Back Pain Conditions Research Articles

Sacroiliac joint syndrome: aetiology, clinical presentation, diagnosis and management

Sacroiliac joint (SIJ) syndrome is a relevant disorder to study because of the high prevalence of back pain conditions in people of working age. SIJ syndrome is a cause of pain in 15–30% of people with chronic pain in the lower lumbar spine. This review describes the anatomical structure of the SIJ and the aetiological factors that can lead to its dysfunction. Pathogenetic links in the development of this condition are identified separately. The issue of differential diagnosis with other vertebrogenic pain syndromes is considered in detail, and diagnostic tests are presented. The main current approaches to treating SIJ syndrome are described. Interventional methods for treating SIJ dysfunction are described in detail, including radiofrequency neuroablation as an alternative to conservative management.

Back Pain and Co-occurring Conditions: Erratum

Back Pain and Co-occurring Conditions: Erratum

Effective Recovery and Control of Chronic Low Back Pain by using Rehabilitation Exercises Therapy

Exercise is a commonly recommended treatment for chronic low back pain due to its effectiveness in enhancing work and function. This study aims to review numerous crucial phases of the usefulness and safety of exercise in order to provide vital information for treating chronic low back pain. An online literature search of Medline was performed using “exercise,” “fitness,” “low back pain,” “backache” and “rehabilitation” as search words abstracts that identified using this method were carefully read, and relevant articles were considered for further analysis. Additional materials were gathered by sourcing relevant research articles. The articles were carefully examined for relevance. There is no evidence that exercise increases low back pain problems, particularly for people with acute, subacute or chronic low back pain. Current studies indicate that exercise has either a neutral effect or might reduce the risk of future back injuries to some extent. Exercise might be suggested for patients with chronic low back pain for three purposes. The first and most recognized purpose is to enhance or decrease deficiencies in back flexibility and strength and improve the performance of endurance activities. It is evident that this purpose can be achieved for most patients suffering from chronic low back pain. The second purpose of exercise is to decrease the severity of low back pain. Many studies reported an overall decrease in the intensity of low back pain ranging from 10% to 50% subsequent to exercise treatment. The third purpose of the exercise is to decrease low back pain–related incapacity by desensitizing worries and anxieties and changing pain attitudes and beliefs. The exercise mechanisms that can be employed to achieve the aforementioned purposes have been the subject of extensive study. The relevance of using exercise as a therapeutic method to decrease deficiencies in back flexibility and strength has been established. Several studies reported enhancements in global pain ratings subsequent to exercise programs. Exercise can also reduce the cognitive, behavioral, and disability effects of low back pain conditions.

Chronic Pain Two Cures

Background: This study presents several anecdotal case reports of chronic pain patients cured with two different plant medicines from the Chumash Indian tradition. Methods: Patients suffering from fibromyalgia, chronic back pain, chronic bursitis, chronic tendinitis and other conditions were treated. California sagebrush (Artemisia californica) was grown by the author and made into a liniment. The liniment was applied to painful sites on the skin. Black sage (Salvia mellifera) was made into a sun tea. Chronic pain patients soaked their feet in the preparation. Results: The liniment provided relief from even severe pain within a minute or so. After daily use for 1 – 7 days, chronic pain was cured in several patients. The sun tea provided pain relief throughout the body within 20 minutes. After 1 – 7 days of once daily use, several chronic pain patients were cured. Conclusions: Both A. californica liniment and S. mellifera sun tea provide pain medicines that can cure chronic pain.

The Effects of Pain Severity, Pain Catastrophizing, Depression, and Exercise on Perceived Disability in Acute Low Back Pain Patients.

Background/Purpose: The effectiveness of cognitive treatments for low back pain, a prevalent and costly condition, are commonly based on the principles of the Cognitive Behavioral Model of Fear of Movement/(Re)injury. In this model, persons with a painful injury/experience who also engage in pain catastrophizing are most likely to avoid activity leading to disability. The validation of this model in patients with acute low back is limited. The purpose of this project was to examine the relationship of perceived disability with variables identified in the Cognitive Behavioral Model of Fear of Movement/(Re)injury such as, pain severity, pain catastrophizing, depression, and exercise in persons with acute low back pain. Methods: A multiple linear regression model was used to assess the association of perceived disability with pain severity, pain catastrophizing, depression, and exercise at baseline among subjects with acute low back pain (N = 44) participating in a randomized clinical trial to prevent transition to chronic low back pain. Results: Controlling for age, the overall model was significant for perceived disability (F[5, 35] = 14.2; p < .001). Higher scores of pain catastrophizing (p = .003) and pain severity (p < .001) were associated with higher perceived disability levels. Exercise and depression were not significantly associated with perceived disability. Implications: The use of the Cognitive Behavioral Model of Fear of Movement/(Re)injury in acute LBP patients is appropriate; because this model is commonly used as rationale for the effectiveness of cognitive treatments, these findings have clinical relevance in the treatment of this condition.

Back Pain and Co-occurring Conditions

Cross-sectional population-level health survey. To describe the frequency of co-occurring conditions with back pain; to identify risk factors for back pain controlling for co-occurring conditions; and to examine the association between back pain and individual co-occurring conditions. Back pain shares risk factors with a range of other conditions. Most studies have considered risk factors for back pain without taking into account the potential influence of co-occurring conditions. Analysis of the 2013 Canadian Community Health Survey (n = 61,854, age ≥15 yr). Back pain status and co-occurring conditions were determined from questions about long-term health conditions diagnosed by a health profession. Multivariable log-Poisson regression analysis was used to assess the adjusted association of back pain with demographic and lifestyle characteristics and co-occurring conditions. The population prevalence of reported back pain was 19.3%. Most (71%) reported at least one co-occurring condition. Most frequently reported were arthritis (35%), high blood pressure (26%), migraine (18%), and mood disorders (14%). Following the addition of co-occurring condition count to the regression model, being female and being overweight/obese were no longer significantly associated with back pain, and the associations with ages 45 to 54 years and older, low-income, smoking, and being physical inactive were significantly attenuated. The highest prevalence ratio, 3.32 (95% confidence interval: 3.06-3.59), was for 3+ co-occurring conditions. In multivariable regression all but a few individual chronic conditions remained significant associated with back pain. Established risk factors for back pain may be largely a reflection of shared risk factors with co-occurring conditions. The high frequency of co-occurring conditions likely reflects diverse mechanisms related to heterogeneity of back pain. The extent of association of co-occurring conditions with back pain has implications for clinical management and need for further research to characterize subgroups. 2.

The Effects of Pilates Exercise on Cardiometabolic Health, Low Back Pain and Disease

Pilates is a form of exercise that challenges core strength and seeks to improve both muscular endurance and postural alignment and it may prove to be helpful for those with medical issues in improving general fitness through building strength and flexibility. This paper reviews the studies that investigated the efficacy of Pilates exercises on medical conditions including cardiometabolic parameters, low back pain, multiple sclerosis, fibromyalgia, ankylosing spondylitis, and breast cancer. Due to the limited number of studies investigating cardiometabolic parameters, it is difficult to draw a conclusion despite some favorable findings. While more studies exist on the effect of Pilates on low back pain than studies on other conditions, they are still limited and lack generalizability due to the heterogeneity of participants as well as the variability of exercises prescribed. Even then, it appears that Pilates is feasible and effective in alleviating symptoms associated with low back pain and other medical conditions. Overall, the studies reviewed here have shown high adherences rates in Pilates training with no adverse effects.

Low back pain, obesity, and inflammatory markers: exercise as potential treatment.

Low back pain is a health issue with significant impact to patients and society. This narrative review aims to synthesize the relationship between obesity, low-grade inflammation and low back pain. It is known that a sedentary lifestyle is a risk factor for obesity and related disorders. The adipose tissue of obese people secretes a range of cytokines of character pro- and anti-inflammatory, with many molecular effects. In addition, pro-inflammatory cytokines are sensitizers of C-reactive protein (CRP), a marker of acute inflammation that can be linked to the musculoskeletal pain sensation individuals with back pain. Another inflammatory marker deserves mention, prostaglandin E2. Prostaglandin E2 is important in the process of triggering actions such as pyrexia, sensation of pain and inflammation, which are exhibited in low back pain condition. The potential for exercises and physical activity to control these mediators and act as a preventative measure for back pain are important because they work as a nonpharmacological strategy to this target audience. There are two types of exercise discussed in this review, the moderate-intensity continuous training and high-intensity interval training.

Reliability of ultrasound shear-wave elastography in assessing low back musculature elasticity in asymptomatic individuals

Patients with low back pain commonly exhibit impaired morphology and function of spinal musculature that may be quantifiable using shear-wave elastography (SWE). The purpose of this study was to assess the intra-rater and test-retest reliability of SWE elasticity measures of the lumbar erector spinae and multifidus muscles during rest and differing levels of contraction in asymptomatic individuals. This single-group repeated-measures design involved a baseline measurement session and a follow-up session 3 days later. The lumbar multifidus was imaged at rest and during three levels of contraction (minimal, moderate, and maximum). The lumbar erector spinae (illiocostalis and longissimus muscles) were imaged at rest only. Overall reliability estimates were fair to excellent with ICCs ranging from 0.44 to 0.92. Reliability was higher in the lumbar multifidus muscles than the erector spinae muscles, slightly higher during contraction than during rest, and substantially improved by using the mean of 3 measurements. By reliably quantifying impaired spinal musculature, SWE may facilitate an improved understanding of the etiology and treatment of low back pain and other muscle pain-related conditions such as trigger points and fibromyalgia.

Cost-effectiveness of yoga for managing musculoskeletal conditions in the workplace.

BackgroundBack pain and musculoskeletal conditions negatively affect the health-related quality of life (HRQL) of employees and generate substantial costs to employers.AimsTo assess the cost-effectiveness of yoga for managing musculoskeletal conditions.MethodsA randomized controlled trial evaluated an 8-week yoga programme, with a 6-month follow-up, for National Health Service (NHS) employees. Effectiveness in managing musculoskeletal conditions was assessed using repeated-measures generalized linear modelling for the Roland-Morris Disability Questionnaire (RDQ) and the Keele STarT Back Screening Tool. Cost-effectiveness was determined using area-under-the-curve linear regression for assessing HRQL from healthcare and societal perspectives. The incremental cost per quality-adjusted life year (QALY) was also calculated. Sickness absence was measured using electronic staff records at 6 months.ResultsThere were 151 participants. At 6 months, mean differences between groups favouring yoga were observed for RDQ [−0.63 (95% CI, −1.78, 0.48)], Keele STarT [−0.28 (95% CI, −0.97, 0.07)] and HRQL (0.016 QALY gain). From a healthcare perspective, yoga yielded an incremental cost-effectiveness ratio of £2103 per QALY. Given a willingness to pay for an additional QALY of £20 000, the probability of yoga being cost-effective was 95%. From a societal perspective, yoga was the dominant treatment compared with usual care. At 6 months, electronic staff records showed that yoga participants missed a total of 2 working days due to musculoskeletal conditions compared with 43 days for usual care participants.ConclusionsYoga for NHS employees may enhance HRQL, reduce disability associated with back pain, lower sickness absence due to musculoskeletal conditions and is likely to be cost-effective.

Efficacy of Mulligan Mobilization Versus Muscle Energy Technique in Chronic Sacroiliac Joint Dysfunction

Background: Sacroiliac joint dysfunction represents 15% of low back pain conditions. Normal sacroiliac joint works as a safeguard and transmits upper body weight into the pelvis and lower extremities. If the SIJ is hypomobile, it cannot effectively absorb forces and other body parts may be overstressed causing musculoskeletal dysfunction. The study conducted by comparing the effectiveness of Mulligan mobilization versus muscle energy technique in chronic SIJ dysfunction.Methods: 45 patients with chronic sacroiliac joint dysfunction from both genders joined the study. They were divided into three groups 15 in each group. Group A: received Mulligan mobilization with movement using posterior and anterior innominate methods plus conventional treatment program. Group B: received muscle energy technique using a post-isometric relaxation technique to erector spinae, hamstrings, iliopsoas and quadratus lumborum plus conventional treatment program. Group C: control group obtained conventional treatment program only. Doppler imaging of vibration, palpation meter, and the visual analogue scale was utilized for evaluating patients (pre and post-treatment).Results: The study findings revealed a statistical remarkable improvement in post-intervention values for sacroiliac mobility in Mulligan mobilization group (p > 0.0001) and a statistically significant decrease of anterior pelvic tilting angle in Mulligan mobilization and muscle energy technique groups (p > 0.0001), also a significant decrease of pain in the 3 groups compared with pre-intervention values (p > 0.0001), additionally, Mulligan mobilization group showed a statistical high detectable difference in right and left sacroiliac mobility more than muscle energy technique and control groups (p > 0.0001).Conclusion: Mulligan mobilization is more effective than muscle energy technique in the treatment of chronic sacroiliac joint dysfunction.

Transient Glaucoma After An Epidural Steroid Injection: A Case Report

Background: Steroids are recognized as a beneficial treatment for various medical conditions, yet clinically relevant side effects of steroids are common and problematic, ranging from a minor case of acne to a potentially life-threatening Addisonian crisis. In anesthetic medicine, the use of epidural steroid injections (ESIs) for chronic low back pain and other radicular pain-related conditions has become standard practice in interventional pain management.Case Report: We report the case of a patient who experienced sudden bilateral blurred vision after receiving an ESI and required urgent ophthalmic interventions and follow-up care. The main clinical findings from this case showed that the patient had high intraocular pressure (IOP) that caused unexpected short-term vision loss. The symptom resolved after 4 months without ophthalmic treatment.Conclusion: Clinicians should inform patients about the possibility of visual complications associated with pain procedures involving steroids. Among the high-risk groups with predisposing factors, such as uncontrolled hypertension and diabetes mellitus, routine eye tests that include measuring IOP prior to ESI should be recommended as a preventive measure. Alternative pain management therapies should be considered if possible. Comprehensive planning of patient care will also ensure safety and prevent unwanted outcomes, particularly with high-risk patients receiving steroids for pain procedures.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 821-824

Evaluation and management of lower back pain in young athletes.

Lower back pain in young athletes is a common problem. The prevalence of back pain from different causes in adolescent age group is between 20% and 30%. However, the incidence of low back pain in young athletes varies widely in different sports. Overuse injuries are the most common cause of low back pain in young athletes. In case of overuse injuries, the cause and effect relationship between back pain and specific condition is often difficult to establish. In adolescent athletes, the most common underlying identified cause of low back pain is lumbar spondylolysis. During adolescent growth spurt, the severity of the pain generally correlates with adolescent growth spurt. Participation in sports starting at an early age and for a longer duration tends to increase the risk for back pain. Numerous conditions cause low back pain in athletes. These include acute trauma, chronic overuse or repetitive trauma, and referred pain. Our focus in here will be on selected conditions that cause recurrent or chronic low back pain.

Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature

BackgroundMost conventional treatment for musculoskeletal conditions continue to show moderate effects, prompting calls for ways to increase effectiveness, including drawing from strategies used across other health conditions. Therapeutic alliance refers to the relational processes at play in treatment which can act in combination or independently of specific interventions. Current evidence guiding the use of therapeutic alliance in health care arises largely from psychotherapy and medicine literature. The objective of this review was to map out the available literature on therapeutic alliance conceptual frameworks, themes, measures and determinants in musculoskeletal rehabilitation across physiotherapy and occupational therapy disciplines.MethodsA scoping review of the literature published in English since inception to July 2015 was conducted using Medline, EMBASE, PsychINFO, PEDro, SportDISCUS, AMED, OTSeeker, AMED and the grey literature. A key search term strategy was employed using “physiotherapy”, “occupational therapy”, “therapeutic alliance”, and “musculoskeletal” to identify relevant studies. All searches were performed between December 2014 and July 2015 with an updated search on January 2017. Two investigators screened article title, abstract and full text review for articles meeting the inclusion criteria and extracted therapeutic alliance data and details of each study.ResultsOne hundred and thirty articles met the inclusion criteria including quantitative (33%), qualitative (39%), mixed methods (7%) and reviews and discussions (23%) and most data came from the USA (23%). Randomized trials and systematic reviews were 4.6 and 2.3% respectively. Low back pain condition (22%) and primary care (30.7%) were the most reported condition and setting respectively. One theory, 9 frameworks, 26 models, 8 themes and 42 subthemes of therapeutic alliance were identified. Twenty-six measures were identified; the Working Alliance Inventory (WAI) was the most utilized measure (13%). Most of the therapeutic alliance themes extracted were from patient perspectives. The relationship between adherence and therapeutic alliance was examined by 26 articles of which 57% showed some correlation between therapeutic alliance and adherence. Age moderated the relationship between therapeutic alliance and adherence with younger individuals and an autonomy support environment reporting improved adherence. Prioritized goals, autonomy support and motivation were facilitators of therapeutic alliance.ConclusionTherapeutic Alliance has been studied in a limited extent in the rehabilitation literature with conflicting frameworks and findings. Potential benefits described for enhancing therapeutic alliance might include better exercise adherence. Several knowledge gaps have been identified with a potential for generating future research priorities for therapeutic alliance in musculoskeletal rehabilitation.

Facilitated Pronociceptive Pain Mechanisms in Radiating Back Pain Compared With Localized Back Pain.

These findings have clinical implications because the underlying mechanisms in different back pain conditions may require different treatment strategies.

Gender Differences in Demographic and Clinical Correlates among Veterans with Musculoskeletal Disorders

BackgroundStudies suggest that women may be at greater risk for developing chronic pain and pain-related disability. MethodsBecause musculoskeletal disorders (MSD) are the most frequently endorsed painful conditions among veterans, we sought to characterize gender differences in sociodemographic and clinical correlates among veterans upon entry into Veterans Health Administration's Musculoskeletal Disorders Cohort (n = 4,128,008). ResultsWomen were more likely to be younger, Black, unmarried, and veterans of recent conflicts. In analyses adjusted for gender differences in sociodemographics, women were more likely to have diagnoses of fibromyalgia, temporomandibular disorders, and neck pain. Almost one in five women (19.4%) had more than one MSD diagnosis, compared with 15.7% of men; this higher risk of MSD multimorbidity remained in adjusted analyses. Adjusting for sociodemographics, women with MSD were more likely to have migraine headache and depressive, anxiety, and bipolar disorders. Women had lower odds of cardiovascular diseases, substance use disorders, and several MSDs, including back pain conditions. Men were more likely to report “no pain” on the pain intensity Numeric Rating Scale, whereas more women (41%) than men (34%) reported moderate to severe pain (Numeric Rating Scale 4+). ConclusionsBecause women veterans are more likely to have conditions such as fibromyalgia and mental health conditions, along with greater pain intensity in the setting of MSD, women-specific pain services may be needed.

Lumbopelvic Core Stabilization Exercise and Pain Modulation Among Individuals with Chronic Nonspecific Low Back Pain.

Lumbopelvic stabilization training (LPST) may provide therapeutic benefits on pain modulation in chronic nonspecific low back pain conditions. This study aimed to examine the effects of LPST on pain threshold and pain intensity in comparison with the passive automated cycling intervention and control intervention among patients with chronic nonspecific low back pain. A within-subject, repeated-measures, crossover randomized controlled design was conducted among 25 participants (7 males and 18 females) with chronic nonspecific low back pain. All the participants received 3 different types of experimental interventions, which included LPST, the passive automated cycling intervention, and the control intervention randomly, with 48 hours between the sessions. The pressure pain threshold (PPT), hot-cold pain threshold, and pain intensity were estimated before and after the interventions. Repeated-measures analysis of variance showed that LPST provided therapeutic effects as it improved the PPT beyond the placebo and control interventions (P < 0.01). The pain intensity under the LPST condition was significantly better than that under the passive automated cycling intervention and controlled intervention (P < 0.001). Heat pain threshold under the LPST condition also showed a significant trend of improvement beyond the control (P < 0.05), but no significant effects on cold pain threshold were evident. Lumbopelvic stabilization training may provide therapeutic effects by inducing pain modulation through an improvement in the pain threshold and reduction in pain intensity. LPST may be considered as part of the management programs for treatment of chronic low back pain.

Synofit Premium in Refractory Low Back Pain: A Retrospective Observational Study

In this retrospective observational study, information about pain and quality of life was collected for analysis from medical records of 85 patients with chronic low back pain who were treated for 3 months with Synofit? Premium (2 - 3 capsules daily), a liquid mixture of green-lipped mussel from New Zealand, blackcurrant leaf, and curcuma extract. Within the first 6 weeks of therapy, a significant clinical benefit was observed for relief from pain, need for pain-relieving drugs, and the interference of pain with personal care and lifting. This benefit was more pronounced at 3 months. The mixture was well tolerated without significant side effects. Adherence was estimated to be “good” to “very good.” Patients assessed global improvement and efficacy as “sufficient” to “good.” Based on this study, the mode of action of Synofit? Premium appears mainly to be analgesic, as reported by patients, and allows them to reduce the consumption of other pain-relieving substances and improve their quality of life. In conclusion, Synofit? Premium holds potential as a promising candidate alternative therapy for relief of low back pain and likely other painful rheumatic conditions, with almost no or minor side effects.

Good News on Opioid-Benzodiazepine Coprescription: It's Rare

Anecdotal evidence suggests that providers often prescribe centrally acting benzodiazepine sedatives in combination with opioids for back pain and other conditions, despite the risks for respiratory depression. To determine the frequency of benzodiazepine-opioid coprescription, investigators reviewed a national database of emergency department …

Treatment of osteoporosis secondary to hypogonadism in prostate cancer patients: a prospective randomized multicenter international study with denosumab vs. alendronate.

Osteoporosis is a complication of androgen deprivation therapy (ADT) in men with prostate carcinoma. This is a multicenter, randomized, double-blind prospective study on use of denosumab versus alendronate in the therapy of secondary osteoporosis related to ADT. A total of 234 patients with diagnosis of osteoporosis underwent ADT for prostate cancer were enrolled. Patients were randomly assigned 1:1 to receive denosumab 60 mg subcutaneously every 6 months or alendronate (70 mg/week) for 2 years. All patient received supplemental vitamin D (600 IU/day) and supplemental calcium to maintain a calcium intake of 1200 mg per day. Effectiveness of therapy in both groups (denosumab group and alendronate group) was assessed by changes in bone turnover markers (BTMs), bone mineral density, fracture incidence, Visual Analogue Scale score for back pain, and Short Form-8 health survey score for health-related quality of life. In the denosumab study group, level of BTMs for bone formation were significantly increased from baseline at all time points during the study (P<0.001); in the alendronate study group level of BTMs for bone formation were increased too (P>0.05). Mean changes in BMD at final follow-up differed significantly between two groups. BMD changes at the lumbar spine at 24 months were 5.6% with denosumab vs. -1.1% with alendronate (P<0.001). Denosumab and alendronate showed similar clinical efficacy in the therapy of ADT-related osteoporosis in men with prostate carcinoma; both drugs provided significant improvements in back pain and general health conditions. Denosumab showed significant increase of BTMs and BMD than alendronate with lower rate of new vertebral fractures.