Treatment Of Chronic Low Back Pain Research Articles

ARE THE ATTITUDES AND BELIEFS OF AUSTRALIAN EXERCISE-BASED PRACTITIONERS ASSOCIATED WITH THEIR USE OF, AND CONFIDENCE IN, TREATMENT MODALITIES FOR PEOPLE WITH CHRONIC LOW BACK PAIN?

BACKGROUND Practitioners’ attitudes and beliefs towards chronic low back pain (CLBP) influence their clinical decision making, but few studies have investigated decision making outside the context of patient vignettes, for a range of first- and second-line treatment options for CLBP, or in Accredited Exercise Physiologists (AEPs). METHODS Using an online survey, Australian AEPs and physiotherapists rated their use of different treatments for CLBP (exercise, education, manual therapy, cognitive behavioural therapy) and their confidence in these treatments for reducing pain and disability. Their biomedical and biopsychosocial beliefs were also assessed using the Pain and Attitudes Beliefs Scale for Physiotherapists. Differences between disciplines in treatment use and confidence were analysed using Mann-Whitney U tests and independent t-tests, respectively. Multiple linear regression was used to explore factors associated with treatment choices. RESULTS Two-hundred thirty-three practitioners (n=143 physiotherapists, n=90 AEPs) completed the survey. Most practitioners were confident treating CLBP, had a moderate-high level of confidence in the different treatments, and regularly used them in practice. Practitioners with higher biomedical beliefs had greater use of, and confidence in, specific exercise, manual therapy, and combined exercise and manual therapy. Practitioners with higher biopsychosocial beliefs were more confident in general exercise, cognitive behavioural therapy, pain education and combined exercise and pain education. CONCLUSION Practitioner beliefs influence their use of, and confidence in, different treatments for CLBP. These findings suggest a need for strategies to enhance biopsychosocial beliefs/reduce biomedical beliefs in Australian exercise-based practitioners.

360 Diffusion Imaging-Derived Structural Changes in Cerebral Pain Regions of Chronic Low-Back Pain Patients Implanted With Thoracic Spinal Cord Stimulation

INTRODUCTION: Thoracic spinal cord stimulation (tSCS) is an effective treatment of chronic low-back pain (cLBP). Although diffusion imaging has been conducted in this group of patients, the study of diffusion-derived structural imaging of regions involved in pain processing has not been conducted. METHODS: Diffusion-weighted imaging scans were acquired in five patients (1 female) post-tSCS with cLBP and five healthy subjects (2 female). Patient MRI scans were taken post-implantation with the SCS device turned off during the MRI session. Four DTI maps and four MAP maps were derived and normalized into MNI space and smoothed. DTI and MAP values for each measure from the pain ROI atlas were extracted and compared between patients and controls. RESULTS: Statistically significant differences were found in regions involved with sensory processing of pain (ASG, PSG) as well as affective pain experience (ACC) across the DTI measures. MAP measures showed significance across five ROIs involved with sensory processing of pain, affective pain experience, and fear response (AMYG). CONCLUSIONS: Diffusion-derived structural imaging of pain regions suggests that cLBP patients receiving SCS have differences in diffusion imaging-derived structural parameters involved with pain processing, cognition, and fear response.

349 Brain Functional Imaging of Pain States Using Resting-State fMRI and Multi-Delay PCASL in Chronic Low-Back Pain Patients Implanted With Thoracic Spinal Cord Stimulation

INTRODUCTION: A treatment of chronic low-back pain is implantation of a thoracic spinal cord stimulator (tSCS), which has been shown to reduce pain. The functional changes in pain processing regions of the brain as assessed by resting-state fMRI and multi-delay pseudocontinuous arterial spin labeling (PCASL) have never been studied. METHODS: PCASL data based on 5 post-label delays (0.5–2.5s) as well as rsfMRI were acquired in five patients (1F) post-tSCS with cLBP and five healthy subjects (2F). Patient MRI scans were taken post-implantation with the SCS device turned off. Three PCASL measures and four rsfMRI measures were derived and normalized into MNI space and smoothed. Averaged values for each measure from the pain ROI atlas were extracted and compared between patients and controls. Statistics were conducted following Box-Cox transformation of data. RESULTS: Arterial transit time derived from PCASL showed a significant difference in the OFC, SMA, and PSG of patients, but other ASL measures showed no effect. Several regions across the rs-fMRI measures showed significant differences, including those involved in cognition (DLPFC, PCC), and pain processing (PSG) and sensation (S2). CONCLUSIONS: Functional imaging showed that cLBP patients treated with SCS display differences in resting-state function and brain perfusion across several pain regions of the brain. These areas are mainly part of the cognitive and behavioral components of the pain circuitry.

Repetitive Transcranial Magnetic Stimulation Combined with Sling Exercise Modulates the Motor Cortex in Patients with Chronic Low Back Pain

The study aims to explore the effects of combining repetitive transcranial magnetic stimulation (rTMS) with sling exercise (SE) intervention in patients with chronic low back pain (CLBP). This approach aims to directly stimulate brain circuits and indirectly activate trunk muscles to influence motor cortex plasticity. However, the impact of this combined intervention on motor cortex organization and clinical symptom improvement is still unclear, as well as whether it is more effective than either intervention alone. To investigate this, patients with CLBP were randomly assigned to three groups: SE/rTMS, rTMS alone, and SE alone. Motor cortical organization, numerical pain rating scale (NPRS), Oswestry Disability Index (ODI), and postural balance stability were measured before and after a 2-week intervention. The results showed statistically significant differences in the representative location of multifidus on the left hemispheres, as well as in NPRS and ODI scores, in the combined SE/rTMS group after the intervention. When compared to the other two groups, the combined SE/rTMS group demonstrated significantly different motor cortical organization, sway area, and path range from the rTMS alone group, but not from the SE alone group. These findings highlight the potential benefits of a combined SE/rTMS intervention in terms of clinical outcomes and neuroadaptive changes compared to rTMS alone. However, there was no significant difference between the combined intervention and SE alone. Therefore, our research does not support the use of rTMS as a standalone treatment for CLBP. Our study contributed to optimizing treatment strategies for individuals suffering from CLBP.

The Emotion Regulation of Acupuncture in Chronic Low Back Pain: A Clinical Neuroimaging Protocol.

Acupuncture is effective for patients with chronic low back pain (CLBP), which can relieve pain intensity and regulate negative emotional states such as pain-related anxiety and depression. Previous studies mainly discuss the analgesic mechanism of acupuncture treatment of CLBP, but there are multiple dimensions to pain, including sensation, emotion and cognition. Therefore, this study aims to investigate the central mechanism of acupuncture for CLBP from the perspective of emotional regulation by functional magnetic resonance imaging (fMRI). A total of 72 patients with CLBP will be recruited in the study and randomly assigned to the verum acupuncture group or the sham acupuncture group. The trail will last for 18 weeks including a 2-week baseline, a 4-week treatment and a 12-week for follow-up period. The primary outcomes are the visual analog scale (VAS) and the Japanese Orthopaedic Association Scores (JOA) score. The secondary outcomes are the 12-item short form health survey (SF-12), the state trait anxiety inventory (STAI), the self-rating anxiety scale (SAS) and self-rating depression scale (SDS). The VAS, JOA, STAI SAS and SDS will be collected at baseline, week 2, week 4, and after follow-up. The SF-12 will be evaluated at baseline, week 2 and week 4. Functional magnetic resonance imaging (MRI) data will be collected at baseline and the end of treatment. Emotion-related brain regions will be chosen as regions of interest (ROIs). The gray matter volume (GMV), amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), functional connectivity (FC), and large-scale functional brain network based on these ROIs will be analyzed within and between the two groups. This study will verify the emotional regulation of acupuncture and explore the mechanism of acupuncture for emotion regulation in patients with CLBP. https://www.chictr.org.cn/showproj.html?proj=195486, identifier: ChiCTR2300070557.

Efficacy of Acupuncture in Chronic Low Back Pain Treatment: A Literature Review

Aims: To evaluate the effects of the use of acupuncture as a treatment of chronic low back pain.
 Methodology: This study follows the integrative methodology of literature review, seeking articles published on PubMed, using keywords from Medical Subject Headings (MeSH) to form the search Formula: Acupuncture AND "low back pain". Inclusion criteria were randomized controlled trials published between 2018 and 2023, with free full text available in english or portuguese. The exclusion criteria was not answering this review’s orienting question. 
 Results: Several studies analyzed the efficacy of different acupuncture and electroacupuncture approaches in the treatment of chronic low back pain. One study highlighted invasive laser acupuncture with different wavelengths, revealing improvements in pain and disability scales after 4 weeks. Another research compared electroacupuncture at various frequencies, observing similar reductions in pain between the groups. Combined acupuncture (hands and ear) was more effective than usual medical treatment, showing greater reduction in pain and cure rate. Both electroacupuncture and manual acupuncture also demonstrated efficacy in reducing pain intensity and quality. Acupuncture with embedded wires stood out, showing positive and rapid results in chronic low back pain. Another study revealed that both electroacupuncture and a placebo had positive impacts on pain intensity.
 Conclusion: Even though there are multiple forms of acupuncture used throughout the studies, and even those that appear on multiple studies are done differently on those appearances, all are used as a way to reduce CLBP. In that sense, the positive effects from using traditional acupuncture or some different form of acupuncture as a treatment for CLBP is highlighted by the results from the studies that were a part of this review.

DIAGNOSIS-RELATED BELIEFS OF FILIPINOS WITH CHRONIC BACK PAIN: A QUALITATIVE STUDY

Introduction: Patient education is needed in the effective management of chronic low back pain (CLBP). To be effective, education resources need to target key beliefs and attitudes around back pain. This study aimed to explore the diagnosis-related beliefs of Filipinos who are seeking treatment for CLBP. The specific objective is to explore patients’ understanding of their diagnoses and their beliefs about how health care professionals might help them. Methods: We used a qualitative research design with an interpretive description approach. We conducted a semi-structured phone interview strategy, using piloted questions. Patients’ understanding of diagnosis and their beliefs was explored using a thematic analysis. We had seven adult participants with non-specific CLBP of at least three months duration attending physiotherapy sessions at the Department of Rehabilitation Medicine outpatient clinic of a tertiary teaching hospital in Metro Manila. To the researchers’ judgement, these selected participants could provide information-rich data, communicate experiences and opinions in an articulate (self-reported ability to understand, speak and write in Filipino), expressive and reflective manner. Results: The analysis of data identified four themes with subthemes related to information that clinicians need to understand and consider when developing effective educational resources for patients with CLBP: (1) Beliefs about causes of back pain; (2) Experience of Back Pain; (3) Actions & Responses to Back Pain; and (4) What might help. Discussion: The overall finding of this study is that many of the beliefs and experiences in this group of Filipinos with back pain are similar to those from other populations and some of the findings were somewhat unique or at the least nuanced to Filipinos with back pain. One of the themes that appeared more unique to these participants were the beliefs about cold and damp weather causing back pain. These beliefs appear to inform the choices of treatment – hot pack, liniments, and avoidance behavior described by the participants in relation to cold weather. Another unique theme that emerged in this study is the role of faith and religion in managing back pain. Participants from this study appeared to portray prayer as a potential form of therapy to manage back pain rather than as a form of coping mechanism. When developing education resources for patients with CLBP, clinicians may consider integrating information that matches the beliefs and understanding of Filipinos with CLBP to make the education resources more suitable, relevant, and fit to the Filipino context.

Effects of breathing exercises on chronic low back pain: A systematic review and meta-analysis of randomized controlled trials.

A range of studies concerning the effects of breathing exercises on chronic low back pain (CLBP) have been proven inconclusive. The study aimed to evaluate the effectiveness of breathing exercises for the treatment of CLBP. We considered randomized controlled trials in English or Chinese that used breathing exercises for the treatment of CLBP. An electronic search was performed in the MEDLINE, EMBASE, Web of Science, Cochrane Library, CNKI, Wan Fang, and CBM databases for articles published up to November 2022. Two reviewers independently screened the articles, assessed the risk of bias using the Cochrane risk of bias tool, and extracted the data. The outcomes included pain, lumbar function and pulmonary function post-intervention. A total of thirteen studies (n= 677) satisfied the inclusion criteria. The meta-analysis results demonstrated a significant effect of breathing exercises on the Visual Analog Scale (VAS) score (SMD =-0.84, 95% CI: -1.24 to -0.45, P< 0.0001), the Oswestry Disability Index (ODI) score (SMD =-0.74, 95% CI: -0.95 to -0.54, P< 0.00001), Forced Vital Capacity (FVC) score (MD = 0.24, 95% CI: 0.10 to 0.37, P= 0.0006), Forced Expiratory Volume in 1 second /Forced Vital Capacity (FEV1/FVC) (MD = 1.90, 95% CI: 0.73 to 3.07, P= 0.001), although there was no significant difference between the breathing exercises and control interventions for Forced Expiratory Volume in the first second (FEV1) score (MD = 0.22, 95% CI = [0.00, 0.43], P= 0.05), and Maximal Voluntary Ventilation (MVV) score (MD = 8.22, 95% CI = [-4.02, 20.45], P= 0.19). Breathing exercises can reduce pain, assist people with lumbar disabilities, and improve pulmonary function, and could be considered as a potential alternative treatment for CLBP.

Chronic Low Back Pain Treatment

Chronic low back pain is the attachment point of lumbar muscle fascia and sola.t, and chronic inflammation damage. This is one of the common causes of low back pain. The main symptoms are lumbar or lumbar spine swelling pain, soreness, recurred, and pain changes with the degree of climate or accumulation. Lumbar pain can also from muscle pain to shooting, burning or stabbing. In addition, pain will emit legs. Bending, twisting, weightlifting, standing or walking will make the situation worse. Lumber muscles degeneration has a lot of different treatments like Muscle strengthening such as ab strengthening, gluteal strengthening, back strengthening to prevent muscle dystonia. Physical therapy, such as electromagnetic, ultrasonic, infrared, laser, acts on the human body through sound, light, electricity, heat, and plays the role of thinning tendons and activating complexions. Chinese medicine therapy such as electroacupuncture. This article is about the above three therapies, hope to provide reference for chronic low back pain treatment.

The effect of self-management techniques on relevant outcomes in chronic low back pain: A systematic review and meta-analysis.

Among many treatment approaches for chronic low back pain (CLBP), self-management techniques are becoming increasingly important. The aim of this paper was to (a) provide an overview of existing digital self-help interventions for CLBP and (b) examine the effect of these interventions in reducing pain intensity, pain catastrophizing and pain disability. Following the PRISMA guideline, a systematic literature search was conducted in the MEDLINE, EMBASE, PsychInfo, CINAHL and Cochrane databases. We included randomized controlled trials from the last 10 years that examined the impact of digital self-management interventions on at least one of the three outcomes in adult patients with CLBP (duration ≥3 months). The meta-analysis was based on random-effects models. Standardized tools were used to assess the risk of bias (RoB) for each study and the quality of evidence for each outcome. We included 12 studies (n = 1545). A small but robust and statistically significant pooled effect was found on pain intensity (g = 0.24; 95% CI [0.09, 0.40], k = 12) and pain disability (g = 0.43; 95% CI [0.27, 0.59], k = 11). The effect on pain catastrophizing was not significant (g = 0.38; 95% CI [-0.31, 1.06], k = 4). The overall effect size including all three outcomes was g = 0.33 (95% CI [0.21, 0.44], k = 27). The RoB of the included studies was mixed. The quality of evidence was moderate or high. In summary, we were able to substantiate recent evidence that digital self-management interventions are effective in the treatment of CLBP. Given the heterogeneity of interventions, further research should aim to investigate which patients benefit most from which approach. This meta-analysis examines the effect of digital self-management techniques in patients with CLBP. The results add to the evidence that digital interventions can help patients reduce their pain intensity and disability. A minority of studies point towards the possibility that digital interventions can reduce pain catastrophizing. Future research should further explore which patients benefit most from these kinds of interventions.

Are the attitudes and beliefs of Australian exercise-based practitioners associated with their use of, and confidence in, treatment modalities for people with chronic low back pain?

Practitioners' attitudes and beliefs towards chronic low back pain (CLBP) influence their clinical decision making, but few studies have investigated decision making outside the context of patient vignettes for a range of first- and second-line treatment options for CLBP, or in accredited exercise physiologists (AEPs). Using an online survey, Australian AEPs and physiotherapists rated their use of different treatments for CLBP (exercise, education, manual therapy, cognitive behavioural therapy) and their confidence in these treatments for reducing pain and disability. Their biomedical and biopsychosocial beliefs were also assessed using the Pain and Attitudes Beliefs Scale for Physiotherapists. Differences between disciplines in treatment use and confidence were analysed using Mann-Whitney U tests and independent t-tests, respectively. Multiple linear regression was used to explore factors associated with treatment choices. Two-hundred thirty-three practitioners (n=143 physiotherapists, n=90 AEPs) completed the survey. Most practitioners were confident in treating CLBP, had a moderate-high level of confidence in the different treatments, and regularly used them in practice. Practitioners with higher biomedical beliefs had greater use of, and confidence in, specific exercise, manual therapy, and combined exercise and manual therapy. Practitioners with higher biopsychosocial beliefs were more confident in general exercise, cognitive behavioural therapy, pain education and combined exercise and pain education. Practitioner beliefs influence their use of, and confidence in different treatments for CLBP. These findings suggest a need for strategies to enhance biopsychosocial beliefs/reduce biomedical beliefs in Australian exercise-based practitioners.

Efficacy of ultrasound versus short wave diathermy in the treatment of chronic low back pain in patients with lumbar disk herniation: a prospective randomized control study

BackgroundLumbar disk herniation (LDH) is a cause of chronic low back pain (CLBP) treated using physical therapy (PT), including exercise and physical modalities such as ultrasound (US) and short wave diathermy (SWD). Despite the use of US and SWD, there is inconclusive evidence on their efficacy. The aim of this study was to investigate the efficacy of US and SWD in the treatment of CLBP in patients with LDH.MethodsA prospective randomized control clinical study. Individuals with radicular CLBP and LDH on magnetic resonance imaging, presenting to the Physical and Rehabilitation Medicine Department were randomized into 3 treatment groups. All participants received 10 sessions of hotpack, transcutaneous nerve stimulation (TENS) and therapeutic exercises. In addition, Group 1 received 10 sessions of therapeutic US (1 MHz, 1.5W/cm2, 10 min), Group 2 SWD (27.12 MHz, wavelength 11.06 m, induction technique, 20 min) to the lower back. Group 3 (control group) received hotpack, TENS and therapeutic exercises alone. Visual analogue scale (VAS) for LBP, Modified Oswestry Disability Index (MODI) and Short Form 36 (SF-36) were evaluated pre and post treatment and at one and three months follow up.ResultsIn all groups, VAS for LBP and MODI improved with treatment and at the one and three month follow up (p < 0.001). In Groups 1 and 2, MODI scores continued to reduce at 1 and 3 months (p < 0.001 and p = 0.012 respectively). SF-36 physical, social function and pain parameters reduced in all groups (p < 0.05). Role limitation due to physical and emotional problems, emotional well-being, vitality and mental health improved in Groups 1 and 2 (p < 0.05).ConclusionsDeep heating agents can be used as part of the physical therapy for CLBP in those with LDH with positive mid-term effects.Trial registrationNCT03835182, 02/04/2019.

Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis.

Chronic low back pain (CLBP) is an aging and public health issue that is a leading cause of disability worldwide and has a significant economic impact on a global scale. Treatments for CLBP are varied, and there is currently no study with high-quality evidence to show which treatment works best. Exercise therapy has the characteristics of minor harm, low cost, and convenient implementation. It has become a mainstream treatment method in clinics for chronic low back pain. However, there is insufficient evidence on which specific exercise regimen is more effective for chronic non-specific low back pain. This network meta-analysis aimed to evaluate the effects of different exercise therapies on chronic low back pain and provide a reference for exercise regimens in CLBP patients. We searched PubMed, EMBASE, Cochrane Library, and Web of Science from inception to 10 May 2022. Inclusion and exclusion criteria were used for selection. We collected information from studies to compare the effects of 20 exercise interventions on patients with chronic low back pain. This study included 75 randomized controlled trials (RCTs) with 5,254 participants. Network meta-analysis results showed that tai chi [standardized mean difference (SMD), -2.11; 95% CI, -3.62 to -0.61], yoga (SMD, -1.76; 95% CI -2.72 to -0.81), Pilates exercise (SMD, -1.52; 95% CI, -2.68, to -0.36), and sling exercise (SMD, -1.19; 95% CI, -2.07 to -0.30) showed a better pain improvement than conventional rehabilitation. Tai chi (SMD, -2.42; 95% CI, -3.81 to -1.03) and yoga (SMD, -2.07; 95% CI, -2.80 to -1.34) showed a better pain improvement than no intervention provided. Yoga (SMD, -1.72; 95% CI, -2.91 to -0.53) and core or stabilization exercises (SMD, -1.04; 95% CI, -1.80 to -0.28) showed a better physical function improvement than conventional rehabilitation. Yoga (SMD, -1.81; 95% CI, -2.78 to -0.83) and core or stabilization exercises (SMD, -1.13; 95% CI, -1.66 to -0.59) showed a better physical function improvement than no intervention provided. Compared with conventional rehabilitation and no intervention provided, tai chi, toga, Pilates exercise, sling exercise, motor control exercise, and core or stabilization exercises significantly improved CLBP in patients. Compared with conventional rehabilitation and no intervention provided, yoga and core or stabilization exercises were statistically significant in improving physical function in patients with CLBP. Due to the limitations of the quality and quantity of the included studies, it is difficult to make a definitive recommendation before more large-scale and high-quality RCTs are conducted.

P029 Comparing the Impact of General Strength Conditioning and Motor Control Manual Therapy on Sleep Quality in Adults with Chronic Low Back Pain: A Randomised Controlled Trial

Abstract Introduction There is strong evidence indicating interactions between sleep and chronic low back pain (CLBP). However, evidence on the effect of exercise training (first-line treatment for CLBP), especially of specific modes of exercise training, on sleep is limited. This study aimed to investigate the effect of two exercise-based interventions (general strength and conditioning [GSC] and motor control and manual therapy [MCMT]) on sleep quality in adults with CLBP. Methods We conducted a two-group parallel (1:1), randomised controlled trial. Forty adults (mean age [SD]: 34.7 [6.1] years) with CLBP were randomised to receive either GSC (n=20) or MCMT (n=20) for 6 months. Sleep quality and its sub-components (e.g., sleep disturbance, sleep duration) were measured by the Pittsburgh Sleep Quality Index (PSQI). Analysis employed an intention-to-treat approach and group-by-time effects were assessed with mixed linear effect models. Results Both GSC (PSQI mean change [95%CI]: -1.58 [-2.70, -0.46] points) and MCMT (-1.61 [ 2.79, -0.43]) improved sleep quality at 6 months, but no group-by-time effect was detected (β [95%CI]: 0.03 [-1.60, 1.65]). For sleep quality sub-components, GSC improved daytime dysfunction (-0.33 [-0.65, -.0.01]), but led to a small decline in sleep efficiency (0.06 [0.01, 0.10]). MCMT improved sleep disturbance ( 0.31 [-0.55, -0.07]). Conclusion Both GSC and MCMT improved sleep quality, although neither intervention appeared superior. Sleep disturbance was improved in the MCMT group and daytime dysfunction was improved in the GSC group. Future studies would benefit from including a true control, objective sleep measures, and investigation of potential mediators.

Experiences of adults with opioid-treated chronic low back pain during the COVID-19 pandemic: A cross-sectional survey study.

This study aimed to evaluate the impact of the COVID-19 pandemic on adults with opioid-treated chronic low back pain (CLBP), an understudied area. Participants in a "parent" clinical trial of non-pharmacologic treatments for CLBP were invited to complete a one-time survey on the perceived pandemic impact across several CLBP- and opioid therapy-related domains. Participant clinical and other characteristics were derived from the parent study's data. Descriptive statistics and latent class analysis analyzed quantitative data; qualitative thematic analysis was applied to qualitative data. The survey was completed by 480 respondents from June 2020 to August 2021. The majority reported a negative pandemic impact on their life (84.8%), with worsened enjoyment of life (74.6%), mental health (74.4%), pain (53.8%), pain-coping skills (49.7%), and finances (45.3%). One-fifth (19.4%) of respondents noted increased use of prescribed opioids; at the same time, decreased access to medication and overall healthcare was reported by 11.3% and 61.6% of respondents, respectively. Latent class analysis of the COVID-19 survey responses revealed 2 patterns of pandemic-related impact; those with worse pandemic-associated harms (n = 106) had an overall worse health profile compared to those with a lesser pandemic impact. The pandemic substantially affected all domains of relevant health-related outcomes as well as healthcare access, general wellbeing, and financial stability among adults with opioid-treated CLBP. A more nuanced evaluation revealed a heterogeneity of experiences, underscoring the need for both increased overall support for this population and for an individualized approach to mitigate harms induced by pandemic or similar crises.

The Impact of Diabetes Mellitus on Patient-Reported Outcomes of Chronic Low Back Pain with Modic Changes at One Year: A Prospective Cohort Study.

Prospective cohort study. Diabetes mellitus (DM) is associated with unfavourable patient-reported outcomes after spine surgery. Chronic low back pain (CLBP) with Modic Changes (MCs) in the lumbar vertebrae, as observed on MRI, forms a specific subgroup. This study aims to investigate the potential influence of DM on CLBP with MCs. This study involved 259 patients with CLBP accompanied MCs. We recorded the patient-reported outcomes (visual analogue scale (VAS), Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ)) at baseline, 3, 6, and 12months. Multivariable linear regression analyses were performed to determine predictors of patient-reported outcomes. 103 patients had DM. Patients with DM exhibited higher VAS (P < .05), ODI (P < .001), and RMDQ (P < .001) scores at 3, 6, and 12months, while patients without DM experienced more significant improvements in the scores over time (P < .001). Patients with DM reported longer durations of physical exercise (P = .007). Additionally, patients without DM had a significantly higher patient satisfaction index (P < .001) and a lower prevalence of hypertension (P < .001). Notably, significant differences were observed in the distribution of MCs of lumbar vertebrae (P = .034) and Pfirrmann grades of intervertebral disc degeneration between two groups (P < .001). Patients with DM demonstrated poorer patient-reported outcomes compared to those without DM in 1-year. DM emerged as an independent predictor of adverse patient-reported outcomes. It can be utilized to enhance the management and treatment of CLBP in patients with MCs.

Effects of Isolated Myofascial Release Therapy in Patients with Chronic Low Back Pain-A Systematic Review.

Dysfunctions of the lumbosacral area and related pain syndromes, such as chronic low back pain (CLBP), are among the most common musculoskeletal problems in modern society. The purpose of this study was to evaluate the effectiveness of isolated myofascial release techniques (MFR) in the treatment of CLBP in adults. PubMed, Web of Science, Scopus, and Cochrane Library databases were searched for studies published from 1 January 2013 to 1 March 2023. We included English-language randomized controlled trials evaluating the effect of isolated MFR performed by a specialist on adults with CLBP. Only studies with a comparison group without treatment or with sham MFR were included. A total of 373 studies were detected, of which 6 studies were finally included in this review. There was a total of 397 CLBP patients aged 18-60 in all study groups. The studies evaluated the effects of a series of MFR treatments as well as a single intervention. After applying a series of treatments, a statistically significant reduction in pain intensity, improvement in the range of motion, reduction in the level of functional disability and fear-avoidance beliefs, as well as a decrease in the activity of paraspinal muscles at maximum trunk flexion were demonstrated. A single, 40-min complex intervention involving tissues at various depths significantly reduced the level of pain, improved the range of motion, and reduced the resting activity of paraspinal muscles in the standing position, but did not affect postural stability. The use of a single 5 min MFR technique did not affect pain intensity and sensitivity and functional disability. The findings suggest that the use of a series of isolated MFR improves the condition of patients with CLBP by reducing the intensity of pain, improving functional efficiency, and reducing the activity of the paraspinal muscles in the position of maximum forward bend. The use of a single intervention containing a set of techniques covering superficial and deep tissue also reduces the intensity of pain, improves mobility, and reduces the resting activity of the paraspinal muscles in a standing position. Given the small number of eligible studies with limitations, conclusions should be interpreted with caution and avoid overgeneralizing the benefits of isolated MFR based on limited or mixed evidence.

Effect of an Online Cognitive-Motor Control Training Program on Pain and Its Related Psychological Factors in People With Non-Specific Chronic Low Back Pain: A Randomized Clinical Trial

Background and Aims Non-specific chronic low back pain (LBP) is one of the most common types of LBPs. Due to the complexity of the injury mechanism in this condition, combined interventions and treatments have been suggested. People’s attitudes towards pain and the interaction between biological characteristics of people and social/psychological factors should be considered. Due to the high cost of face-to-face therapy and the difficulty of access to subjects, recent studies have used online methods. So far, the effectiveness of online interventions in the treatment of chronic LBP has not been studied. Therefore, this study aims to investigate the effect of an online cognitive-motor control training program on pain and its related psychological factors in people with non-specific chronic LBP. Methods This is a randomized clinical trial conducted on 44 female and male patients with non-specific chronic LBP aged 25-55 years, selected from the physiotherapy clinics in Tehran and Karaj provinces of Iran based on the inclusion and exclusion criteria, and randomly divided into two groups of 22 including training and control. The intervention was provided at 18 sessions for 12 weeks. Pain and its related psychological factors were assessed by the visual analog scale, fear-avoidance belief questionnaire, and pain self-efficacy questionnaire. For statistical analysis, repeated measures analysis of variance, independent t-test, and paired t-test were used. The significance level was set at 0.05. Results There was a significant difference between the pre-test and post-test scores of the training group in pain, pain self-efficacy, avoidance of physical activity, and avoidance of work (P&lt;0.001). In the control group, no significant difference was reported in these variables between the pre-test and post-test scores. Conclusion The online cognitive-motor control training program can relieve pain and improve the pain-related psychological factors of people with non-specific chronic LBP. It can be used for this purpose in these people.

Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain.

Treatment of chronic low back pain (CLBP) based on the fear-avoidance model (FAM) has received support in randomized controlled trials, but few studies have examined treatment processes associated with treatment outcome. This study examined changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy as mediators of the relation between changes in pain intensity and disability in exposure-based treatment of CLBP. Data from a randomized controlled trial with 2 treatment arms (exposure treatment based on the FAM with/without in-session exposure) was pooled, including only participants with complete data (N = 69). Change scores (pre to booster session) were computed for all variables, and the indirect effect of change in pain intensity on change in 3 measures of disability, through change in the proposed mediators, was tested in parallel mediation analyses. Decreases in pain catastrophizing and fear-avoidance beliefs, as well as increases in pain self-efficacy, mediated a unique proportion of the relation between changes in pain intensity and disability, depending on the outcome measure. The direct relation between changes in pain intensity and disability was absent when indirect effects were controlled. The results suggest that the way pain is interpreted (pain catastrophizing, fear-avoidance beliefs), as well as pain self-efficacy, are all more critical for reducing disability in exposure-based treatment of CLBP than symptom relief per se.

Review: Discogenic Back Pain: Update on Treatment.

Lower back pain (LBP) has a lifetime prevalence of 80% in the United States population. Discogenic back pain (DBP), a subcategory of LBP, occurs as a result of the interverbal disc degeneration without disc herniation. Diagnosis relies on history, physical exam, and imaging such as MRI, provocative discography, or CT discography. Treatment of DBP involves a multifaceted approach with an emphasis on conservative measures including behavioral modification, pharmacologic management, and other non-pharmacologic interventions with invasive therapy reserved for select patients. Due to the paucity of data on the treatment of DBP, treatment also relies on data derived from treatment of chronic LBP (CLBP). Despite the scarcity of data for the treatment of DBP, treatments do exist with varying efficacy for DBP. Novel techniques such as the use of biologics may provide another avenue for treatment though further studies are needed to better evaluate the most efficacious regimen for both novel and existing treatments.