Chronic Low Back Pain Population Research Articles

Preliminary Characterization of Age and Chronic Low Back Pain Effects on Multimodal Pain Sensitivity: A Comparison Study in Older Adults with and Without Chronic Low Back Pain

Though pain sensitivity impairments contribute to chronic pain in younger adults, it is unclear if pain hypersensitivity manifests with aging and is heightened in the geriatric chronic low back pain population. The cross-sectional study preliminarily addressed this gap by measuring pain sensitivity in older adults with chronic low back pain (n = 25) as well as pain-free sex-matched older (n = 25) and younger adults (n = 25). Pain sensitivity was quantified by 8 distinct measures that were subdivided as static (ie, pressure pain thresholds, heat pain thresholds, fixed mechanical pain, and fixed cold pain) and dynamic pain sensitivity (ie, mechanical temporal summation, thermal ramp and hold, heat pain aftersensations, and conditioned pain modulation). Test-retest reliability values for pain sensitivity ranged from moderate to excellent (intraclass correlation coefficients ≥ .500; p’s < .05). The main effect for the group was significant (partial η2 = .413, P < .001), revealing between-group differences in pain sensitivity on 5 out of 8 tests (p’s ≤ .043). Predominantly, both older adult groups demonstrated increased pain facilitation and decreased pain inhibition during dynamic pain sensitivity testing compared to pain-free younger adults (p’s ≤ .044). Despite qualitative differences, static and dynamic pain sensitivity responses were statistically similar between older adults with and without chronic LBP (p’s > .05). Findings suggest pain sensitivity can be reliably measured in older adults and that pain hypersensitivity develops with chronological aging, providing partial support for the theory that pain hypersensitivity may impact geriatric chronic pain populations. Further study is needed to more definitively parse out whether pain hypersensitivity is comparatively heightened in older adults with chronic LBP beyond the influence of chronological aging. PerspectiveThis article establishes that surrogate measures of centrally mediated pain sensitization are heightened with aging. Impaired endogenous pain modulation may influence chronic pain development, maintenance, treatment efficacy, and/or ensuing disability, necessitating research to comprehensively characterize how pain hypersensitivity contributes to geriatric chronic pain conditions.

Comparison of transversus abdominis activation characteristics between healthy and chronic low back pain population during upright functional movement.

Previous literature suggests that transversus abdominis (TrA) activation is diminished in chronic low back pain (cLBP) subjects compared to healthy subjects in less-functional positions. However, few studies have investigated the effects of upright functional movement on TrA activation in cLBP individuals. This pilot study aimed to compare TrA activation characteristics in healthy and cLBP subjects during the movement of double leg standing (DLS) to single leg standing (SLS) and to a 30∘ single leg quarter squat (QSLS). TrA activation was determined by the percentage change in TrA thickness from DLS to SLS and DLS to QSLS. TrA thickness was measured in 14 healthy and 14 cLBP participants using ultrasound imaging with a probe holder at 20mm and 30mm from the fascia conjunction point. At both measurement points (20 and 30mm), there were no significant main effects of body sides, lower limb movements and the interactions between them on TrA activations between the healthy and cLBP participants even after covariates were adjusted for (all p> 0.05). Results from this study suggest the evaluation of TrA activation during upright functional movements as part of an assessment for cLBP management may not be suggested.

Burden of disease and management of osteoarthritis and chronic low back pain: healthcare utilization and sick leave in Sweden, Norway, Finland and Denmark (BISCUITS): study design and patient characteristics of a real world data study.

Osteoarthritis (OA) and chronic low back pain (CLBP) are common musculoskeletal disorders with substantial patient and societal burden. Nordic administrative registers offer a unique opportunity to study the impact of these conditions in the real-world setting. The Burden of Disease and Management of Osteoarthritis and Chronic Low Back Pain: Health Care Utilization and Sick Leave in Sweden, Norway, Finland and Denmark (BISCUITS) study was designed to study disease prevalence and the societal and economic burden in broad OA and CLBP populations. Patients in Sweden, Norway, Finland and Denmark with diagnoses of OA or CLBP (low back pain record plus≥2 pain relief prescriptions to indicate chronicity) were identified in specialty care, in primary care (Sweden and Finland) and in a quality-of-care register (Sweden). Matched controls were identified for the specialty care cohort. Longitudinal data were extracted on prevalence, treatment patterns, patient-reported outcomes, social and economic burden. Almost 1.4 million patients with OA and 0.4 million with CLBP were identified in specialty care, corresponding to a prevalence in the Nordic countries of 6.3 and 1.9%, respectively. The prevalence increased to 11-14% for OA and almost 6% for CLBP when adding patients identified in primary care. OA patients had a higher Elixhauser comorbidity index (0.66 vs. 0.46) and were using opioids (44.7 vs. 10.2%) or long-term nonsteroidal anti-inflammatory drug (NSAIDs) (20.9 vs. 4.5%) more than four times as often as compared to controls. The differences were even larger for CLBP patients compared to their controls (comorbidity index 0.89 vs. 0.39, opioid use 77.7 vs. 9.4%, and long-term NSAID use 37.2 vs. 4.8%). The BISCUITS study offers an unprecedented, longitudinal healthcare data source to quantify the real-world burden of more than 1.8 million patients with OA or CLBP across four countries. In subsequent papers we aim to explore among others additional outcomes and subgroups of patients, primarily those patients who may benefit most from better healthcare management.

Differences and Correlations of Anxiety, Sleep Quality, and Pressure-Pain Threshold between Patients with Chronic Low Back Pain and Asymptomatic People.

Background Chronic low back pain (CLBP) is a clinically common and expensive disease. Patients frequently take sick leaves because of pain and dysfunction, and their unpleasant life and work experiences cause psychological depression and anxiety and affect their quality of life. Sleep disturbance is a common problem among patients with low back pain (LBP) with more than 50% complaining about poor sleep quality. This study aimed to explore the correlations between anxiety, sleep quality, and pressure-pain threshold (PPT) and their differences between patients with CLBP and asymptomatic people. Methods Forty patients with CLBP and 40 asymptomatic people were recruited. Relevant data, including State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, and PPT, were individually and independently collected by blinded physiotherapists with a practicing certificate and then statistically analyzed. An independent sample t-test was used to determine the intergroup differences between patients with CLBP and asymptomatic populations. Pearson correlation coefficient was employed for correlation analysis. Results The CLBP group had significantly higher anxiety scores (41.64 ± 9.88 vs. 36.69 ± 8.31; t = −2.496, p=0.015) than the asymptomatic group. A significant difference was found in the total score of the Pittsburgh Sleep Quality Index (6.41 ± 2.43 vs. 5.09 ± 2.18; t = −2.628, p=0.010) but not in the trait anxiety (44.00 ± 7.83 vs. 42.67 ± 9.51; t = −0.695, p=0.489) of the two groups. State−Trait Anxiety Inventory showed a low to moderate negative correlation with PPT. No remarkable correlation was observed between Pittsburgh Sleep Quality Index and PPT. Conclusions Patients with CLBP showed considerably worse state anxiety and sleep quality than asymptomatic people; however, no substantial difference in PPT was found between the two groups. The results suggest that in clinical practice, the focus should include pain and related social and psychological factors. CLBP treatment could be considered from multiple perspectives and disciplines.This trial is registered with Chinese Clinical Trial Registry (Trial registration: ChiCTR-TRC-13003701).

Can We Identify Subgroups of Patients with Chronic Low Back Pain Based on Motor Variability? A Systematic Scoping Review

The identification of homogeneous subgroups of patients with chronic low back pain (CLBP), based on distinct patterns of motor control, could support the tailoring of therapy and improve the effectiveness of rehabilitation. The purpose of this review was (1) to assess if there are differences in motor variability between patients with CLBP and pain-free controls, as well as inter-individually among patients with CLBP, during the performance of functional tasks; and (2) to examine the relationship between motor variability and CLBP across time. A literature search was conducted on the electronic databases Pubmed, EMBASE, and Web of Science, including papers published any time up to September 2021. Two reviewers independently screened the search results, assessed the risk of bias, and extracted the data. Twenty-two cross-sectional and three longitudinal studies investigating motor variability during functional tasks were examined. There are differences in motor variability between patients with CLBP and pain-free controls during the performance of functional tasks, albeit with discrepant results between tasks and among studies. The longitudinal studies revealed the persistence of motor control changes following interventions, but the relationship between changes in motor variability and reduction in pain intensity was inconclusive. Based on the reviewed literature, no stratification of homogeneous subgroups into distinct patterns of motor variability in the CLBP population could be made. Studies diverged in methodologies and theoretical frameworks and in metrics used to assess and interpret motor variability. In the future, more large-sample studies, including longitudinal designs, are needed, with standardized metrics that quantify motor variability to fill the identified evidence gaps.

Cross-Cultural Adaptation, Reliability, and Psychophysical Validation of the Pain and Sleep Questionnaire Three-Item Index in Finnish.

Reciprocal relationships between chronic musculoskeletal pain and various sleep disturbances are well established. The Pain and Sleep Questionnaire three-item index (PSQ-3) is a concise, valid, and reliable patient-reported outcome measure (PROM) that directly evaluates how sleep is affected by chronic low back pain (CLBP). Translation and cross-cultural validation of The Pain and Sleep Questionnaire three-item index Finnish version (PSQ-3-FI) were conducted according to established guidelines. The validation sample was 229 subjects, including 42 pain-free controls and 187 subjects with chronic musculoskeletal pain. Our aims were to evaluate internal consistency, test–retest reliability, measurement error, structural validity, convergent validity, and discriminative validity and, furthermore, to study the relationships between dizziness, postural control on a force plate, and objective sleep quality metrics and total PSQ-3-FI score. The PSQ-3-FI demonstrated good internal consistency, excellent test–retest reliability, and small measurement error. Confirmatory factor analysis confirmed acceptable fit indices to a one-factor model. Convergent validity indicated fair to good correlation with pain history and well-established pain-related PROMs. The PSQ-3-FI total score successfully distinguished between the groups with no pain, single-site pain, and multisite pain. A higher prevalence of dizziness, more impaired postural control, and a general trend towards poorer sleep quality were observed among subjects with higher PSQ-3-FI scores. Postural control instability was more evident in eyes-open tests. The Finnish PSQ-3 translation was successfully cross-culturally adapted and validated. The PSQ-3-FI appears to be a valid and reliable PROM for the Finnish-speaking CLBP population. More widespread implementation of PSQ-3 would lead to better understanding of the direct effects of pain on sleep.

Reliability and Validity of the Y-balance Test in Young Adults with Chronic Low Back Pain

BackgroundIndividuals with chronic low back pain (CLBP) may demonstrate reduced ability to perform dynamic tasks due to fear of additional pain and injury in response to the movement. The Y-balance test (YBT) is a functional and inexpensive test used with various populations. However, the reliability and validity of the YBT used for assessing dynamic balance in young adults with CLBP have not yet been examined.PurposeTo determine the inter-rater reliability of the YBT and to compare dynamic balance between young adults with CLBP and an asymptomatic group.Study DesignReliability and validity study.MethodsFifteen individuals with CLBP (≥ 12 weeks) and 15 age- and gender-matched asymptomatic adults completed the study. Each group consisted of 6 males and 9 females who were 21-38 years of age (27.47 ± 5.0 years). The YBT was used to measure participant’s dynamic balance in the anterior (ANT), posteromedial (PM) and posterolateral (PL) reach directions. The scores for each participant were independently determined and recorded to the nearest centimeter by two raters. Both the YBT reach distances and composite scores were collected from the dominant leg of asymptomatic individuals and the involved side of participants with CLBP and were used for statistical analysis.ResultsThe YBT demonstrated excellent inter-rater reliability, with intraclass correlation coefficients ranging from 0.99 to 1.0 for the YBT scores of both asymptomatic and CLBP groups. The CLBP group had lower scores than those of the asymptomatic group in the reach distances of the ANT (p = 0.023), PM (p < 0.001), and PL (p = 0.001) directions, and the composite scores (p < 0.001).ConclusionsThe results demonstrated excellent inter-rater reliability and validity of the YBT for assessing dynamic balance in the CLBP population. The YBT may be a useful tool for clinicians to assess dynamic balance deficits in patients with CLBP.Level of Evidence2b.

Preliminary validity study comparing the prone lumbar hypermobility test against the prone instability test*

Abstract: Objective: The Prone Instability Test (PIT) is an established orthopaedic test that predicts the probability of low back pain patients responding positively to a spinal stabilization program (.71 sensitivity, .57 specificity for PIT). This preliminary study suggests the Prone Lumbar Hypermobility Test (PLHT) as an effective alternative to the PIT that is more suitable for a wider population due to the modified patient positioning. In contrast to the PIT, the PLHT has the patient's entire body supported by the examination table. This is hypothesized to maximize patient comfort while still maintaining clinical effectiveness for the chronic low back pain population. The purpose of this preliminary study is to determine whether the PLHT is comparable to the PIT in diagnostic effectiveness when predicting the benefits of stabilization interventions. Methods: To compare the clinical effectiveness of the PLHT to the PIT, each subject underwent parts I and II (relaxed and contracted) of each test (PIT and PLHT). 36 subjects received both parts of PIT and PLHT (in a randomized order). Subjects assumed each of the four positions and 4 kg/cm2 of pressure was applied directly on the skin over the L4 spinous process, using an algometer. The subjects verbally indicated perceived pain following each of the 4 positions. Results: Of the 36 participants included in the study, 23 participants had a negative PIT and a negative PLHT and six had a positive PIT and a positive PLHT. Three participants had a positive PIT and negative PLHT and four had a positive PLHT and negative PIT. This indicates that the PIT and PLHT have a statistically significant level of agreement. Conclusions: This study found that the PLHT is valid in identifying negative results in the predicted negative population, as well as positive results in the predicted positive population. For future investigations, a larger sample size is advantageous - particularly with an evenly distributed and accurate sample of positive and negative participants. This will more accurately determine the validity of the PLHT and broaden the application of the PLHT to the population for which the test is aimed to identify in clinical practice.

Benefits of Adding Gluteal Dry Needling to a Four-Week Physical Exercise Program in a Chronic Low Back Pain Population. A Randomized Clinical Trial.

To determine if adding dry needling to a four-week exercise program has an additional benefit compared with adding sham dry needling to the same exercise program in subjects with chronic low back pain. Randomized clinical trial. Physiotherapy and Pain Clinic of Alcala University. Forty-six patients with chronic low back pain. Subjects were randomized to two groups: the dry needling group (N = 23) or sham dry needling group (N = 23). Both groups received a four-week exercise program and before the exercise started a session of dry needling or sham dry needling. Pain (visual analog scale), disability (Roland-Morris Questionnaire), and fear avoidance beliefs (Fear Avoidance Beliefs Questionnaire) were assessed at baseline, after treatment, and at three-month follow-up. Pressure pain thresholds (algometer) were measured at baseline, after the dry needling or the sham dry needling, and after treatment. Both groups showed significant improvements for all variables. In the between-group comparison, the dry needling group improved significantly in pain at three-month follow-up and pressure pain thresholds at the end of treatment for all measures, and at three-month follow-up there was no improvement in gluteus medium. In chronic low back patients, adding dry needling to a four-week exercise program has an additional benefit in pain and sensitivity compared with adding sham dry needling to the same exercise program.

Mindfulness predicts current risk of opioid analgesic misuse in chronic low back pain patients receiving opioid therapy

BackgroundAcceptance and mindfulness processes indicating psychological flexibility may be important mechanisms in chronic pain adaptation; however, their association with opioid analgesic misuse (OA) risk is unclear. The present study investigated the extent to which psychological flexibility is associated with OA misuse risk within a chronic low back pain population on long-term opioid therapy. MethodsParticipants were 156 patients presenting for treatment at an academic pain clinic. Aspects of psychological flexibility were assessed using the Mindfulness Attention Awareness Scale (MAAS) and the Acceptance and Action Questionnaire II (AAQ II). The Current Opioid Misuse Measure (COMM) determined heightened risk of opioid analgesic misuse. Participants were 59% female, 48.3 years old on average (SD = 9.8), and largely White, Hispanic. ResultsNested multiple linear regression indicated that the higher mindfulness levels predicted opioid misuse risk while controlling for pain severity, pain-related interference, pain anxiety, and acceptance. The full regression model predicted 54% of the variance in OA misuse risk. ConclusionResults suggest that psychological flexibility, particularly mindfulness processes, may be important in predicting and mitigating OA misuse risks among chronic pain patients. Non-pharmacological interventions are critical to addressing the current opioid misuse crisis.

Transcutaneous electrical nerve stimulation and heat to reduce pain in a chronic low back pain population: a randomized controlled clinical trial

BackgroundLow back pain is the leading cause of disability worldwide. The therapeutic management of patients with chronic LBP is challenging. ObjectivesThe aim of this study is to evaluate the effects of heat and transcutaneous electrical nerve stimulation combined on pain relief in participants with chronic low back pain. MethodsFifty participants with chronic (≥3 months) low back pain were randomly assigned to two groups: HeatTens (n=25) and control group (n=25). Primary outcome was pain. Secondary outcomes were pressure pain thresholds, temporal summation, conditioned pain modulation, fear-avoidance and beliefs questionnaire, central sensitization inventory, quality of life, and medication use. The control group received no treatment and continued usual care. After four weeks of treatment, all measurements were repeated. ResultsFifty individuals participated in this study. Significant higher pressure pain threshold measures after both 30min and 4 weeks for the lower back region and the second plantar toe were found only in the experimental group. ConclusionThe combination of heat and transcutaneous electrical nerve stimulation does not reduce pain scores in patients with chronic low back pain. Pressure pain threshold values significantly improved, showing beneficial effects of the experimental treatment.ClinicalTrials.gov: NCT03643731 (https://clinicaltrials.gov/ct2/show/NCT03643731).

The IMPACT study: A clustered randomized controlled trial to assess the effect of a referral algorithm for axial spondyloarthritis.

BackgroundA substantial number of patients with chronic low back pain (CLBP) have axial spondyloarthritis (axSpA), but early recognition of these patients is difficult for general practitioners (GPs). The Case Finding Axial Spondyloarthritis (CaFaSpA) referral strategy has shown to be able to identify patients with CLBP at risk for axSpA, but its impact on clinical daily practice is yet unknown.ObjectiveTo assess the effect of the CaFaSpA referral strategy on pain caused by disability in primary care patients with CLBP.MethodsWithin this clustered randomized controlled trial 93 general practices were randomized to either the CaFaSpA referral model (intervention) or usual primary care (control). In each group primary care patients between 18 and 45 years with CLBP were included. The primary outcome was disability caused by CLBP, measured with the Roland Morris Disability Questionnaire (RMDQ) at baseline and four months. Secondary outcome was the frequency of new axSpA diagnosis. Descriptive analyses were performed, and a linear mixed-effects model was used.ResultsIn total 679 CLBP patients were included of which 333 patients were allocated to the intervention group and 346 to the control group. Sixty-four percent were female and mean age was 36.2 years. The mean RMDQ score at baseline was 8.39 in the intervention group and 8.61 in the control group. At four months mean RMDQ score was 7.65 in the intervention group and 8.15 in the control group. This difference was not statistically significant (p = 0.50). Six (8%) out of the 75 finally referred patients, were diagnosed with axSpA by their rheumatologist.ConclusionsThe CaFaSpA referral strategy for axSpA did not have an effect on disability after four months caused by CLBP. However, the strategy is able to detect the axSpA patient within the large CLBP population sufficiently.Trial registration number: NCT01944163, Clinicaltrials.gov.

Physical Therapy Management of Patients With Chronic Low Back Pain and Hip Abductor Weakness.

Hip abductor dysfunction is common in individuals with chronic low back pain (CLBP). Previous research investigating abductor strengthening in the heterogeneous CLBP population is sparse and has failed to target those patients most likely to benefit. The aim of the current case series was to describe the physical therapy management and outcomes of 3 patients with CLBP matching a previously identified subgroup characterized by substantial hip abductor weakness. Three nonconsecutive patients with CLBP-a 77-year-old man, a 78-year-old woman, and an 85-year-old woman-were treated in an outpatient physical therapy clinic. All 3 patients matched a previously identified CLBP subgroup characterized by substantial hip abductor weakness. Patients were treated using a targeted exercise approach consisting mostly of hip abductor strengthening for 11 to 17 visits over 8 to 10 weeks. Patients received additional treatments including heel lift and pain neuroscience education when indicated. By discharge, all patients had made clinically important improvements in pain (3- to 7-point reduction on the Numeric Pain Rating Scale), function (10- to 16-point change on the Modified Oswestry Disability Index), and perceived improvement (6-7 on Global Rating of Change Scale). Lumbar range of motion was painless, and hip abductor strength was improved from 2+/5 to 3+/5 in all 3 patients. These gains were maintained at 3-month follow-up. The current case series describes the use of a targeted exercise approach consisting mostly of hip abductor strengthening in a group of patients with CLBP and hip abductor weakness. The results indicated that this approach may be effective in reducing pain and improving function, particularly for older patients.

Pain Behaviour Scale (PaBS): An Exploratory Study of Reliability and Construct Validity in a Chronic Low Back Pain Population.

Objectives To examine the interrater and intrarater reliability and construct validity of the Pain Behaviour Scale during standard physical performance tests in people with chronic low back pain and to confirm the test-retest reliability of the physical performance tests in this population. The Pain Behaviour Scale (PaBS) is an observational scale that was recently designed to uniquely measure both the presence and severity of observed pain behaviours. Methods Twenty-two participants with chronic low back pain were observed during performance of five physical performance tests by two raters. Pain behaviours were assessed using the Pain Behaviour Scale. The Visual Analogue Scale and Modified Oswestry Disability Index were used to measure pain and disability, respectively. Descriptive statistics were used to report demographic features of participants. Reliability was analyzed using ICCs. Rater agreement was analyzed using the weighted Cohen's kappa. Correlations between PaBS, self-reported measures, and physical performance tests were calculated using Pearson's product-moment correlations. Results The PaBS demonstrated excellent interrater (ICC2,1 = 1.0, 95% CI: 0.9 to 1.0) and intrarater (ICC3,1 = 0.9, 95% CI: 0.8 to 1.0) reliability. Component physical performance tests (i.e., time and distance) demonstrated good test-retest (0.6–1.0) reliability. Perfect agreement in the reporting of pain behaviours was found (95–100%). Correlations between pain behaviour severity and pain intensity (r = 0.6) and disability (r = 0.6) were moderate. Moderate correlations were found between pain behaviours and physical performance tests in sit to stand (r = 0.5), trunk flexion (r = 0.4), timed up and go (r = 0.4), and 50-foot walk (r = 0.4). Conclusion The Pain Behaviour Scale is a valid and reliable tool for measuring the presence and severity of pain behaviour, and the physical performance tests are reliable tests.

The effect of implicit theories of pain on pain and disability in people with chronic low back pain

BackgroundImplicit theories of pain represent a socio-cognitive mechanism linked to important coping, emotional, and expressive reactions to chronic pain. Evidence suggests that chronic low back pain (CLBP) patients who hold an incremental theory of pain (i.e., view pain as a malleable) use more active coping strategies, display less pain behavior, and report lower levels of depression than those with an entity theory of pain (i.e., view pain as a fixed). However, a link between implicit theories of pain and symptoms of pain and disability in people with CLBP has not been established. ObjectivesThis study investigated the relationship between implicit theories of pain and the level of pain and disability reported by people with CLBP. DesignCross-sectional observational study. MethodsOne hundred and two participants with CLBP completed an online survey distributed through social media channels. The online survey assessed pain intensity and pain-related disability (Chronic Pain Grade Scale), implicit theories of pain (Implicit Theory of Pain Scale), and perceived control over pain (Survey of Pain Attitudes control scale). ResultsParticipants with an incremental theory of pain reported significantly less pain and disability compared to those with an entity theory of pain (p < 0.001). ConclusionsThese findings suggest that implicit theories of pain may guide self-reported symptoms of pain and disability in a CLBP population. Prospective studies are required to confirm the relevance of these findings for risk of future low back pain, and to confirm whether this relationship changes with and without treatment.

The Sacroiliac Joint Injection

Background: the sacroiliac joint (SIJ) is the largest axial joint in the body, with an average surface area of 17.5 cm2, it is an accepted source of low back and/or buttock pain with or without lower extremity pain. Based upon history and physical examination findings, the prevalence of sacroiliac joint pain in chronic low back pain population has been shown to range from 22.5% to 62.8%. Aim of this work: to evaluate the therapeutic benefit of intra articular corticoid injections into the sacroiliac joints in a standardized fashion. Patients and Methods: This study included 20 adults with SIJ pain due to different reasons and who were scheduled to undergo SIJ injection of corticosteroids and local anesthetic. Demographic data to consider include sex, age, weight, occupation, affected side, co morbidity and suggested pathology of the examined SIJ. Results: there is a significant decrease of the inflammatory back pain in 85% of patients; on mean post 2.00±1.86 compared to pre 7.50±1.24 according to VAS of patients after 6 months follow up (p-value <0.001 HS). Its minimally invasive procedure & good result by single injection to all patients during 6 months follow up. Conclusion: CT guided sacroiliac joint minimally invasive, short time, very accurate and good results obtained. Intra articular SIJ injection is an effective method for alleviating pain in patients suffers from SIJ pain at least in short term.

Physical and physiological effects of yoga for an underserved population with chronic low back pain

Background:Yoga has been shown useful in reducing chronic low back pain (CLBP) through largely unknown mechanisms. The aim of this pilot study is to investigate the feasibility of providing yoga intervention to a predominantly underserved population and explore the potential mechanisms underlying yoga intervention in improving CLBP pain.Methods:The quasi-experimental within-subject wait-listed crossover design targeted the recruitment of low-income participants who received twice-weekly group yoga for 12 weeks, following 6–12 weeks of no intervention. Outcome measures were taken at baseline, preintervention (6–12 weeks following baseline), and then postintervention. Outcome measures included pain, disability, core strength, flexibility, and plasma tumor necrosis factor (TNF)-α protein levels. Outcomes measures were analyzed by one-way ANOVA and paired one-tailed t-tests.Results:Eight patients completed the intervention. Significant improvements in pain scores measured over time were supported by the significant improvement in pre- and post-yoga session pain scores. Significant improvements were also seen in the Oswestry Disability Questionnaire scores, spinal and hip flexor flexibility, and strength of core muscles following yoga. Six participants saw a 28.6%–100% reduction of TNF-α plasma protein levels after yoga, while one showed an 82.4% increase. Two participants had no detectable levels to begin with. Brain imaging analysis shows interesting increases in N-acetylaspartate in the dorsolateral prefrontal cortex and thalamus.Conclusion:Yoga appears effective in reducing pain and disability in a low-income CLBP population and in part works by increasing flexibility and core strength. Changes in TNF-α protein levels should be further investigated for its influence on pain pathways.

Exploring the pre-morbid contexts in which central sensitisation developed in individuals with non-specific chronic low back pain. A qualitative study

BackgroundCentral sensitisation pain is a predominant mechanism in a proportion of individuals with non-specific chronic low back pain and is associated with poor outcomes. It is proposed that the pre-morbid experiences and contexts may be related to the development of central sensitisation. ObjectivesThe objective of this study was to explore the pre-morbid experiences and personal characteristics of participants with central sensitisation pain from a non-specific chronic low back pain population. MethodsThis was a qualitative, exploratory study, using a concurrent nested design within a mixed methods protocol. n=9 participants were recruited purposively based on sensory profiles and trait anxiety-related personality types. Data were collected through semi structured interviews, managed using QSR NVivo 10 software and analysed using theoretical thematic analysis. ResultsFour themes emerged: developmental learning experiences, personal characteristics, sensitivity and trauma. Reported was lack of confidence, low esteem and a need to please others, physical hyper-sensitivities (smell, light, sound) and emotional sensitivity (anxiety) as well as physical hypo-sensitivity. Participants had also suffered emotional and/or physical trauma. Learning difficulties, sensory sensitivities and trauma are associated with autonomic stress responses, which in turn have been linked to physiological changes seen in central sensitisation pain. ConclusionCentral sensitisation pain developed in the context of sensory processing differences related to learning difficulties, sensitivities and trauma, and personal characteristics of low confidence and control, in a group of participants with non-specific chronic low back pain. The role of pre-existing sensory processing differences, as a component of altered central nervous system function, in relation to central sensitisation pain warrants further investigation.

Análise discriminante da resistência e força muscular em jovens sedentárias com dor lombar crônica

Introdução: A dor lombar crônica (DLC) apresenta disfunções neuromusculares, por exemplo, está diminuição da força e resistência muscular, que são essenciais na realização das tarefas e manutenção postural. Objetivo: Caracterizar o comportamento de força e resistência muscular e discriminar qual variável tem maior influência na população com DLC. Métodos: Foram avaliadas 35 mulheres sedentárias entre 18 e 27 anos, divididas em: grupo com DLC (n=18), grupo sem DLC (n=17). A avaliação foi composta pela avaliação do nível de dor (Escala Visual Analógica), força isométrica dos músculos extensores de tronco (Dinamômetro Lombar) e resistência estática dos extensores e tronco (Teste Biering-Sorensen). Foi realizada Análise de Variância Multivariada e Análise Discriminante, adotando o nível de significância de 5%. Resultados: O grupo com DLC tem menor força (21%; p=0,01) e resistência (71%, p0,001) muscular. A análise discriminante mostrou acurácia diagnóstica de 97,1% para resistência e 68,7% para a força muscular. Conclusão: O grupo com DLC apresentou menor força e resistência.

Measurement of transversus abdominis activation in chronic low back pain patients using a novel standardized real-time ultrasound imaging method.

Real-time ultrasound imaging (US) to measure abdominal muscle dimensions has aided low back pain rehabilitation and research. Notwithstanding, ultrasound imaging measurement of transversus abdominis muscle activation in chronic low back pain populations has been characterized by variable and generally suboptimal intra-observer reliability. Methodological deficiencies of 'freehand' ultrasound imaging are uncontrolled probe-skin pressure, inclination and roll of the probe. Despite previous attempts to standardize these parameters, intra-observer reliability in chronic low back pain was poor to moderate (0.32-0.62). Therefore, a standardized method that controls and records probe force, inclination and roll during ultrasound imaging may optimize measurement reliability in chronic low back pain. This pilot study investigated utility, standardization and intra-observer reliability of ultrasound imaging transversus abdominis thickness measurement in chronic low back pain patients (n = 17). Transversus abdominis imaging over two separate measurement sessions was conducted using a novel method to standardize probe parameters. Resting and contracted transversus abdominis thickness, and transversus abdominis activation measurements were obtained from duplicate paired images (n = 68). Intra-class correlation coefficients were reported with 95% confidence intervals. Transversus abdominis thickness at rest (intra-class correlation coefficient = 0.97 confidence interval: 0.93, 0.99), when contracted (intra-class correlation coefficient = 0.99 confidence interval: 0.97, 0.99) and transversus abdominis activation (intra-class correlation coefficient = 0.93 confidence interval: 0.81, 0.97) measurements were highly reliable. Ultrasound imaging of transversus abdominis using the novel standardized ultrasound imaging method produced highly reliable intra-observer transversus abdominis measurements, superior to 'freehand' ultrasound imaging, despite the physical limitations typically associated with a chronic low back pain population. Unique standardizing ranges for 'probe force device' probe parameters were obtained. This novel standardized ultrasound imaging method may optimize transversus abdominis activation assessment in chronic low back pain and other populations, aiding future research.