Effects of strength training program in the treatment of chronic non-specific low back pain

BackgroundChronic low back pain is considered to be one of the main causes of absenteeism from work and primary and specialized consultations. The symptoms of nonspecific chronic low back pain may be accompanied by the activation of myofascial trigger points in the muscles, together with local and/or referred pain. Electrical dry needling is increasingly used in the treatment of lumbar myofascial pain. Conventional physiotherapy, however, is a popular approach to chronic pathologies, and there is evidence of different modalities of physiotherapy being used in the treatment of chronic low back pain. The aim of this study has been to determine the effectiveness of electrical dry needling versus conventional physiotherapy when applied to active and latent myofascial trigger points in patients with nonspecific chronic low back pain.MethodsThis is a controlled, randomized, two-arm, double-blind study. A total of 92 patients with chronic low back pain (time to onset ≥ 3 months, Roland Morris Disability Questionnaire score ≥ 4) will be recruited from the University of Almería. Participants will be divided into two study groups (n = 40) to receive treatment of low back pain with electrical dry needling and conventional physiotherapy (ischaemic compression, analytic stretching and postural education training dossier). A total of 6 sessions will be administered once a week for 6 weeks. Pain intensity, disability, fear of movement, quality of life, quality of sleep, anxiety and depression, pressure pain threshold, abdominal strength and lumbar mobility will be recorded at 6 weeks (post-immediate) and 2 months after the end of treatment.DiscussionWe believe that an approach including electrical dry needling to chronic low back pain dysfunction will be more effective in these patients. The results of this study will inform clinicians on which type of treatment is more beneficial for patients with chronic low back pain.Trial registrationClinicalTrials.gov NCT04804228. Registered on 14 January 2021

The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain.

Introduction The health locus of control is defined as the perception of individuals in relation to whom they believe to be responsible for their health condition, including low back pain.Objective To identify whether individuals suffering from chronic low back pain in active physical therapy treatment believe they are responsible for their own condition.Material and methods Cross-sectional study involving 28 patients under active physical therapy treatment for non-specific chronic low back pain. Sociodemographic data and low back characteristics — including disability and pain severity — were collected. The Multidimensional Health Locus of Control (MHLC) scale was used to assess the health locus of control.Results Participants undergoing active low back pain treatment presented a mean (SD) of 26 points (11.40) in a 0–100 point scale for disability and 6.39 points (2.24) on a 0–10 scale for pain. In relation to the health locus of control, the means (SD) for internal, external and chance subscales were, respectively: 29.32 (3.98), 24.75 (3.58), and 13.71 (6.67). 82.1% of the participants presented higher rates for internal locus of control.Conclusion Patients undergoing active treatment for chronic low back pain believe they are responsible for their own condition. Further longitudinal studies may determine whether active treatments affect the beliefs of low back pain patients.

Managing Nontraumatic Acute Back Pain

The treatment of chronic low back pain is not primarily focused on removing an underlying organic pathology, but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioural interventions are commonly used in the treatment of chronic (disabling) low back pain. The objective of this systematic review was to determine if behavioural therapy is more effective than reference treatments for chronic non-specific low back pain, and which type of behavioural treatment is most effective. We searched the Medline, PsycLit databases, and the Cochrane Controlled Trials Register up to April 1999, Embase up to September 1999. We also screened references of identified randomised trials and relevant systematic reviews. Only randomised trials on any type of behavioural treatment for non-specific chronic low back pain were included. Methodological quality assessment and data extraction was done by two reviewers independently. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioural outcomes, overall improvement, back pain specific and generic functional status, return to work, and pain intensity) using the random effects model. Only 6 studies (25%) were high quality. There is strong evidence (level 1) that behavioural treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% CI 0.25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI -0.04, 0.74) and behavioural outcomes (pooled effect size 0.40; 95% CI 0.10, 0.70) of chronic low back pain patients when compared to waiting list controls or no treatment. There is moderate evidence (level 2) that an additional behavioural component to a usual treatment program for chronic low back pain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% CI - 0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI - 0.30, 0. 36) and behavioural outcomes (pooled effect size 0.19; 95% CI - 0.08, 0.45). Behavioural treatment seems to be an effective treatment for chronic low back pain patients, but it is still unknown what type of patients benefit most from what type of behavioural treatment.

Benefits and harms of treatments for chronic nonspecific low back pain without radiculopathy: systematic review and meta-analysis

Low back pain, one of the skeletal and muscular system problems, is one of the most common chronic diseases in the world. Chronic low back pain is an important disorder that affects the daily, social, and work-life of individuals. The majority of people experience low back pain at least once in their life. In this sense, it affects both social and economic life. Low back pain can be acute or chronic, depending on the duration of the syndrome. Interventional, medication, rehabilitation, and exercise methods can be used in the treatment of chronic low back pain. In this study, it was investigated which exercise among the exercise models was more effective in the treatment of non-specific chronic low back pain. “Exercise” and “Chronic low back pain” were used as keywords in database searches. As treatment approaches, the effects of Abdominal Hypopressive exercise, Pilates, Yoga, Tai Chi, McKenzie, Gait, Dynamic and Static Stabilization Exercises, Motor Control and Gradual Activity Exercises in patients with low back pain were investigated. It has been determined that all the exercise models investigated reduce non-specific chronic low back pain and positively affect the mental state and quality of life of the patients. The fact remains that, it can be said that Pilates exercises come into prominence more than other exercises in terms of the stated effects.

Back pain is the second leading cause of disability among American adults and is currently treated either with conservative therapy or interventional pain procedures. However, the question that remains is whether we, as physicians, have adequate therapeutic options to offer to the patients who suffer from chronic low back pain but fail both conservative therapy and interventional pain procedures before they consider surgical options such as discectomy, disc arthroplasty, or spinal fusion. The purpose of this article is to review the potential novel therapies that are on the horizon for the treatment of chronic low back pain. We discuss medications that are currently in use through different phases of clinical trials (I–III) for the treatment of low back pain. In this review, we discuss revisiting the concept of chemonucleolysis using chymopapain, as the first drug in an intradiscal injection to reduce herniated disc size, and newer intradiscal therapies, including collagenase, chondroitinase, matrix metalloproteinases, and ethanol gel. We also review an intravenous glial cell-derived neurotrophic growth factor called artemin, which may repair sensory nerves compressed by herniated discs. Another new drug in development for low back pain without radiculopathy is a subcutaneous monoclonal antibody acting as nerve growth factor called tanezumab. Finally, we discuss how platelet-rich plasma and stem cells are being studied for the treatment of low back pain. We believe that with these new therapeutic options, we can bridge the current gap between conservative/interventional procedures and surgeries in patients with chronic back pain.

ObjectivesTo investigate the efficacy of non-surgical and non-interventional treatments for adults with low back pain compared with placebo.Eligibility criteriaRandomised controlled trials evaluating non-surgical and non-interventional treatments compared with placebo or...

Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs. The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments. We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update. We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration. Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo. We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity.For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias. Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups. We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective of this systematic review is to assess the effectiveness of exercise therapy for reducing pain and disability and improving overall health in adults with non‐specific chronic LBP compared to no treatment (including placebo and sham treatment) and other conservative treatments. Subsequent investigations will compare the effectiveness of different types of exercise therapy and explore exercise intervention characteristics that decrease pain and improve function in adults with non‐specific persistent LBP.

To assess analgesic properties of melatonin in the treatment of chronic non-specific low back pain and to study predictors of its efficacy. A study included 178 patients, aged from 40 to 65 years, with chronic non-specific low back pain during >3 month and the VAS score >3. Patients were stratified into 6 groups (3 pairs of comparison). In the first pair, patients of both groups received a combination of 500 mg of glucosamine hydrochloride and 500 mg of chondroitin sulfate; in the second pair - a combination of 500 mg of glucosamine hydrochloride and 500 mg of chondroitin sulfate and diclofenac, in the third pair - diclofenac. All patients received additionally melaxen. The duration of the study was 3 month in the first pair and one month in the second and third pairs. With regard to response to melatonin, patients of the main groups were divided into responders and non-responders. Baseline factors determining the efficacy of treatment with melatonin were studied. A significant reduction in pain intensity at movement and resting state was noted in all main groups compared to comparison groups. This result indicates possible analgesic properties of melatonin. Moreover, factors predicting the efficacy of such therapy were determined. Addition of melatonin to the standard scheme of low back pain treatment increases its efficacy, in particular in case of comorbidity of pain and sleep disorders and depressive symptoms.

Intradermal administration of analgesic drugs with mesotherapy is effective for the local treatment of musculoskeletal pain. Few studies analyzed the effects of different drugs administrated with this technique. The aim of this study was to compare the efficacy of diclofenac versus lysine acetylsalicylate-based mesotherapy in relieving pain (primary outcome), and disability (secondary outcome) in patients with nonspecific chronic low back pain. Retrospective observational study. Outpatient rehabilitation medicine center. Records of 101 patients with nonspecific chronic low back pain. Data were extracted from the outpatients records of patients affected by nonspecific chronic low back pain since 12 weeks before, treated with 5 sessions of mesotherapy with diclofenac mixtures (group A) or aspirin-lysine acetylsalicylate mixture (group B). Assessments recorded were taken before the first treatment (T0), at the end of the 5-week treatment (T1), and at 4 (T2) and 12 weeks (T3) of follow-up after the last treatment, using a pain visual analogue scale (VAS) primary outcome, Oswestry Disability Index (ODI) secondary outcome, and the Short-Form McGill Pain Questionnaire (SF-MPQ) Comparisons within and between groups were performed using the t-test, the χ2 test, and analysis of variance (ANOVA) models, as appropriate. Records from 101 patients consecutively were analyzed, 51 in group A (mean age and standard deviation [SD]=62.8±10.7; F/M=33/18) and 50 in group B (mean age±SD=64.1±15.8; F/M=30/20). At baseline VAS, SF-MPQ, ODI scores were respectively 7.6±1.3, 22.49±9.96, 44.80±15.55 (mean and SD) in group A; VAS, SF-MPQ, ODI scores were respectively 6.7±1.6, 18.66±9.65, 39.04±16.06 (mean and SD) in group B. Mean differences between group A and group B in the changes of scores from baseline (T0) to end of study (T3) were -1.3 (VAS), -5.81 (SF-MPQ) and -17.05 (ODI). Mesotherapy induced significant reductions in pain severity and disability in both groups with better results in diclofenac-based treatment. This retrospective pilot study suggests the efficacy and safety of diclofenac mesotherapy for relieving pain and disability in patients affected by chronic nonspecific low back pain in a convenient sample but further studies will confirm these results. Diclofenac mesotherapy appears to be a viable treatment. to reduce pain and improve function in patients affected by chronic moderate-to-severe nonspecific low back pain.

Introduction: Chronic low back pain is the leading cause of disability, which reduces quality of life and increases the healthcare costs. Psychosocial factors (depression, kinesiophobia and somatization) may also have an important role in the appearance and duration of chronic nonspecific low back pain. Depression may predispose low back pain, while the chronicity of pain affects the degree of disability, which is also related to mental health. Many studies suggest the association between depression and low back pain by explaining a significant physiological link. Different types of manual therapy are used in the treatment of chronic low back pain, but recent studies suggest that a rehabilitation models which combine manual therapy and exercise, provide better results compared to individual (separate) applications. The aim of this research was to examine the effects of the rehabilitation program, which in-cludes manual yumeiho therapy and exercise, on depression in people suffering from chronic nonspecific low back pain. Methods: The study included 21 participants, aged 40 to 60 (M=51.1, SD=5.9) who suffer from chronic nonspecific low back pain. The study included the initial and final depression test and the initial and final neuropathic pain test. Between the initial and the final testing, a three-week therapeutic procedure of yumeiho manual therapy and exercise was performed (15 treatments). Repeated estimates of depression and neuropathic pain were tested 30 and 60 days after the implementation of the rehabilitation protocol. Results: Statistically significant improvements were noted between the initial and the final test in both observed variables. Significant improvements (lower depression and neuropathic pain) have also been noted 30 and 60 days after the implementation of the rehabilitation pro-tocol (in relation to the initial state). Conclusion: The findings indicate that the rehabilitation protocol, involving manual yumeiho therapy and exercise, is an effective method for treating depression and neuropathic pain in people suffering from chronic nonspecific low back pain. Considering the lack of research on the effects of manual therapy by yumeiho technique, the results contribute to a better under-standing of technique which, although used in practice, has not been suficiently explored. Further research is required, on comparing this rehabilitation model to other methods, as well as longer follow-up in the post-rehabilitation period.

Low back pain has become the most common critical health problem and it is well known for causing a personal, and community financial burden globally. Low back pain is demarcated as non-specific, non-radiating pain with no accompanying neurological signs and symptoms. Objective: The purpose of this study was to compare the effectiveness between Mckenzie exercises and back school exercises in the treatment of low back pain. Methods: This research included 36 patients who met the eligibility criteria. Prior to undertaking any examinations or receiving treatments, each participant in this study gave their ethical approval via filling out informed consent. Patients with nonspecific chronic back pain were divided randomly into 3 groups. In ‘group A’ only the conventional treatment was provided and in group 2 patients performed back school exercises. Similarly, in group 3 patients performed Mckenzie exercises. The lottery method was used to assign patients to these three randomized groups. All of these aforementioned groups received conventional therapy, which remained identical throughout the study. The conventional treatment included a hot pack for 10 minutes and back isometrics. Additionally, group A received conventional therapy, group B received conventional therapy along with back school exercises, and group 3 received Mckenzie exercises and conventional therapy. Each patient received treatment three times a week for of total 4 weeks. Roland Morris’s disability questionnaire was used to measure self-reported physical impairment due to low back pain. Moreover, a numeric pain rating scale was used to measure pain severity. Results: This study showed that patients receiving back school and Makenzie exercises showed marked improvement in pain and disability scores. Conclusion: This study concluded that Mckenzie exercises are more effective than back school exercises for the management of chronic nonspecific low back pain. That is because Mckenzie’s exercises not only decrease pain but equally improve, the flexibility and posture of the spine