Chronic Non-specific Low Back Pain Research Articles

WHICH SCALE TO ASSESS PAIN SELF-EFFICACY SHOWS BETTER MEASUREMENT PROPERTIES IN CHRONIC LOW BACK PAIN? A HEAD-TO-HEAD COMPARISON STUDY.

to compare the quality of the measurement properties of PSEQ-10, PSEQ-4 and PSEQ-2 and CPSS (long-form: CPSS-LF and short-form: CPSS-SF) in patients with Chronic Low Back Pain (CLBP). Cross-sectional and longitudinal studies (measurement properties) SETTING: Outpatient Rehabilitation PARTICIPANTS: 245 participants with non-specific CLBP (18 and 60 years, 63% female) were enrolled in this study. Not applicable. Pain self-efficacy questionnaires were administered in three occasions: baseline assessment, one-week after the first assessment (reliability) and after an eight-week exercise program (responsiveness). The intraclass correlation coefficient (ICC) and Cronbach's α were used to assess reliability and internal consistency, respectively. Pearson's correlation and confirmatory factor analysis were used to assess construct validity. The area under the curve and hypothesis testing were used to assess responsiveness. None difference was observed for all the questionnaires regarding internal consistency (Cronbach's α>.7), criterion validity (r>.88) and reliability (ICC>.7). The scales confirmed more than 75% of the hypotheses for the construct validity, except for CPSS-SF. PSEQ-2 did not meet the criterion for structural validity. PSEQ-10 met all the criteria for good measurement properties according to COSMIN. It was not possible to calculate structural validity for PSEQ-2, CPSS-SF did not meet the criterion for suitable hypothesis testing for construct validity and all the questionnaires did not show suitable measurement error, except for the PSEQ-10. Hence, the PSEQ-10 was the unique scale that met all the criteria for good measurement properties for assessing pain self-efficacy in CLBP.

Passive intervertebral restraint is different in patients with treatment-resistant chronic nonspecific low back pain: a retrospective cohort study and control comparison.

In vivo studies of continuous lumbar sagittal plane motion have found passive intervertebral motion to be more uneven in patients with chronic nonspecific low back pain (CNSLBP) than healthy controls, but the mechanisms are unclear. This study aimed to compare patients with CNSLBP with a matched group of pain-free controls for intervertebral restraint during passive recumbent bending. Seventeen patients with CNSLBP and minimal disc degeneration who had quantitative fluoroscopy investigations were matched to 17 healthy controls from a database acquired using the same imaging protocol. The entire database (n = 136) was examined for clustering of peaking times, magnitudes and ROM of the first derivatives of the intervertebral angle/motion curves (PTFD, PMFD and ROM) during flexion and return that might introduce confounding. The groups were then compared for differences in these variables. There were significant segmental ROM differences among clusters in the database when PMFD and ROM were used as clustering variables, indicating heterogeneity. However, in the patient-control study, it was PTFD (velocity) that differentiated the groups. At L5-S1, this was at 10.82% of the motion path compared with 25.06% in the controls (p = 0.0002). For L4-5, PTFD was at 23.42% of the motion path in patients and 16.33% in controls (p = 0.0694) suggesting a reduced initial bending moment there. There were no significant differences for PMFD or ROM. Peaking time of passive intervertebral velocity occurs early at L5-S1 in patients with CNSLBP; however, these findings should be treated with caution pending their replication. Future studies should explore relationships with altered disc pressures and biochemistry. Usefulness for monitoring regenerative disc therapies should be considered.

Immediate effect of extracorporeal shockwave therapy in patients with chronic non-specific low back pain: A randomised placebo-controlled triple-blind trial.

To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-specific low back pain. Randomised placebo-controlled study with three intervention groups. The patients recruited for this study were sent for physiotherapy treatment at primary care between May and July 2022. Eighty-one patients with chronic non-specific low back pain aged 18-80 years with pain for ≥3 months and pain intensity ≥3 were randomly recruited for the study. The patients received a single intervention of radial shockwave therapy with 2000 discharges at 100 mJ energy and 5 Hz frequency using concave or convex tips or placebo treatment. The primary outcome was pain intensity immediately post-intervention. The secondary outcomes were pressure pain threshold, temporal summation of pain, and functional performance. Data were collected at baseline and post-intervention. The post-intervention pain intensity in the concave tip group is an average of two points lower (95% CI = -3.6, -0.4; p < 0.01) than that in the placebo group. The post-intervention pressure pain threshold for the concave tip group was an average of 62.8 kPa higher (95% CI = 0.4, 125.1; p < 0.05) than for the convex tip group and 76.4 kPa higher (95% CI = 14, 138.7; p < 0.01) than in the placebo group. The concave tip shockwave therapy is effective in reducing pain and local hyperalgesia in patients with chronic non-specific low back pain.

ADHERENCE TO PRESCRIBED EXERCISE AND CLINICAL OUTCOMES IN PEOPLE WITH CHRONIC NONSPECIFIC LOW BACK PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS

BACKGROUND Exercise is widely accepted as a first-line treatment for chronic non-specific low back pain (CNSLBP). However, the benefits of exercise diminish over time, as does adherence to exercise. It is unclear whether greater exercise adherence is associated with improvements in pain intensity (PI) and functional limitation (FL). We explored the relationship between exercise adherence and patient-reported outcomes in people with CNSLBP. METHODS We conducted a secondary analysis of the Cochrane systematic review, ‘Exercise therapy for chronic low back pain’, using a subset of 24 trials that measured exercise adherence compared to usual care. Random-effects meta-analysis was performed in R for PI and FL at the closest time point post-intervention. We used predefined subgroups of exercise adherence of ‘Good’ (90-100%), ‘Moderate’ (70-89%), or ‘Poor’ (14-69%) adherence. We used the risk of bias judgements provided by Cochrane. RESULTS All trials included were deemed low risk of bias. Compared to usual care, ‘Good’ adherence was associated with reduced PI by 17.83 points on a 100-point scale (95% CI -26.23 to -9.43; I2 = 81.7%) and FL by 9.69 points on a 100-point scale (95% CI -12.64 to -6.74; I2 = 18.9%). ‘Moderate’ adherence was associated with reduced PI by 6.93 points (95% CI -10.43 to -3.44; I2 = 18.3%) and FL by 3.80 points (95% CI -6.10 to -1.49; I2 = 0%). ‘Low’ adherence was associated with reduced PI by 7.50 points (95% CI -19.83 to -4.84; I2 = 89.7%) and FL by 3.35 points (95% CI -10.45 to -3.74; I2 = 82.7%). CONCLUSIONS Greater adherence to exercise is associated with greater improvements in PI and FL in adults with CNSLBP. Further research is needed to understand the causal effect of adherence on patient-reported outcomes. Better reporting of this potentially important exercise parameter in randomised trials is also needed.

CAN AN INTERVAL-BASED RUNNING EXERCISE INTERVENTION IMPROVE LUMBAR INTERVERTEBRAL DISC HEALTH? THE ASTEROID RANDOMISED CONTROL TRIAL

BACKGROUND AND AIMS Low back pain is the leading cause of global disability, with lumbar disc pathologies estimated to contribute to up to 40% of cases. Exercise training is an established treatment to reduce pain intensity and disability in individuals with low back pain; however, the effect of exercise training on intervertebral discs is unknown. Cross-sectional studies have shown that endurance running (&amp;gt;50km per week) is associated with healthier intervertebral discs, as evidenced by greater T2-relaxation (hydration) and intervertebral disc height. However, no studies have explored the relationship between running and disc health prospectively. This study aims to examine the impact of a 12-week progressive run-walk exercise intervention on intervertebral disc health in individuals with chronic low back pain. METHODS Forty individuals with non-specific low back pain were enrolled in a 12-week parallel randomised control trial and allocated to either a digitally-delivered progressive run-walk interval exercise intervention (supervised by an accredited exercise physiologist) or waitlist control. All participants underwent magnetic resonance imaging at baseline, 6 and 12 weeks to examine intervertebral disc health (e.g. T2-relaxation, intervertebral disc height, Pfirrmann grade). RESULTS Thirty-nine participants (20 intervention and 19 waitlist control; mean [SD] age: 33 [6] years, female: 50%) underwent MRI at baseline, 6 and 12 weeks. At baseline, intervertebral disc outcomes were no different in either group (T2-relaxation[ms] mean[SD]:81.07[6.61] and 85.11[9.33]; p=0.939, height[mm] mean[SD]: 8.77[0.87] and 9.03[0.90]; p=0.819, respectively). Six and 12-week outcomes are currently being analysed and results will be available for presentation at the conference. CONCLUSION This randomised control trial will provide world-first evidence on the effects of a progressive run-walk exercise intervention on lumbar intervertebral disc health in adults with non-specific chronic low back pain. Should this intervention prove effective, findings will have marked implications for current guidelines and clinical management of this debilitating chronic condition.

THE SMALLEST WORTHWHILE EFFECT OF EXERCISE THERAPY FOR PEOPLE WITH CHRONIC LOW BACK PAIN: A DISCRETE CHOICE EXPERIMENT STUDY

INTRODUCTION Understanding the magnitude of treatment effect patients need to see to consider a treatment worthwhile is of clear clinical and research importance. Current measures of clinical importance, such as the minimum clinical important difference, are limited as they are not determined by patients, and do not reflect specific costs, risks or inconveniences of individual treatments, i.e. you could have the same MCID for surgery as for exercise. We aimed to identify the smallest worthwhile effect (SWE), a new measure of clinical importance, of exercise therapy for people with non-specific chronic low back pain (CLBP) using discrete choice experiment. METHODS The SWE was estimated as the lowest reduction in pain that participants would consider exercising worthwhile, compared to not exercising i.e., effects due to natural history and other components (e.g., regression to the mean). We recruited English-speaking adults in Australia with non-specific CLBP to our online survey via email from a registry of previous participants and advertisements on social media. We used discrete choice experiment to estimate the SWE of exercise compared to no exercise for pain intensity. We analysed the discrete choice experiment using a mixed logit model, and mitigated hypothetical bias through certainty calibration, with sensitivity analyses performed with different certainty calibration thresholds. RESULTS 213 participants completed the survey. Mean age (±SD) was 50.7±16.5, median (IQR) pain duration 10 years (5-20), and mean pain intensity (±SD) was 5.8±2.3 on a 0-10 numerical rating scale. For people with CLBP the SWE of exercise was a between-group reduction in pain of 20%, compared to no exercise. This means, for a baseline pain of 5, the SWE would be a 1/10 between-group reduction in pain. CONCLUSION This patient-informed threshold of clinical importance should guide the interpretation of findings from randomised trials and meta-analyses of exercise therapy compared to no exercise.

EFFICACY, FEASIBILITY AND OPTIMAL TRAINING PARAMETERS FOR RUNNING IN ADULTS WITH CHRONIC LOW BACK PAIN: THE ASTEROID RANDOMISED CONTROLLED TRIAL

INTRODUCTION &amp; AIMS Running is common and one of the most accessible forms of exercise training, yet the suitability for adults with chronic low back pain is unknown. This study assessed the efficacy and feasibility of running in adults with chronic low back pain (LBP) and explored the relationship between training parameters and pain intensity. METHODS This two-arm parallel (1:1) individually randomised controlled trial allocated 40 participants (mean [SD] age: 33 [6] years, female: 50%) with non-specific chronic LBP to a 12-week intervention or waitlist control. The intervention was a progressive run-walk interval program comprising three 30-minute sessions per week, that were digitally delivered and remotely supported by an exercise physiologist. Efficacy outcomes were self-reported average and current pain intensity (100-point visual analogue scale) and disability (100-point Oswestry Disability Index). Training parameters examined were fortnightly adherence, pace and distance. RESULTS At 12-week follow-up, the intervention decreased average pain intensity (mean net difference [95%CI]: -15.30 [-25.33, -5.27] points, P=0.003), current pain intensity (-19.35 [32.01, -6.69] points, P=0.003) and disability (-5.20 [-10.12, -0.24] points, P=0.038), compared to control. There was no attrition and mean (SD) training adherence was 70% (20%; i.e. 2.1 of 3 sessions per week). Nine non-serious adverse events deemed potentially study-related were reported (lower limb injury/pain: n=7, cardiac syncope associated with an underlying condition: n=1, LBP: n=1). Greater fortnightly adherence (-0.04 [-0.33, 0.25] points), pace (0.23 [-0.48, 0.02] points) and distance (-0.03 [-0.13, 0.06] points) tended to be associated with greater reductions in pain intensity, yet did not reach statistical significance. CONCLUSION Running was feasible and improved pain intensity and disability in individuals aged 18-45 years with non-specific chronic LBP when compared to control. An individualised and conservative run-walk program should be considered a suitable form of physical activity for adults with chronic LBP.

Increased water content in multifidus muscles of young adults with chronic nonspecific low back pain detected by dual-energy CT and MRI

Increased water content in multifidus muscles of young adults with chronic nonspecific low back pain detected by dual-energy CT and MRI

A Review of Clinical Practice Guidelines for Physiotherapy Management of Patients with Non-Specific Low Back Pain

Background: Despite the availability of various clinical practice guidelines (CPGs) offering evidence-based recommendations, there exists a global diversity in physiotherapy practices for managing patients with non-specific low back pain (NSLBP). In this review, we aim to critically appraise and map the current evidence regarding physiotherapy management for patients with NSLBP. Methods: A search strategy was formulated and searched in MEDLINE, Scopus, EBSCOhost, PEDro and Google Scholar between 2013 and 2023 in English. Critical appraisal was performed using International Centre for Allied Health Evidence (iCAHE) guideline checklist. Results: A total of 12 CPGs met the selection criteria were synthesised. Exercise therapy, physical activity and manual therapy were consistently recommended for patients with NSLBP across most guidelines, irrespective of symptom duration. Cognitive-behavioural therapy was frequently advised for those with chronic NSLBP. However, notable absences of recommendations for electrotherapy, mechanical traction, bed rest, and lumbar corsets in NSLBP management. Moreover, emerging treatments such as shock wave therapy and cognitive-functional therapy were not extensively addressed in the guidelines. Conclusion: Multimodal and active forms of physiotherapy management were predominantly recommended in most of the guidelines. However, there is a clear necessity for updated CPG that effectively integrate biopsychosocial approaches into the management of patients with NSLBP.

Prevalence of Disability in Chronic Non-Specific Low Back Pain Patients

Background: Lower back pain (LBP) is the most frequent medical condition requiring rehabilitation in most countries, and it is also the most common medical issue among individuals with disabilities. Numerous illnesses, such as nephrolithiasis, endometriosis, tumors, fibromyalgia, and psychological disorders, can induce back pain that is not related to the spine. Objective: To determine the disability prevalence among patients with chronic non-specific low back pain Materials and Methods: The cross sectional observational study was conducted in the Department of Physical Medicine and Rehabilitation, Dhaka Medical College &amp; Hospital, Dhaka. Total 103 cases diagnosed individuals with chronic non-specific low back pain after fulfilling enrollment criteria was enrolled in this study. Question about sex life (ODI-8) was asked at the end of the interview. Disability refers to impairment, activity limitation and participation restrictions that may occur with a health condition. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior gluteal folds with or without referred leg pain. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Results: Prevalence of the disability more than half (52.4%) of the patients had severe disability, 27(26.2%) had moderate, 14(13.6%) had crippled and 8(7.8%) had minimal disability. Conclusion: The prevalence of severe disability in Chronic Non-Specific Low Back Pain was 52.4%. The duration and severity of pain are significantly correlated with impairment.

Effects of different treatments on pain, functional disability, position sense and range of motion in elite bodybuilders with chronic low back pain

Back pain is one of the major global challenges and is one of the most prevalent musculoskeletal disorders occurring in 80% of people at least once in their lifetime. Therefore, the need to find appropriate treatment methods for this issue is very important. The objective is to examine the short-term and acute effects of a treatment session with dry needling, massage therapy, stretching exercises and Kinesio tape on pain, functional disability, position sense and range of motion in elite bodybuilders with non-specific chronic low back pain. The sample of this quasi-experimental study consisted of 48 bodybuilders with non-specific chronic low back pain (all male, mean age = 25.96 ± 2.18 years; mean weight = 74.45 ± 4.51 kg; mean height = 173.88 ± 3.74 cm; mean BMI = 24.60 ± 0.74 kg/m2) who randomly were placed in 4 dry needling, massage therapy, stretching exercises and Kinesio tape groups. The duration of each intervention was 30 min. The dependent variables in this study included the massage range of motion, position sense tests and visual pain scale that were taken separately from each subject in pretest, posttest (acute effect) and follow-up test (72 h after posttest; short-term effect). The results of a 4 (groups) × 3 (time) the mixed ANOVAs showed that pain in the short-term phase was significantly lower in the dry needling group than in the stretching and massage groups (P < 0.05). Also in the acute effect phase, the flexion range of motion was significantly lower in the dry needling group than in the massage group (P < 0.05). Furthermore, the two groups of stretching and massage exercises showed significantly greater range of motion (P < 0.05). Other comparisons were not significant (P > 0.05). The findings of the study showed that both massage and stretching treatment have higher acute effects, while dry needling treatment was more effective in follow up. On the other hand, these findings show that these treatment methods can have immediate and lasting positive effects in improving the performance in elite bodybuilders with non-specific chronic low back pain.

Evaluation of the efficacy of complex analgesic therapy, including a combination of B vitamins, in patients with combination of osteoarthritis and chronic non-specific low back pain (results of an open-label pilot clinical trial)

The vitamin B1, B6 and B12 complex (VBC) is frequently used to treat acute and chronic low back pain.Objective: to investigate the effect of a combination of a non-steroidal anti-inflammatory drug (NSAID) and a VBC on the main manifestations of nociceptive system dysfunction in patients with combination of osteoarthritis (OA) and chronic non-specific low back pain (NSLBP).Material and methods. The study group consisted of 99 patients (82% women, mean age 63.6±17.2 years) with OA of various localization andNSLBP who had moderate to severe pain (≥4 on a numerical rating scale, NRS 0–10). All patients received etoricoxib 60 mg/day (up to 14 days) and a course of intramuscular (IM) injections of VBC (a drug for parenteral administration containing solutions of thiamine 100 mg, pyridoxine 100 mg, cyanocobalamin 1.0 mg and lidocaine 20 mg) 2.0 ml №10. Treatment outcome was assessed after 14 days.Results and discussion. During treatment, the vast majority of patients showed a significant improvement: the median severity of pain on movement (NRS) decreased from 6.3 [5.0; 8.0] to 3.7 [3.0; 5.0], p=0.0001; functional impairment – from 3.8 [2.0; 6.0] to 2.2 [1.0; 3.0], p=0.001; fatigue – from 5.6 [4.0; 8.0] to 3.5 [0.0; 2.0], p=0.0001. 71.6% of patients rated the treatment results as good or excellent. Six patients had adverse reactions: 2 – local pain at the site of the intramuscular injections, 1 – arterial hypertension, 3 – epigastric pain. No serious adverse events were recorded.Conclusion. The combined use of NSAIDs and VBC can provide significant improvement in patients with a combination of OA and NSLBP.

The smallest worthwhile effect on pain intensity of exercise therapy for people with chronic low back pain: a discrete choice experiment study.

OBJECTIVE: To identify the smallest worthwhile effect (SWE) of exercise therapy for people with non-specific chronic low back pain (CLBP). DESIGN: Discrete choice experiment. METHODS: The SWE was estimated as the lowest reduction in pain that participants would consider exercising worthwhile, compared to not exercising i.e., effects due to natural history and other components (e.g., regression to the mean). We recruited English-speaking adults in Australia with non-specific CLBP to our online survey via email obtained from a registry of previous participants and advertisements on social media. We used discrete choice experiment to estimate the SWE of exercise compared to no exercise for pain intensity. We analysed the discrete choice experiment using a mixed logit model, and mitigated hypothetical bias through certainty calibration, with sensitivity analyses performed with different certainty calibration thresholds. RESULTS: Two-hundred and thirteen participants completed the survey. The mean age (±SD) was 50.7±16.5, median (IQR) pain duration 10 years (5-20), and mean pain intensity (±SD) was 5.8±2.3 on a 0-10 numerical rating scale. For people with CLBP the SWE of exercise was a between-group reduction in pain of 20%, compared to no exercise. In the sensitivity analyses, the SWE varied with different levels of certainty calibration; from 0% without certainty calibration to 60% with more extreme certainty calibration. CONCLUSION: This patient-informed threshold of clinical importance could guide the interpretation of findings from randomised trials and meta-analyses of exercise therapy compared to no exercise.

Long-term impact of self-compassion training with core stability exercise on patients with nonspecific chronic low back pain: A randomized controlled trial

ObjectiveTo compare the long-term effectiveness of self-compassion therapy (SCT) combined with core stability exercise (CSE) versus CSE alone in managing nonspecific chronic low back pain (NCLBP). MethodsThe combined group received SCT and CSE, while the exercise group only received CSE. Treatment was administered once weekly for four weeks, followed by one year of follow-up. The primary outcomes were changes in functional limitations (measured by Roland and Morris Disability Questionnaire scores[RMDQ]) and self-reported back pain (measured by the Numeric Pain Rating Scale[NRS]) at 52 weeks, with assessments also conducted at 2, 4, and 16 weeks. Results52 (83.9%) completed the follow-up assessments and were included in the analysis (42 women [80.8%]; mean [SD] age,35.3 [10.0] years). In the combined group, the baseline mean (SD) RMDQ score was 9.3 (4.1),5.7 (5.8) at 2 weeks, 3.8 (3.4) at 4 weeks, 3.8 (3.7) at 16 weeks, and 2.4 (2.7) at 52 weeks. For the exercise group, the RMDQ scores were 8.2 (3.3) at baseline, 6.2 (4.2) at 2 weeks, 5.5 (4.7) at 4 weeks, 4.4 (4.5) at 16 weeks, and 5.2 (5.6) at 52 weeks. The estimated mean difference between the groups at 52 weeks was −3.356 points (95% CI, −5.835 to −0.878; P = 0.009), favoring the combined group. NRS scores showed similar changes. ConclusionThe addition of self-compassion therapy enhances the long-term efficacy of core stability training for NCLBP (Preregistered at chictr.org.cn:ChiCTR2100042810).

Barriers and enablers to exercise adherence in people with nonspecific chronic low back pain: a systematic review of qualitative evidence.

Exercise is a first-line treatment for chronic low back pain (CLBP), reducing pain and disability in the short term. However, exercise benefits decrease over time, with a lack of long-term exercise adherence a potential reason for this. This study aimed to synthesize the perceptions and beliefs of individuals with CLBP and identify their barriers and enablers to exercise adherence. We searched CENTRAL, Embase, CINAHL, SPORTDiscus, PubMed, PsycINFO, and Scopus databases from inception to February 28, 2023, for qualitative studies that explored the factors influencing exercise adherence for people with CLBP. A hybrid approach combining thematic synthesis with the Theoretical Domains Framework was used to analyze data. We assessed methodological quality using the Critical Appraisal Skills Programme checklist and the level of confidence of the themes generated using the Confidence in the Evidence from Reviews of Qualitative Studies. Twenty-three papers (n = 21 studies) were included (n = 677 participants). Four main themes affected exercise adherence: (1) exercise, pain, and the body, (2) psychological factors, (3) social factors, and (4) external factors. These themes contained 16 subthemes that were predominantly both barriers and enablers to exercise adherence. The individual's experiences of barriers and enablers were most appropriately represented across a spectrum, where influencing factors could be a barrier or enabler to exercise adherence, and these could be specific to pre-exercise, during-exercise, and post-exercise situations. These findings may be used to improve exercise adherence and ultimately treatment outcomes in people with CLBP.

Effects of transcutaneous electrical nerve stimulation on pain, function, and descending inhibition in people with non-specific chronic low-back pain: a study protocol for a randomized crossover trial

BackgroundLow back pain (LBP) is a significant public health problem, is very prevalent, and is often characterized by the persistence of symptoms. Transcutaneous electrical nerve stimulation (TENS) may benefit people with chronic LBP because it can activate descending inhibitory pathways and inhibit central excitability. However, previous studies that have investigated the effects of TENS on pain in people with LBP have failed to use proper intensities of current, and the timing of the assessment of pain was not performed during the peak of the analgesic response or functional activities. Therefore, the present study aims to assess the effects of TENS on measures of pain, function, and descending inhibition using the maximal tolerable intensity of TENS in participants with LBP.Methods/designThis study will be a randomized crossover trial. The participants for this study will be recruited from various places, including the University of Hartford, physical therapy clinics, and local businesses in the Hartford area, as well as online websites geared towards clinical trial recruitment. A total of 34 participants will receive all three treatments: active TENS, placebo TENS, and no treatment control. The treatment order will be randomized using a website-based randomization tool. For active TENS, a modulating frequency of 2–125 Hz will be applied with a variable pulse duration and maximal tolerable intensity for 30 min. The TENS will be left on for post-treatment testing to assess the effects during its maximally effective period for a total of 50 to 60 min. Furthermore, the intensity may be turned down if muscle twitching is present to ensure blinding of the evaluator. For placebo TENS, the unit will deliver current for 45 s, ramping to 0 in the last 15 s. The primary outcome will be pain intensity at rest and with movement, determined using the numerical pain rating scale. The secondary outcomes will be pressure pain threshold, heat pain threshold, temporal summation of pain, conditioned pain modulation, sit-to-stand test, and repeated trunk flexion. The assessments will be performed immediately before and after treatment. Statistical analysis of the data obtained will consider a significance level of p < 0.05.DiscussionThis study will provide evidence concerning the effects and mechanisms of TENS treatment in participants with chronic non-specific low back pain. The outcomes, including pain, function, and descending inhibition, will help us gain a greater understanding of how TENS can be used for these participants.Trial registrationClinicalTrials.gov NCT05812885. Registered on 24th May 2023.

Comparison of lumbar muscle morphology in patients with chronic nonspecific low back pain with and without clinical lumbar segmental instability.

Evaluation of spinal muscle morphology may be critical because of its impact on segmental stability and control of the lumbar spine in the subset of patients with clinical lumbar segmental instability (LSI). The purpose of this study was to compare lumbar muscle morphology in CNLBP patients with clinical LSI, CNLBP patients without clinical LSI. This case-control study included 30 patients with CNLBP (15 with clinical LSI and 15 without clinical LSI) and 15 subjects without LBP. Axial magnetic resonance images from the L2 to S1 lumbar levels were used to evaluate the morphology of the lumbar muscles. A significant increase in the muscle-to-fat infiltration index and a significant decrease in the relative muscle cross-sectional area (rmCSA) of the multifidus muscle at the L3-L4 to L5-S1 levels were observed in both CNLBP groups compared to the control group (p<0.05). The mean erector spinae mean rmCSA was significantly greater in the clinical LSI group compared to the control group (SMD = 0.853, 95% CI = 0.105 to -1.6, P = 0.044) and also compared to the CNLBP without clinical LSI (SMD = 0.894, 95% CI = -1.645 to -0.144, P = 0.030) at the L4-L5 level. The atrophic changes of the multifidus muscle, in CNLBP patients with or without clinical LSI was observed. However, hypertrophic changes of the erector spinae muscle at the L4-L5 lumbar level were observed only in the clinical LSI group. Psaos major did not show significant atrophic or hypertrophic changes.

Effects of Pain Neuroscience Education and Physiotherapy on Chronic Low Back Pain, Fear of Movement and Functional Status: A Randomised Pilot Study.

Background: Chronic non-specific low back pain is a non-harmous condition often found in the general population. It is one of the most significant disabilities and needs different treatment modalities. This study investigates the effects of pain neuroscience education and physiotherapy on pain intensity, fear of movement and functional status in a Lithuanian cohort with non-specific low back pain. Methods: The study was performed at the primary health care unit in Kaunas, Lithuania. The key inclusion criterion was persistent non-specific low back pain longer than three months and which affects daily life functions. Thirty participants (mean 33.47, SD 4.38 years age, 70% women) were randomised into two training groups with and without pain neuroscience education (for a total of 60 min of teaching). Physiotherapy was performed twice per week during 45 min/session for a period of 10 weeks with exercises which strengthen, stabilize, and stretch the spinal cord muscles. Outcomes included pain intensity, kinesiophobia and disability and these were measured by self-scored questionnaires (numeric rating scale, Tampa scale for kinesiophobia-11, Oswestry disability index and the Roland-Morris questionnaire, respectively). Results: The results indicate that both groups improved in the measured outcomes, with the only difference between them being a better improvement in kinesiophobia in the group receiving physiotherapy and pain neuroscience education. Conclusions: The results of this study confirm that a relatively short intervention of pain neuroscience education enhances the effects of physiotherapy and should be implemented in clinical practice.

Association of Muscle Strength, Psychological Factors, and Central Sensitization With Movement-Evoked Pain in Patients With Nonspecific Chronic Low Back Pain: The BACKFIT Project.

People with chronic pain might evade certain movements to prevent their experience of pain. Movement-evoked pain (MEP) might induce lower functionality during daily activities. (1) MEP after physical fitness tests would vary depending on the main musculature involved in the test; (2) physical and psychological factors would be associated with MEP in patients with NSCLBP. Cross-sectional design. Level 3. A total of 104 (69 women) patients aged 51.0 ± 10.3 years with NSCLBP participated. MEP was measured with a visual analog scale (VAS) at baseline and immediately after performing each physical fitness test, that is, the Biering-Sørensen, prone bridging, handgrip, chair-stand, and 8-foot time-up-and-go tests, measuring back extensor, back flexor, upper- and lower-body muscle strength, and motor agility, respectively. Global muscle strength was calculated with normalized index (z-score) procedure. Depression, anxiety, pain catastrophizing, and central sensitization were assessed with the Beck Depression Inventory II, State Trait Anxiety Inventory I, Pain Catastrophizing Scale, and Central Sensitization Inventory (CSI), respectively. Patients showed greater pain after completion of the Biering-Sørensen (mean difference 95% CI, 0.02, 1.11), prone bridging (0.15, 1.21), lower pain after handgrip (-1.46, -0.52), and the 8-foot time-up-and-go (-1.43, 0.46) tests (all P ≤ 0.04). Lower global muscular strength (β between -0.18 and -0.30), and greater pain catastrophizing (β = 0.16), and CSI scoring (β between 0.18 and 0.27) were associated with greater MEP (all P ≤ 0.04). Greater MEP was observed after tests measuring core musculature strength than after tests measuring distal (limbs) strength and agility. Greater MEP was overall associated with lower muscle strength, greater pain catastrophizing, and central sensitization. Fitness testing might be implemented as a complementary tool for the monitoring of NSCLBP in clinical settings.

Transcranial Direct Current Stimulation Combined With Aerobic Exercise for the Treatment of Chronic Nonspecific Low Back Pain

Objective: The purpose of the study is to determine the effectiveness of transcranial direct current stimulation (tDCS) combined with aerobic exercise in the short, medium, and long term. Methods: Two-arms triple-blind randomized controlled trial. Thirty-eight subjects with a diagnosis of nonspecific chronic low back pain. Experimental group will receive real-tDCS and aerobic exercise and control group will be treated with sham tDCS and aerobic exercise. Pain intensity, pressure pain, disability, kinesiophobia, quality of life, catastrophism, heart rate variability, and critical flicker fusion frequency will be measured before and after each session and at 3- and 6-month follow-up. Discussion and Conclusion: This study introduces the novel measurement of heart rate variability and cortical arousal to explore their potential in understanding the effects of tDCS on pain modulation. Trial Registration: ClinicalTrials.gov ID NCT05830851. Date of registration: April 14, 2023.