Management Of Chronic Low Back Pain Research Articles

Stepping towards relief: a scoping review on the impact of unstable footwear in chronic low back pain management.

Chronic low back pain (CLBP) is a prevalent condition causing significant disability worldwide. Traditional treatments often have limited effectiveness, prompting research into alternative, non-invasive interventions. This review examines the impact of unstable footwear on CLBP management, exploring its potential to reduce pain and disability. We analyzed randomized controlled trials focusing on adults with CLBP. Studies comparing unstable footwear to standard care or conventional footwear were included. Main outcomes measured were pain reduction, functional improvement, and biomechanical changes. Methodological quality was assessed using the PEDro scale. Five studies met the inclusion criteria, showing a consistent trend towards pain reduction in participants using unstable footwear. Specifically, intervention groups reported significant improvements in pain levels and, in some cases, disability scores compared to control groups. However, findings on functional performance and long-term effects were mixed, with no significant differences in certain studies. Methodological quality varied, with an estimated PEDro score range of 6-7 across the reviewed studies. Unstable footwear may offer a beneficial non-invasive intervention for individuals with CLBP, contributing to pain reduction and possibly improving disability. Nonetheless, the evidence is tempered by methodological limitations and the need for further research. Future studies should focus on long-term outcomes, larger sample sizes, and clarifying the mechanisms behind the observed benefits. Clinicians should consider unstable footwear as part of a personalized treatment plan for CLBP, keeping abreast of new research to inform their practice.

Discogenic chronic low back pain management: intradiscal radiofrequency biacuplasty versus conservative treatment

BackgroundThis prospective bicentric study aims to evaluate and compare the efficacy of intradiscal radiofrequency biacuplasty (IDB) versus conservative management (CM) in treating chronic discogenic low back pain (CDLBP).MethodsForty-four patients with CDLBP were randomly assigned to either the biacuplasty group or the conservative management group. The biacuplasty group received treatment with two radiofrequency (RF) needles, positioned bilaterally on the annulus fibrosus under fluoroscopic guidance and local anaesthesia, to administer bipolar RF. Patients were monitored for 6 months, with the allowance of pain medication as needed. In the conservative management group, patients who continued to experience low back pain after three months were permitted to switch to the biacuplasty group. The study was conducted over two years, starting on July 1, 2020.ResultsThe studied groups had comparable age and gender distributions, with no significant difference in BMI. The Oswestry Disability Index (ODI) was assessed at baseline, 1 month, 3 months, and 6 months. At baseline, no significant difference was observed between the groups (p = 0.263). However, at the 1-month, 3-month, and 6-month follow-up, the biacuplasty group exhibited significantly lower ODI scores compared to the conservative management group (all p < 0.001), indicating that biacuplasty was more effective in reducing disability caused by chronic low back pain.ConclusionsIntradiscal radiofrequency biacuplasty is a minimally invasive interventional technique that has proven effective for patients with CDLBP who do not respond to conservative management.

Duloxetine for individuals with chronic back pain: A systematic review and meta‑analysis of randomized controlled trials.

The current study aimed to assess the efficacy of duloxetine in reducing pain and improving the quality of life of individuals with chronic low back pain (CLBP). An extensive literature search was conducted to identify relevant studies that examined the efficacy of duloxetine in CLBP management. The primary objective of the present study was to assess the role of duloxetine use on pain levels, as well as improvements in quality of life, using validated instruments. The results were synthesized using a random-effects model. A total of 8 studies were included in the analysis. Duloxetine demonstrated clear benefits in pain reduction, evidenced by improvements across multiple scales including the visual analogue scale, brief pain inventory-interference (BPI), BPI-severity, weekly worst pain over 24 hours and Roland-Morris Disability Questionnaire scores. Quality of life improved with duloxetine treatment, as indicated by the 36-item short form survey (SF-36). However, there was no significant impact on the physical function component of SF-36. The present study provides evidence to affirm the efficacy of duloxetine in treating CLBP. Further research is required to validate these findings and to establish whether combining duloxetine with other CLBP treatments yields superior outcomes.

Technology supported High Intensity Training in chronic non-specific low back pain (the Techno-HIT trial): study protocol of a randomised controlled trial

Chronic low back pain (CLBP) is one of the most common chronic musculoskeletal disorders worldwide. Guidelines recommend exercise therapy (ET) in CLBP management, but more research is needed to investigate...

Enhancing chronic low back pain management: an initial neuroimaging study of a mobile interoceptive attention training.

Chronic low back pain (cLBP) poses significant challenges, often addressed through avoidance or distraction. Emerging evidence suggests that mind-body interventions, like our novel Mind Your Pain (MyP) smartphone mobile application, may offer relief. We conducted a single-arm, mixed-methods neuroimaging study to assess the degree to which treatment response to our 8-week intervention, as measured by the reduction in the Pain, Enjoyment of Life and General Activity Scale (PEG), was associated with enhanced pain-related insula activation over time. Twenty-nine individuals with cLBP completed patient-reported assessments, qualitative sensory testing (QST) measures, and neuroimaging pre- and post-MyP. Functional MRI data during experimental heat pain on the left forearm were collected and analyzed, comparing responders (≥50% reduction in PEG scores) and non-responders. MyP led to significant decreases in PEG scores overall. Furthermore, MyP responders exhibited increased pain-related activation in key brain regions, including the contralateral posterior insula, bilateral ventral anterior insula, ventral anterior cingulate, dorsolateral prefrontal cortex, and nucleus accumbens. Although baseline behavioral and sensory measures did not differ between the two responder groups, baseline neural differences related to the impact of the endogenous back pain were observed. MyP appears to modify pain response and underlying neural circuitry, suggesting neural changes in interoception may serve as biomarkers for mind-body interventions in cLBP. This study highlights the potential of MyP as a novel approach for cLBP management, warranting further investigation.

“I could 100% see myself getting hurt if I did it wrong”: a qualitative exploration of exercise perceptions in people with chronic low back pain

Purpose Traditionally, a specific “core” exercise focus has been favoured for chronic low back pain (CLBP) which contrasts holistic exercise approaches. This study aims to explore the perceptions of exercise in people with CLBP and whether exercise itself can convey implicit messages regarding its use in CLBP management in the absence of a clinical narrative. Materials and methods Participants were asked about their CLBP history, views of exercise for CLBP, and current exercise behaviours through online semi-structured interviews. Then, participants watched the interviewer perform the deadlift, Jefferson curl, and bird dog and were asked if they thought each individual exercise was beneficial for CLBP, and why. Data were analysed using reflexive thematic analysis through a critical realism and social constructivism lens. Results All participants (n = 16) viewed all exercises as beneficial for health and pain relief, but perceived efficacy varied. “Core” exercises were deemed crucial for CLBP relief, while spinal flexion and external load were often perceived as potentially injurious. Distrust towards healthcare practitioners also influenced exercise perceptions. Conclusion People with CLBP perceive different exercises to either relieve pain or improve health. Healthcare practitioners can influence these perceptions, highlighting the need for consideration of exercise perceptions in clinical contexts.

Factors Predicting Nonadherence to Treatment Recommendations for Patients With Chronic Low Back Pain in India: A Cross-Sectional Survey

ObjectiveThe purpose of this study was to examine patients' expectations and factors that influence adherence to physiotherapists' treatment recommendations on chronic low back pain (CLBP). MethodOne hundred and forty seven patients with CLBP were included in this study. Predictive indicators including demographic information, views, expectations, and opinions regarding the health status and treatment expectations of patients were derived from questionnaires. The dependent outcome variables were the absence of trust in treatment recommendations provided by physiotherapists, the anticipation of treatment recommendations based on patient expectations, and the resistance to modifying expectations despite efforts by physiotherapists to persuade otherwise. The study was carried out between April 2022 and January 2023 in 2 regions located in India. ResultsMultivariate regression analyses show that age, expectations about diagnosis, preference for passive therapies and medical care, and information seeking behavior emerged as independent predictors of a lack of trust in physiotherapists' treatment recommendations. The information-seeking behavior of the patients’ alone predicted the anticipation of treatment recommendations based on patient expectations and the reluctance to alter those expectations despite the physiotherapists' persuasion. ConclusionOur results suggest that information seeking behavior is the most consistent independent predictor of treatment expectations that will align with physiotherapist recommendations. This indicates the importance of screening for such factors and the importance of patient education to optimize the management of CLBP. However, larger studies incorporating all variables associated with patient expectations in similar patient populations are needed to confirm these results.

Effectiveness of yoga intervention on depression, stress, and sleep quality in IT professionals with chronic low back pain: A randomized controlled trial

Chronic low back pain (CLBP) is prevalent among IT professionals and often accompanied by psychological symptoms such as depression, stress, and sleep disturbances. While conventional treatments primarily target pain management, holistic approaches like yoga show promising results in addressing both physical and psychosomatic factors. This randomized controlled trial (RCT) aims to assess the impact of a yoga intervention on depression, stress, and sleep quality in IT professionals with CLBP. A total of 83 IT professionals with CLBP were randomly allocated to either a yoga (n = 40) intervention group or a control group (n = 40) receiving standard care. The intervention group underwent a structured yoga program tailored for CLBP, while the control group followed a standard care protocol. Outcome measures, including pain intensity, depression levels, perceived stress, and sleep quality, were assessed using validated standard questionnaires. Preliminary analysis reveals significant enhancements in the yoga intervention group compared to the control group. Specifically, participants in the yoga group reported a statistically significant reduction in pain intensity (p &lt; 0.05), along with notable decreases in depression scores (p &lt; 0.05), anxiety score (p &lt; 0.05), and stress levels (p &lt; 0.05). Additionally, the yoga intervention group demonstrated enhanced sleep quality (p &lt; 0.05) compared to the control group. This RCT provides compelling evidence for the efficacy of yoga as an adjunctive therapy for CLBP management in IT professionals. The findings emphasize the potential of yoga in alleviating both physical and psychological symptoms associated with CLBP. Healthcare providers may consider incorporating yoga into treatment programs for CLBP in IT professionals to optimize outcomes and enhance overall well-being. Moreover, these results emphasize the importance of holistic interventions in addressing the complex nature of CLBP in the workplace.

MyoActivation®, a Structured Assessment and Therapeutic Process for Adolescents With Myofascial Dysfunction and Chronic Low Back Pain: A Case Series.

Introduction Myofascial dysfunction is a significant, but often unrecognized, contributor to chronic low back pain (CLBP). myoActivationis an innovative method that utilizes a structured assessment and therapeutic process to recognize and manage myofascial dysfunction and pain. Since 2017, the British Columbia Children's Hospital Complex Pain Service has used myoActivation as a tool in the interdisciplinary care of adolescents with chronic pain. This case series explores the journey to discharge of patients in whom myoActivation was incorporated as part of their CLBP management. Methods We retrospectively reviewed clinical records of adolescents reporting CLBP who underwent myoActivation between August 2022 and January 2023 and had subsequently been discharged. Information obtained for analysis included preclinical information (medical/injury/pain history, previous investigations, diagnoses, therapies, and quality of life indicators); clinic recommendations, assessment findings, management strategies, and specifics of the myoActivation process; and reported changes at discharge (quality-of-life measures and medication use). Results Eight cases were reviewed: all female, with a median age (range) of 16.5 (15.7-19.5) years. Before admission, patients had experienced chronic pain for a median duration of 4.3 (1-8) years, had self-reported average pain intensity of 7.5 (4-9) on the 0-10 numeric pain scale, with poor quality-of-life impacts including sleep disturbance (8/8, 100%), school absence (8/8, 100%), and low mood (6/8, 75%). Patients attended three (2-5) myoActivation sessions over two (1-10) weeks. The overall duration of their interdisciplinary care was 12 (7-25) months. At discharge, there were improvements in pain (7/8, 88%), physical functioning (5/8, 63%), sleep (6/8, 75%), school attendance (5/8, 63%), and mood (4/6, 67%) and reduced prescription and over-the-counter medication use in most cases. Conclusion This case series suggests that myoActivation may be a useful clinical tool in the assessment and management of adolescents with myofascial dysfunction and CLBP. Prospective longitudinal research is required to establish evidence that confirms the clinical efficacy of myoActivation within interdisciplinary care.

Navigating complexities: clinicians’ experiences and systemic challenges in the implementation of evidence-based practice for chronic low back pain – a qualitative study

Purpose Implementation of evidence-based practice (EBP) for chronic low back pain (CLBP) is poor. This study aimed to investigate the factors that influence exercise-based clinicians’ implementation of EBP for people with CLBP. Materials and Methods Semi-structured interviews were conducted with 40 clinicians (20 physiotherapists and 20 accredited exercise physiologists). Interviews explored clinicians’ definition of EBP, understanding of EBP in CLBP management, barriers and enablers to EBP, and the impact of these factors on EBP implementation. Interviews were analysed using reflexive thematic analysis. Results A complex interplay among clinician factors, systemic factors, and patient interactions was identified. Clinicians encountered challenges stemming from their misconceptions about EBP, which influenced their perspective(s) on its implementation. Clinicians expressed the challenges of implementing EBP when navigating patient expectations and beliefs, experiencing external pressures from funders and business models, and the subsequent impacts on their well-being. Continuing professional development, support from community, and workplaces that prioritised EBP enhanced clinicians’ ability to make decisions that accommodate for the complexities of CLBP and better align with EBP. Conclusion A variety of factors impact exercise-based clinicians’ implementation of EBP. The interaction between these factors greatly influences clinicians’ ability to engage in and implement EBP in clinical practice.

Appropriateness of exercise therapy delivery in chronic low back pain management: cross-sectional online survey of physiotherapy practice in Germany

BackgroundIn Germany, exercise therapy represents the most commonly prescribed physiotherapy service for non-specific, chronic low back pain (NSCLBP). So far, little is known about current practice patterns of German physiotherapists in delivering this intervention. Thus, the aim of this study was to investigate the appropriateness of exercise therapy delivered to NSCLBP patients in German physiotherapy care and to identify practitioner-related drivers of appropriate exercise delivery.MethodsWe used a vignette-based, exploratory, cross-sectional, online-survey study design (76-items; data collection between May and July 2023). Eligible participants were required to hold a professional degree in physiotherapy and were required to be practicing in Germany. Access links to anonymous online surveys were spread via established German physiotherapy networks, educational platforms, social media, e-mail lists, and snowball sampling. Appropriateness of exercise therapy was calculated by an equally weighted total score (400 points) including scales on shared-decision-making, exercise dose selection, pain knowledge and self-management promotion. “Appropriate exercise delivery” was determined by a relative total score achievement of > 80%. “Partly appropriate exercise delivery” was determined by a relative total score achievement of 50–79%, and “inappropriate exercise delivery” by a score achievement of < 50%. Practitioner-related drivers of exercise appropriateness were calculated by bivariate and multiple linear regression analyses.Results11.9% (N = 35) of 298 physiotherapists’ exercise delivery was considered “appropriate”, 83.3% (N = 245) was “partly appropriate”, and 4.8% (N = 14) was “inappropriate”. In the final multiple regression model, most robust parameters positively influencing appropriate delivery of exercise therapy were increased scientific literacy (B = 10.540; 95% CI [0.837; 20.243]), increased average clinical assessment time (B = 0.461; 95% CI [0.134; 0.789]), increased self-perceived treatment competence (B = 7.180; 95% CI [3.058; 11.302], and short work experience (B = − 0.520; 95% CI [-0.959; − 0.081]).ConclusionAppropriate exercise delivery in NSCLBP management was achieved by only 11.9% of respondents. However, the vast majority of 95.2% of respondents was classified to deliver exercise therapy partly appropriate. Long work experience seemed to negatively affect appropriate exercise delivery. Positive influences were attributed to scientific literacy, the average clinical assessment time per patient as well as the perceived treatment competence in NSCLBP management.RegistrationOpen science framework: https://doi.org/10.17605/OSF.IO/S76MF.

‘Specialist before physiotherapist’: physicians’ and physiotherapists’ beliefs and management of chronic low back pain in Ghana – A qualitative study

Purpose This study provides an understanding of the chronic low back pain (CLBP) beliefs and management practices of physicians/doctors and physiotherapists in Ghana, and the mechanisms underlying their beliefs and practices. Materials/Methods Thirty-three individual semi-structured interviews, involving eighteen physio­therapists and fifteen physicians involved with CLBP management, were carried out. Interviews were audio recorded, transcribed, and analysed using Straussian grounded theory principles and critical realist philosophy. Results Five categories were derived: The predominance of bio-medical/mechanical beliefs, maladaptive beliefs, maladaptive practices, limited involvement of physiotherapists and other healthcare professionals (HCPs) and evidence-based beliefs and practices. The predominant mechanisms underlying the HCPs beliefs and practices were: the healthcare environment (professional roles/identity hinged around paternalistic and biomedical care, fragmented CLBP management, limited physiotherapy/HCPs’ knowledge) and sociocultural environment (sociocultural/patients’ expectations of passive therapy and paternalism). Conclusion The CLBP beliefs and practices of HCPs involved with CLBP in Ghana is modelled around a professional identity that is largely hinged on paternalism and bio-medical/mechanical understandings. Lack of collaboration and sociocultural expectations also play a significant role. There is the need for a reconstitution of Ghanaian HCPs’ CLBP beliefs and management approaches to align with evidenced-based approaches (e.g., imaging should not be universally prescribed, biopsychosocial and patient-centred care).

How and why do people with chronic low back pain modify their physical activity? A mixed-methods survey.

This study investigated the impact of Chronic Low Back Pain (CLBP) on individuals' physical activity (PA) behaviours, specifically, how they modify, cease, or continue PA when experiencing CLBP. The primary aim was to explore the relationship between CLBP and PA and how this is influenced in different contexts (e.g., necessity of a task). A mixed-methods survey was administered to 220 participants, including self-reported outcomes, and capturing responses to three distinct questions related to PA and CLBP. The data was analysed via a content analysis. The findings revealed that individuals with CLBP are most likely to modify PA in work-related contexts and least likely to cease it in the same setting. Housework emerged as the most common domain for cessation of PA, while work/study activities were predominantly continued. Reasons for these trends were typically task-based rather than health or enjoyment based and influenced by the perceived necessity of the task in question. The study highlights the role of occupational and educational settings in individual responses to CLBP. The findings also highlight a gap in public awareness regarding effective CLBP management strategies, emphasising the need for increased education and awareness programs.

Integrating intra- and interpersonal perspectives on chronic low back pain: the role of emotion regulation and attachment insecurity.

Chronic low back pain (CLBP) is burdensome and interferes with psychological and physical functioning of those affected. Past research has examined interpersonal (e.g., attachment insecurity) or intrapersonal factors (e.g., emotion regulation [ER]) involved in chronic pain. However, to enhance our understanding of CLBP's biopsychosocial underpinnings, more empirical integration of both intra- and interpersonal factors involved in CLBP is needed. Thus, our study examined the independent and joint associations of insecure attachment dimensions and ER strategies with CLBP severity and interference. We recruited 242 US adults with CLBP through Prolific Academic, an online participant pool. Participants from Prolific Academic were eligible for the study if they were at least 18 years of age, resided in the US, reported CLBP at least half the days over the past 6 months (>3 months), and used prescribed pain medication for their CLBP. Data collection was between November 2021 and February 2022. Eligible participants filled out a Qualtrics survey which consisted of measures assessing insecure attachment dimensions, ER strategies, as well as demographical information. Outcome variables in the present study were CLBP severity and interference. We ran multiple linear regression models to examine the associations between ER strategies and insecure attachment dimensions as predictors, and CLBP severity or interference as predicted variables, after controlling for sex as a covariate; we also conducted moderation analyses to investigate the interactions between ER strategies and insecure attachment dimensions when testing associations with CLBP severity or interference. Our results indicated that, after controlling for ER strategies, anxious attachment was positively associated with CLBP interference but not pain severity (CI: 0.101 to 0.569; CI: -0.149 to 0.186); avoidant attachment was not associated with CLBP interference or severity (CI: -0.047 to 0.511; CI: -0.143 to 0.256). After adjusting for anxious and avoidant attachment, emotional expression and expressive suppression were positively associated with CLBP severity (CI: 0.037 to 0.328; CI: 0.028 to 0.421) but not interference (CI: -0.003 to 0.403; CI: -0.406 to 0.143). Furthermore, emotional expression was associated with CLBP severity and interference at low and medium levels of avoidant attachment (CI: 0.165 to 0.682; CI: 0.098 to 0.455); expressive suppression and cognitive reappraisal did not interact with attachment dimensions when examining CLBP severity or interference (CIs: LLs ≤ -0.291 to ULs ≥ 0.030). Our study shows that anxious attachment may be an interpersonal risk factor related to CLBP, above and beyond intrapersonal ERs, as anxious attachment was associated with higher levels of pain interference. Furthermore, emotional expression was associated with increased CLBP severity and interference, particularly among individuals at low and medium levels of avoidant attachment. Existing studies on chronic pain have mostly focused on examining intrapersonal or interpersonal correlates in isolation. The present study extends our understanding of CLBP by considering the role of interpersonal factors (i.e., insecure attachment dimensions), in combination with intrapersonal ER strategies. Given the correlational nature of the present study, longitudinal studies are needed to establish causality between psychosocial correlates and CLBP symptoms. Ultimately, we hope our integrated approach will facilitate the development of treatments and interventions tailored to address patients' attachment-related needs, enhancing the management and maintenance of CLBP among patients.

Changes in spinal motor behaviour are associated with reduction in disability in chronic low back pain: A longitudinal cohort study with 1-year follow-up.

The need to improve spinal motor behaviour in chronic low back pain (CLBP) rehabilitation remains unclear. The objective of this study was to test if changes in spinal motor behaviour were associated with changes in disability after an interdisciplinary rehabilitation program (IRP) in patients with CLBP. Seventy-one patients with CLBP participating in an IRP were included. Spinal motor behaviour was assessed with biomechanical (lumbar angular amplitude and velocity, erector spinae muscle activity and duration of the task), cognitive-emotional (task-specific fear [PRF]) and pain-related (movement-evoked pain [MEP]) measures during a lifting task before and after the IRP. Disability was measured before and after the IRP, and at 3-month and 1-year follow-ups. After adjusting for confounders, changes in disability were significantly associated with MEP changes (β adj. = 0.49, p < 0.001) and PRF changes (β adj. = 0.36, p = 0.008), but not with changes in any of the biomechanical measures. MEP at the end of IRP was also associated with disability at 3 months (β adj. = 0.37, p = 0.001) and 1 year (β adj. = 0.42, p = 0.01). Biomechanical measures at the end of the IRP were not associated with disability, except for the duration of the task that was significantly associated with reduction of disability at 3 months (β non-adj = 0.5, p < 0.001). Pain-related and cognitive-emotional measures of spinal motor behaviour were associated with reduction in disability following an IRP. Future research is needed to further investigate causal relationships between spinal motor behaviour and disability. This study supports a multidimensional understanding and analysis of spinal motor behaviour, integrating the cognitive-emotional, pain-related and biomechanical domains. It also supports the consideration of spinal motor behaviour as a potentially important treatment target in chronic low back pain management. Moreover, it suggests that reducing movement-evoked pain and task-specific fear may have more influence on disability than changing lumbar amplitude, lumbar angular velocity or erector muscle activity, which may have important implications for rehabilitation.

"What helps your back pain?" A qualitative analysis of pain management strategies in opioid-treated adults with chronic low back pain.

The purpose of this qualitative analysis was to better understand what pain management strategies adults with opioid-treated chronic low back pain (CLBP) found most helpful. A subgroup of participants from a larger randomized control trial of two psychological interventions were asked: "What helps your back pain?" at baseline and 12 months (exit) in brief, video-recorded interviews. Videos were analyzed using qualitative thematic content analysis utilizing Transana™. Participants were recruited from the community and outpatient clinics in three United States sites. Seventy-nine adults with long-term (≥3 months) opioid-treated (≥15 mg/day morphine equivalent) CLBP. Participants' baseline and exit qualitative responses to the question "What helps your back pain?" At baseline, participants identified medication (n = 63), body position (n = 59), thermal application (n = 50), physical activity (n = 49), and stretching (n = 24) as the CLBP management strategies they found helpful. At exit, the reports of medication (n = 55), physical activity (n = 41), and stretching (n = 21) were often considered helpful for CLBP and remained relatively stable, while position (n = 36) and thermal application (n = 35) strategies were mentioned less frequently and psychological strategies (n = 29) were mentioned more frequently (up from n = 5) compared to baseline. Over time, the reports of medication and active pain management strategies, eg, physical activity, remained stable, while the reports of some passive pain management strategies, eg, position and thermal, declined over time. Increased use of psychological strategies implies that study interventions were incorporated as useful pain self-management strategies.

Acceptability, values, and preferences of older people for chronic low back pain management; a qualitative evidence synthesis

BackgroundChronic primary low back pain (CPLBP) and other musculoskeletal conditions represent a sizable attribution to the global burden of disability, with rates greatest in older age. There are multiple and varied interventions for CPLBP, delivered by a wide range of health and care workers. However, it is not known if these are acceptable to or align with the values and preferences of care recipients. The objective of this synthesis was to understand the key factors influencing the acceptability of, and values and preferences for, interventions/care for CPLBP from the perspective of people over 60 and their caregivers.MethodsWe searched MEDLINE, CINAHL and OpenAlex, for eligible studies from inception until April 2022. We included studies that used qualitative methods for data collection and analysis; explored the perceptions and experiences of older people and their caregivers about interventions to treat CPLBP; from any setting globally. We conducted a best fit framework synthesis using a framework developed specifically for this review. We assessed our certainty in the findings using GRADE-CERQual.ResultsAll 22 included studies represented older people’s experiences and had representation across a range of geographies and economic contexts. No studies were identified on caregivers. Older people living with CPLBP express values and preferences for their care that relate to therapeutic encounters and the importance of therapeutic alliance, irrespective of the type of treatment, choice of intervention, and intervention delivery modalities. Older people with CPLBP value therapeutic encounters that validate, legitimise, and respect their pain experience, consider their context holistically, prioritise their needs and preferences, adopt a person-centred and tailored approach to care, and are supported by interprofessional communication. Older people valued care that provided benefit to them, included interventions beyond analgesic medicines alone and was financially and geographically accessible.ConclusionsThese findings provide critical context to the implementation of clinical guidelines into practice, particularly related to how care providers interact with older people and how components of care are delivered, their location and their cost. Further research is needed focusing on low- and middle-income settings, vulnerable populations, and caregivers.

Biomedical Dogmas Still Influence the Delivery of Exercise Therapy in Chronic Low Back Pain Management: Mixed-Methods Study.

Non-specific, chronic low back pain (NSCLBP) is a leading cause of disability, prompting long-term rehabilitation. Positive patient beliefs and expectations towards lasting exercise engagement play a crucial role for a successful management of this condition. The aim was to investigate beliefs, unmet needs and expectations of NSCLBP patients for exercise-related health behaviour change in the context of rehabilitative care. In a mono-centric mixed-methods study, we conducted semi-structured interviews with NSCLBP patients and care providers. We recruited in a rehabilitation clinic which is specialized in orthopaedics and internal medicine. Interviews were analysed deductively by combining health behaviour change theories with Donabedian's quality model of care. In a patient survey, disability (RMDQ), exercise behaviours, fear avoidance beliefs (FABQ), self-efficacy in chronic disease management (SES6G), process- and outcome-expectations (OEE-2) were queried and analysed descriptively. Twenty-two interviews were conducted and 40 questionnaires completed. Qualitative results revealed that NSCLBP patients had persistent biomedical perspectives on their health condition, marked by strong preferences for biomedical diagnostics and beliefs in the superiority of specific exercise regimes. Based on met expectations and positive movement experiences, patients' motivation was successfully fostered in the motivational phase of health behavior change. In the volitional phase, the postulated desire to receive self-management strategies was largely unmet. Psychosocial aspects of care were not widely accepted. The survey study sample showed a disability score (RMDQ) of M = 6.8 (±4.6). Mean scores of validated scales reflecting on attitudes, beliefs and expectations of chronic NSCLBP management were at FABQ-pa M = 15.4 (±6.0), FABQ-w M = 24.0 (±12.1), SES6G M = 6.4 (±2.3), and OEE-2 M = 2.7 (±0.5). In this sample, patients' understanding of NSCLBP was still dominated by biomedical dogmas and perspectives. Inpatient rehabilitation predominantly addressed expectations towards the motivational phase of exercise-related health behaviour change.

Chronic Low Back Pain Management: Comparison of Facet Denervation with Radiofrequency Thermoablation and Facet Joint Injection

Chronic Low Back Pain Management: Comparison of Facet Denervation with Radiofrequency Thermoablation and Facet Joint Injection

Experiences of patients with chronic low back pain plus comorbid depressive symptoms in a videoconference group acceptance and commitment therapy or behavioral activation treatment for depression: a qualitative study

Purpose To explore the experiences of patients with chronic low back pain (CLBP) plus comorbid depressive symptoms who received a remote synchronous videoconference group form of Acceptance and Commitment Therapy (ACT) or Behavioral Activation Treatment for Depression (BATD). Methods A qualitative study (IMPACT-Q) was nested within a randomized controlled trial (RCT) designed to assess the efficacy and the cost-utility/cost-effectiveness of two therapies in the management of CLBP and depression. Fifty-five patients with CLBP plus depression were selected from the RCT. Twelve focus group sessions, each approximately 60–90 min long, were audio-recorded, transcribed verbatim, and analyzed by six coders through a thematic analysis (deductive and inductive) based on a descriptive phenomenological approach. Results Patients perceived behavioral, affective, and cognitive improvements after completing group sessions. Overall, psychotherapy was perceived as a safe and non-judgmental place to express emotions and feel understood. The main barriers reported were lack of human contact and loss of social interaction. In contrast, ease of access, flexibility in the ability to connect from anywhere, avoidance of the need to travel, and savings in time and money were key facilitators to increase attendance and adherence to therapy. Conclusion This study provided support for the acceptability of videoconference-delivered ACT or BATD in patients with CLBP plus comorbid depressive symptoms.