MRI correlation between paraspinal muscle Atrophy, Age, and degenerative lumbar spine changes in low back pain patients.

To analyze the correlation between paraspinal muscle atrophy, facet joint degeneration, and degenerative scoliosis (DS). A retrospective study included 231 chronic low back pain patients from Zhongda Hospital Affiliated to Southeast University (January 2023-January 2024). Radiographic diagnosis assigned 150 patients to DS group (subclassified into mild [n = 72], moderate [n = 56], severe [n = 22]) and 81 to non-DS control group. Using T2-weighted MRI at L3-S1 levels, ImageJ software measured multifidus (MF) and erector spinae (ES) cross-sectional area (CSA) and functional muscle ratio (LCSA/GCSA). Surgimap software quantified facet joint angle (FJA), facet overhang (FO) length, and facet joint space width (FJSW). Logistic regression analyzed risk factors with ROC curves determining diagnostic thresholds. The non-DS group demonstrated a significantly higher proportion of males (P = 0.023) and greater bone mineral density (P = 0.043) compared to the DS group. Regarding paraspinal muscle parameters, the non-DS group exhibited significantly larger MF CSA, MF + ES CSA, and LCSA/GCSA at the L3/4, L4/5, and L5/S1 levels, as well as a larger ES CSA at the L3/4 level (all P < 0.05). Conversely, the ES CSA at the L5/S1 level was significantly smaller in the non-DS group. For facet joint parameters, the non-DS group showed significantly smaller FJA, FO Length at the L3/4, L4/5, and L5/S1 levels, and smaller FJSW at the L3/4 and L4/5 levels (all P < 0.05). Within the DS group, significant differences were observed between the convex and concave sides at all L3-S1 levels for LCSA/GCSA, MF CSA, ES CSA, FJA, FO Length, and FJSW (all P < 0.05). With increasing severity of DS, there was a progressive decrease in LCSA/GCSA, MF CSA, and ES CSA, and a progressive increase in FJA and FO Length across the L3-S1 levels (all P < 0.01). Post-hoc analysis revealed significant differences in the majority of muscle parameters between severe DS and mild/moderate DS (P < 0.05). Correlation analysis indicated that, except for FJSW at L5-S1 (P = 0.526), the Cobb angle was negatively correlated with MF CSA, ES CSA, LCSA/GCSA, and FJSW, and positively correlated with FJA and FO Length (all P < 0.001). In both the DS and non-DS groups, most LCSA/GCSA and other CSA measurements demonstrated no significant correlations with FJA, FO length, and FJSW. Among the few statistically significant correlations observed, all were weak (rho < 0.30). Multivariate logistic regression analysis identified the following risk-associated factors for DS: lower BMD (OR = 0.802, P = 0.032), reduced LCSA/GCSA (OR = 0.005, P = 0.003), smaller MF CSA (OR = 0.969, P = 0.027), smaller ES CSA (OR = 0.973, P = 0.014), larger FJA (OR = 1.075, P = 0.016), and greater FO length (OR = 1.067, P = 0.001). ROC analysis yielded AUCs/cut-offs: BMD (0.581/-0.900T-score), LCSA/GCSA (0.712/0.805), MF CSA (0.608/635 mm2), ES CSA (0.463/832 mm2), FJA (0.627/57°), FO length (0.651/6.550mm). DS patients demonstrate progressive paraspinal muscle atrophy, sagittal-oriented facet joints, and advanced facet degeneration correlating with scoliosis severity. Diagnostic thresholds indicating DS probability are BMD < - 0.900T-score, LCSA/GCSA < 0.805, MF CSA < 635 mm2, ES CSA < 832 mm2, FJA > 57°, and FO length > 6.550mm.

Pelvic and lower limb gait pattern differ between sex but not between chronic low back pain patients and pain-free individuals under strict inclusion criteria.

Spinal range of motion during different swim strokes in people with chronic low back pain: a randomised crossover trial.

Higher task-specific pain-related fear has been linked to restricted lumbar spine range of motion (ROM) during lightweight object lifting in chronic low back pain (LBP) patients and reduced lumbar spine flexion angles in healthy individuals, suggesting protective movement strategies. However, it remains unclear whether these findings apply to individuals who repetitively lift heavier objects at work. This study aimed to determine whether the effect of task-specific pain-related fear on lifting kinematics differs between individuals with (LIFTER) and without (NON-LIFTER) occupations involving repetitive lifting, and to quantify how this effect depends on object weight, task (lifting or lowering), and LBP history. 156 healthy individuals provided information on previous LBP episodes, completed pain-related fear questionnaires, and lifted 5-kg and 15-kg boxes. Kinematic outcomes included lumbar spine ROM and whole-body lifting strategy. Linear mixed models revealed that the effect of task-specific pain-related fear on lumbar spine ROM significantly differed between group (NON-LIFTER vs. LIFTER: -0.087), weight (5 kg vs. 15 kg: 0.026), and task (lifting vs. lowering: 0.059), but not LBP history (No LBP vs. LBP: -0.005). Higher task-specific pain-related fear was associated with reduced lumbar spine ROM in NON-LIFTER but not in LIFTER, suggesting that fear-driven protective movement strategies vary by occupation.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-24890-z.

Chronic non-specific low back pain (cNSLBP) is a leading cause of disability. However, its impact on daily activities (e.g., walking in public spaces) remains poorly understood. This study aimed to examine how cNSLBP individuals make navigation decisions when exposed to varying situational and social conditions. Eighteen cNSLBP (45.7 ± 9.2 years, 10 women) and eighteen asymptomatic adults (AA, 43.7 ± 9.5 years, 7 women) walked a 10-meter path to reach a goal and chose to pass between two apertures placed midway according to four conditions: (1) baseline: two large apertures, (2) situational: narrow and large apertures, (3) situational and social: human interferer facing the narrow or for (4) large aperture. Measures included switch point, walking speed, clearance distance, and pain perception. Results revealed that cNSLBP participants adopted more conservative decision-making strategies. Under situational and social conditions, they showed a marked preference for the larger aperture (switch points per conditions (1) 0.1; (2) 1.83; (3) 3.35, and (4) 3.34), with weaker modulation of their choices based on goal position (p < 0.01) than AA participants (switch points per conditions (1) 0.2; (2) 0.70; (3) 1.77, and (4) 2.15). While all individuals adapted their strategy in the presence of a human interferer, cNSLBP participants gave less consideration to social norms, with no difference between switch points for conditions 3 and 4. In terms of kinematics, cNSLBP participants walked significantly slower than AA, regardless of condition or goal position (p < 0.001). For both groups, clearance distance significantly increased for all trials involving a human interferer (p < 0.05). No significant differences were observed between groups or conditions in shoulder rotation or in trunk torsion (p > 0.05). This paradigm offers a promising approach to addressing cNSLBP-related functional impairments, though further research is needed to clarify the underlying mechanisms.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-25011-6.

Background: Chronic low back pain (CLBP) patients present with morphological and functional deficits to the lumbar multifidus. Electromyostimulation (EMS) can be used to improve activation and strength in atrophied skeletal muscle, but its effect on multifidus morphology and function in CLBP patients is understudied. The aims of this study were to compare the effect of two EMS protocols on lumbar multifidus morphology, function, and patient-reported outcomes. Methods: Two-arm randomized control trial (RCT). Individuals with CLBP were randomized to receive either the ‘phasic’ or ‘combined’ muscle therapy protocol with the StimaWELL 120MTRS, a medium-frequency EMS device. T-tests and non-parametric equivalents were used to assess change in imaging-based outcomes, and a repeated-measures ANOVA was used for patient-reported outcomes. Results: Apart from a significant within-group decrease in fatty infiltration at left L5-S1 in the combined group (MD = −1.51, 95% CI = −2.79, −0.23, p = 0.024), results revealed no significant within- or between-group changes to multifidus morphology or function. Pairwise comparisons revealed that both groups experienced significant improvements in multiple pain outcome measures, with a significant group*time effect for LBP with sitting (p = 0.019) and pain interference (p = 0.032) in favor of the phasic group. Additionally, there were significant improvements in the phasic group in disability, pain interference, and pain catastrophizing (all p < 0.01). Conclusions: A 10-week EMS intervention produced no between-group differences in multifidus muscle morphology or function. Participants in both groups experienced significant improvements in a variety of patient-reported outcomes.

Impact of non-immersive virtual reality on procedural pain, anxiety, and satisfaction in chronic low back pain patients: A quasi-experimental study

Concurrent validity of the directional preference phenomenon compared to controlled lumbar discography: A supplementary analysis of a diagnostic accuracy study.

Low back pain (LBP) is one of the leading causes of disability in the world's population, yet there are limitations in providing an objective clinical assessment due to its widespread nature. In this work, five machine learning models (LightGBM, XGBoost, HistGradientBoosting, GradientBoosting, and StackingRegressor) were compared to predict trunk mobility based on inertial sensor data. There were 77 individuals with a total of 2160 movement samples of flexion–extension, rotation, and lateralization. Synthetic data augmentation and normalization were performed to be able to work with the data efficiently. Mean absolute error (MAE), mean square error (MSE), and R2 were used to evaluate model performance. Additionally, ANOVA and Tukey’s HSD were used to assess the statistical significance of the models. GradientBoostingRegressor was found to produce the lowest error and statistical significance in flexion–extension and lateralization, while StackingRegressor produced the best error in rotation. The results indicate that inertial sensors and machine learning (ML) can be applied to predict mobility, facilitating personalized rehabilitation and reducing costs. The present study demonstrates that predictive trunk motion modeling can facilitate clinical monitoring and help reduce socioeconomic limitations in patients.

PurposeChronic low back pain (cLBP) is a commonly occurring and debilitating disorder that impacts health related quality of life (HRQOL) which in turn affects their perception toward pain medication. This study was carried on to assess the association between HRQOL and pain medication perceptions among cLBP patients. The study aims to enhance patient-centered care by identifying sociodemographic traits, common therapeutic drugs, and associations between HRQOL and pain medication perceptions.Patients and MethodsA cross-sectional study design was employed, involving 350 patients diagnosed with cLBP the Orthopedics and Traumatology Outpatient Department of Dhulikhel Hospital (DH), Nepal. Data collection was performed via two structured of questionnaires; WHO Quality of Life-BREF (WHOQOL-BREF) for assessing HRQOL and the Pain Medication Attitude Questionnaire (PMAQ -14) for evaluating patients’ perception of pain medication.ResultsThe study revealed notable negative correlations between concerns over addiction, side-effects, tolerance, and withdrawal and both overall quality of life (OQOL) (rs = −0.273, rs = −0.160, rs = −0.287 and rs = −0.304) and physical health domain (PD) (rs = −0.265, rs = −0.108, rs = −0.307 and rs = −0.272). This suggests that greater concerns regarding these factors were linked to a lower quality of life (QoL). However, the perceived necessity for pain medication displayed a slight positive correlation with general health satisfaction (GHS) of QoL where (rs = 0.132), whereas concerns such as scrutiny with Social Relationship Domain (SRD) (rs = −0.105) and mistrust in doctor showed weaker and negligible associations.ConclusionThis study revealed that transformed OQOL was moderate with physical and psychological domains being the most impaired. Among the four domain scores, the highest score was in the SRD, while PD scored the lowest. Participants have neither good nor bad perceptions of QoL and are dissatisfied with their health showing significant concerns about addiction, side effects, and withdrawal, while societal judgement was minimal.

Background: Chronic low back pain is among the most prevalent musculoskeletal disorders globally, leading to significant disability and reduced quality of life. Conventional physiotherapy often provides temporary relief but fails to address the neuromuscular deficits underlying spinal instability. Core stabilization exercises have gained clinical attention for their potential to enhance spinal control, improve functional movement, and alleviate pain through targeted activation of deep trunk musculature. Objective: To evaluate the effectiveness of core stabilization exercises on functional mobility, pain intensity, and trunk muscle endurance among individuals with chronic low back pain. Methods: This randomized controlled trial was conducted in physiotherapy centers across South Punjab, including sixty participants aged 25–50 years diagnosed with chronic low back pain of more than twelve weeks’ duration. Participants were randomly assigned to an intervention group receiving core stabilization exercises or a control group receiving conventional physiotherapy for twelve weeks. Functional mobility was assessed using the Timed Up and Go (TUG) test, pain intensity using the Visual Analogue Scale (VAS), and trunk endurance using the Prone Plank Test. Data were analyzed using independent and paired t-tests for normally distributed data, with significance set at p &lt; 0.05. Results: The intervention group showed significantly greater improvements in all outcome measures compared with the control group. Mean TUG time decreased from 11.8 ± 1.5 to 7.9 ± 1.1 seconds (p &lt; 0.001), VAS scores reduced from 7.3 ± 1.0 to 2.9 ± 0.9 (p &lt; 0.001), and plank endurance increased from 36.5 ± 8.2 to 68.9 ± 11.3 seconds (p &lt; 0.001). No adverse events were reported. Conclusion: Core stabilization exercises significantly improved mobility, reduced pain, and enhanced trunk endurance in chronic low back pain patients, supporting their integration into routine physiotherapy practice.

Lumbar stabilization exercise with and without real-time ultrasound imaging biofeedback in chronic low back pain patients: a randomized controlled trial.

Background: Several studies suggest that exogenous oxytocin nasal spray may enhance placebo analgesia in healthy volunteers and experimental pain models, although the findings remain mixed. The oxytocin placebo hypothesis suggests that increased oxytocin levels trigger a cascade of brain processes that boost positive expectations and augment the placebo response. Since endogenous oxytocin secretion has been found to increase during positive interactions, we hypothesized that changes in endogenous oxytocin levels will affect placebo analgesia in chronic-back-pain patients. Given the role sex has in both placebo analgesia and oxytocin secretion, we hypothesized that the response magnitude will differ by sex. Methods: Chronic-back-pain patients (n = 112) were prospectively recruited and received placebo injections. The placebo response was calculated as the change in the back-pain Visual Analog Score (VAS), and changes between pre- and post-injection salivary oxytocin levels were measured. The effect of sex and changes in oxytocin levels on pain reduction was calculated using two-way analysis of variance (ANCOVA). Results: Oxytocin levels decreased in 62.5% of participants and increased in 37.5%. Increased oxytocin levels were associated with greater pain reduction than decreased oxytocin levels (p = 0.024). Females exhibited greater pain reduction than males (p = 0.034). No interaction between the oxytocin change pattern and sex was observed. Conclusions: This study demonstrates that following a placebo injection, patients suffering from chronic back pain, who exhibited an increase in endogenous oxytocin levels, showed a higher placebo response. Females had a greater placebo response, but this was not associated with an endogenous oxytocin change. These results provide initial support for the oxytocin placebo hypothesis.

Background and ObjectiveThe Oswestry Disability Index (ODI)–English is a valid and reliable instrument for disability measurement in low back pain (LBP) patients. There is no existing ODI–Ilokano that evaluates LBP patients. This study aimed to cross-culturally adapt the ODI–English into Ilokano.MethodsThe ODI–English was cross-culturally adapted into Ilokano through a process that included forward translation, synthesis of the translations, back translation, expert committee review, and testing of the pre-final version.ResultsForward translation focused on capturing the essence of terms related to pain intensity, personal care, and daily activities, achieving consensus on phrases that accurately mirrored the original English meanings. Subsequent synthesis refined these translations, emphasizing idiomatic and conceptual equivalence over literal interpretations, particularly in nuanced areas like sleep disturbance and social life activities. Backward translation processes aligned Ilokano and English terms, especially for pain intensity and personal care, ensuring consistency across languages. The expert committee review addressed spelling, word choice, and sentence structure, making strategic adjustments for cultural relevance. Pilot testing with participants from Ilocos Norte and Ilocos Sur, Philippines highlighted comprehension challenges with specific terms, leading to adaptations like replacing 'milya' and 'yarda' with metric units and retaining culturally sensitive terms with supplementary English explanations.ConclusionThis study refined the ODI–English into a culturally adapted Ilokano version, focusing on semantic, idiomatic, and cultural equivalence. Incorporating pilot testing feedback, such as modifying measurement units and addressing sensitive terms, highlighted the thorough adaptation process. The collaborative translation efforts and diverse patient input ensured a culturally resonant ODI version for Ilokano speakers. This adaptation enhances physical therapy practices by improving patient assessments and advocates for adapting patient-reported outcomes to diverse cultures, advancing patient-centered care.

Study Design. Randomized, placebo-controlled, double-blinded phase 2b study. Objective. To compare the effects of STA363 (90 or 180 mg intradiscally) and placebo on low-back pain (LBP) in patients with lumbar degenerative disc disease (DDD) Summary of Background Data. Results from preclinical studies and a small phase 1b study have indicated that STA363 transforms the nucleus pulposus (NP) into connective tissue and thereby increases flexural rigidity. Such effects may improve LBP in DDD patients. Methods. 109 patients were equally randomized into the three treatment groups. After screening, test formulation was injected intradiscally, and patients were followed-up for up to 12 months. Primary endpoint was improvement in LBP as evaluated using the numerical rating scale. Results. The percentage of patients reporting ≥1 adverse event was 50, 55 and 63% in the placebo, STA363 90 mg and STA363 180 mg groups, respectively. The patients of all groups showed a marked reduction in LBP after treatment but there was no difference between placebo and STA363 at any follow-up time. Water content as reflected by decrease in T2 time (ms) was reduced in a dose-dependent manner (6 mo: placebo 1.5±9.0; STA363 90 mg 2.3±7.3; STA363 180 mg 5.7±9.2 (P=0.06 vs. placebo). The corresponding values for 12 months were 1.5±6.4, 4.0±7.3 and 5.3±13.4 (P=0.11). Conclusion. While MRI results were consistent with fibrosis of the NP after treatment with STA363, these changes did not translate into any significant effects on LBP in DDD patients as compared with patients injected with placebo.

BACKGROUND Despite advances in conservative back pain treatments, optimal methods for restoring multifidus muscle function - especially via neuromodulation like intramuscular electrical stimulation (IMES) - remain under investigation. This study evaluated the effects of a 6-week IMES protocol on multifidus muscle properties in individuals with chronic low back pain. MATERIAL AND METHODS In a randomized controlled trial, 29 participants (mean age: 39.2±10.9 years) were assigned to either a control group (receiving transcutaneous electrical nerve stimulation [TENS], myofascial trigger point therapy, and exercise), or an experimental group (same therapy but with IMES replacing TENS, applied via acupuncture needles under ultrasound guidance). Outcomes included muscle stiffness (MS), tension (MT), tissue perfusion (TP), pressure pain threshold (PPT), pain rating (NRS), postural stability (PS), range of motion (ROM), and maximal voluntary contraction (MVC). Assessments were conducted at baseline, immediately after treatment, and at follow-up 4 weeks later using validated instruments. RESULTS Compared to controls, the IMES group showed significant improvements after treatment and at follow-up in MT right, TP (right and left), PPT left, NRS, ROM, and PS (P values ranging from <0.001 to 0.006). No significant changes were found in MS (right or left) or MVC at any time point, nor in TP (right and left) at 4 weeks. CONCLUSIONS IMES combined with standard therapy significantly improves muscle tension, perfusion, pain threshold, intensity, ROM, and postural stability in chronic low back pain patients, outperforming standard therapy with TENS. However, causality remains uncertain due to both protocols being embedded in multimodal treatment.

The prediction of the analgesic placebo effect is moderated by direction of attention: Results from fibromyalgia and healthy controls.

Modic changes (MC) are vertebral endplate bone marrow lesions frequently observed in patients with chronic low back pain (CLBP), but their immunogenetic underpinnings remain unknown. We investigated HLA allele associations to uncover immune-mediated mechanisms and potential biomarkers for patient stratification. We analysed the blood transcriptome from 257 patients with CLBP aged ≥40 years, consisting of 187 patients with MC (types 1-3) and 70 without MC. Bootstrapped LASSO regression identified candidate HLA alleles, which were correlated with MC status using multivariate logistic regression adjusted for demographic covariates. Key findings were validated against US population allele frequencies from 8830 subjects stratified by race and ethnicity. HLA-A*26:01 was strongly associated with MC in CLBP patients (OR = 18.9; FDR = 0.041), and enrichment was independently confirmed by comparison with external population data (OR = 2.15; FDR = 0.008). HLA-DQA1*03:03 was associated with reduced risk of MC (OR = 0.09; FDR = 0.0038). A trend toward positive association was noted for HLA-DRB1*11:01 (OR = 6.0; FDR = 0.069). This is the first study to identify significant associations between HLA and MC. The link to HLA-A*26:01 highlights the significance of CD8 + T-cell-mediated immune responses in MC pathobiology. These findings suggest HLA typing may enable personalised treatment strategies in chronic low back pain patients with MC. What is already known: MC are inflammatory spinal lesions common in CLBP, but their immunogenetic basis is undefined.What this study adds: We identify HLA-A*26:01 as a novel risk allele for MC, validated across external population datasets.How this may affect research, practice or policy: HLA typing may help stratify patients with MC for targeted therapy or inclusion in immunomodulatory trials.

BackgroundLow back pain (LBP) is a major global health issue, affecting approximately two-thirds of the population at some point in their lives. Modic changes (MCs) in the vertebral endplates, as observed on MRI, are recognized contributors to LBP and may be linked to advanced stages of intervertebral disc degeneration (IDD). Prior research has shown a decrease in the genus Bifidobacterium in the endplate cartilage of patients with IDD and concurrent MCs. The potential link between reduced Bifidobacterium levels and MC-related LBP remains unclear.MethodsThis multicenter, double-blinded, randomized, placebo-controlled trial will be conducted at four hospitals in China, comparing the efficacy of orally administered Bifidobacterium adolescentis (BA) with that of a placebo. Participants will receive the treatment twice daily for a duration of three months. The study targets patients with chronic low back pain (LBP) and Modic type I or II. Eligible patients will be randomly assigned to receive either Bifidobacterium adolescentis or a placebo for three months. The primary outcome will be the change in the Simplified Chinese Roland-Morris Disability Questionnaire (SCRMDQ) score at 3, 6, and 12 months post-treatment. Secondary outcomes include changes in DASS-21 scores, MRI imaging, bone density measurements, and serum biomarker analysis.DiscussionThis study will provide valuable insights into the therapeutic potential of Bifidobacterium adolescentis in managing chronic LBP associated with Modic changes, potentially offering a novel approach to treating this common and debilitating condition.Trial registrationThe trial has been registered with China Clinical Trial Registry, under the registration number ChiCTR2400088577. Registered on 21 August. The study was prospectively registered.