Chronic Low Back Pain Research Articles

Tuina versus physiotherapy or a combination of both for the management of chronic nonspecific low back pain: A randomized controlled trial

ObjectiveTo rigorously evaluate the short-term and long-term effectiveness of Tuina (TN), alone and in combination with physiotherapy (PT), for Chronic nonspecific low back pain (CNLBP) through a comprehensive, high-quality clinical trial. MethodsThis randomized, single-blind trial was conducted from September 2020 to July 2023, involving 204 CNLBP patients from the First Affiliated Hospital of Jinan University. Participants underwent a baseline assessment, 6 treatment sessions over 8 weeks, a post-treatment evaluation in the 9th week, and a 20-week follow-up. Participants were randomly assigned to TN, PT, or a combination of TN and PT (TP) groups. Each treatment involved 6 sessions with a minimum 7-day interval, each lasting 30 minutes. Primary outcome was the change in Visual Analog Scale (VAS) for pain. Secondary outcomes included the Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), Range of Motion (ROM) of the spine, Traditional Chinese Medicine Syndrome Scale (TCMSS), and adverse events (AE). ResultsAmong the 204 participants, 67.16 % were female, and 88.73 % completed the 20-week follow-up. All groups showed significant reductions in VAS scores post-treatment and at follow-up. Secondary outcomes improved significantly, with notable decreases in ODI and TCMSS scores. Pairwise comparisons within groups indicated statistical significance, particularly in ODI scores, with clinical relevance. No significant differences were found between the groups. ROM and SF-36 showed statistical but not clinical significance. Only one AE (0.49 %) was reported, with no severe incidents. ConclusionAll treatment groups, including TN, TP, and PT, demonstrated significant reductions in VAS scores for CNLBP patients, with effects lasting up to 20 weeks. While TN and TP showed substantial improvements in secondary outcomes, particularly in ODI scores, no significant differences were found between the groups. These findings suggest that all treatments can be effective for managing CNLBP, supporting clinical practitioners in selecting appropriate interventions for patients, especially for those unable to engage in active exercises, utilizing passive movements like TN to enhance health outcomes.

Pain profiles and variability in temporal summation of pain and conditioned pain modulation in pain-free individuals and patients with low back pain, osteoarthritis, and fibromyalgia.

Pain profiles (e.g. pro- and anti-nociceptive) can be developed using quantitative sensory testing (QST) but substantial variability exists. This study describes the variability in temporal summation of pain (TSP) and conditioned pain modulation (CPM) in chronic musculoskeletal pain patients, proposes cut-off values, and explores the association with clinical pain intensity. This is a secondary analysis in which TSP and CPM were assessed using cuff algometry in pain-free subjects (n = 69), and patients with chronic low back pain (cLBP, n = 267), osteoarthritis (n = 134), and fibromyalgia (n = 101). Using TSP and CPM from the pain-free subjects as a reference, four distinct pain profiles TSP (low/high) and CPM (low/high) were created, and differences in clinical pain between pain profiles were explored. Individual data revealed large inter-person variability. High TSP and low CPM were found in fibromyalgia (p < 0.01) and osteoarthritis (p < 0.01) but not cLBP when compared to pain-free subjects. The proportion of patients classified into the distinct pain profiles was significantly different (p < 0.001) with the largest proportion in the high TSP and low CPM group in fibromyalgia (52.5%) and osteoarthritis (41.4%). Clinical pain was not significantly different comparing the pain profiles, and no significant correlations were observed between clinical pain and TSP or CPM. These results demonstrated substantial inter-person variability in TSP and CPM in patients with different chronic pain conditions and pain-free subjects. The proportion of patients with a pro-nociceptive profile appears larger in fibromyalgia and osteoarthritis, but we found no association to clinical pain. This analysis shows that there is variability when assessing TSP and CPM in both pain-free subjects and patients with chronic pain. A cut-off for determining when a person is pain-sensitive is proposed, and data based on this cut-off approach suggest that significantly more patients with osteoarthritis and fibromyalgia are pain-sensitive (i.e. higher TSP and lower CPM) compared to pain-free subjects. This analysis does not find an association between pain sensitivity and clinical pain.

Psychosocial Treatment Techniques to Augment the Impact of Occupational Therapy Interventions for Chronic Low Back Pain among School Teachers

Background: School teachers perform numerous tasks that contribute to low back pain and affect their activities of daily living, social and vocational abilities. Low back pain is multidimensional in nature constituting physical, psychological and social components. Psychosocial variables pose as an obstacle to rehabilitative recovery and have a role in development of chronicity, these factors are often neglected in the rehabilitation process, the present study integrates psychosocial factors with musculoskeletal factors and utilizes a rehabilitation program that focuses on overall recovery. Objectives: This study aims to find effective treatment for psychosocial variables and examines the physical and psychosocial changes that occur in school teachers suffering with CLBP when they receive occupational therapy augmented with psychosocial intervention. The intervention targets anxiety, perceived stress, and self-efficacy. Methodology: The study sample consisted of 60 school teachers, half of the sample was enrolled for occupational therapy intervention and other half for occupational therapy intervention augmented with psychosocial treatment techniques. Results: At post-treatment participants in the occupational therapy augmented with psychosocial treatment group showed significant difference in measures of anxiety, perceived stress and self-efficacy, pain intensity, pain severity, pain disability and 5-minute walk test distance compared to participants who received occupational therapy treatment only. The two groups did not differ significantly in finger-to-floor test. Conclusion: The findings of the study suggest that augmenting psychosocial variables is beneficial to person-environment factors of disability and result in better rehabilitation outcomes in terms of both psychosocial variables as well as pain related variables.

Investigating the effects of artificial baroreflex stimulation on pain perception: A comparative study in no-pain and chronic low back pain individuals.

The autonomic nervous system (ANS) and pain exhibit a reciprocal relationship, where acute pain triggers ANS responses, whereas resting ANS activity can influence pain perception. Nociceptive signalling can also be altered by 'top-down' processes occurring in the brain, brainstem and spinal cord, known as 'descending modulation'. By employing the conditioned pain modulation (CPM) paradigm, we previously revealed a connection between reduced low-frequency heart rate variability and CPM. Individuals with chronic pain often experience both ANS dysregulation and impaired CPM. Baroreceptors, which contribute to blood pressure and heart rate variability regulation, may play a significant role in this relationship, although their involvement in pain perception and their functioning in chronic pain have not been sufficiently explored. In the present study, we combined artificial 'baroreceptor stimulation' in both pressure pain and CPM paradigms, seeking to explore the role of baroreceptors in pain perception and descending modulation. In total, 22 individuals with chronic low back pain (CLBP) and 29 individuals with no-pain (NP) took part in the present study. We identified a differential modulation of baroreceptor stimulation on pressure pain between the groups of NP and CLBP participants. Specifically, NP participants perceived less pain in response to baroreflex activation, whereas CLBP participants exhibited increased pain sensitivity. CPM scores were associated with baseline measures of baroreflex sensitivity in both CLBP and NP participants. Our data support the importance of the baroreflex in chronic pain and a possible mechanism of dysregulation involving the interaction between the ANS and descending pain modulation. KEY POINTS: Baroreflex stimulation has different effects on pressure pain in participants with chronic pain compared to matched individuals with no-pain. Baroreceptor activation decreases pain in participants with no-pain but increases pain perception in participants with chronic pain. Baroreflex sensitivity is associated with conditioned pain modulation in both groups of chronic pain and no-pain participants. The reactivity of the baroreflex during autonomic stress demonstrated a positive correlation with Pain Trait scores in participants with chronic back pain.

Efficacy of antidepressants in the treatment of chronic nonspecific low back pain: a systematic review and meta-analysis.

Aim: This study reassesses the efficacy and safety of antidepressants in treating nonspecific chronic low back pain (NCLBP).Materials & methods: A systematic review was conducted following PRISMA guidelines, including randomized clinical trials (RCTs) from PubMed, Embase, Scopus, LILACS, SciELO and Cochrane CENTRAL, published through August 2024. Studies compared antidepressants with placebo or active comparators. The primary outcomes were pain relief and quality of life. Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42023307516.Results: Nine RCTs involving 1758 patients were analyzed. The antidepressants examined included duloxetine, escitalopram, bupropion, amitriptyline, imipramine and desipramine. Duloxetine 60mg significantly reduced pain (MD=-0.57; 95% CI=-0.78 to -0.36) and improved quality of life compared with placebo, with side effects that were generally tolerable. Notably, higher doses of duloxetine (120mg) were associated with an increase in adverse events. However, other antidepressants like amitriptyline and escitalopram demonstrated only modest or inconsistent effects.Conclusion: Duloxetine at 60mg provides consistent pain relief and improves the quality of life in NCLBP, but higher doses increase adverse events. Escitalopram might offer modest benefits but should be considered a third-line treatment. Other antidepressants, such as amitriptyline, bupropion, imipramine and desipramine, have limited evidence supporting their efficacy and are associated with adverse effects.

Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain

Background &amp; Objective: Low back pain (LBP) is an ever-increasing menace in the young men as well as women. Many factors causing it have been identified, the most common being improper spinal posture. LBP has been targeted by physicians, anesthetists, surgeons and rehabilitation medicine specialists. We compared the effects of Kinesio Taping and dry needling on pain reduction and disability improvement in patients diagnosed with mechanical chronic LBP. Method: A randomized control trial (RCT) was conducted at Rawal General and Dental Hospital and Al-Nafees hospital in Islamabad from January 2020 to October 2021. Probability-based sampling method was used to select participants for the study (simple random sampling). Thirty patients, aged 18 to 75 y were included. Sample size was calculated with Epitools. The selected patients were divided in two groups i.e., 15 patients in the Kinesio taping group (KT group) and 15 in the dry needling group (DN group). Two patients in the needling group were dropped. Numeric Pain Rating Scale (NPRS) and Roland-Morris Disability Index Questionnaire (RMDQ) were used to assess the pain and the disability at baseline, two weeks post-intervention and four weeks post-treatment. Chi-Square test was use to find association. Results: The mean age of the patients was 39.60 ± 13.69 y for KT group and 37.15 ± 12.54 y for DN group. The mean BMI for KT group was 27.15 ± 6.70 kg/m2 and for DN group 27.52 ± 5.13 kg/m2. Before treatment, there were no differences between the groups for NPRS and RMDQ. Both dry needling and Kinesio taping produced significant improvements in NPRS and RMDQ after two and four weeks of treatment (P &lt; 0.05). However, statistical analysis results showed that there was no association between pain and disability in patient with non-specific low back pain. (P &gt; 0.05). Conclusion: Both, Kinesio taping and dry needling, significantly reduced pain and disability after two- and four-weeks treatment in patients with low back pain, but there was no statistical differences between the pain and disability in both groups. Keywords: Disability; Dry Needling; Kinesio Tape; Low Back Pain; Numeric Pain Rating Scale; Physiotherapy Citation: Asad A, Irshad A, Hassan T, Kiran Q, Kouser S, Hassan F. Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain. Anaesth. pain intensive care 2024;28(5):933−938; DOI: 10.35975/apic.v28i5.2561 Received: April 26, 2024; Reviewed: July 16, 2024; Accepted: July 18, 2024

Improvements in Forward Bending Are Related to Improvements in Pain and Disability During Cognitive Functional Therapy for People With Chronic Low Back Pain.

OBJECTIVE: To investigate whether improvements in forward bending were related to improvements in pain and disability in people with chronic low back pain (CLBP) who were undergoing Cognitive Functional Therapy (CFT). DESIGN: Longitudinal observational study. METHODS: Two hundred and sixty-one participants with CLBP received CFT. Forward bending was assessed at each treatment session over 13 weeks (an average of 4.3 timepoints per participant [range, 1-8]). Spinal range of motion (ROM) and velocity were recorded using 2 inertial measurement units located at T12 and S2. Participants reported (1) average pain intensity (0-10 scale) (pain) and (2) pain-related activity limitation (Roland Morris Disability Questionnaire [disability]) via online questionnaires at 0, 3, 6, and 13 weeks. Multivariate multilevel models were used to evaluate associations between individual rates of change over time for 3 spinal movement measures (trunk velocity, trunk ROM, lumbar ROM) and pain/disability. RESULTS: Strong correlations were observed for increased trunk velocity with reduced pain (r = -0.81; 95% CI: -0.98, -0.05) and with reduced disability (r = -0.77; 95% CI: -0.95, -0.22). Moderate correlations were observed between increased trunk ROM with reduced pain (r = -0.37; 95% CI: -0.67, 0.04) and with reduced disability (r = -0.32; 95% CI: -0.6, 0.03). There was no evidence of association between changes in lumbar ROM and pain (r = -0.46; 95% CI: -0.90, 0.44) or disability (r = -0.01; 95% CI: -0.56, 0.55). CONCLUSION: Reductions in pain and disability were strongly correlated with increased trunk velocity in people with CLBP who were undergoing CFT. These findings are consistent with CFT that explicitly trains "nonprotective" spinal movement. J Orthop Sports Phys Ther 2024;54(11):721-731. Epub 7 October 2024. doi:10.2519/jospt.2024.12727.

Running is acceptable and efficacious in adults with non-specific chronic low back pain: the ASTEROID randomised controlled trial

ObjectivesRunning is one of the most accessible forms of exercise, yet its suitability for adults with chronic low back pain (LBP) is unknown. This study assessed the efficacy and acceptability...

6976 Early-Onset Paget's Disease- A Unique Presentation In A Young Female With Elevated Alkaline Phosphatase And Low Back Pain

Abstract Disclosure: F. El Sayed: None. Background Paget disease of bone is an age-related disorder characterized by abnormal growth in certain bones, leading to changes in size and shape. Commonly affecting the skull, spine, pelvis, and long bones, it is more prevalent in men, those over 55, with a family history, and of European ancestry. The prevalence of Paget's disease of bone is approximately 2-3% in individuals over 55 in the United States and Europe, with higher rates in those of European descent. Symptoms, such as pain and deformities, may arise from the condition itself or complications like arthritis. While Paget disease can cause visible abnormalities and fractures in affected bones, most individuals remain asymptomatic. Diagnosis often involves blood tests measuring alkaline phosphatase levels, bone scans, and x-rays. Case Presentation We present the case of a 34-year-old woman who sought evaluation due to persistently elevated alkaline phosphatase (ALP) levels in the thousands. The abnormality was discovered during routine blood work conducted during her pregnancy in 2020, and subsequent investigation revealed a chronic elevation for over three years. The patient reported chronic lower back pain but denied other neurological symptoms. Quantification of ALP Bone showed elevated levels at 629, with normal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, as well as within-range calcium and gamma-glutamyl transferase (GGT). A whole-body bone scan revealed marked radio tracer uptake in the calvarium, raising concerns for Paget's disease. The patient received a one-time infusion of Zoledronic acid (5 mg), leading to a significant decrease in ALP levels to 182 after three months. Subsequent examination by an Ear, Nose, and Throat (ENT) specialist unveiled bilateral extra bone deposition and mild hearing loss in the right ear, adding a unique dimension to the patient's presentation. This case highlights the importance of a comprehensive approach to diagnose and manage Paget's disease, even in younger individuals with atypical symptoms. Discussion and conclusion Paget's disease presenting in young adults with back pain can be a diagnostic challenge due to its atypical occurrence in this age group. Although back pain is a common symptom, the underlying cause might not immediately be linked to Paget's disease, which typically affects older individuals. However, when encountering persistent back pain in young adults, especially when accompanied by elevated alkaline phosphatase levels, clinicians should consider Paget's disease as a potential differential diagnosis. Further investigation, including imaging studies and bone scans, becomes crucial to confirm the presence of Paget's disease and initiate appropriate management strategies to mitigate its impact on the patient's health and quality of life. Presentation: 6/2/2024

A Case of Chronic Back Pain: Revealing Complete Ureteral Duplicity in an Adult Woman

Ureteral duplication is a rare congenital anomaly, often diagnosed incidentally, characterized by the presence of two distinct ureters draining a single kidney. This condition can lead to complications such as vesicoureteral reflux or upper pole obstruction, often due to ectopic ureteral insertion or ureterocele. We report the case of a 40-year-old woman presenting with left-sided chronic low-back pain. Imaging studies, including ultrasound and CT urography, revealed bilateral ureteral duplication with significant left ureterohydronephrosis due to dysplasia and ectopic insertion of the upper ureter. Radiological imaging, especially CT urography, is essential for diagnosing ureteral duplication and identifying its complications. Timely imaging and intervention are critical for preserving renal function, with treatment options depending on the extent of renal impairment. These may include partial or total ureteronephrectomy or ureteral reimplantation.

Discogenic chronic low back pain management: intradiscal radiofrequency biacuplasty versus conservative treatment

BackgroundThis prospective bicentric study aims to evaluate and compare the efficacy of intradiscal radiofrequency biacuplasty (IDB) versus conservative management (CM) in treating chronic discogenic low back pain (CDLBP).MethodsForty-four patients with CDLBP were randomly assigned to either the biacuplasty group or the conservative management group. The biacuplasty group received treatment with two radiofrequency (RF) needles, positioned bilaterally on the annulus fibrosus under fluoroscopic guidance and local anaesthesia, to administer bipolar RF. Patients were monitored for 6 months, with the allowance of pain medication as needed. In the conservative management group, patients who continued to experience low back pain after three months were permitted to switch to the biacuplasty group. The study was conducted over two years, starting on July 1, 2020.ResultsThe studied groups had comparable age and gender distributions, with no significant difference in BMI. The Oswestry Disability Index (ODI) was assessed at baseline, 1 month, 3 months, and 6 months. At baseline, no significant difference was observed between the groups (p = 0.263). However, at the 1-month, 3-month, and 6-month follow-up, the biacuplasty group exhibited significantly lower ODI scores compared to the conservative management group (all p < 0.001), indicating that biacuplasty was more effective in reducing disability caused by chronic low back pain.ConclusionsIntradiscal radiofrequency biacuplasty is a minimally invasive interventional technique that has proven effective for patients with CDLBP who do not respond to conservative management.

Pain Resilience and Coping Behaviors in Individuals in a Collectivist Social Context.

Pain resilience (PR) may be associated with different coping skills, resulting in differences in pain outcomes. This study aimed to understand the role of PR in dictating the choice of coping methods. This study completed a preliminary validation of the Mandarin Chinese version of the Pain Resilience Scale (PRS-C) with online survey data (n = 46). Further, we conducted interviews with individuals with chronic low back pain (n = 24). The PRS-C psychometric properties were assessed using a confirmatory factor analysis. The interviews explored pain history, treatment experiences, and coping strategies and were analyzed thematically. The validated PRS-C (10 items) demonstrated satisfactory psychometric properties. The interview results showed that participants who scored lower were more likely to adopt disengagement rather than engagement coping strategies. Qualitative data revealed three themes explaining why and how participants in this collectivist social framework chose their coping methods. The findings suggest that while participants tried to understand their pain and treatment experiences, the cognitive appraisal construct in PR influenced some of the coping experiences. However, deeply influenced by Confucianism and Buddhism, participants also expressed factors beyond the scope of individual fortitudes, such as the relationship with a higher power that significantly influenced their coping behaviors.

Clinical Prediction and Characterisation of Digital Pressure Magnitude During Vertical Oscillatory Pressure on Patients with Chronic Low Back Pain

Clinical Prediction and Characterisation of Digital Pressure Magnitude During Vertical Oscillatory Pressure on Patients with Chronic Low Back Pain

Effects of Supervised Exercise Therapy on Function and Quality of Life in Patients with Chronic Low Back Pain: A Randomized Clinical Trial

Chronic low back pain is one of the leading causes of disability worldwide. This study evaluated the effects of supervised exercise therapy on physical function and quality of life in patients with chronic low back pain. A randomized clinical trial was conducted with 100 participants divided into two groups: an experimental group that received supervised exercise therapy for 12 weeks and a control group that received standard treatment. The results showed significant improvements in physical function and quality of life in the experimental group compared to the control group. These findings suggest that supervised exercise therapy is an effective intervention to improve quality of life in patients with chronic low back pain.

Duloxetine for individuals with chronic back pain: A systematic review and meta‑analysis of randomized controlled trials.

The current study aimed to assess the efficacy of duloxetine in reducing pain and improving the quality of life of individuals with chronic low back pain (CLBP). An extensive literature search was conducted to identify relevant studies that examined the efficacy of duloxetine in CLBP management. The primary objective of the present study was to assess the role of duloxetine use on pain levels, as well as improvements in quality of life, using validated instruments. The results were synthesized using a random-effects model. A total of 8 studies were included in the analysis. Duloxetine demonstrated clear benefits in pain reduction, evidenced by improvements across multiple scales including the visual analogue scale, brief pain inventory-interference (BPI), BPI-severity, weekly worst pain over 24 hours and Roland-Morris Disability Questionnaire scores. Quality of life improved with duloxetine treatment, as indicated by the 36-item short form survey (SF-36). However, there was no significant impact on the physical function component of SF-36. The present study provides evidence to affirm the efficacy of duloxetine in treating CLBP. Further research is required to validate these findings and to establish whether combining duloxetine with other CLBP treatments yields superior outcomes.

Lumbar spine marker placement errors and soft tissue artifact during dynamic flexion/extension and lateral bending in individuals with chronic low back pain

Quantitative in vivo biomechanical assessments are typically performed with optoelectronic motion capture (MoCap) using retroreflective markers attached to skin. This technique inherently contains measurement errors from both marker placement on palpated bony landmarks and skin motion relative to the underlying bone (i.e., soft tissue artifact (STA)). Research on lumbar spine STA is scarce and limited to young, healthy participants in static positions. This study aimed to evaluate static placement errors, lumbar spine STA from MoCap marker clusters (MMC), and linear relationships between STA and patient characteristics. Thirty-nine participants with cLBP performed three trials each of flexion/extension and lateral bending while imaged simultaneously by MoCap (120 Hz) and dynamic biplane radiography DBR (20 Hz). MMCs were placed 29.5 ± 18.0 mm and 27.1 ± 13.4 mm superior to the most prominent aspect of the L1 and L5 spinous process, respectively. L1 relative to L5 STA was larger during flexion/extension (8.6 ± 5.7°) than lateral bending (4.5 ± 2.1°) (p < 0.001). After correcting for marker placement errors, components of the L1 and L5 STA averaged as much as 16.3 mm and 11.4° during flexion/extension, but only 4.0 mm and 4.8° or less during lateral bending. On average, STA for individual L1 and L5 vertebrae increased as participants moved away from the upright neutral position. STA was participant-dependent, however, age and BMI did not model STA well. Given the inaccuracy in marker placement and wide range of patterns of STA, caution is urged when making clinical decisions or when using computational models to estimate spine tissue loading based upon lumbar spine kinematics obtained from skin-mounted markers.

The Effect of 8 Weeks of Dynamic Neuromuscular Stabilization Training on Pain, Electromyography Activity of Lumbar Muscles, and Quality of Life in People with Chronic Low Back Pain

Objectives: To evaluate the effects of an 8-week DNS training program on pain, EMG activity, and quality of life in individuals with CLBP. Design: Semi-experimental study. Participants: Thirty male participants with non-specific CLBP, divided into DNS (n=15) and control (n=15) groups. Main Outcome Measures: Pain levels (Quebec Back Pain Disability Scale), lumbar muscle EMG activity (MegaWin EMG device), and quality of life (SF-36 questionnaire). Results: The DNS group showed significant pain reduction (P=0.00), increased EMG activity in rectus abdominis (P=0.000), erector spinae (P=0.002), and gluteus maximus (P=0.002), and improved quality of life (P=0.02). Conclusions: DNS exercises significantly reduce pain, enhance muscle activity, and improve quality of life in CLBP patients

Effects of osteopathic manipulative treatment associated with transcranial direct current stimulation in individuals with chronic low back pain: A double-blind, randomised placebo-controlled trial

Objective To evaluate the effectiveness of osteopathic manipulative treatment (OMT) associated with transcranial direct current stimulation (tDCS) in reducing pain, disability, and improving quality of life in participants with non-specific chronic low back pain. Design A randomised double-blind clinical trial. Setting Clinical outpatient unit. Subjects 72 participants with non-specific chronic low back pain were randomised into three groups: active tDCS + OMT (n = 24), sham tDCS + sham OMT (n = 24), and sham tDCS + OMT (n = 24). Interventions Evaluations were performed before, after the intervention, and one month post-intervention. tDCS consisted of ten 20-minute sessions over two weeks (five sessions per week). OMT was administered once per week, with two sessions conducted before the first and sixth tDCS sessions. Main measures Pain, disability, and quality of life were assessed at baseline, after two weeks, and at one month of follow-up. Results The visual analogue scale showed a significant decrease in all groups (p < 0.001). However, tDCS + OMT and sham tDCS + OMT demonstrated a clinically significant reduction compared to the sham combination (effect size n² = 0.315). Roland-Morris scores decreased across all groups without specific group effects. EuroQoL 5-Dimension 3-Level improvement was observed only in the tDCS + OMT and sham tDCS + OMT groups (significant difference between T2 and T0, p = 0.002). Conclusion The combination of OMT and tDCS did not provide clinically significant improvement over OMT alone in participants with non-specific chronic low back pain.

Communication and empathy within the patient-physician relationship among patients with and without chronic pain.

Chronic pain may affect the relationship between patients and their treating physicians. This study was designed to compare four aspects of physician communication and physician empathy reported by patients with chronic pain and in chronic pain-free controls. A cross-sectional study was conducted within a national pain research registry from July 2020 through January 2024. Patients with chronic low back pain of greater than 3months duration were matched to chronic pain-free controls utilizing propensity scores derived froma logistic regression model based on 11 variables thatincluded sociodemographic characteristics, cigarette smoking status, history of comorbid medical conditions, and duration of the current patient-physician relationship. Patients reported on the primary outcomes of physician communication utilizing the Communication Behavior Questionnaire (CBQ) and physician empathy utilizing the Consultation and Relational Empathy (CARE) measure. Group means were compared for each aspect of physician communication (patient participation and patient orientation, effective and open communication, emotionally supportive communication, and communication about personal circumstances) and physician empathy, and Cohen's d statistic was utilized to assess the clinical relevance of between-group differences. Secondary exploratory analyses were also performed to compare patients treated by osteopathic physicians vs. allopathic physicians and to determine whether study group X physician type interaction effects were present. The 387 patients in each study group were matched within a caliper width of 0.001 on the propensity score. Overall, patients ranged from 21 to 79 years of age (mean, 50.7 years; standard deviation [SD], 15.1 years), and 617 (79.7 %) of them were female. Patients in the chronic pain group reported poorer scores for all aspects of physician communication and physician empathy than the chronic pain-free controls. All between-group differences were clinically relevant. There were no differences in physician communication or physician empathy according to physician type in the exploratory analyses, and study group X physician type interaction effects were not observed. In this cross-sectional study, patients with chronic pain reported having physicians with poorer communication and less empathy than chronic pain-free controls. Longitudinal research is needed to more clearly determine the temporal relationship between patients' chronic pain and physician communication and physician empathy during medical encounters.

Associations between pain-related fear and lumbar movement variability during activities of daily living in patients with chronic low back pain and healthy controls

Low back pain (LBP) is a global issue involving biological, psychological, and social factors. Pain-related fear has been shown to influence movement behavior, however, its association with some measures of movement behavior, such as spinal movement variability, remains inconclusive. To further investigate this, spinal kinematics during various activities of daily living (i.e., walking, running, lifting, and stair climbing) of 49 patients with chronic LBP and a group of 51 sex-, age-, and BMI-matched healthy controls were used to calculate lumbar spine movement variability which was quantified using different indices (i.e., coefficient of variation, coupling angle variability in vector coding, deviation phase of the continuous relative phase and an angle-angular velocity variability). General and task-specific pain-related fear was assessed using the Tampa Scale of Kinesiophobia and the Photograph Series of Daily Activities—Short Electronic Version, respectively. Linear regression analyses showed no significant association between movement variability and pain-related fear, however, the sample consisted of younger individuals with moderate disability and with low levels of pain and pain-related fear. In addition, the different variability indices were weakly correlated and varied greatly depending on the method used and the task performed. Therefore, comparisons between studies with different movement variability calculation methods or different activities should be treated with caution.