Chronic Low Pain Research Articles

A “Motor Skill Training” Approach to Chronic Low Back Pain

For patients with chronic low back pain, two possible approaches to therapy are traditional strength/flexibility exercises and more-personalized

Osteopathic Manipulative Treatment for Nonspecific Subacute and Chronic Low Back Pain

Data are scant regarding the efficacy of osteopathic manipulative treatment (OMT) for reducing pain and disability in patients with nonspecific

Comparison of the effects of spinal manipulation and muscle energy techniques on motor control in Non- Specific Chronic Low Back Pain by Beta-band intermuscular pool coherence

Background: Until now, a variety of techniques have been introduced to address the adverse effects of NS-CLBP, including SMT and MET. However, most of these techniques have focused on pain assessment and disability. In other words, the effectiveness of these techniques on the corticospinal tract function was not studied. Therefore, the purpose of this study was to compare the effects of SMT and MET on corticospinal tract function during flexion-extension task phases in NS-CLBP using PC of Bb-IMC. Methods: A cross-sectional study was designed that in which 20 healthy and twenty-four (20–45 years) NS-CLBP patients men voluntarily participated. The patients had continuous or recurrent symptoms for 3 months or more without any referral pain to the lower extremities. The patients were randomly assigned to two equal intervention groups (SMT and MET) and the techniques were applied as described by Greenman. sEMGs from lumbopelvic muscles was recorded for all participants before and after the intervention while they performed three trials of F-ET and the PC for all muscles was calculated using Bb-IMC analysis. Multivariate analysis of variance test was used to compare the differences between the healthy subjects and patient groups before the interventions. Furthermore, in NS-CLBP patients, comparisons were made before and after the interventions in each group (i.e. SMT and MET groups). Results: There were significant differences in A and B muscle cross in the SMT group before and after the intervention in four phases of F-ET (P < 0.05). However, no significant differences were found in the MET group. Conclusion: These results showed that the SMT intervention was more effective than the MET intervention by reducing the PC of Bb-IMC in all phases of FE-T. Therefore, the PC of Bb-IMC could be considered as an approach for clinicians when designing the rehabilitation protocol to ensure optimal treatment.

The Effectiveness of Manual Therapy on Musculoskeletal and Respiratory Parameters in Patients with Chronic Low Back Pain: A Systematic Review

The Effectiveness of Manual Therapy on Musculoskeletal and Respiratory Parameters in Patients with Chronic Low Back Pain: A Systematic Review

Efeitos de exercícios de Pilates em parâmetros antropométricos e hemodinâmicos de portadores de dor lombar crônica inespecífica: ensaio clínico randomizado

Introdução: Exercícios do método Pilates têm sido utilizados como recurso para modificar parâmetros antropométricos e hemodinâmicos, além de reduzir a intensidade da dor lombar crônica inespecífica (DLCI). Objetivo: Avaliar o comportamento de parâmetros antropométricos e hemodinâmicos e da intensidade dolorosa em indivíduos com DLCI submetidos a um protocolo de exercícios de Pilates no solo ou a estimulação elétrica nervosa transcutânea (TENS). Metodologia: Trata-se de um ensaio clínico randomizado, com 36 portadores de DLCI de ambos os sexos com idades entre 18 a 59 anos. Os indivíduos foram alocados aleatoriamente em grupo controle (GC; n=17), tratado por meio da TENS e grupo de exercícios de Pilates (GP; n=19). Os desfechos primários foram as medidas antropométricas e a porcentagem de gordura. Os desfechos secundários foram a intensidade dolorosa, avaliada por meio da escala analógica visual (EAV), a pressão arterial sistólica (PAS), a pressão arterial diastólica (PAD) e a frequência cardíaca de repouso (FCR). Resultados: Não houve diferença entre os grupos na análise comparativa dos dados antropométricos (P&gt;0,05). Houve redução significativa (P&lt;0,001) da intensidade da DLCI tanto no GC quanto no GP. Foram identificadas reduções significativas na PAS (P=0,002) e na FCR (P=0,029) apenas no GP. Conclusão: Tanto a TENS como os exercícios de Pilates no solo são eficazes na redução da intensidade da DLCI em curto prazo. O protocolo de exercícios de Pilates aplicado neste estudo não provocou alteração de parâmetros antropométricos, porém, foi eficaz na redução dos níveis da PAS e da FCR em curto prazo.

Effectiveness of Mindfulness-Based Interventions on Pain Intensity in Patients with Chronic Low Back Pain: A Systematic Review

Context: Chronic low back pain (CLBP) is the most prominent cause of disability worldwide. For the treatment of CLBP, Mindfulness-based Interventions (MBIs) such as mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), mindfulness meditation (MM) are often used; however, their exact effect on pain intensity has not yet been determined for these people. Objectives: This study aimed to evaluate the effectiveness of MBIs on pain intensity in people with CLBP. Data Sources: In this systematic review, all of the randomized controlled trials available on PubMed, PsycInfo, Cochrane Library, Google Scholar, Scopus, and ProQuest databases from 2014 to 2020 were reviewed. This study is also the first review article in the field of chronic low back pain that reviews the databases of Google Scholar, Irandoc, and SID in Persian. Study Selection: Studies were included if they were: (1) RCT; (2) had patients with chronic low back pain; (3) made a comparison between MBIs and a passive comparator (usual care) or an active comparator (such as cognitive-behavioral therapy (CBT) or health education); (4) examined pain intensity. Results: In the initial search, we found 297 trials in total databases. After removing duplicates and applying all inclusion and exclusion criteria, 9 RCT (totaling 959 patients) with CLBP were included for this systematic review. Conclusions: MBIs are effective solutions for coping with CLBP, and their effects are maintained for a long time. No significant difference was found between the effectiveness of these treatments and CBT treatment on pain intensity of patients with CLBP.

Intermittent traction therapy in the treatment of chronic low back pain.

Aim To investigate the effect of intermittent traction therapy (ITT) on pain in patients with chronic low back pain (CLBP). Methods A total of 81 patients with CLBP were included: experimental group received ITT (n=40) and control group received conservative physical treatment (n=41) 10 times for two weeks. A visual analogue scale (VAS) was used for measuring low back pain. Results In the experimental group, 26 (out of 40; 65.0%) patients were females, in the control group 20 (out of 41; 48.8%) were females (p=0.141). In a within-group comparison, median of VAS value was significantly decreased in both groups after ITT. A comparison of pre-intervention and post-intervention VAS value showed no statistically significant difference. Females from the experimental group had a significantly greater decrease of VAS compared with females from the control group. Patients in the ITT group with L5/S1 level of hernia had lower estimated marginal mean of VAS scale compared to the control group, as well the patients with left side of leg pain. Conclusion: Intermittent traction therapy is an effective treatment for pain reduction in patients with chronic low back pain.

Comparison of clinical efficacy between dexamethasone and triamcinolone for transforaminal epidural steroid injections in the management of low back pain

The objective of this study was to compare the clinical efficacy of transforaminal epidural injection of dexamethasone and triamcinolone in the management of chronic low back pain with or without radiculopathy due to herniated intervertebral disc. It was a prospective, randomized, single-blind study, conducted in eighty patients of either sex suffering from low back pain of more than 3 months duration due to herniated intervertebral disc. The patients were allocated into two groups to receive either injection dexamethasone 8 mg or injection triamcinolone acetonide 40 mg as 2 ml solution through transforaminal epidural route. Each patient underwent unilateral lumbar transforaminal epidural steroid injections (TFESIs) at one level only depending on predominant involvement of nerve root on magnetic resonance imaging computed tomography of the spine and consistent with a clinical presentation of patients. Patients in both the groups were assessed prior to epidural injection and at the 2nd, 6th, and 12th weeks following epidural injection for the intensity of pain using a numerical rating scale of 0–10 and requirement of analgesics on weekly basis. Any adverse event following epidural injection was also noted during the follow-up period of the study. Improvement in pain score was significantly better with transforaminal epidural injection of triamcinolone acetonide compared to dexamethasone, in patients with chronic low back pain due to herniated intervertebral disc. No major adverse event was reported during the follow-up period in patients of either group.

The gait patterns of youths with chronic, nonspecific low back pain

Objective To quantify the kinematic changes in the gait cycle among youths with chronic, nonspecific low back pain (CNLBP). Methods A Qualisys 3D optical motion capture system was used to document the gait kinematics of 11 youths with CNLBP and 11 healthy counterparts. Gait profile scores and movement analysis profiles were then calculated. Results The young CNLBP subjects exhibited gait abnormalities, as reflected by the significant difference of the gait variable the range of motion of the dominant knee between the CNLBP and healthy groups [(5.66±1.83)° vs (3.64±1.13)°]. Gait profile scores and movement analysis profiles are applicable to evaluating them. Conclusions There manifested gait abnormalities in youth CNLBP patients. Gait profile scores and movement analysis profiles are applicable to evaluating them. Key words: Back pain; Gait profile scoring; Movement analysis; Gait variables

Effects of Kinesio-Taping on Pain, Range of Motion and Isokinetic Strength of Back Extensors in Chronic Non-specific Low Back Pain Patients

BACKGROUND: low back pain is a common problems that encountered in physical therapy clinic. Many treatment regime are present. Kinesio-taping is a newly treatment introduced for patients with low back pain. OBJECTIVES: To investigate the effect of kinesio-taping on pain, range of motion, and back muscle strength in non-specific low back pain patients. METHODS AND MEASURES: Twenty four patients were involved in this study. Informed consent were signed by the patients and patients were divided into two groups by randomization ,thirteen in Group A and eleven in Group B. Pain, range of motion, and back muscle strength were assessed on day one and six by VAS scale, modified-modified schober test (MMST), isokinetic dynamometer. Kinesio-taping (KT) was applied twice per six days. Group A patients were receiving I-shape KT longitudinally .Group B patients were receiving K taping Horizontally. RESULTS: The results of this study showed significant improvement in pain intensity and functional disability within groups. No significant differences between both groups. CONCLUSION: The Kinesio-taping with conventional physiotherapy will be more beneficial than kinesio- taping alone when treating nonspecific low back pain patients.

Antibiotics for Chronic Low Back Pain with Imaging Signal Changes

Some patients with chronic low back pain have magnetic resonance imaging (MRI) signal changes in the vertebral bone marrow known as “Modic changes,”

Effects of Sustained Natural Apophyseal Glides with and without thoracic posture correction techniques on mechanical back pain: a randomized control trial.

To determine effectiveness of sustained natural apophyseal glides with and without thoracic postural correction techniques on patients of chronic mechanical low back pain . The randomized control trial was conducted at the National Institute of Rehabilitation Medicine, Islamabad, Pakistan, from November 1, 2015, to January 31, 2016, and comprised females aged 20-60 years experiencing mechanical low back pain for more than 03 months. They were randomly assigned to two equal groups. Group 1 was given Mulligan sustained natural apophyseal glides mobilization, while group2 was given the same along with thoracic postural correction techniques for 4 weeks, 3 sessions per week and one session per day. Outcome measures included Numeric Pain Rating Scale, Oswestry Disability Index and Goniometry of Lumbar Range of Motion. Data was analysed using SPSS 20. Of the 40 patients, there were 20(50%) in each of the groups. Mean age of patients in group 1 was 41.30±10.45years, while in group 2 it was 35.12±9.04 years. Compared to the baseline readings, pain, functional independence and range of motion showed significant improvement (p<0.0001) postintervention in both groups. Mean scores in group 2 showed more improvement than group 1 (p<0.0001) in all variables. The effectiveness of thoracic postural correction exercises along with sustained natural apophyseal glides was noted in patients with mechanical low back pain.

Effects of real-time ultrasound as biofeedback on transversus abdominis activation level in patients with chronic low back pain

Objective To investigate the effects of abdominal drawing-in maneuver with real-time ultrasound biofeedback on transversus abdominis activation level during functional tasks in different positions in patients of chronic low back pain with stabilization-deficit. Methods Nineteen patients of chronic low back pain with stabilization-deficit were randomly divided into verbal instruction group(n=9) and ultrasound biofeedback group(n=10), and received abdominal drawing-in maneuver with verbal instruction and ultrasound biofeedback respectively. Percentage changes of transversus abdominis thickness during supine and upright loaded tasks were compared before and after intervention. Results After intervention, percentage changes of transversus abdominis thickness increased significantly in verbal instruction group during supinehip external rotation, straight leg raising and upright loaded functional tasks (P 0.05). Conclusions Ultrasound image could effectively assess the thickness changes of transversus abdominis in patients with chronic low back pain during supine and upright loaded functional tasks. Ultrasound image could provide chronic low back pain patients with real-time and dynamic visual feedback. However, compared with verbal instruction, adding real-time ultrasound biofeedback to abdominal drawing-in maneuver does not further increase the transversus abdominis activation level. Key words: Ultrasonography; Transversus abdominis activation; Chronic low back pain

Evidence-Based Recommendations on the Pharmacological Management of Osteoarthritis and Chronic Low Back Pain: An Asian Consensus

The overall burden of chronic musculoskeletal pain in Asian countries will continue to increase as the population ages, as will the demand for safe and effective pain management. Currently available Asian guidelines are mostly outdated and targeted only to primary care. Implementation of international guidelines may be unsuitable for Asian patients due to cultural, local economic and regulatory factors. With the aim of developing Asian-specifi c consensus recommendations for the pharmacological management of osteoarthritis (OA) pain and chronic low back pain (cLBP), we convened to review and discuss recent available evidence for pharmacotherapy, clinical experiences, and current practice challenges they face in the region, including challenges in opioid use. Taking these into consideration, we provided general recommendations for the overall assessment and management of OA pain and cLBP. The strength of the recommendations regarding the use of pharmacological agents was assessed using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. Where evidence is confl icting or limited, we made no recommendation pending the availability of further evidence. We recommend topical non-steroidal anti-infl ammatory drugs (NSAIDs) as a fi rst-line pharmacological treatment of OA pain, while oral NSAIDs should be considered as a fi rst-line pharmacological treatment of cLBP. Acetaminophen has been commonly used as the fi rst-line treatment for OA pain and cLBP, but its long-term use is not recommended based on recent evidence. These consensus recommendations are not prescriptive, and serve as a guide for decision-making in clinical practice. The optimal management of OA pain and cLBP should ultimately be individualized to each patient.

Effects of lumber and back muscle exercise training program based on the theory of protective motivation on intensive care unit nurses with chronic low back pain

Objective To evaluate the effects of lumber and back muscle exercise training program based on the theory of protective motivation on nurses' chronic low back pain and improving effect on the fear-avoid belief. Methods By convenience sampling, a total of 40 nurses in Intensive Care Unit (ICU) in a Class Ⅲ general hospital were selected from April to June of 2017, based on the theory of protective motivation, the back muscle exercise training program was designed and the intervention was carried out. Before intervention and 8 weeks after intervention, Visual Assimilation Scale (VAS) , Roland Morris Dysfunction Questionnaire (RMDQ) , the Chinese Version of the Fear-Avoidance Beliefs Questionnaire (FABQ-CHI) were used to evaluate the implementation effects of the training program. Results 8 weeks after intervention, the nurses' score of chronic low back pain in VAS dropped from (4.60±1.17) to (2.58±0.96) , RMDQ score dropped from (10.05±4.03) to (4.40±1.46) , and FABQ score dropped from (65.63±10.49) to (49.28±7.54) , all with statistical differences (P<0.05) . Conclusions The training program based on the theory of protective motivation can alleviate the symptoms of chronic low back pain and reduce the fear-avoidance belief level of nurses when facing operation or behavior that may potentially cause chronic low back pain. Key words: Nurses; Chronic low back pain; Protective motivation theory; Occupational protection; Exercise

Effects of Muscle-Strengthening Intervention Exercise on Pain Alleviation and Postural Control in Patients with Chronic Low Back Pain

The abstract not available.

Does Diabetes Mellitus Affect Lumbar Paraspinal Muscle Morphometry

Background: Changes in paraspinal muscle cross-sectional surface area (CSA) have been shown to occur in patients with chronic and acute low back pain. Numerous factors can affect muscle density; however, the relationship between metabolic disease, such as type II diabetes mellitus (DM) and lumbar paraspinal morphometry, has not been examined. Therefore, we set out to compare paraspinal CSA in diabetic patients undergoing lumbar fusion to patients without diabetes. Methods: A retrospective review of 101 patients, who underwent posterior lumbar fusion for degenerative spondylolisthesis, was performed. Data collected included preoperative Oswestry Disability Index, SF-12 physical and mental health scores, and visual analog scale for back pain. Utilizing standard measurement software for the iliocostalis, longissimus, multifidus, and psoas muscles, individual paraspinal muscle CSA was measured on preoperative magnetic resonance imaging. Average CSA measurements were then compared between diabetic and non-diabetic patients utilizing Student’s t-test. Results: Thirteen patients were included in the DM group while 88 composed the non-DM group. There were no differences in age or body mass index between the groups. There were no significant differences in preoperative health-related outcome scores. Average psoas muscle iliocostalis as well as multifidus CSA were not significantly different between the non-DM and DM groups (p=0.09, 0.263, 0.458). The longissimus CSA was significantly decreased in the DM group compared to the non-DM (p=0.004). Conclusions: This study shows that type II DM is associated with decreased paraspinal muscle CSA, but this finding was specific to the longissimus muscle. Our findings suggest that metabolic factors may play an important role in the maintenance of paraspinal muscle balance.

Assessment of Sleep and Life Qualities of Patient with Chronic Low Back Pain; Single-Centered, Prospective Observational Study

Assessment of Sleep and Life Qualities of Patient with Chronic Low Back Pain; Single-Centered, Prospective Observational Study

Lumbar Combined Rehabilitation Exercise for Lumbar Reposition Sense, Static Balance and Pain of the Patient’s with Chronic Low Back Pain

Lumbar Combined Rehabilitation Exercise for Lumbar Reposition Sense, Static Balance and Pain of the Patient’s with Chronic Low Back Pain

Effectiveness of yoga combined with back school program on anxiety, kinesiophobia and pain in people with non-specific chronic low back pain: a prospective randomized trial

Effectiveness of yoga combined with back school program on anxiety, kinesiophobia and pain in people with non-specific chronic low back pain: a prospective randomized trial