The aim of this study was to compare the effects of the MET and the Bowen Technique on hamstring tightness and pain reduction in patients with CLBP. Methods: This randomized controlled trial included 62 participants with CLBP, who were divided into two groups to receive either the MET or the Bowen Technique. The interventions were administered over an 8-week period, with sessions occurring three times per week. Outcome measures included hamstring flexibility (measured by the Active Knee Extension Test), pain intensity (measured by the Visual Analogue Scale), and functional disability (measured by the Oswestry Disability Index). Data were analyzed using repeated measures ANOVA and independent t-tests. Results: Both groups showed significant improvements in all measured outcomes. Participants in the MET group demonstrated a greater reduction in pain intensity from baseline to 8 weeks (5.5161±1.20750 to 1.4839±1.15097, P&lt;0.000) compared to the Bowen Technique group (7.2258±0.88354 to 0.2581±0.51431, P&lt;0.000). Similarly, hamstring flexibility and functional disability scores improved significantly in both groups, with the MET group showing slightly more substantial improvements in functional disability. Conclusion: The study concluded that both the MET and the Bowen Technique are effective interventions for reducing pain and improving hamstring flexibility in patients with CLBP. However, the MET showed a slight advantage in improving functional disability outcomes.

To assess the clinical utility of 5 physical therapy (PT) outcome measures in quantifying functional changes in pediatric lower extremity chronic pain treated at a hospital-based interdisciplinary rehabilitation center. This was a cross-sectional study with retrospective review of 173 individuals, 8 to 18 years old, treated from June 2008 to 2013. The measures used were the Timed Up and Go, Timed Up and Down Stairs, Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, 6-minute walk test, and Lower Extremity Functional Scale. Participant performance was correlated with demographic characteristics, the Functional Disability Index, Multidimensional Anxiety Scale for Children, Child Depression Inventory, and Canadian Occupational Performance Measure. Scores from all 5 PT measures showed significant improvement following treatment. Functional Disability Index correlated to every PT measure except the 6-minute walk test. This study supports the clinical use of these PT measures to track functional progress after rehabilitative treatment of lower extremity chronic pain-related disability.

Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine.

More than two-thirds of pregnant women experience low-back pain and almost one-fifth experience pelvic pain. The two conditions may occur separately or together (low-back and pelvic pain) and typically increase with advancing pregnancy, interfering with work, daily activities and sleep. To update the evidence assessing the effects of any intervention used to prevent and treat low-back pain, pelvic pain or both during pregnancy. We searched the Cochrane Pregnancy and Childbirth (to 19 January 2015), and the Cochrane Back Review Groups' (to 19 January 2015) Trials Registers, identified relevant studies and reviews and checked their reference lists. Randomised controlled trials (RCTs) of any treatment, or combination of treatments, to prevent or reduce the incidence or severity of low-back pain, pelvic pain or both, related functional disability, sick leave and adverse effects during pregnancy. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We included 34 RCTs examining 5121 pregnant women, aged 16 to 45 years and, when reported, from 12 to 38 weeks' gestation. Fifteen RCTs examined women with low-back pain (participants = 1847); six examined pelvic pain (participants = 889); and 13 examined women with both low-back and pelvic pain (participants = 2385). Two studies also investigated low-back pain prevention and four, low-back and pelvic pain prevention. Diagnoses ranged from self-reported symptoms to clinicians' interpretation of specific tests. All interventions were added to usual prenatal care and, unless noted, were compared with usual prenatal care. The quality of the evidence ranged from moderate to low, raising concerns about the confidence we could put in the estimates of effect. For low-back painResults from meta-analyses provided low-quality evidence (study design limitations, inconsistency) that any land-based exercise significantly reduced pain (standardised mean difference (SMD) -0.64; 95% confidence interval (CI) -1.03 to -0.25; participants = 645; studies = seven) and functional disability (SMD -0.56; 95% CI -0.89 to -0.23; participants = 146; studies = two). Low-quality evidence (study design limitations, imprecision) also suggested no significant differences in the number of women reporting low-back pain between group exercise, added to information about managing pain, versus usual prenatal care (risk ratio (RR) 0.97; 95% CI 0.80 to 1.17; participants = 374; studies = two). For pelvic painResults from a meta-analysis provided low-quality evidence (study design limitations, imprecision) of no significant difference in the number of women reporting pelvic pain between group exercise, added to information about managing pain, and usual prenatal care (RR 0.97; 95% CI 0.77 to 1.23; participants = 374; studies = two). For low-back and pelvic painResults from meta-analyses provided moderate-quality evidence (study design limitations) that: an eight- to 12-week exercise program reduced the number of women who reported low-back and pelvic pain (RR 0.66; 95% CI 0.45 to 0.97; participants = 1176; studies = four); land-based exercise, in a variety of formats, significantly reduced low-back and pelvic pain-related sick leave (RR 0.76; 95% CI 0.62 to 0.94; participants = 1062; studies = two).The results from a number of individual studies, incorporating various other interventions, could not be pooled due to clinical heterogeneity. There was moderate-quality evidence (study design limitations or imprecision) from individual studies suggesting that osteomanipulative therapy significantly reduced low-back pain and functional disability, and acupuncture or craniosacral therapy improved pelvic pain more than usual prenatal care. Evidence from individual studies was largely of low quality (study design limitations, imprecision), and suggested that pain and functional disability, but not sick leave, were significantly reduced following a multi-modal intervention (manual therapy, exercise and education) for low-back and pelvic pain.When reported, adverse effects were minor and transient. There is low-quality evidence that exercise (any exercise on land or in water), may reduce pregnancy-related low-back pain and moderate- to low-quality evidence suggesting that any exercise improves functional disability and reduces sick leave more than usual prenatal care. Evidence from single studies suggests that acupuncture or craniosacral therapy improves pregnancy-related pelvic pain, and osteomanipulative therapy or a multi-modal intervention (manual therapy, exercise and education) may also be of benefit.Clinical heterogeneity precluded pooling of results in many cases. Statistical heterogeneity was substantial in all but three meta-analyses, which did not improve following sensitivity analyses. Publication bias and selective reporting cannot be ruled out.Further evidence is very likely to have an important impact on our confidence in the estimates of effect and change the estimates. Studies would benefit from the introduction of an agreed classification system that can be used to categorise women according to their presenting symptoms, so that treatment can be tailored accordingly.

Low back pain (LBP) poses a serious challenge worldwide to the health care system. Therapeutic exercises are considered one of the major interventions for decreasing pain and increasing self-efficacy. Gluteus Medius muscle has been found to be weak and tender in patients with Non-specific Chronic Low Back Pain (LBP). This study therefore aimed to establish the effect of Gluteus Medius strengthening on pain, functional disability, quality of life and physical activity of individuals with NSCLBP. Fifty (50) individuals with NSCLBP were recruited from two hospitals in Lagos State Nigeria. Participants were randomly assigned into two groups: Participants in group one received stabilization exercises, while participants in group two received gluteus Medius strengthening exercises in addition to stabilization exercises. Measurement of pain, functional disability, quality of life and physical activity were measured using the Numerical rating scale, Oswestry disability index, SF-36 questionnaire and International Physical Activity Questionnaire respectively at baseline, 4th week and 8th week post intervention. Independent t-test was used to compare the variables between the groups and repeated measure ANOVA was used to compare variables within the groups at 95% confident interval. Findings from this study revealed improved clinical outcomes in all variables in the two groups post intervention (p

Background/aims The lumbosacral curvature of the spine has a special role in its mobility during weight-bearing activities. Office work is a sedentary role, which requires sitting for long durations, having a negative effect on spinal posture. Therefore, low back pain risk factors in office workers are different from other populations. The aim of this study was to examine the effect of lumbosacral joint angle on the lumbar mobility, functional disability, pain intensity and overall health in office workers with chronic low back pain. Methods A total of 116 male office workers with chronic low back pain (aged between 30–59 years) participated in this cross-sectional study. The lumbosacral radiography was used to divide the participants into two groups, according to the value of their lumbosacral joint angle: group A (lumbosacral joint angle &lt;20°, n=61) and group B (lumbosacral joint angle group &gt;20°, n=55). The lumbar mobility, functional disability, pain intensity and overall health issues of participants were measured. Results The functional disability and pain intensity of individuals in group A were significantly higher than group B (P&lt;0.05). There was a significant decrease in the lumbar flexion and extension range of motion and activities of daily living of those in group A compared to group B (P&lt;0.05). There was a significant increase in emotional health problems and impaired social activity of individuals in group A compared to group B (P&lt;0.05). There were fair positive correlations between lumbosacral joint angle values and functional disability, pain intensity and social activity in office workers in group B (r=0.292, 0.036, 0.333 respectively). Conclusions A decreased lumbosacral joint angle increases functional disability and pain intensity, decreasing lumbar mobility and level of functionality. Furthermore, it reduces emotional health and social activity in participants with low back pain. Therefore, measuring the lumbosacral joint angle of patients with chronic low back pain during treatment may be useful to decrease their pain intensity and improve their functional disability and quality of life.

Prospective, randomized, controlled trial. To investigate the effectiveness of home-based exercise on pain, dysfunction, and quality of life (QOL) in Japanese individuals with chronic low back pain (CLBP). Exercise therapy is a widely used treatment for CLBP in many countries. The studies on its effectiveness have been performed only in Western industrialized countries. The existence of cross-cultural differences and heterogeneity of patients in each country may influence the outcome of interventions for CLBP. Data that would enable researchers to compare the effectiveness of interventions between widely different societies is lacking. A total of 201 patients with nonspecific CLBP were randomly assigned to either the control or exercise therapy group: 89 men and 112 women with a mean age of 42.2 years. The control group was treated with nonsteroidal anti-inflammatory drugs (NSAIDs), and the exercise group performed trunk muscle strengthening and stretching exercises. The primary outcome measures were pain intensity (visual analogue scale) and dysfunction level (Japan Low back pain Evaluation Questionnaire [JLEQ] and Roland-Morris Disability Questionnaire [RDQ]) over 12 months. The secondary outcome measure was FFD (Finger-floor distance). Statistical analysis was performed using Wilcoxon signed-ranks and Mann-Whitney U tests, and estimation of the median with 95% CI was calculated. In both groups, significant improvement was found at all points of follow-up assessment. However, JLEQ and RDQ were significantly more improved in the exercise group compared to the control group (P = 0.021 in JLEQ, P = 0.023 in RDQ). The 95% CI for the difference of medians of the change ratio between exercise and NSAID groups, [Exercise] - [NSAID], was -0.25 to -0.02 in JLEQ, -0.33 to 0.00 in RDQ, and -0.20 to 0.06 in visual analogue scale. The home-based exercise prescribed and monitored by board-certified orthopedic surgeons was more effective than NSAIDs for Japanese patients with CLBP.

Research background. In the modern society, lower back pain is the most widespread health disorder with negative economic consequences for healthcare costs and labour productivity. According to the epidemiological research, lower back pain is ranked 6th out of 291 diseases and conditions, that cause the highest rate worldwide of incapacity to work. The aim of the research was to establish the effect of different physoiotherapy methods on pain, torso functional of people with chronic non-specifc lower back pain. Methods. Forty patients were included in the study. Subjects were divided into control and three experimental groups: back-stabilization exercises group; physiotherapy in water group; Nordic walking group. We measured intensity of lower back pain, functional state of the torso, mobility of lumbar spine, active movements amplitudes and the static endurance of the torso. Results. It was found that all the analysed parameters statistically significantly (p &lt; 0.05) improved in all examined groups. While assessing the results of the investigated groups interdependently, it was determined that the parameters such as: the intensity of the pain, the functional state and the mobility of the torso, statistically signifcantly (p &lt; 0.05) improved more effectively in the physiotherapy in water and back-stabilization exercise groups in comparison with the Nordic walking group. Conclusions. Physiotherapy procedures in water and back-stabilization exercises decreased the intensity of the pain and functional disability, improved the lumbar spine mobility and active movements amplitudes, more efciently than the programme of Nordic walking, for people with chronic non-specifc lower back pain. However, all three types of exercises equally increased the static endurance of the torso.Keywords: chronic non-specifc lower back pain, spinal stabilization exercises, physiotherapy in water, Nordic walking.