What Do Guidelines Say About First-Line Treatment of Acute Low Back Pain?

Managing Nontraumatic Acute 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...

Objectives: To review the available evidence on the effectiveness of acupuncture in the treatment of low back pain. Data Sources:MEDLINE, National Guideline Clearinghouse, Guidelines Finder, Cochrane Library, DARE, Bandolier, UpToDate and Index of Portuguese Medical Magazines. Review Methods: Research using the MeSH terms acupuncture and low back pain and the DeCS terms acupuntura e dor lombar. The search was limited to articles published between January 2000 and May 2009 in english, portuguese and spanish. American Family Physicians Strength of Recommendation Taxonomy (SORT) was used to assess the level of evidence. Results: Two meta-analysis, six systematic reviews, three randomised controlled trials and three guidelines met inclusion criteria. Guidelines say that acupuncture might be helpful in the treatment of low back pain. Unspecific chronic low back pain: the meta-analysis, systematic reviews and randomised controlled trials demonstrated that acupuncture is more effective than notreatment and that the association of acupuncture with conventional treatment is more effective than isolated conventional treatment. The studies didnt demonstrate that acupuncture was more effective than placebo or conventional therapies. Acute low back pain: data are inconclusive. Conclusions: Acupuncture is effective in the treatment of unspecific chronic low back pain, isolated or in addition to other interventions (SORT A); it was not proved that acupuncture was superior to other interventions. In the treatment of acute low back pain, there was no evidence of effectiveness of acupuncture. It would be advisable to do high quality, long-term, controlled and randomised studies, addressing its cost-benefit.

The efficacy and safety of a homeopathic gel in the treatment of acute low back pain: a multi-centre, randomised, double-blind comparative clinical trial

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

Tizanidine and aceclofenac individually have shown efficacy in the treatment of low back pain. The efficacy and tolerability of the combination have not yet been established. The objective of the study was to evaluate the efficacy and safety of aceclofenac-tizanidine fixed dose combination against aceclofenac alone in patients with acute low back pain. This double-blind, double-dummy, randomized, comparative, multicentric, parallel group study enrolled 197 patients of either sex in the age range of 18-70 years with acute low back pain. The patients were randomized to receive either aceclofenac (100 mg)-tizanidine (2 mg) b.i.d or aceclofenac (100 mg) alone b.i.d for 7 days. The primary efficacy outcomes were pain intensity (on movement, at rest and at night; on VAS scale) and pain relief (on a 5-point verbal rating scale). The secondary efficacy outcomes measures included functional impairment (modified Schober's test and lateral body bending test) and patient's and investigator's global efficacy assessment. aceclofenac-tizanidine was significantly superior to aceclofenac for pain intensity (on movement, at rest and at night; P < 0.05) and pain relief (P = 0.00) on days 3 and 7. There was significant increase in spinal flexion in both the groups from baseline on days 3 and 7 with significant difference in favour of the combination group (P < 0.05). There were significantly more number of patients with excellent to good response for the aceclofenac-tizanidine treatment as compared to aceclofenac alone (P = 0.00). Both the treatments were well tolerated. In this study, aceclofenac-tizanidine combination was more effective than aceclofenac alone and had a favourable safety profile in the treatment of acute low back pain.

The aim of this research was to investigate the relative effectiveness of manipulation versus core rehabilitation in the treatment of acute mechanical low back pain in sedentary patients. Recent research has found that dysfunction of the primary core stabiliser muscles is linked with an increasing number of the general population suffering from low back pain; this is thought to be due to the fact that people in general are living more sedentary lifestyles. The Aims and Objectives of this study were to determine the relative effect of manipulation and core rehabilitation in sedentary patients suffering from acute mechanical low back pain in terms of subjective findings, objective findings and to determine any correlations between these findings Thirty-two participants, with acute low back pain participated in the study. They received treatment over a period of three weeks, two treatments in the first week, two treatments in the second week and a follow up seven days later. Group A received a spinal manipulation while Group B received core rehabilitation exercises. Readings were taken at three time points, namely visit one, three and five before the treatment, they included the following readings: Numerical Pain Rating Scale, Algometer, Roland Morris Low Back Pain and Disability Questionnaire, Biofeedback Stabiliser and the Surface EMG. The results showed that there was no differential (p&lt;0.05) treatment effect between the two Groups, and that both Groups showed a clinical improvement in their low back pain. In conclusion, it appears that even though both these treatment protocols have very different mechanisms of action, both can be effective treatment protocols and that core rehabilitation exercises when properly performed are as effective as manipulation in the treatment of acute low back pain.

THU0600 Value of Mesotherapy for Treatment of Chronic Low Back Pain: A Randomized Trial

Core strengthening has become a major trend in the rehabilitation of patients suffering with acute low back pain. Clinical trials have shown that core strengthening is beneficial for patients with low back pain. According to the literature, core strengthening consists of activating the trunk musculature in order to stabilize hypermobile symptomatic joints and thus, lessen mechanical stress to the spine. Literature suggests that vibration/acceleration training may be a more effective and sufficient method of core stability exercises, with regards to core muscle endurance and activation in treatment of acute low back pain. This may have more advantages than using traditional core stability exercises in the treatment of acute low back pain. However, vibration/acceleration training as core stability exercises has yet to be investigated. In order to choose the most appropriate treatment protocol for managing this condition, it is essential for research to be carried out to identify the most effective treatment, which would allow for better overall management of low back pain during the acute period. Therefore, this study was designed to establish the effectiveness of vibration/acceleration training as a core stability exercise in the treatment of acute low back pain and to establish whether this protocol should be utilized routinely in the management of this condition.

The intention of this study was to investigate any additional benefits of pulsed electromagnetic energy used as an adjunct to routine physiotherapy for the treatment of acute non-specific low back pain. To address this aim, a single centre, double blinded, placebo controlled randomised control trial was conducted. Forty participants presenting to the University of Otago, School of Physiotherapy Clinic with acute non-specific low back pain (&lt; 6 weeks) were recruited. The Oswestry Disability Index was employed as the primary outcome measure. Secondary outcomes included the Patient Specific Functional Scale and the Numeric Pain Rating Scale. Outcomes were collected at baseline, one week and four weeks (or discharge). Baseline characteristics exhibited no differences between groups. The group treated with active pulsed electromagnetic energy failed to demonstrate any significant additional improvements in Oswestry Disability Index, Patient Specific Functional Scale or Numeric Pain Rating Scale scores (p &gt; 0.05). Irrespective of group allocation, all participants experienced significant improvements in Oswestry Disability Index, Patient Specific Functional Scale and Numeric Pain Rating Scale scores over both follow-up periods (p&lt;0.05). Concisely, pulsed electromagnetic energy provides no significant additional benefit to physiotherapy in the treatment of acute non-specific low back pain.

Low back pain

Introduction: Lower back pain is one of the most common disorders in the world. Acupuncture is one the methods of treatment, but its efficiency is still researched. Aim of the study: To verify the effectiveness of acupuncture on low back pain. Material and Methods: Search of the PubMed database using the following keywords: acupuncture, lower back pain. Only full-length articles were taken into consideration. Results: The studies show that acupuncture is effective in the treatment of chronic low back pain and is not inferior to the usual care. However its efficiency in treatment of acute low back pain is not satisfactory and patients still require additional pharmacotherapy. Conclusion: Acupuncture is efficient in the treatment of chronic low back pain, however more research is needed on its efficiency in treatment of acute low back pain. Keywords: acupuncture, lower back pain

A systematic review summarizes the results of studies on the efficacy of myorelaxants (tolperisone, tizanidine, thiocolchicoside or baclofen) in the treatment of acute nonspecific low back pain published up to Dec. 2017. The authors conclude that there are enough data to confirm the efficacy of myorelaxants in treatment of nonspecific low back pain, myorelaxants are recommended as monotherapy or in combination with analgesics or NSAID, the nonsedative drugs tolperisone or thiocolchicoside should be preferred.

BackgroundMany methods have been used in to treat low back pain. In this study, we aimed to investigate the efficacy of dexketoprofen alone and in combination with methylprednisolone in the treatment of low back pain in the emergency department using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI).MethodsThis prospective, randomized, single-blind study included 150 patients admitted to the emergency department of a university hospital. Patients with low back pain were divided in to two groups: those receiving intravenous dexketoprofen treatment (Group D) and those receiving dexketoprofen + methylprednisolone treatment (Group DM). The efficacy of the treatments received by the patients was evaluated with the VAS at minutes 0, 15, 30, and 60 and hour 48. Statistical evaluations were also undertaken on the ODI results evaluated at minute 0 and hour 48.ResultsThe VAS scores decreased in both groups at all follow-up evaluations performed throughout the treatment (p = 0.000). The mean VAS score evaluated 48 h after treatment was 1.69 ± 1.71 (Median:1) cm in Group DM and 4.13 ± 2.27 (Median:4) cm in Group D (p = 0.000). The decrease in the ODI score was greater in Group DM than in Group D (p = 0.000).ConclusionDexketoprofen showed analgesic efficacy in the treatment of non-traumatic low back pain and decreased disability. When combined with methylprednisolone, dexketoprofen treatment exhibit a greater analgesic effect and further reduced disability.Trial registrationCurrent Controlled Trials NCT06932367 (Retrospectively registered).Clinical trial numberNot applicable.

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.