Acute Low Back Pain Research Articles

Prevalence of Acute Low Back Pain after Cesarean Delivery in Health Care Centers

Background: Low back pain is the common problem faced by mothers after cesarean delivery under spinal anesthesia. Application of spinal anesthesia leads to severe acute and chronic low back pain post-delivery. Physiotherapy plays an important role during and after pregnancy as it helps in reducing the incidence of low back pain and others musculoskeletal pain post-delivery. The aim of the study was to determine the prevalence of acute low back pain after cesarean section and to assess the percentage of population aware about antenatal and postnatal physiotherapy and percentages had taken the treatment in Heath care centers. Materials and methods: Study population comprised of 162 caesarean delivery females out of which 104 were selected of age between 19 to 35 having acute low back pain in postnatal cesarean ward of Heath care centers. Population was chosen through convenient sampling. Data collection tools were modified questionnaire. The data collected was analyzed through SPSS software Version 29.0.2.0(20). Prevalence and awareness were measured through descriptive statistics. Result: 64.1% postpartum caesarean section females had low back pain under spinal anesthesia.18.2% had mild pain,34.6% had moderate pain,30.7% had severe pain and 16.4% had very severe pain. Only18.3% were aware of antenatal and postnatal physiotherapy out of which only 6.7% had taken treatment.81.7% were unaware and 93.3% had not taken physiotherapy treatment. Low back pain is dependent upon Occupation and daily activity of the patient, awareness about antenatal and postnatal treatment is dependent upon educational level and patient age is seen as an associative factor for the patient dependency. Conclusion: Majority of postpartum caesarean delivery females complained of acute low back pain and very less had taken physiotherapy treatment during and after delivery. The majority were unaware about the antenatal and postnatal physiotherapy as they were not recommended by the gynecologist doctors. KEYWORDS: Acute back pain, Caesarean delivery, Spinal anesthesia, Antenatal, Postnatal, Physiotherapy, Awareness.

Characterisation of plasma proteins and circulating microRNAs in out-of-hospital cardiac arrest patients - approaches for predicting outcome

Abstract Rationale: Early prognostication after out-of-hospital cardiac arrest (OHCA) is an unmet clinical need. There is limited data on serial release kinetics of cardiac, brain and systemic biomarkers such as Neuron Specific Enolase (NSE) and S-100B. miRNAs are sensitive biomarker candidates in acute myocardial infarction (MI). Objective The objective was to characterise circulating biomolecules in the early release kinetics after OHCA, compared with a STEMI control group and assessed with clinical outcome. Methods and Results Serial blood samples of patients with OHCA with STEMI (n=20) and STEMI control (n=20) were collected at baseline and at 6, 12, 24 and 48h after admission. Untargeted plasma proteomics were performed using data-independent acquisition–mass spectrometry (DIA–MS). Candidate proteins and miRNAs were quantified. Proteomics returned n=156 proteins with significantly different kinetics between OHCA and STEMI. Six clusters, depicting distinct biological pathways, with characteristic differences between OHCA and STEMI were identified. The most distinct and significant differences between OHCA and STEMI patients were seen for acute phase reactants LBP, AACT, CRP and the lipid metabolite A2GL as well as endothelial and platelet miR-126 and cardiomyocyte-apoptosis/ischemia-reperfusion related miR-320a. Cardiogenic shock was best characterised by differential kinetics of coagulation and complement related proteins FA9, HRG, FHR1 and inflammation related miR-146. The primary endpoint was poor neurological recovery at 30-days. Individuals with good outcome showed distinct differences in adaptive immune response, complement and coagulation cascades and hemostasis. Circulating plasma levels of hypoxia-associated miR-101, miR-210 and S-100B protein were significantly elevated at baseline in OHCA patients. These molecules further showed higher baseline values in patients with poor outcome. For current prognosis marker NSE, this difference only develops after 48h. Cardiac/muscle miRNAs followed an early release-pattern similar to high-sensitivity cardiac troponin-T (hs-cTnT). Machine learning models were used to calculate the AUC for the prediction of poor neurological outcome at baseline. This was highest for hypoxia-induced miR-210 (AUC: 0.854), which performed significantly better than the protein biomarkers NSE (AUC: 0.646) and S-100B (AUC:0.656). Conclusions Untargeted mass spectrometry reveals distinct biological pathways and candidate biomolecules affected in patients suffering from OHCA compared with STEMI controls, in patients developing cardiogenic shock and in those with adverse versus good neurological outcome. Platelet-, inflammation and hypoxia associated miRNAs are associated with OHCA, cardiogenic shock and prognostication of adverse neurological outcome. Pronounced differences in early release kinetics of RNA and protein biomarkers may improve identification of OHCA patients at risk of poor outcome.

Relationship of Lumbar Lordosis With Non-specific Acute Low Back Pain

Relationship of Lumbar Lordosis With Non-specific Acute Low Back Pain

A Local Heating Profile to Manage Lower Back Pain in an Automotive Seat: A Pilot Study.

Lower back pain (LBP) is one of the most prevalent health losses in adults worldwide. Historically, heat has been successfully used for treating pain and relieving tight muscles. Given the effective contact with the occupant's back and proximity to the heat source, coupled with increasing commute times, automotive seats offer an opportunity to intervene. Fifteen adults (nine female) who experienced acute, subacute, and chronic lower back pain were recruited to examine the effectiveness of heat delivered to the lower back in providing temporary pain relief. Participants sat in a car seat for 38 min on two days, which included a 5-min baseline followed by a 33-min intervention; control, or localized. For the control condition, participants sat for 33 min without any thermal devices on, while the localized condition heated and maintained the seat surface temperature of the lower seat back area to ~45 °C. Over the 33-min control condition, the back skin temperature increased by ~1-2 °C and did not impact the subjective LBP. Heating the lower back for 33 min to ~39 °C reduced the subjective LBP by 10%. We demonstrated that lower back pain can be alleviated from an automotive seat providing heat to the lower back within normal commute times in those with lower back pain.

Efficacy of Thiocolchicoside for Musculoskeletal Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Despite the fact that thiocolchicoside has been widely used in the treatment of musculoskeletal pain, its efficacy has never been systematically evaluated. We carried out a systematic review and meta-analysis of randomized clinical trials (RCTs) to appraise the existing evidence on the efficacy of thiocolchicoside for musculoskeletal pain management. Methods: The literature search was performed on multiple databases, extracting reports of RCTs evaluating the efficacy of thiocolchicoside compared to placebo or no exposure. The reduction in pain intensity was evaluated through between-groups mean differences (MDs) in Visual Analogue Scale (VAS) scores after the intervention. The pooled effect estimates were compared to a minimally important difference (MID) of 1 point on a scale from 0 to 10. Results: We retrieved eight RCTs, including a total of 1397 patients. All the included studies were determined as being at high risk of bias. Seven trials evaluated patients with acute low back pain. After 2-3 days of treatment, the pooled MD in VAS score was -0.49 (95%CI = -0.90; -0.09) compared to controls. After 5-7 days of treatment, the summary MD was -0.82 (95%CI = -1.46; -0.18). Conclusions: Although thiocolchicoside was found to significantly reduce patient-reported low back pain, the clinical impact was very small, as the pooled effect estimates were below the MID, and the overall certainty of evidence was very low. In light of the safety concerns raised by the European Medicine Agency, an in-depth analysis on the risk-benefit balance of thiocolchicoside is required.

Efficacy of Turmeric-Boswellia Formulation for Acute Low Back Pain: A Double-blind, Randomized, Placebo-controlled Trial

Efficacy of Turmeric-Boswellia Formulation for Acute Low Back Pain: A Double-blind, Randomized, Placebo-controlled Trial

COMPARING THE CLINICAL OUTCOMES OF LUMBAR TRANSFORAMINAL VS INTERLAMINAR EPIDURAL STEROID INJECTIONS IN A REGISTRY COHORT

Epidural steroid injections are a safe and effective treatment for acute low back pain associated with radicular pain. Objective: The main objective of the study is to find the clinical outcomes of lumbar transforaminal vs interlaminar epidural steroid injections in a registry cohort. Methods: This prospective cohort study was carried out at Ghurki Trust Teaching Hospital, Lahore, over one year, from June 2023 to June 2024. A total of 185 patients were included in the study. Patients aged >18 years and presented with symptoms of lumbar radiculopathy due to lumbar disc herniation, spinal stenosis, or degenerative disc disease were included in the study. Results: The mean age of the TFESI group was 45.6 ± 10.3 years, while the ILESI group had a mean age of 46.2 ± 9.8 years (p = 0.67). The gender distribution was also comparable, with 55 males and 37 females in the TFESI group, and 58 males and 35 females in the ILESI group (p = 0.78). Baseline pain intensity (VAS score) and disability (ODI score) were similar between the two groups, with no significant differences in VAS (7.6 ± 1.1 vs. 7.5 ± 1.2, p = 0.58) or ODI (52.4 ± 10.2 vs. 51.9 ± 9.9, p = 0.71). In the TFESI group, 52.2% of patients had lumbar disc herniation, compared to 49.5% in the ILESI group (p = 0.69). Lumbar spinal stenosis was diagnosed in 32.6% of patients in the TFESI group and 34.4% in the ILESI group (p = 0.81). Conclusion: It is concluded that both lumbar transforaminal epidural steroid injections (TFESI) and interlaminar epidural steroid injections (ILESI) are effective in the management of lumbar radiculopathy, leading to significant reductions in pain and improvements in functional outcomes.

Effect of Methocarbamol on acute low back pain: A systematic review

Introduction Pharamcological treatment for acute low back pain (ALBP) typically involves opioid drugs, and non-steroidal anti-inflammatory drugs (NSAIDs). Methocarbamol is utilized primarily for managing muscle spasms and pain. This systematic review aims to provide an updated synthesis of published literature on the effects of Methocarbamol on pain outcomes in ALBP. Methods This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Original articles published until December 2023 were sourced from PubMed, Embase, and the Cochrane Library. Articles focusing on the impact of Methocarbamol on pain outcomes in ALBP patients were included. Results Three studies met the inclusion criteria, published between 2018 and 2023. The total study population comprised 405 ALBP patients, with 163 receiving Methocarbamol. Compared to patients not receiving Methocarbamol, those in the Methocarbamol group showed pain improvement at one week. However, at 30 and 60 minutes after intravenous administration, Methocarbamol was less effective than Diazepam. The primary reported adverse event was nausea. Conclusion When administered in combination with Indomethacin or Naproxen, Methocarbamol shows potential for improving pain outcomes at one week in ALBP patients. However, its efficacy appears inferior to Diazepam in the short-term management of pain

Transition from Acute to Chronic Low Back Pain in a Community-Based Cohort

The transition from acute to chronic low back pain (LBP) in community settings is not well understood. The purpose of this study was to assess the feasibility of recruitment and estimate the transition and continuation of chronic LBP. We also explored characteristics associated with this transition to chronic LBP. We enrolled n=131 participants, of which n=118 (90%) completed 3-month outcomes and n=111 (85%) completed 6-month outcomes. Acute LBP was defined by a duration of <4 weeks and a 30-day LBP-free period before the current acute episode. Chronic LBP was defined as pain most or every day over the past 3 months. The transition from acute to chronic LBP at 3 months was 32.2% (38/118), and at 6 months, 80.6% (25/31) of participants who transitioned at 3 months continued to have chronic LBP at 6 months. Participants with more frequent acute LBP and at an intensity of 30/100 were more likely to transition to chronic LBP (Risk Ratio (RR)=3.13, 95% Confidence Interval (CI) 1.84, 5.30) and continue to have chronic LBP at 6-months (RR=3.10, 95% CI 1.48, 6.08). Higher risk on the STarT Back Screening Tool was associated with the transition to chronic LBP at 3 months (RR=1.73, 95% CI 1.28, 2.35) and continuation of chronic LBP at 6 months (RR=1.26, 95% CI 1.10, 1.45). The recruitment of acute LBP was feasible in a community setting. Acute LBP is a common condition in the community and frequently transitions to chronic LBP, suggesting the potential for substantial burden in the community. PerspectiveThis article presents the feasibility of conducting a community-based study to describe the transition, continuation, and psychosocial predictors of acute to chronic low back pain. These findings could help identify community participants at high risk of incident and continued chronic low back pain. Data AvailabilityThe data that support the findings of this study are available from the corresponding author, [AG], upon reasonable request.

Study of correlation between arches of foot and lower back pain in Eastern India

Background: Low back pain is one of the most common disorders of the musculoskeletal system, leading to impaired function and decreased quality of life in many patients. Foot arch alterations may lead to structural changes and/or affect its load distribution. It should be noted that even slight elevations of the foot’s medial longitudinal arch above the norm may lead to changes in load and pressure distribution. Hence, it becomes important to find the relationship between low back pain and altered foot arch indices leading to improper body balance. Aims and Objectives: The aims and objectives of the study are to find any correlation between lower back pain and an altered foot arch index in the Eastern Indian population. Materials and Methods: A total of 60 subjects aged 20–40 years with varying degrees of low back pain were selected. Low back pain scores of the subjects were found using modified oswestry low back pain disability questionnaire. Footprints in standing position using ink were taken on graph paper and the foot arch indices were calculated. Results: 54.16% of the male and 36.11% of female participants had low arched feet, 20.83% of male and 52.78% of female participants had normal arched feet, and 25% of male and 11.11% of female participants had high arched feet with varying degrees of low back pain. 77.42% of the participants with minimal disability due to low back pain were having normal arched feet, 71.43% of the participants with moderate disability due to low back pain were having low arched feet, and 100% of the participants with severe disability due to low back pain were having either high or low arched feet. Conclusion: This study showed that people having either low or high arched feet are at an increased risk of developing acute or chronic low back pain at some stage in their lives. Knowledge of this risk factor might even help people to choose appropriate occupations in the future.

A COMPARATIVE STUDY OF MANUAL TRACTION AND MECHANICAL TRACTION ON ACUTE DISCOGENIC PAIN

Background and purpose: Acute low back pain is defined as Low back pain that has been present for less than three months and it was estimated that 80% of the population suffers from low back pain (LBP) at some point of their lives. Low back pain is the primary factors which limit activity in patients less than 45 years old and it is of significant socio-economic relevance because it may lead to temporary loss of productivity, enormous medical and indirect costs or even leads to permanent disability. The purpose of study was to compare a manual traction versus mechanical traction for reduce acute discogenic pain. Method: The study was conducted at JKK Munirajah Medical Research Foundation college of physiotherapy Out Patient department 30 subjects were selected in random sampling method. They were divided into 2 Group, namely Group A and Group B with 15 subjects in each Group. The enrolled 30 subjects were randomly allotted to two Group A (15) &amp;B (15).After recruitment on eligibility, informed consent is obtained on explaining the treatment to be given. Result: The result showed that there was statistical significant difference between Group A and B. The acute discogenic pain patient who was treated with manual traction had shown good improvement in reduction of acute discogenic pain. Conclusion: The study concluded that there was a statistically significant improvement in reduction of pain improving flexibility and functional ability after the treatment of manual traction for 4 weeks. Thus the study concluded that manual traction (MAT) was the effective treatment than mechanical traction (MET) of acute discogenic low back pain.

Persistence, not avoidance, is associated with low back pain-An observational cohort study.

Low back pain (LBP) is increasingly understood as a long-lasting condition with a variable course. Avoidance and persistence behaviour have been described to mediate pain persistence by potentially linking psychosocial factors and biomechanics. The resulting maladaptive changes in musculoskeletal structures can result in movement control impairment (MCI). This investigation aimed to observe avoidance and persistence behaviour and MCI in participants with acute LBP over 1 year and explore their association with pain persistence. In this observational cohort study, 165 participants were assessed at five time points: ≤ 1 month (baseline), 2, 3, 6, and 12 months after the onset of acute LBP. Simultaneously collected clinical data such as self-reported outcomes at baseline for avoidance and persistence and assessments of MCI were filled in linear mixed-effects regression models. The mixed-effects analysis revealed for the adjusted model that a one-point increase in persistence scores resulted in a 3.31-point increase in pain intensity while interacting with state anxiety over time (p = 0.05, 95% confidence interval 0.07-6.07). This effect was not found for avoidance behaviour at baseline (p = 0.21) and MCI. The relationship between persistence and pain intensity throughout measurement suggests that continuing usual activities beyond pain, coupled with feelings of distress, may lead to persistent LBP. These results underscore the need for a therapeutic shift toward a multidimensional approach that considers the physical and psychological characteristics of persons with LBP. Screening for activity patterns in acute LBP is critical for providing tailored treatment and counselling. In acute low back pain (LBP), maintaining usual activities despite pain and distress can contribute to the continuation of LBP. Alongside a multidimensional approach that considers physical and psychological factors, attitudes toward daily activities are also important. Screening for both maladaptive and adaptive activity patterns in individuals with acute LBP is essential for effective LBP management, improving patient outcomes, and preventing persistent pain.

Perceived Community Control in Adults with Acute Low Back Pain: A Community-Based Study.

Low back pain (LBP) is the leading cause of disability for individuals and societies globally. Prior investigations have predominantly centered around biological and psychological factors. Addressing social determinants is critical for enhancing the effectiveness and equity of pain interventions. We aimed to characterize social factors, sleep, and pain among adults with acute LBP, focusing on perceived community control. A community-based sample of adults with acute LBP was recruited from two cities in North Carolina, United States, and followed up at 3 months. We used descriptive statistics to characterize social factors, sleep, and pain, overall and by levels of perceived community control. In total, 110/131 enrolled participants had data on perceived community control (lower scores indicate higher control). Overall, the median perceived community control was 14 (interquartile range [IQR] = 11, 15). People with high perceived community control also had, on average, higher perceived individual control, better-perceived neighborhood walkability, lower number of sites with bothersome comorbid pain, and higher sleep quality. A higher proportion of participants with high perceived community control were of male sex, White race, and had a higher socioeconomic position. Community control and related constructs may be further explored in future intervention development as potentially modifiable social factors that may reduce pain burden.

Spontaneous intraspinal and intracranial subdural hematoma in a highly active antiretroviral therapy-naïve-patient with HIV

Spontaneous intraspinal and intracranial subdural hematomas (SDHs) are rare, potentially life-threatening complications. We present the case of a 38-yearold highly active antiretroviral therapy-naïve human immunodeficiency virus (HIV)- positive patient who developed simultaneous intraspinal and intracranial SDHs without hemostatic abnormalities. The patient presented with acute lower limb weakness and back pain, and later developed neurological symptoms, including diplopia and incontinence. This case highlights the importance of considering SDHs in HIV-positive patients presenting with neurological symptoms, and underscores the need for prompt diagnosis and multidisciplinary management.

The Association Between Femoral Nerve Tension and Hip Flexor Length

Background: Femoral nerve tension and hip flexor muscle length are critical factors in musculoskeletal health. Their relationship is particularly important in diagnosing and managing conditions like low back pain, often associated with tight hip flexors.Objective: This study aimed to explore the association between femoral nerve tension and hip flexor muscle length in individuals with acute low back pain compared to healthy controls.Methods: A correlational study was conducted with 68 participants (34 healthy controls and 34 acute low back pain patients). Data were collected using self-administered questionnaires and clinical tests, including the Prone Knee Bend Test and Modified Thomas Test. Femoral nerve tension and hip flexor length were measured using a goniometer. Data were analyzed using Pearson correlation and linear regression in SPSS version 25.Results: The Thomas Test showed a statistically significant negative correlation between femoral nerve tension and hip flexor length in Group B (-0.096, p=0.042). In the Prone Knee Bend Test, a minimal positive correlation was observed (0.007, p&gt;0.05). Cross-tabulation highlighted a significant association between test results in the control group (p=0.025).Conclusion: A significant relationship exists between femoral nerve tension and hip flexor length in individuals with acute low back pain. These findings suggest the need for targeted interventions focusing on neural and muscular components.

Low back pain characteristics in adolescent patients with early-stage spondylolysis: a prospective study.

Early-stage spondylolysis (ESS) is a common cause of acute low back pain (LBP) in adolescents. When treating patients with ESS, early diagnosis is essential, yet difficult without magnetic resonance imaging. This study evaluates a self-reported questionnaire for detecting ESS. We evaluated a total of 69 adolescents (≤ 18years old) with acute LBP (≤ 1month) with plain radiography, magnetic resonance imaging and a questionnaire including the following parameters: exercise frequency per week, daily training time, the necessity for stopping sports activity, pain-producing situations, pain quality, pain response to hyperextension or hyperflexion, pain location, and pain extent. Patients with obvious pathological findings other than ESS (e.g., disk herniation or infection) were excluded. The correlation of each question and gender, regarding ESS was determined, to evaluate the value of the originally developed questionnaire. 24 out of 69 patients were diagnosed with ESS (ESS group), with a mean age of 13.9years old and 21 males and 3 females in the group. 45 patients had NS-LBP, with a mean age of 14.6years old, and 28 males and 17 females in the group. Correlation analyses showed weak associations between ESS and higher frequency of exercise per week, longer training time per day, and pain-producing situations. There was also a moderate association between ESS and male gender. Exercise frequency, training time, pain-provoking situations, and gender could be important factors to detect ESS within this questionnaire.

A Comparative Study of Skeletal Muscle Relaxant Effects of Thiocolchicoside, Diazepam and Their Combination in Wistar Rats Using the Rotarod Apparatus.

Introduction Thiocolchicoside (THC) is a semi-synthetic derivative of colchicoside and anaturally occurring compound in the seeds of the Gloriosa Superba L.plant. At present, it is used as a skeletal muscle relaxant. It is used to treat rheumatic arthritis, orthopaedic conditions, and trauma. Topically, it is used to relieve excruciating spasms in the muscles.It is also used to treat a wide range of conditions, which include surgical pain, cervicobrachial neuralgia, acute to chronic torticollis, Parkinson's disease, drug-induced Parkinsonism,spastic hemiplegia, tooth soreness,acute lower back pain, etc. THC is used in conjunction with non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and analgesics.By downregulating and inhibiting the synthesis of NF-κB-regulated gene products, it possesses anti-inflammatory properties. To prevent aneuploidy, the European Medical Agency has placed restrictions on the use of THC, stating that it should not be injected for five days or taken orally for longer than seven days. This is because its metabolism in the body may lead to the production of the metabolite M2. When used during pregnancy, the growing fetus is more negatively impacted. It has also been connected to infertility in men. Aim To study the skeletal muscle relaxant effects of THCin Wistar rats in comparison with standard drugs. Materials and methods The skeletal muscle relaxant activity level was measured using the rotarod apparatus. There were five groups of Wistar rats (n = 6). Group I received 0.9% normal saline (NS) as a control. Group II (test group) received THC 2 mg/kgintraperitoneally (ip).Group III (test group) received THC 4 mg/kg (ip). Group IV diazepam (DIZ) 3 mg/kg (ip) which is the standard treatment group.Group V received a combination of THC 2 mg/kg and DIZ 3 mg/kg. After treatment, retention time was noted at intervals of 30, 60, and 120 minutes. Results Group I (control), Group II (THC 2 mg/kg) and Group III (THC 4 mg/kg) did not demonstrate any skeletal muscle relaxant activity. Group IV (DIZ 3 mg/kg) and Group V (THC 2 mg/kg + DIZ 3 mg/kg) showed statistically significant skeletal muscle relaxant activity when compared to control. However, there was no statistically significant difference between the skeletal muscle relaxant activity of these two groups. This indicates that the addition of THC did not potentiate the skeletal muscle relaxant activity of DIZ. Conclusion THC didn't show skeletal muscle relaxant properties in both doses and did not potentiate the activity of DIZ.

Multimodal Analgesia Approach in Acute Low Back Pain Management: A Phase III Study of a Novel Analgesic Combination of Etoricoxib/Tramadol.

Pain and disability management are crucial for a speedy recovery. Combining analgesics with different mechanisms of action provides greater pain relief with lower doses, promoting efficient multimodal analgesia. This study evaluated the efficacy and safety between two fixed-dose combinations (FDC): etoricoxib/tramadol compared to paracetamol/tramadol for the management of acute low back pain (LBP) in a 7-day treatment. We conducted a phase IIIb, prospective, randomized, and multicenter study in patients with acute LBP treated with etoricoxib 90mg/tramadol 50mg (one packet of granules diluted in 100ml of water, once a day [QD], for 7 days) or paracetamol 975mg/tramadol 112.5mg (one tablet of 325mg/37.5mg, three times a day [TID], for 7 days) to assess the efficacy (in terms of pain and disability improvement) and safety. One hundred and twenty-four patients were randomized to receive either etoricoxib/tramadol QD (n = 61) or paracetamol/tramadol TID (n = 63). From the magnitude of change in pain evaluations, differences were observed between the treatment groups at 3 [p = 0.054, CI 95% -0.648 (-0.010 to 1.306)] and 5days (p = 0.041). The proportion of patients with a 30% reduction in Visual Analogue Scale (VAS) score was statistically significant when comparing the treatment groups on the third day of follow-up [p = 0.008, CI 95% 0.241 (0.061-0.421)]. An improvement in LBP's disability to perform activities of daily routine (Oswestry and Roland-Morris questionnaires) was observed in both treatment groups. A total of 79 adverse events (AEs) (38 [48.1%] with etoricoxib/tramadol and 41 [51.9%] with paracetamol/tramadol) were reported. The most frequent AEs were nausea (17.7%) and dizziness (16.4%). The results show the clinical benefits of etoricoxib/tramadol FDC, such as the sparing effect of tramadol dose per day, early therapeutic response rate compared with paracetamol/tramadol; which translates into faster pain relief, better adherence, less tramadol drug dependency, and a reduction of related AEs incidence. ClinicalTrials.gov identifier, NCT04968158.

Can assessment of human assumed central sensitisation improve the predictive accuracy of the STarT Back screening tool in acute low back pain?

BackgroundThe STarT Back Screening Tool (SBT) is recommended to provide risk-stratified care in low back pain (LBP), yet its predictive value is moderate for disability and low for pain severity. Assessment of human assumed central sensitisation (HACS) in conjunction with the SBT may improve its predictive accuracy. ObjectivesTo examine whether assessment of HACS in acute LBP improves the predictive accuracy of the SBT for LBP recovery at six months in people with acute non-specific LBP. DesignA prospective longitudinal study. MethodData were drawn from the UPWaRD study. One hundred and twenty people with acute non-specific LBP were recruited from the community. Baseline measures included SBT risk status, nociceptive flexor withdrawal reflex, pressure and heat pain thresholds and conditioned pain modulation. Primary outcome was the presence of LBP (pain numeric rating scale ≥1 and Roland Morris Disability Questionnaire score ≥3) at six-month follow-up. Regression coefficients were penalised using the least absolute shrinkage and selection operator technique to select predictor variables. Internal validation was performed using ten-fold cross-validation. Results/findingsSBT risk status alone did not predict the presence of LBP at six months (area under receiver operating characteristic curve [AUC] = 0.58). Adding measures of HACS to the SBT did not improve discrimination for whether LBP was present at six months (AUC = 0.59). ConclusionsThis study confirmed the suboptimal predictive accuracy of the SBT, administered during acute LBP, for LBP recovery at six months. Assessment of HACS in acute LBP does not improve the predictive accuracy of the SBT.

Best practice care for acute low back pain: A new clinical standard to assist general practitioners.

Low back pain is one of the most common presentations in general practice. Although there is excellent evidence regarding best management of the condition, in primary care there is often overuse of less effective and expensive options, whereas effective, inexpensive options are underused.After broad consultation and evidence review, the Australian Commission on Safety and Quality in Health Care has developed a clinical care standard in response to this identified gap between best and actual practice. A clinical care standard focuses only on key areas of care where the need for quality improvement is greatest. We explore the new standard using a typical patient scenario in primary care to highlight evidence-based approaches for challenging aspects of management, such as imaging and pain management. General practitioners (GPs) might find the practical GP 'quick guide' resource from the standard useful to support their care of patients with low back pain.