Chronic Low Back Pain Symptoms Research Articles

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.

Importance of an Integrated Assessment of Functional Disability and Work Ability in Workers Affected by Low Back Pain

BackgroundThis study examines the relationship between functional disability and work ability in workers affected by low back pain (LBP) through an analysis of correlations between the Oswestry Disability Index (ODI) and Work Ability Index (WAI). The role of personal and work factors on functional disability/work ability levels has also been studied. LBP is the most common musculoskeletal problem and a major disabling health problem worldwide. Its etiology is multifactorial. Multidisciplinary approaches may help reduce the burden of pain and disability and improve job continuity and reintegration at work. MethodsA cohort of 264 patients affected by LBP from an Italian outpatient clinic were included in a clinical diagnostic/therapeutic trial aiming at rehabilitation and return to work through an integrated investigation protocol. Data were collected during the first medical examination using anamnestic and clinical tools. The final sample is composed of 252 patients, 57.1% man, 44.0 % blue collars, 46.4% with the high school degree, 45.6% married. ResultsWAI and ODI reported a negative and fair correlation (r = –0.454; p = .000). Workers with acute LBP symptoms have a higher probability of severe disability than those with chronic LBP symptoms. White collars without depressive symptoms reported higher work ability – even in chronic disability conditions-than those with depressive symptoms. ConclusionThe study found that ODI and WAI have a convergent validity and this suggests that the two tools measure capture distinctive aspects of disability related to personal, environmental, and occupational characteristics. The most important and modifiable prognostic factors found for ODI and WAI were depressive symptoms, workday absence, and intensity of back pain. The study also found a mild association between age and ODI. The study's findings highlight the importance of using a multidisciplinary approach to manage and prevent disability due to LBP.

International Society for the Advancement of Spine Surgery Statement: Restorative Neurostimulation for Chronic Mechanical Low Back Pain Resulting From Neuromuscular Instability.

This International Society for the Advancement of Spine Surgery statement has been generated to respond to growing requests for background, supporting literature and evidence, and proper coding for restorative neurostimulation for chronic low back pain. Chronic low back pain describes the diverse experience of a significant proportion of the population. Conservative management of these patients remains the predominant care pathway, but for many patients, symptom relief is poor. The application of new techniques in patients who have exhausted traditional care paradigms should be undertaken with a detailed understanding of the pathology being treated, the mechanisms involved, and the data supporting efficacy. This statement on restorative neurostimulation places this technology in the context of the current understanding of the etiology of mechanical low back pain and the currently available evidence for this technique. In an appropriately selected cohort with a specific subset of chronic low back pain symptoms, this technique may provide benefit to payers and patients.

The Cross-Sectional Area Assessment of Pelvic Muscles Using the MRI Manual Segmentation among Patients with Low Back Pain and Healthy Subjects.

The pain pathomechanism of chronic low back pain (LBP) is complex and the available diagnostic methods are insufficient. Patients present morphological changes in volume and cross-sectional area (CSA) of lumbosacral region. The main objective of this study was to assess if CSA measurements of pelvic muscle will indicate muscle atrophy between asymptomatic and symptomatic sides in chronic LBP patients, as well as between right and left sides in healthy volunteers. In addition, inter-rater reliability for CSA measurements was examined. The study involved 71 chronic LBP patients and 29 healthy volunteers. The CSA of gluteus maximus, medius, minimus and piriformis were measured using the MRI manual segmentation method. Muscle atrophy was confirmed in gluteus maximus, gluteus minimus and piriformis muscle for over 50% of chronic LBP patients (p < 0.05). Gluteus medius showed atrophy in patients with left side pain occurrence (p < 0.001). Muscle atrophy occurred on the symptomatic side for all inspected muscles, except gluteus maximus in rater one assessment. The reliability of CSA measurements between raters calculated using CCC and ICC presented great inter-rater reproducibility for each muscle both in patients and healthy volunteers (p < 0.95). Therefore, there is the possibility of using CSA assessment in the diagnosis of patients with symptoms of chronic LBP.

Facilitated Health Coaching Improves Activity Level and Chronic Low back Pain Symptoms

ABSTRACT Introduction Behavioral treatments, like increasing physical activity (PA), are recommended for chronic low back pain (CLBP). Finding methods for promoting behavior change with potential for translatability as well as effective behavioral targets remains challenging. Purpose This randomized controlled pilot study evaluated the effectiveness of low-dose facilitated health coaching with activity monitors to improve PA and sedentary behaviors (SB), symptoms, and Patient Global Impression of Change (PGIC) in CLBP. A secondary purpose was identifying behaviors associated with symptom change to inform future trials. Methods Seventy-one adults with CLBP were randomized to receive a wearable activity monitor alone (WAM) or with one primary session of health coaching and two check-ins based on motivational interviewing (WAM + HC) or a wait-list control (WLC) condition for 12 wk. Moderate and vigorous PA (MVPA), light PA (LPA), total and prolonged SB (i.e., sedentary &gt;60 min per bout), and pain (Short Form McGill Pain Questionnaire (MPQ)) were assessed before and after intervention along with PGIC. Regression analyses examined group differences in MVPA, LPA, total and prolonged SB, MPQ, and PGIC after intervention as well as behavioral predictors of symptom improvement (change in MPQ). Results WAM + HC improved MPQ scores (β = −0.25, P = 0.02), LPA (β = 0.23, P = 0.04), MVPA (β = 0.21, P = 0.03), and total SB (β = −0.24, P = 0.03) compared with WLC over time. Both WAM + HC and WAM had significantly higher PGIC compared with WLC (P &lt; 0.05). Change in prolonged SB was the only significant predictor of change in MPQ (β = 0.48, P = 0.01). Conclusions WAM + HC may be effective for changing activity-related behaviors and improving CLBP. Furthermore, reducing prolonged SB may be a meaningful target for future interventions in CLBP. Research focused on reducing prolonged SB including larger samples, and examining changes in symptoms will be important for identifying optimal translational treatment strategies for CLBP.

Custom-Made Foot Orthoses as Non-Specific Chronic Low Back Pain and Pronated Foot Treatment.

Excessive foot pronation has been reported as being related to chronic low back pain symptoms and risk factors in sports-specific pathologies. Compensating custom-made foot orthotics treatment has not been entirely explored as an effective therapy for chronic low back pain (CLBP). This study aims to observe the effects of custom-made foot orthoses, in subjects with foot pronation suffering from CLBP. A total of 101 patients with nonspecific CLBP and a pronated foot posture index (FPI) were studied. They were randomized in two groups: an experimental one (n = 53) used custom-made foot orthotics, and the control group (n = 48) were treated with non-biomechanical effect orthoses. The CLBP was measured using the Oswestry Disability Index (ODI) Questionnaire and a visual analogue scale (VAS), both for lower back pain. The symptoms were evaluated twice, at first when the subject was included in the study, and later, after 4 weeks of treatment. The analysis of outcomes showed a significant decrease in CLBP in the custom-made foot orthoses participants group (p < 0.001 ODI; p < 0.001 VAS). These findings suggest that controlling excessive foot pronation by using custom-made foot orthoses may significantly contribute to improving CLBP.

Revisiting the lumbosacral orthosis from the perspective of dynamical systems theory: a preliminary randomized clinical trial on patients with chronic low back pain.

The prevalent method for investigating the effect of therapeutic interventions on walking in the individuals with chronic low back pain (CLBP) is component-level approach in which all measurements focus on the spine component alone. However, this approach cannot disclose information about the overall function of the movement system such as complex walking patterns, which, in turn, reveal the underlying movement control. To compare the effect of 3-week wearing of lumbosacral orthosis (LSO) along with routine physical therapy with routine physical therapy alone on walking complexity in the individuals with nonspecific CLBP on the basis of the systems approach. Preliminary randomized clinical trial. Twenty-four subjects were randomly allocated to two groups. The control group received the routine physical therapy for 3 weeks. The intervention group received the same program plus an LSO. Nonlinear analysis was used to quantify walking complexity, as behavior of the entire movement system, before and after the intervention and at 1-month follow-up. An average of 496 strides during ten minutes of walking was used for analysis. There was no significant difference (p > 0.05) in degree of walking complexity between two groups during all evaluation periods. The administered orthotic intervention did not alter walking complexity. This suggests that therapeutic goal of current LSOs, which is not based on the systems approach, cannot recover the emergent behavior of the movement system. This may be a potential source of controversies. To achieve an effective treatment, orthotists should focus on the individuals themselves, not only on their CLBP symptoms. Although the component-level approach aims to decrease the symptoms, the systems approach focuses on the whole context that fosters LBP symptoms.

(274) Novel Neurosteroid Intervention for Chronic Low Back Pain in Iraq/Afghanistan-Era Veterans

Chronic low back pain symptoms are extremely common among Iraq/Afghanistan-era Veterans. However, pharmacological management for pain is frequently suboptimal, and many Veterans experience persistent and unalleviated pain symptoms and/or intolerable side effects to pain medications. Current medications such as opioids that are frequently used to treat chronic pain symptoms have side effect risks such as respiratory depression, addiction, sedation, and potentially lethal interactions with other drugs. There is thus an acute and immediate need for the development of effective, safe, and non-habit-forming pharmacological treatments for chronic pain disorders. Neurosteroids are endogenous molecules that are enriched in human brain and hold promise for pain therapeutics. Data in rodent models demonstrate that neurosteroids exhibit pronounced analgesic actions, and our data in Iraq/Afghanistan-era Veterans suggest that neurosteroids are decreased in the setting of pain symptoms in clinical populations. Neurosteroids are hence logical candidates for pain alleviation and have not been tested yet for this indication. We thus conducted a 6-week randomized, double-blind, placebo-controlled trial of pregnenolone versus placebo to determine if adjunctive pregnenolone has therapeutic utility for the treatment of chronic low back pain in Iraq/Afghanistan-era Veterans. The primary outcome measure was average pain intensity ratings from a daily pain diary. Secondary outcomes included pain interference scores. Pregnenolone was extremely well-tolerated. Veterans randomized to pregnenolone reported significant reductions in low back pain relative to those randomized to placebo (pain diary p=0.024; pain recall p=0.010). Pain interference scores for “work” (p=0.040) and “activity” (p=0.031) were also improved in Veterans randomized to pregnenolone compared to placebo. Pregnenolone may thus represent a new intervention for pain conditions that is safe, well-tolerated, non-habit-forming, and potentially efficacious for the alleviation of pain symptoms in Iraq/Afghanistan-era Veterans.

The effect of pulsed electromagnetic frequency therapy on health-related quality of life in military service members with chronic low back pain

BackgroundIn the U.S. military, chronic low back pain is among the most frequent complaints for medical visits, lost work time, and attrition from active duty and the deployed setting by service members. PurposeThe aim of this pilot study was to determine whether adjunctive treatment with pulsed electromagnetic frequency (PEMF) produced significant variability in chronic low back pain symptoms and secondary health-related quality of life, mental health and disability outcomes. MethodsProspective, randomized pilot study with repeated measures at baseline, post-treatment, and 1 month follow-up for two groups: usual care (UC) vs. UC + PEMF. FindingsIn a convenience sample of 75 service members, health-related quality of life mental and physical component scores were significant: F(2, 104) = 4.20, p = .018 (η2 = .075) and F(2, 104) = 4.75, p = .011 (η2 = .084), respectively; as was anxiety symptom severity: F(2, 104) = 5.28, p = .007 (η2 = .092). Discussion and RecommendationsAdjunctive treatment with PEMF demonstrated improvements in service members’ overall physical health-related quality of life with expected, yet statistically nonsignificant improvements in reported pain and LBP-related disability. There were significant between group differences in anxiety symptom severity with higher symptoms reported by the UC + PEMF group, surprising findings that warrant further investigation.

Effects of Pilates and Classical Kinesiotherapy on chronic low back pain: a case study

Abstract Introduction : Chronic low back pain (LBP) is characterized by daily lower back pain lasting more than three consecutive months. It may lead to functional disability and can be treated by several physical therapy techniques, including therapeutic exercise. The aim of this study was to investigate the effects of pilates and classical kinesiotherapy on the treatment of pain and functional disability in patients with chronic low back pain. Materials and methods : The study sample consisted of five patients with a diagnosis of chronic low back pain and a mean age of 32.4 ± 15.6 years. A Visual Analogue Scale (VAS) was used for pain assessment, and the Oswestry Disability Index was used to assess functional disability at the beginning and at the end of the intervention. Patients were divided into two groups and received 20 individual sessions of therapeutic exercise at a frequency of two sessions per week. Group A was treated with classical kinesiotherapy and group B was treated with pilates exercises. Statistical analysis was performed using Wilcoxon's test. The significance level was set at 5%. Results : There was a significant reduction in pain (p = 043) and functional disability (p = 042) in both groups. We found no significant differences between the effects of pilates and classical kinesiotherapy on pain and functional disability. Conclusions : We conclude that, in the population studied here, both pilates and classical kinesiotherapy were effective in treating chronic low back pain symptoms, with no significant difference between them.

Backing up the stories: The psychological and social costs of chronic low-back pain

BackgroundChronic low-back pain is a widespread condition whose significance is overlooked. Previous studies have analyzed and evaluated the medical costs and physical symptoms of chronic low-back pain; however, few have looked beyond these factors. The purpose of this study was to analyze and evaluate the personal and psychosocial costs of chronic low-back pain. MethodsTo measure the various costs of chronic low-back pain, a questionnaire was generated using a visual analog scale, the Depression Anxiety and Stress Scale, the Short Form 36 Health Survey, and the 1998–1999 Australian Bureau of Statistics Household Expenditure Survey (for demographic questions). The comprehensive survey assessing physical, mental, emotional, social, and financial health was administered to 30 subjects aged 18 years or older who had visited a tertiary spine service with complaints of chronic low-back pain. ResultsIt was found that subjects scored significantly higher on scales for depression, anxiety, and stress after the onset of chronic low-back pain than before the onset of back pain. Subjects also reported a reduction in work hours and income, as well as a breakdown in interpersonal relationships, including marital and conjugal relations. ConclusionChronic low-back pain affects the ability of a patient to work, creating both financial and emotional problems within a home. Relief is delayed for patients because of the sparse allocation of resources for chronic spinal care and inadequate prevention education. Despite this, many patients are exhorted to return to work before they are physically, mentally, or emotionally free of pain, resulting in poor outcomes for recovery. Ultimately, this aggregates into an adverse macrosocial effect, reducing not only the quality of life for individuals with chronic low-back pain but also workforce productivity.

Ottawa Panel evidence-based clinical practice guidelines on therapeutic massage for low back pain

To update evidence-based clinical practice guidelines (EBCPG) on massage therapy compared to control or other treatment for adults (>18 years) suffering from acute, sub-acute and chronic low back pain (LBP). A literature search was performed for relevant articles between January 1, 1948 and December 31, 2010. Eligibility criteria were then applied focussing on participants, interventions, controls, and outcomes, as well as methodological quality. Recommendations based on this evidence were then assigned a grade (A, B, C, C+, D, D+, D-) based on their strength. A total of 100 recommendations were formulated from 11 eligible articles, including 37 positive recommendations (25 grade A and 12 grade C+) and 63 neutral recommendations (49 grade C, 12 grade D, and 2 grade D+). These guidelines indicate that massage therapy is effective at providing pain relief and improving functional status. The Ottawa Panel was able to demonstrate that massage interventions are effective to provide short term improvement of sub-acute and chronic LBP symptoms and decreasing disability at immediate post treatment and short term relief when massage therapy is combined with therapeutic exercise and education.

Flexion Relaxation and Its Relation to Pain and Function over the Duration of a Back Pain Episode

BackgroundRelaxation of the erector spinae often occurs in healthy individuals as full trunk flexion is achieved when bending forward from standing. This phenomenon, referred to as flexion relaxation is often absent or disrupted (EMG activity persists) in individuals reporting low back pain (LBP).Methods and ResultsSelf-reported pain and disability scores were compared to EMG measures related to the flexion relaxation (FR) phenomenon by 33 participants with LBP at up to eight sessions over a study period of up to eight weeks. Fourteen participants served as a control group. In the protocol, starting from standing participants bent forward to a fully flexed posture, and then extended the trunk to return to standing position. A thoracic inclinometer was used to measure trunk posture. Surface electrodes located at the L2 and L5 levels recorded EMG amplitudes of the erector spinae. Ratios of EMG amplitudes recorded during forward bending to amplitudes at full flexion, and ratios of extension to full flexion were calculated. EMG amplitudes and their ratios were compared between control and LBP groups at the initial visit. No significant differences between groups were found except at the L5 location at full flexion. Correlations of the ratios to pain and function scores recorded in repeated sessions over the LBP episode also were compared between LBP group participants classified as having transient, recurrent or chronic symptoms. In another analysis participants were grouped by whether their symptoms resolved over the study period.ConclusionsThe transient LBP group had significantly stronger correlations between pain and function to both ratios, than did those with more chronic LBP symptoms. Participants who experienced symptom resolution generally had stronger correlations of ratios to both pain and function than those with partial or no resolution. Improved understanding of these relationships may provide insight in clinical management of LBP.

Management of a Chronic Lumbar Disk Herniation with Chiropractic Biophysics Methods After Failed Chiropractic Manipulative Intervention

To discuss the use of chiropractic biophysics methods in the treatment and rehabilitation of a patient with a chronic disk herniation at the L5-S1 disk, retrolisthesis of L5, and a reduced lumbar lordosis. A 23-year-old woman suffered from chronic unremitting symptoms of lower back pain and left-leg pain. She was treated five years prior, without relief. Diagnosis at that time was low-back pain and lumbar subluxation. Approximately 3 years later, she was evaluated by an orthopedic surgeon. Magnetic resonance imaging showed a moderate posterior disk protrusion at L5-S1 with degeneration. Chiropractic treatment of this patient consisted of mirror-image chiropractic adjustments, 3-point bending lumbar extension traction, and postural exercises. The patient responded well with a complete resolution of her symptoms and a restoration of her lumbar lordosis. This article suggests that successful management of chronic low-back pain symptoms may require a close analysis of a patient's postural deviations and sagittal plane curves. This study suggests that it is possible to restore lumbar lordosis in some cases and this may have an unforeseen benefit to the patient. Further study is warranted into the treatment of chronic low-back pain with chiropractic biophysics methods.

Impnoved Orthotic Low-Back Support for Help with Low-Back Pain

This article discusses the postoperative rehabilitation success of a 42-year-old white male patient who underwent discectomy cnd fusion of the L5-S1 vertebrae in 1989. The operative procedures were a technical success, but the patient continued to suffer from chronic low-back pain symptoms and remained unemployed and on disability. He was particularly sensitive to forward flexed postures and exhibited low tolerance for exercise. The patient was fitted with a Bending Non-Demand Return (BNDR®) lumbosacral orthosis (LSO) designed speclfically for dynamic assistance white in the forward flexed posture. Results were dramatic; back range of motion and mobility were substantially improved with increased tolerance for exercise, resulting in a weight loss of 34 lbs and improved quality of life. The authors believe this to be the first application of a dynamic orthosis to aid in low-back rehabilitation.

Improved Orthotic Low-Back Support for Help with Low-Back Pain

This article discusses the postoperative rehabilitation success of a 42-year-old white male patient who underwent discectomy and fusion of the L5-S1 vertebrae in 1989. The operative procedures were a technical success, but the patient continued to suffer from chronic low-back pain symptoms and remained unemployed and on disability. He was particularly sensitive to forward flexed postures and exhibited low tolerance for exercise. The patient was fitted with a Bending Non-Demand Return (BNDR®) lumbosacral orthosis (LSO) designed specifically for dynamic assistance while in the forward flexed posture. Results were dramatic; back range of motion and mobility were substantially improved with increased tolerance for exercise, resulting in a weight loss of 34 lbs and improved qual ity of life. The authors believe this to be the first application of a dynamic orthosis to aid in low-back rehabilitation.