Management Of Chronic Low Back Pain Research Articles

Comparative Effectiveness of Lumbar Stabilisation Exercises and Vertical Oscillatory Pressure in the Management of Patients with Chronic Low Back Pain

Background: Chronic Low Back Pain (CLBP) can lead to a diminished ability to engage in a variety of activities such as work. Some of the treatments of CLBP are manual therapy techniques such as Vertical Oscillatory Pressure (VOP) and therapeutic exercises such as Lumbar Stabilization Exercises (LSE). Objective: This study assessed and compared the effectiveness of LSE, VOP and VOP combined with LSE on pain intensity, disability level, health related quality of life, anxiety level and spinal range of motion in patients with CLBP. Methods: This quasi-experimental study involved 63 patients with CLBP. Participants were recruited purposively from Out-patient Physiotherapy Clinics of two Hospitals in Nigeria. Participants who gave their consents were randomly assigned into one of three treatment groups. Treatment effects were assessed in terms of pain intensity, anxiety level, disability index, health related quality of life and spinal ROM using Visual Analogue Scale, Beck Anxiety Inventory, Oswestry Disability Index, Short Form-12 questionnaire and F-F method at baseline, third week and sixth week of treatment. Participants underwent treatment twice weekly for six weeks. Measurements of outcomes were done at baseline, third week and sixth week of treatment. Descriptive statistic of mean, standard deviation and inferential statistics of One-way and Repeated measure ANOVA were used to analyse data. Alpha level was set at p˂0.05 of significance. Results: The results showed VOP had significant effects on disability level and pain intensity while LSE had significant effects on anxiety, pain intensity and health related Quality of Life. Combination of VOP and LSE significantly affected disability level, anxiety level, pain intensity, health related quality of life and spinal ROM. Conclusion: The study concluded that Vertical Oscillatory Pressure (VOP) and Lumbar Stabilization Exercises (LSE) were effective independently, however combined VOP and LSE seems to be more effective in the management of CLBP.

Unconventional Practitioners' Causal Beliefs and Treatment Strategies for Chronic Low Back Pain in Rural Nigeria.

Chronic low back pain (CLBP) is highly prevalent and CLBP disability reinforces poverty and Nigerian rural-urban inequality. Most rural Nigerian dwellers with CLBP consult unconventional practitioners due to difficulty in accessing conventional health care. This interaction may influence back pain beliefs and behaviours, and health outcomes including disability. In line with the recent Lancet Low Back Pain series call to address widespread misconceptions in the population and among health practitioners about low back pain, this study explored the beliefs and management strategies of unconventional practitioners consulted by people living with CLBP in rural Nigeria. Qualitative semi-structured face-to-face individual interviews. Thematic analysis of transcripts was performed using the Framework approach. Nine unconventional practitioners consented to participate in this study. Patent medicine sellers and herbalists had biomedical beliefs about CLBP and encouraged passivity and drug dependence in patients. Pastors adopted spiritual or biopsychosocial-spiritual management models and either encouraged spiritual CLBP causal beliefs and spiritual healing expectations; or patients’ resilience and acceptance, respectively. Unconventional practitioners’ CLBP beliefs and management strategies aligned with the beliefs and coping strategies of patients who consulted them. Unconventional practitioners’ beliefs and management strategies may therefore contribute to the adverse impact of CLBP in rural Nigeria.

The effectiveness of group cognitive behavioural therapy in the management of chronic low back pain

Purpose: Chronic low back pain (CLBP) is a common musculoskeletal condition that is associated with several psychosocial issues such as pain, low mood and fear-avoidance behaviours. Cognitive behavioural therapy (CBT) is a well-documented psychotherapy known to effectively manage these and is usually delivered in individual settings but this can be costly. Group delivery is a resource efficient alternative which has received an increasing amount of research interest. Therefore, the purpose of this paper was to systematically review the current evidence assessing the effectiveness of group CBT in the management of CLBP.

Effectiveness, costs and cost-effectiveness of chiropractic care and physiotherapy compared with information and advice in the treatment of non-specific chronic low back pain: study protocol for a randomised controlled trial

BackgroundLow back pain is a global public health problem and a leading cause of disability all over the world. The lifetime prevalence of low back pain is 70–80% and a significant proportion of people affected develop chronic low back pain (CLBP). Besides a severe negative impact on people’s health and health-related quality of life, CLBP is associated with substantial costs for society. Medical costs for the management of CLBP and costs for production losses due to absenteeism from work are sizeable. Pharmaceuticals, physical activity, manipulation, and multidisciplinary rehabilitation interventions are examples of widely used treatments for CLBP. However, the scientific basis to recommend the use of one treatment over another is limited and more research is needed to study the effects, costs and cost-effectiveness of treatments for CLBP in clinical practice.The aim of the study is to evaluate the effectiveness (back pain-related functional limitation, back pain intensity, general health, health-related quality of life, and working status), costs (medical costs and costs for production losses) and cost-effectiveness of chiropractic care and physiotherapy when added to information and advice in the treatment of patients with non-specific CLBP in Sweden.Methods/designThis is a pragmatic randomised controlled trial, where participants are recruited through six primary care rehabilitation units (PCRUs) in Stockholm County Council, Sweden. Individuals with non-specific CLBP are individually randomised to one of four treatment groups: ‘information and advice’; ‘physiotherapy, and information and advice’; ‘chiropractic care, and information and advice’; or ‘chiropractic care, physiotherapy, and information and advice’. A sample size of 600 participants will be recruited during a period of 33 months. A computer-based questionnaire is used to collect data on back pain-related functional limitation (Oswestry Disability Index), pain intensity (Numeric Rating Scale), general health (self-rated health), health-related quality of life (EQ-5D-3L), and working status (measured as percentage of full-time work). Data will be collected at baseline, and at 3, 6, and 12 months after baseline.DiscussionThe results from our study should be considered when producing evidence-based guidelines and recommendations on which treatment strategies to use for CLBP.Trial registrationISRCTN registry, ID: ISRCTN15830360. Registered prospectively on 2 February 2017.

Peer support for community dwelling older adults with chronic low back pain: a mixed-methods feasibility study

Purpose: Chronic low back pain (CLBP) is a common, costly and disabling condition affecting large numbers of older people. Self-management is a key component of CLBP management, but several barriers to effective self-management exist. The purpose of this study was to develop and test the acceptability and feasibility of a peer support intervention aimed at facilitating self-management and enhancing the health and wellbeing of community dwelling older adults with CLBP.

A Preliminary Study of the Objective Measurement of Compliance Rates for Semirigid Lumbar-Support Use in Patients with Chronic Nonspecific Low Back Pain: How Important Is the Compliance Rate?

Study DesignClinical pilot study.PurposeTo objectively evaluate the compliance rate of lumbar-support use in patients with chronic nonspecific low back pain, as well as to assess low back pain intensity, disability, and fear-avoidance beliefs.Overview of LiteratureWearing time is an important factor in the assessment of the efficacy of lumbar-support use in patients with chronic nonspecific low back pain. Previous studies have measured lumbar-support wearing time based on subjective assessment, and these evaluations are not easily verifiable and are usually overestimated by subjects.MethodsTwelve subjects with chronic nonspecific low back pain who had been wearing semirigid lumbar supports for 6 weeks were evaluated. Compliance was objectively monitored using temperature sensors integrated into the semirigid lumbar supports. Subjects wore their lumbar supports for 8 hour/day on workdays and 3 hour/day on holidays during the first 3 weeks. During the next 3 weeks, subjects were gradually weaned off the lumbar supports. Pain intensity was measured using a numerical rating scale. The Oswestry disability index was used to assess the subjects' disability. Fear-avoidance behavior was evaluated using a fear-avoidance beliefs questionnaire.ResultsThe mean compliance rate of the subjects was 78.16%±13.9%. Pain intensity was significantly lower in patients with a higher compliance rate (p=0.001). Disability index and fear-avoidance beliefs (functional outcomes) significantly improved during the second 3-weeks period of the treatment (p<0.001, p=0.02, respectively).ConclusionsThe compliance rate of patients wearing lumbar supports is a determining factor in chronic low back pain management. Wearing semirigid lumbar supports, as advised, was associated with decreased pain intensity, improved disability index scores, and improved fear-avoidance beliefs in patients with chronic nonspecific low back pain.

Insomnia in patient with chronic low back pain

Chronic low back pain (CLBP) is the most common complaint in rehabilitation system and it is associated with reduced quality of life, limitation of function, high economic costs for health service system and it is almost universally associated with sleep disturbance. It was considered that insomnia was a symptom of pain conditions and of little consequence in its’ own right, new studies suggest that insomnia has important effects on the clinical course of pain syndromes. While pain may disrupt sleep, it appears that problems with sleep increase pain and are associated with impairments in daytime function. The emerging point of view is that specific treatment for both pain and insomnia is needed for optimal clinical management. The aim of the study was to assess insomnia of patients with low back pain and to identify factors associated with this insomnia. Clinical insomnia among CLBP patients’ requires a well standardized and adjusted treatment in the aim of increasing the quality of life. The study included 45 patients suffering from low back pain (24 women, 21 males, mean age: 54.15 ± 7.8 years). Insomnia severity was assessed using Index of Severity of Insomnia with a global score going from 0 (the best situation) to 28 (the worst situation). Relationship between insomnia and low back pain was analyzed. In literature, CLBP is associated with greater sleep disturbance: sleep disturbance and duration, sleep quality, the ability to fall asleep and sleep distress. All these criteria were investigated during the study. Insomnia was reported by 43% of patients and was caused by pain in 82% of them. Insomnia was early, middle and late in respectively 55.32 and 13% fall insomniac patients. Consequences of insomnia were followed by daily activities disturbance, tiredness and mood disorders. Significant correlations were found between index of severity of insomnia and pain (VAS) and body mass index ( P < 0.01). Assessment of insomnia must be integrated in chronic low back pain management. Management strategies for CLBP need to take into consideration all complications that this pathology involves in order to increase the quality of life for these patients.

Most Relevant Neuropathic Pain Treatment and Chronic Low Back Pain Management Guidelines: A Change Pain Latin America Advisory Panel Consensus.

Chronic pain conditions profoundly affect the daily living of a significant number of people and are a major economic and social burden, particularly in developing countries. The Change Pain Latin America (CPLA) advisory panel aimed to identify the most appropriate guidelines for the treatment of neuropathic pain (NP) and chronic low back pain (CLBP) for use across Latin America. Published systematic reviews or practice guidelines were identified by a systematic search of PubMed, the Guidelines Clearinghouse, and Google. Articles were screened by an independent reviewer, and potential candidate guidelines were selected for more in-depth review. A shortlist of suitable guidelines was selected and critically evaluated by the CPLA advisory panel. Searches identified 674 and 604 guideline articles for NP and CLBP, respectively. Of these, 14 guidelines were shortlisted for consensus consideration, with the following final selections made: "Recommendations for the pharmacological management of neuropathic pain from the Neuropathic Pain Special Interest Group in 2015-pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis.""Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society" (2007). The selected guidelines were endorsed by all members of the CPLA advisory board as the best fit for use across Latin America. In addition, regional considerations were discussed and recorded. We have included this expert local insight and advice to enhance the implementation of each guideline across all Latin American countries.

CHRONIC LOW BACK PAIN;

Background: Worldwide prevalence of chronic low back pain is 19.6% in thoseaged between 20-59 years and more prevalent in women. Routine physiotherapy appears to beeffective in reducing pain and improving functional outcome in chronic low back pain patients.Lumbar stabilization exercises are trending in the management of chronic low back pain thoughit is not known whether addition of these exercises produce better results as compared to routinephysiotherapy alone. Objectives: The objective of this study was to determine the effect of thelumbar stabilization exercises on pain, ROM and functional disability in the management ofchronic low back pain. A randomized control trial. Period: February 2016 to July 2016. Setting:Rehab &amp; Research Center, Pakistan Railway General Hospital. Methodology: 42 chronic lowback pain patients (02 drop outs, one from each group). The participants were recruited throughpurposive sampling technique. Random allocation was done through coin toss method into twogroups Lumbar Stabilization Exercise (LSE) group (n=20) and Conventional Physiotherapy(CPT) group (n=20). Tools used to collect data were NPRS, Modified ODI, Goniometer (LumbarFlexion, Extension and Side bendings) and MMT (Trunk Flexors and Extensors). The data wasanalyzed (n=40) at baseline and later after 2 weeks of intervention (8 sessions) on IBM SPSS-20. Results: 28 females and 12 males participated in the study with mean age of 38.88 ±12.69.After 02 weeks of intervention both treatment groups showed improvement in decreasing painand improving functional status. LSE group had significant gains in NPRS p=0.001, ModifiedODI p=0.001, ROM Extension p= 0.027, ROM Right side bend p= 0.024 and MMT Flexion p=0.031 as compared to CPT group. Conclusion: Lumbar stabilization exercises in addition toconventional physiotherapy are found more effective in chronic low back pain managementas compared to conventional physiotherapy alone in terms of reducing pain and functionaldisability.

Communication Skills Training for Practitioners to Increase Patient Adherence to Home-Based Rehabilitation for Chronic Low Back Pain: Results of a Cluster Randomized Controlled Trial

ObjectiveTo assess the effect of an intervention designed to enhance physiotherapists' communication skills on patients' adherence to recommendations regarding home-based rehabilitation for chronic low back pain. DesignCluster randomized controlled trial. SettingPublicly funded physiotherapy clinics. ParticipantsA sample (N=308) of physiotherapists (n=53) and patients with chronic low back pain (n=255; 54% female patients; mean age, 45.3y). InterventionsPatients received publicly funded individual physiotherapy care. In the control arm, care was delivered by a physiotherapist who had completed a 1-hour workshop on evidence-based chronic low back pain management. Patients in the experimental arm received care from physiotherapists who had also completed 8 hours of communication skills training. Main Outcome Measures(1) Patient-reported adherence to their physiotherapists' recommendations regarding home-based rehabilitation measured at 1, 4, 12, and 24 weeks after the initial treatment session. (2) Pain and pain-related function measured at baseline and at 4, 12, and 24 weeks. ResultsA linear mixed model analysis revealed that the experimental arm patients' ratings of adherence were higher than those of controls (overall mean difference, .41; 95% confidence interval, .10–.72; d=.28; P=.01). Moderation analyses revealed that men, regardless of the intervention, showed improvements in pain-related function over time. Only women in the experimental arm showed functional improvements; female controls showed little change in function over time. The Communication Style and Exercise Compliance in Physiotherapy intervention did not influence patients' pain, regardless of their sex. ConclusionsCommunication skills training for physiotherapists had short-term positive effects on patient adherence. This training may provide a motivational basis for behavior change and could be a useful component in complex interventions to promote adherence. Communication skills training may also improve some clinical outcomes for women, but not for men.

The RESOLVE Trial for people with chronic low back pain: protocol for a randomised clinical trial

Low back pain is the leading worldwide cause of disability, and results in significant personal hardship. Most available treatments, when tested in high-quality randomised, controlled trials, achieve only modest improvements in pain, at best. Recently, treatments that target central nervous system function have been developed and tested in small studies. Combining treatments that target central nervous system function with traditional treatments directed towards functioning of the back is a promising approach that has yet to be tested in adequately powered, prospectively registered, clinical trials. The RESOLVE trial will be the first high-quality assessment of two treatment programs that combine central nervous system-directed and traditional interventions in order to improve chronic low back pain. To compare the effectiveness of two treatment programs that combine central nervous system-directed and traditional interventions at reducing pain intensity at 18 weeks post randomisation in a randomised clinical trial of people with chronic low back pain. Two-group, randomised, clinical trial with blinding of participants and assessors. Two hundred and seventy-five participants with chronic low back pain that has persisted longer than 3 months and no specific spinal pathology will be recruited from the community and primary care in Sydney, Australia. Both of the interventions contain treatments that target central nervous system function combined with treatments directed towards functioning of the back. Adherence to the intervention will be monitored using an individual treatment diary and adverse events recorded through passive capture. Participants are informed prior to providing informed consent that some of the treatments are not active. Blinding is maintained by not disclosing any further information. Complete disclosure of the contents of the intervention has been made with the UNSW HREC (HC15357) and an embargoed project registration has been made on the Open Science Framework to meet the Declaration of Helsinki requirement for transparent reporting of trial methods a priori. Participants randomised to Intervention A will receive a 12-session treatment program delivered as 60-minute sessions, scheduled approximately weekly, over a period of 12 to 18 weeks. All treatment sessions are one-on-one. The program includes a home treatment component of 30minutes, five times per week. The intervention comprises discussion of the participant's low back pain experience, graded sensory training, graded motor imagery training and graded, precision-focused and feedback-enriched, functional movement training. Treatment progression is determined by participant proficiency, with mandatory advancement at set time points with respect to a standard protocol. Participants randomised to Intervention B will receive a 12-session treatment program of the same duration and structure as Intervention A. The intervention comprises discussion of the participant's low back pain experience, transcranial direct current stimulation to the motor and pre-frontal cortices, cranial electrical stimulation, and low-intensity laser therapy and pulsed electromagnetic energy to the area of greatest pain. Treatment is delivered according to published recommendations and progressed with respect to a standard protocol. The primary outcome is pain intensity at 18 weeks post randomisation. Secondary outcomes will include disability, depression, pain catastrophising, kinesiophobia, beliefs about back pain, pain self-efficacy, quality of life, healthcare resource use, and treatment credibility. Assessment will occur at baseline and at 18, 26 and 52 weeks after randomisation. Treatment credibility will be assessed at baseline and 2 weeks after randomisation only. A statistician blinded to group status will analyse the data by intention-to-treat using linear mixed models with random intercepts. Linear contrasts will be constructed to compare the adjusted mean change (continuous variables) in outcome from baseline to each time point between intervention A and intervention B. This will provide effect estimates and 95% confidence intervals for any difference between the interventions. Preliminary data suggest that combining treatments that target central nervous system function with traditional interventions is a promising approach to chronic low back pain treatment. In the context of modest effects on pain intensity from most available treatments, this approach may lead to improved clinical outcomes for people with chronic low back pain. The trial will determine which, if either, of two treatment programs that combine central nervous system-directed and traditional interventions is more effective at reducing pain intensity in a chronic low back pain cohort. Central nervous system-directed interventions constitute a completely new treatment paradigm for chronic low back pain management. The results have the potential to be far reaching and change current physiotherapy management of chronic low back pain in Australia and internationally.

Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Most high-quality guidelines recommend education, staying active/exercise, manual therapy and paracetamol/NSAIDs as first-line treatments for LBP. Recommendation of paracetamol for acute LBP is challenged by recent evidence and needs updating.

Pharmacokinetic and pharmacodynamic evaluation of oxycodone and naltrexone for the treatment of chronic lower back pain

ABSTRACTIntroduction: Chronic low back pain (CLBP) is a common and difficult illness to manage. Some individuals with CLBP have pain processing disorders and are also at risk for opioid abuse, misuse; addiction and diversion. Guidelines have been published to guide management; neuromodulation, exercise, mindfulness-based stress reduction and cognitive behavior therapies among other non-pharmacological reduce the pain of CLBP with minimal toxicity. Pharmacological management includes acetaminophen, NSAIDs and antidepressants, mainly duloxetine. Abuse-deterrent opioids have been developed which have been shown to reduce pain and opioid abuse risk. ALO-02 is a tamper-resistant sustained release opioid consisting of extended release oxycodone and sequestered naltrexone. Pivotal studies of ALO-02 have centered on patients with CLBP.Areas covered: This manuscript will review CLBP, the pivotal analgesic and clinical abuse potential studies of ALO-02. The opinion will cover whether opioids should be used for CLBP, when they should be used and opioid choices.Expert opinion: ALO-02 is one of several opioids which can be considered in the management of CLBP. The outcome to a trial of opioids should be function rather than analgesia. Most analgesic trials for CLBP have had analgesia as the primary outcome and function has not been vigorously studied as an outcome. Opioids should be considered as a trial only when other non-opioid analgesics have failed to improve analgesia and function. Universal precautions should be routinely part of phase III analgesic trial particularly for chronic non-malignant pain

Influence of chronic low back pain and fear of movement on the activation of the transversely oriented abdominal muscles during forward bending

Introduction: Chronic low back pain (CLBP) and fear of movement (kinesiophobia) are associated with an overactivation of paravertebral muscles during forward bending. This impairs spine motor control and contributes to pain perpetuation. However, the abdominal muscles activation is engaged too in spine stabilization but its modulation with kinesiophobia remains unknown. Our study tested whether CLBP and kinesiophobia affected the activation pattern of abdominal muscles during trunk flexion/extension. Methods: Surface electromyographical recordings of the internal oblique/transversus abdominis (IO/TrA) and external oblique (EO) muscles were analyzed in 12 people with CLBP and 13 pain-free subjects during low-velocity forward bending back and forth from erected posture. Tampa Scale of Kinesiophobia was also administrated. Results: IO/TrA activation, but not EO, was modulated across the phases of movement in both groups, i.e. maximal at onset of flexion and end of extension, and minimal at full flexion. In CLBP group only, IO/TrA activation was increased near to full trunk flexion and in correlation with kinesiophobia. Conclusions: The phase-dependence of IO/TrA activation during trunk flexion/extension in standing may have a role in spine motor control. The influence of kinesiophobia in CLBP should be further investigated as an important target in CLBP management.

Pain self-efficacy mediates the relationship between depressive symptoms and pain severity.

We examined the relationships between depressive symptoms, pain severity, and pain self-efficacy (PSE) in patients with chronic low back pain (CLBP). We hypothesized that change in depressive symptoms would significantly influence change in pain severity, and that PSE indirectly affects this relationship. Participants were 109 CLBP patients in a 4-week multidisciplinary rehabilitation program for CLBP. They completed measures of PSE, depression, and pain severity at admission and discharge. Structural equation modeling was used to test the significant direct and indirect effects from pretreatment to posttreatment. Change in depressive symptoms significantly predicted change in pain severity in affective (β=0.358; 95% confidence interval [CI], 0.206-0.480; P=0.006), sensory (β=0.384; 95% CI, 0.257-0.523; P=0.002), and evaluative pain (β=0.456; 95% CI, 0.285-0.605; P=0.002). The indirect effects of change in PSE partially accounted for the relationship between change in depressive symptoms and change in sensory (β=0.105; 95% CI, 0.016-0.241; P=0.023) and evaluative pain (β=0.121; 95% CI, 0.010-0.249; P=0.040). The relationship between change in depressive symptoms and change in affective pain was fully accounted for by the indirect effect of change in PSE (β=0.203; 95% CI, 0.082-0.337; P=0.002). These findings suggest that pain management and rehabilitation programs for CLBP should specifically target PSE as a key aspect of treatment.

The knowledge and #8211; practice gap in physiotherapy practice: a clinical audit of the assessment and management of chronic low back pain within outpatient physiotherapy practice.

Objective: The aim of this study was to investigate the extent of the knowledge – practice gap in the assessment and management of chronic low back pain (CLBP) within physiotherapy practice in a South Australian public hospital setting. Methods: Clinical audit of 78 patient records was undertaken to evaluate the level of documented compliance in physiotherapy practice with consensus evidence based guideline recommendations, during the period July 2012 to July 2013 Results: The clinical audit demonstrated variable levels of compliance with guideline recommendations for the assessment and management of CLBP. Documentation supporting the use of diagnostic triage, red flag screening and yellow flag screening in the physiotherapy assessment was identified in 4 (5%), 68 (87%) and 17 (22%) of the 78 medical records audited. Whilst documentation regarding the provision of advice and education, a supervised exercise program and a multidisciplinary approach to management was identified in 13 (17%), 78 (100%) and 3 (4%) medical records respectively. Conclusions: The results of this clinical audit suggest an important knowledge – practice gap between evidence based guidelines and clinical physiotherapy practices within this health care setting. These findings may have implications for clinicians and educators as they raise a number of questions about the acceptance of the biopsychosocial model and implementation of the evidence based practice regarding the assessment and management of CLBP into clinical physiotherapy practice.

Yoga reduces chronic low back pain

Background: Although yoga is an effective treatment for chronic low back pain (CLBP), little is known about the mechanisms responsible for its benefits. Objective: To study the effect of Integrated Approach of Yoga Therapy (IAYT) on disability, depression, and pain in patients with CLBP. Method: Seven days intensive residential IAYT program in a single group pre-post study was conducted in a holistic health centre at Bengaluru, India. Thirty-five patients (22 females, 13 males) with CLBP were selected conveniently to undergo the IAYT program. The IAYT program was a combination of Asanas (physical postures), Pranayama (breathing practices), and meditation, apart from interactive sessions on the philosophical concepts of yoga. The modified Roland-Morris Disability Questionnaire (RMDQ), Beck Depression Inventory (BDI), and Straight Leg Raising (SLR) Test were administered before and after the IAYT program. Statistical Analysis: The Statistical Package for the Social Sciences version 16 was used for statistical analysis. The Shapiro–Wilk test showed that the data was normally distributed. Paired samples t-test was used to compare the means. Results: The data analysis showed significant change (p&lt; 0.001, in all cases) with 54.13% decrease in the RMDQ scores (t = 0.759), 36.46% increase in right (t = 0.887) and 36.04% (t = 0.884) in left SLR scores, and 71.47% decrease in BDI scores (t = 0.797). Conclusion: The present study suggests that 7-day intensive residential IAYT program reduces disability and depression and improves spinal mobility in patients with CLBP. Thus, yoga may play a vital role in the management of CLBP. Additional randomized control trials are needed before a strong recommendation can be made.

Substantive review of the literature of medication treatment of chronic low back pain among adults.

Pain can be debilitating, and it is often inadequately treated, particularly among patients with chronic low back pain (CLBP). CLBP has a substantial economic impact, as it affects an individual's ability to perform activities of daily living and maintain employment. This study aims to review original studies related to the evidence-based management of patients with CLBP to develop an algorithm for prescribing medications and recommending other treatment modalities for patients with CLBP. An electronic search of PubMed, CINAHL, and the Cochrane Database was conducted to identify studies related to the evidence-based management of CLBP that were performed between 2003 and 2012. The following keywords were used: low back pain, back pain, chronic back pain, medication management, and adjunct therapy. The selected articles were specific to CLBP, medication-based management, and additional treatment options, such as adjunct therapies. The collected data revealed that there are a number of approaches to the management of CLBP. Medication regimens are frequently used and widely available, but alternative treatment modalities can also be effective. Providers should encourage patients to explore a variety of treatment modalities that can provide pain relief and improve functionality and overall well-being.

Opioids Versus Physical Therapy for Management of Chronic Back Pain

Chronic low back pain (CLBP) is a common disabling disorder managed by a variety of interventions. The purpose of this article was to review the literature and critique the evidence to determine if opioid analgesics improved patient outcomes compared with physical therapy. No research was found that directly compared the efficacy of opioid analgesics with physical therapy. Although the evidence supports the use of physical therapy in chronic back pain, the study results are conflicting regarding the usefulness of opioid analgesics in CLBP management. More research involving the efficacy of opioid analgesic in treating CLBP is needed.

The effects of Unilaterally Applied Grade III Postero- Anterior (PA) Glide on Transverse Process of Lumbar Spine for Chronic Low Back Pain (LBP) Patients Showing Early Signs of Nerve Impingement- A Critical Literature Review

Introduction : Joint mobilisations in the spine are used as an integral part of the treatment and rehabilitation to alleviate pain and reduce stiffness. Mobilisation has also been used to improve muscle strength as described in the literature. However, there is dearth of data exploring the effect of mobilisation on muscle strength in Chronic LBP. Physiotherapy treatment for patients with Chronic LBP consists of a variety of interventions which includes Spinal Manipulative Therapy (SMT), McKenzie exercises, Core Strengthening Exercises and so on. Specific and most effective treatment regimen for chronic LBP is still undiscovered in physiotherapy context. Aims&Objectives : To explore and present the evidence of the effectiveness of PA Lumbar mobilisation in the management of Chronic LBP in patients with early signs of nerve impingement and the techniques and the physiological effects of lumbar mobilisation through a literature based review. Search Method : All relevant medical databases like AMED, CINAHL, PUBMED, Academic search complete and Cochrane databases for systematic reviews were searched and evaluated to find the relevant researches on the topic. Results&Conclusions : Several studies were identified which supports the use of PA lumbar mobilisation (Grade III) in Chronic LBP patients. From the critical appraisal and looking at the evidences it is evident that Maitland's Postero-Anterior mobilisation of the lumbar spine is helpful in eradicating/reducing the Pain and improving the ROM in LBP patients. The technique definitely has some implications on the pathophysiology of LBP. It also tends to increase the pain threshold locally and creates a hypoalgesic effect. The mobilisation technique tends to produce both general as well neurophysiological effects which are illustrated by many researchers in the course of time.