Chronic Non-specific Low Back Pain Research Articles

The Effects of Dry Needling on Pain Intensity and Pain Pressure Threshold in Patients with Chronic Non-Specific Low Back Pain: A Clinical Randomized Controlled Trial (Original article)

The Effects of Dry Needling on Pain Intensity and Pain Pressure Threshold in Patients with Chronic Non-Specific Low Back Pain: A Clinical Randomized Controlled Trial (Original article)

Effects of whole-body vibration therapy on pain, functionality, postural stability, and proprioception in patients with subacute and chronic non-specific low back pain: asystematic review.

Non-specific low back pain (NLBP) is acommon and clinically significant condition with substantial socioeconomic implications. Whole-body vibration therapy (WBVT) has shown effectiveness in improving pain and sensorimotor function (e.g., in osteoporosis) in previous studies. However, studies had heterogeneous settings. The aim of this study was to assess the effects of WBVT on pain, function, proprioception, and postural stability in patients with subacute and chronic NLBP. Asystematic literature search was conducted in the scientific databases PubMed, EMBASE, and PEDro (from inception until 17.05.2023). Only prospective controlled and uncontrolled studies were included. Outcome measures assessed were pain intensity, function (activities of daily living and physical function), proprioception, and postural stability. Atotal of 12 original articles (n = 821) were included in the analysis. Ten of the studies were randomized controlled trials, one study had acrossover design, and one study had aone-group pre-post study design. The studies compared WBVT vs. no intervention, WBVT vs. basic physical therapy, WBVT vs. core stabilization exercises with and without respiratory resistance, WBVT vs. lumbar extension exercises, and WBVT vs. whole body electromyostimulation training. The treatment approaches varied in terms of duration (2-18weeks), frequency (2-3times per week, two applications with a2-week break), vibration frequency (5-30 Hz), type of exercises (WBVT with or without static or dynamic exercises), and vibration direction (horizontal and vertical). Significant pain reduction was observed in all 10studies that investigated pain levels. Significant improvement in daily activity function was reported in five of the six studies that investigated daily function, while improvement in physical function was observed in all four studies that investigated physical function. Improvement in proprioception was reported in all three studies that investigated proprioception, and significant improvement in postural stability was observed in four out of six studies that investigated postural stability. No adverse events or side effects related to WBVT were reported. The majority of the included studies demonstrated significant pain reduction, improvement in physical and daily functioning, and enhanced proprioception. Improvement in postural stability was less consistent. WBVT appears to be asafe and effective treatment modality for subacute and chronic NLBP when used within amultimodal approach. Future research should focus on standardized settings including assessment methods, treatment regimens, frequencies, and intensities.

A Review on Effects of Exercises Therapy for Office Workers with Chronic No Specific Low Back Pain

Study Design: A literature review was conducted in order to provide an overview of the effect of exercise therapy for office workers with chronic Non-specific low back pain. Review provides a summary of large bodies of evidence and reviews help to explain differences among studies. Objectives: The aim of this study is to review exercises therapy for office workers with chronic nonspecific low back pain treatment. Background: Low back pain is a common syndrome that causes disability and absence from work. Although there are several causes, the most common type of back pain is nonspecific. Exercises are often used to treat back pain, but there is controversy regarding its effectiveness. Exercise therapy is widely used as an intervention in low back pain. Low back pain is defined as discomfort that develops above the posterior glutelines and below the costal edge of the final ribs, with or without lower limb pain(1).Between 60 and 85% of people experience it at some point throughout their lives(2). Methods: Search strategy: Relevant articles were identified by engines such as SCIENCE DIRECT, PUBMED, GOOGLESCHOLAR, and COCHRANE DATA BASE OF SYSTEMATIC REVIEW (www.cochrane.org), and CINALE.Website like physiopedia (www.physiopedia.com) was searched and published texts were `also reviewed in these studies.

Correlation between sagittal parameters and disability of patients with nonspecific chronic low back pain: a cross-sectional study of 435 subjects

BACKGROUND CONTEXTSagittal parameters are significantly correlated with health-related quality of life (HRQoL) in adult spinal deformity patients. Their association with HRQoL in patients with nonspecific chronic low back pain (NSCLBP) is unclear. PURPOSETo analyze the correlation between sagittal parameters and disability in NSCLBP patients. DESIGNA cross-sectional study. PATIENT SAMPLESubjects included 435 patients with NSCLBP divided into low disability and high disability groups. OUTCOME MEASURESFunction was measured using the Oswestry Disability Index (ODI). Pain intensity was measured using the Numeric Rating Scale (NRS) and HRQoL was measured using 36-item Short Form Health Survey (SF-36). METHODSSagittal parameters, demographic data, ODI, SF-36 eight-dimensional scores and NRS scores of patients with NSCLBP were collected. Taking ODI=20 as the cut-off value, patients were divided into low disability group (ODI≤20) and high disability group (ODI>20), and ODI were converted to Ranked ODI (RODI) accordingly. Univariate analysis of the correlation among age, gender, body mass index (BMI), sagittal parameters, RODI, SF-36 eight-dimensional scores, NRS scores were then conducted. The variables related to RODI were analyzed by logistic regression to discover their independent influence on RODI. p<.05 was considered to indicate statistical significance. RESULTSA total of 435 patients with NSCLBP were included. Univariate correlation analysis showed that the correlation coefficients between age, sacral slope-pelvic tilt (SS-PT), spinosacral angle (SSA) and RODI were (r=0.126, p<.01), (r=−0.115, p<.05), (r=−0.116, p<.05), respectively. The logistic regression analysis indicated that the regression coefficients of age and SSA were 0.030 (p=.001), −0.044 (p=.002), respectively, and the odds ratio and 95% confidence interval (CI) were 1.031 (1.012, 1.050), 0.957 (0.930, 0.985). CONCLUSIONSAge and SSA are independent factors for disability of NSCLBP. SSA can comprehensively reflect the sagittal balance of the spine of patients with NSCLBP. Decreased SSA represents poor sagittal balance, which will increase the disability of NSCLBP.

Comparisons of lumbosacral kinematics among non-specific chronic low back pain subgroups and healthy during prolonged sitting: A cross-sectional observational study

BackgroundThe literature has suggested a variety of postural changes of the spine that possibly contribute to the increase in back pain during sitting in persons with non-specific chronic low back pain (NS-CLBP). However, the heterogeneity of NS-CLBP persons has made the ability to attribute pain increase to a particular sitting posture very difficult. Therefore, the purpose of this study was to compare lumbosacral kinematics and their roles in pain increase among homogenous NS-CLBP subgroups and healthy controls over a 1-h sitting period. MethodsTwenty NS-CLBP subjects with motor control impairment [10 classified as having flexion pattern (FP) disorder, and 10 with active extension pattern (AEP) disorder], and 10 healthy controls participated in the study. Subjects underwent a 1-h sitting protocol on a standard office chair. Lumbosacral postures including sacral tilt, third lumbar vertebrae (L3) position, and relative lower lumbar angle were recorded using two-dimensional inclinometers over the 1-h period. Perceived back-pain intensity was measured using a visual analog scale every 10 min throughout the sitting period. ResultsAll study groups (FP, AEP and healthy controls) significantly differed from each other in the measured lumbosacral kinematics at the beginning as well as at the end of the sitting period (p ≤ 0.05). Only the NS-CLBP subgroups showed significant changes in the lumbosacral kinematics across the 1-h sitting period (p < 0.01), and that the directions of change occurred toward end spinal postures (lumbar kyphosis for FP subgroup and lumbar lordosis for the AEP subgroup). In addition, both NS-CLBP subgroups reported a similarly significant increase in pain through mid-sitting (p < 0.001). However, after mid-sitting, the AEP subgroup reported much less increase in pain level that was accompanied by a significant decrease in the lumbar lordotic postures (p = 0.001) compared to FP subgroup. ConclusionThe present study's findings suggest that each NS-CLBP subgroup presented with differently inherent sitting postures. These inherently dysfunctional postures coupled with the directional changes in the lumbosacral kinematics toward the extreme ranges across the 1-h sitting period, might explain the significant increase in pain among subgroups.

The effect of pelvic clock exercises on pain reduction and lumbopelvic proprioception in middle-aged women with chronic nonspecific low back pain (CNSLBP)

IntroductionLow-back pain (LBP) is one of the most common causes of disability in adults. There are many non-invasive interventions to improve this condition, of which the use of exercise therapy is one of the most widely used. But there is contradictory evidence regarding the effectiveness of different types of exercise methods. Therefore, the current research aimed to investigate the effect of pelvic clock exercises on pain reduction and lumbopelvic proprioception in women with chronic nonspecific low back pain (CNSLBP). Materials and methodsThis was a quasi-experimental study with a controlled pre-test-post-test design. The study population included middle-aged women with CNSLBP with an age range of 35–50 years. A total of 30 eligible middle-aged women with CNSLBP were selected using purposive and convenience sampling. The pelvic clock exercise was carried out by the researcher in a gym for eight 45- min sessions each week (three sessions each week). A visual analog scale (VAS) and goniometer were used to measure pain and lumbopelvic proprioception, respectively. However, the control group only participated in the pre-test and post-test stages. For intra-group and inter-group comparisons, paired t-test and independent t-test were used at P < 0.05, respectively. ResultsThe results showed that eight-week pelvic clock exercises had an effect on decreased pain and increase lumbopelvic proprioception in middle-aged women with CNSLBP, but no effect was observed in the control group (P > 0.05). ConclusionAccording to the results of the present study, pelvic clock exercises should be used as a new and practical method to reduce pain and improve lumbopelvic proprioception in middle-aged women with CNSLBP.

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

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

Global perceived improvement and health-related quality of life after physical therapy in Lebanese patients with chronic non-specific low back pain.

The effectiveness of physical therapy (PT) in patients with chronic non-specific low back pain (CNSLBP) is mainly evaluated through pain, disability, and health-related quality of life (HRQOL). However, recent studies have recommended the consideration of improvement from patients' perspectives. This study aimed to investigate the relationship between the global perception of improvement in Lebanese patients with CNSLBP who have undergone PT, the HRQOL levels, as well as pain intensity. 132 patients with CNSLBP who have undergone PT completed a questionnaire consisting of sociodemographic and CNSLBP characteristics questions, pain intensity numeric scale (NRS), 12-Item Short-Form Health Survey (SF-12), and the Global Perceived Effect scale (GPE). Binary logistic regressions and Pearson correlation coefficient were used for analyses. Global perceived improvement of PT varies according to HRQOL levels. A significant correlation was found between pain intensity after PT, perceived improvement from PT, and HRQOL. Educational level and pain irradiation have been shown to be predictive factors of perceived improvement after PT. Pain and HRQOL are interrelated and contributed to elucidating the global perception of improvement after PT in patients with CNSLBP. The findings suggest that patients' global perception of improvement should be considered in evaluating the benefits of physical therapy in addition to pain and HRQOL.

Efficacy of cognitive behavioral therapy for reducing pain susceptibility and increasing social engagement in patients with chronic low back pain: A systematic review and meta-analysis.

The objective of this study was to evaluate the efficacy of cognitive behavioral therapy in improving social engagement and pain susceptibility in patients with chronic low back pain (≥6 months duration). From the initial to January 2023, 5 databases were searched for randomized controlled trials, literature screening, quality evaluation, and data extraction were performed by 2 independent researchers throughout, Meta-analysis was performed using RevMan 5.4 software, standardized mean difference (SMD) was calculated for different indicators, and the combined experimental and control groups were calculated using random-effects models or fixed-effects models effect sizes, and forest plots were drawn to present the results. A total of 16 studies containing 2527 patients with chronic nonspecific low back pain, all of whom had pain lasting longer than 6 months, were included, and after treatment, cognitive behavioral therapy (CBT) was superior to other treatments in improving social participation [SMD = -0.30, 95%CI (-0.60, -0.01), Z = 2.02, P = .04]. There was no significant difference from other treatments in improving patient depression [SMD = -0.07, 95%CI (-0.19, 0.05), Z = 1.11, P = .27] and anxiety [SMD = -0.07, 95%CI (-0.30, 0.16), Z = 0.52, P = .57]. Three papers describe the superiority of CBT over other treatments in improving sleep quality, but the metrics could not be combined due to too little literature. CBT can improve patients' social participation and pain susceptibility to some extent, but it does not show advantages for managing negative emotions (depression, anxiety). Due to the limited number and low quality of included literature, the above findings still need to be validated by conducting a large sample of high-quality RCTs.

Efficacy of pharmacological and non-pharmacological therapy on pain intensity and disability of older people with chronic nonspecific low back pain: a protocol for a network meta-analysis

BackgroundThe purpose of this network meta-analysis (NMA) is to investigate the efficacy of pharmacological and non-pharmacological therapy on pain intensity and disability of older people with chronic nonspecific low back pain, providing comprehensive evidence for an informed decision-making.MethodsWe will perform a systematic search to identify randomized controlled trials of pharmacological and non-pharmacological interventions for older people with chronic nonspecific low back pain. MEDLINE, Cochrane Library, Embase, AMED, PsycINFO, and PEDro will be searched without language or date restrictions. Our primary outcomes are pain intensity and disability. Risk of bias will be assessed for all studies using the revised Cochrane risk-of-bias (RoB) tool 2.0. For each pairwise comparison between the different interventions, estimated mean differences and their 95% confidence intervals will be presented. Standard pairwise meta-analyses will be performed using random effects models in STATA version 16. The competing interventions will be ranked using the surface under the cumulative ranking curve (SUCRA) for the outcomes of interest at short and long terms. The confidence in the results from NMA will be assessed using the Confidence in Network Meta‐Analysis (CINeMA) framework.DiscussionThis NMA compares efficacy of interventions for nonspecific chronic low back pain in older people. It will provide reliable evidence for patients, clinicians, stakeholders, and researchers in this field where competing therapies, many of extraordinarily little value, are commonly used in clinical practice.Systematic review registrationPROSPERO CRD42022312565

Effects of a tailored mat-Pilates exercise program for older adults on pain, functioning, and balance in women with chronic non-specific low back pain: a randomized controlled trial.

Mat-Pilates exercise is effective for chronic non-specific low back pain (NSLBP), but its application in older women is understudied. To examine the effects of a 10-week mat-Pilates program on pain, disability, and balance in older women with chronic NSLBP. Sixty-three women (≥ 65years) with chronic NSLBP were randomly assigned to intervention (IG) or control (CG) groups. IG received individualized mat-Pilates sessions (45min, twice weekly), while CG followed a home-based general exercise program. Primary outcomes included visual analog scale (VAS) for pain, Roland-Morris Disability Questionnaire (RMDQ), timed up-and-go (TUG), and Berg Balance Scale (BBS) at baseline, 10weeks, and 6months post-intervention. Repeated measures multivariate analysis of covariance (MANCOVA) was used, adjusted for exercise adherence and analgesic use. IG significantly improved in VAS and RMDQ scores at 10weeks and 6 months (p > 0.05). No significant differences were observed in TUG and BBS scores at any measurement point. No between-group differences were found in analgesic use or adherence to exercise during the 6-month follow-up. A 10-week mat-Pilates program reduced pain and improved disability in older women with chronic NSLBP, effects which persisted at 6 months. However, no impact on balance, analgesic use, or exercise adherence was observed. NCT04752579/February 12, 2021.

Effects of an Intervention Program on Lumber Muscle Function in Non-Specific Chronic Low Back Pain

PURPOSE: This study compared the effects of different intervention programs of resistance exercise, stretching, and physical therapy in middle-aged women with nonspecific chronic low back pain.METHODS: The study participants were middle-aged women with nonspecific chronic low back pain (n=31), divided into three groups: resistance exercise (n=11), stretching (n=10) and physical therapy (n=10). They performed regular intervention thrice weekly for 12 weeks. Parameters measured include body composition via impedance, lumbar extensor strength, and lumbar stabilizing muscle strength.RESULTS: There was a significant interaction between group (resistance exercise, stretching, and physical therapy) and time period (pre– post) at 24°, 36°, 48°, 60°, and 72° of lumbar extensor strength (&lt;i&gt;p&lt;/i&gt;=.015, &lt;i&gt;p&lt;/i&gt;=.040, &lt;i&gt;p&lt;/i&gt;=.004, &lt;i&gt;p&lt;/i&gt;=.009, &lt;i&gt;p&lt;/i&gt;=.003, respectively), and a significant interaction between group and time at -135° (&lt;i&gt;p&lt;/i&gt;=.022) and +180° (&lt;i&gt;p&lt;/i&gt;=.013) for lumbar stabilizing muscle strength.CONCLUSIONS: This study demonstrated that resistance training had a positive effect on chronic low back pain after 12 weeks of intervention in middle-aged women with nonspecific chronic low back pain, with improvements in lumbar extensor and stabilizer strength.

Different Methods for Treating Pain, Functional Disability and Thickness of Back Muscles in Patients With Non-Specific Low Back Pain: A Review Study

Background and Aims Low back pain (LBP) is the most common cause of activity limitation. Various treatments such as electrotherapy, hydrotherapy, and exercise therapy have been suggested to improve nonspecific LBP. The present study aims to review studies that have investigated the effect of different methods on pain and disability in people with nonspecific LBP. Methods This is a review study. A search was first conducted in Google Scholar, ScienceDirect, PubMed, and Scopus databases for related articles published from 2016 to 2021 using the keywords exercise therapy, corrective exercise, electrotherapy, treatment, and non-specific chronic low back pain. The PEDro scale was used to check the quality of articles. Results Among the articles found, 15 were selected for the review. These studies mainly examined the effect of therapeutic methods on pain, functional disability, thickness, and activity of core muscles in people with non-specific chronic low back pain. Conclusion Core stabilization exercises with an emphasis on deep muscles have a better effect on pain, functional disability, and muscle thickness of people with nonspecific LBP.

Baduanjin exercise for chronic non-specific low back pain: protocol for a series of N-of-1 trials

IntroductionChronic non-specific low back pain (CNLBP) is one of the most common health problems worldwide. According to the clinical guideline released by the American College of Physicians, exercise has been...

Efficacy of core stabilization program and conventional exercises in low back pain

Background: Patients experiencing low back pain (LBP) often benefit from therapeutic exercise. These exercises can retrain trunk muscles and improve spinal stability and sensory integration. Consequently, we aimed to compare the efficacy of a core stabilization program and conventional exercises in low back pain. Methods: This prospective, comparative study comprised 192 subjects aged 20-60 with nonspecific chronic low back pain (NSLBP). Core stabilization or usual physical therapy activities were randomly assigned to groups C or R. Both treatment groups received TENS and ultrasound therapy. Pretreatment, second, fourth, and sixth-week post-treatment outcomes were documented using a visual analogue scale (VAS). Results: Both groups were female-dominated. Height, weight, and BMI were comparable. At baseline, group C had a mean VAS score (5.69±1.80), while group R had (5.52±1.42). P value 0.4684 indicates no significant difference between exercise groups. At the final assessment, group C had a considerably (p&lt;0.0001*) lower mean VAS score (2.96±0.39) than group R (3.89±0.98). Group C had a substantially higher mean VAS score change from baseline to the final evaluation (-2.73±0.51) than group R (-1.18±0.79). Conclusions: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in chronic NSLBP.

The Pace of Biological Aging Predicts Nonspecific Chronic Low Back Pain Severity

This study aimed to determine if and how the pace of biological aging was associated with nonspecific chronic low back pain (cLBP) and compare what measure of epigenetic age acceleration most strongly predicts cLBP outcomes. We used the Dunedin Pace of Aging from the Epigenome (DunedinPACE), Horvath’s, Hannum’s, and PhenoAge clocks to determine the pace of biological aging in 69 cLBP, and 49 pain-free controls (PFCs) adults, ages 18 to 85 years. On average, participants with cLBP had higher DunedinPACE (P < .001) but lower Horvath (P = .04) and Hannum (P = .02) accelerated epigenetic age than PFCs. There was no significant difference in PhenoAge acceleration between the cLBP and PFC groups (P = .97). DunedinPACE had the largest effect size (Cohen’s d = .78) on group differences. In univariate regressions, a unit increase in DunedinPACE score was associated with 265.98 times higher odds of cLBP than the PFC group (P < .001). After controlling for sex, race, and body mass index (BMI), the odds ratio of cLBP to PFC group was 149.62 (P < .001). Furthermore, among participants with cLBP, DunedinPACE scores positively correlated with pain severity (rs = .385, P = .001) and interference (rs = .338, P = .005). Epigenetic age acceleration from Horvath, Hannum, and PhenoAge clocks were not significant predictors of cLBP. The odds of a faster pace of biological aging are higher among adults with cLBP, and this was associated with greater pain severity and disability. Future interventions to slow the pace of biological aging may improve cLBP outcomes. PerspectiveAccelerated epigenetic aging is common among adults with nonspecific cLBP. Higher DunedinPACE scores positively correlate with pain severity and interference, and better predict cLBP than other DNA methylation clocks. Interventions to slow the pace of biological aging may be viable targets for improving pain outcomes.

Pilates method in low back pain: a randomized clinical trial

Objectives: To analyze the effectiveness of the Pilates ground method in individuals with chronic non-specific low back pain (LBP) in reducing pain, improve the functionality, strength of the transverse abdomen muscle and quality of life. Methods: Double-blind randomized controlled trial in the University clinic. Thirty volunteers of both sexes were allocated randomly to two groups of 15 participants each: Pilates (PG) with Pilates exercises, and Control (CG). The PG held 16 sessions of 60 minutes, held twice a week for eight weeks. Participants were assessed pre-treatment and post-treatment for pain (Numerical Pain Scale - NPS and McGill Pain Questionnaire -MPQ), functional disability (Oswestry), transverse abdomen muscle strength (TrA) by the biofeedback unit test pressure (BTP) (Chattanooga Group, Australia) and quality of life by Medical Outcomes Study 36- Item Short-form Health Survey (SF-36). Results: There was a statistically significant increase in TrA (p &lt; 0.001) and a significant reduction in pain intensity plus qualification (p &lt;0.001) and functional disability (p &lt; 0.001), as well as an increase in quality of life (p &lt; 0.001). A positive correlation was observed between functional disability and pain assessed by Visual Anagolic Scale (VAS) (rho = 0.773; p = 0.001), as well as a negative correlation between disability and quality of life assessed by SF-36 (rho = -0.589; p = 0.021). Conclusion: The present study suggests that Mat Pilates exercises may be a choice for the treatment of patients with chronic non-specific low back pain.

Walking Performance during Concurrent Cognitive and Motor Tasks in Individuals with Nonspecific Chronic Low Back Pain: A Case-Control Study.

The present study aimed to compare the effects of simultaneous cognitive and motor tasks on walking performance between individuals with nonspecific chronic low back pain (NSCLBP) and healthy controls. A total of 20 patients with NSCLBP and 20 healthy controls participated in this study. They walked at their self-selected speed on a treadmill under 3 walking conditions in a randomized order: walking only, walking while performing a concurrent cognitive task, and walking while performing a concurrent motor task. Two-way repeated measure analysis of variance with additional post hoc comparison (Bonferroni test) was used to evaluate the effects of group and walking conditions on gait parameters. The result showed a significant main effect of the group for swing time ( P = 0.012) and double support time (P = 0.021) in those with NSCLBP compared with healthy controls. Moreover, there was a significant interaction between the group and condition for cadence ( P = 0.004) and step width variability (P = 0.016).Regarding stride length variability and stride time variability, the analysis indicated a significant effect of condition (P = 0.002 and P = 0.030, respectively). In both groups, no significant differences were observed in gait parameters between motor dual task and single walking ( P > 0.05). Our findings indicated that those with NSCLBP adapted successfully to walking performance to maintain the performance of the concurrent cognitive task under the cognitive dual-task walking condition. Moreover, the present study observed no dual-task interference under the motor dual-task condition.

The Intra-Rater Reliability of Ultrasonography for the Measurement of Lumbar Multifidus and Erector Spinae Thickness in Different Positions in People with and without Active Extension-Related Non-Specific Low Back Pain.

The paraspinal muscles, including multifidus (MF) and erector spinae (ES) play key roles in the stability and movement of the lumbar spine. This study aimed to determine the intra-rater reliability of the ES and MF muscle thickness measures of the rehabilitative ultrasound imaging (RUSI) in people with active extension pattern (AEP) non-specific chronic low back pain and controls. Fifteen females with AEP and 19 controls participated in this test-retest intra-rater reliability study, including two different testing sessions performed in four to seven days apart. The primary (raw) and derived (normalized) measures of the L4 MF and ES muscles`thickness were examined in three different positions (prone, sitting, and standing) on both days. A two-way mixed average of intra-class correlation coefficient (ICC3, K) with confidence interval (CI = 95%) was used to determine the relative reliability. The standard error of measurement (SEM) and minimal detectable change (MDC) values at a CI of 95% were computed to examine the absolute reliability. The ICC values for the primary thickness of the L4 ES and MF muscles were from 0.85 to 0.91, except for MF muscle thickness in standing (ICC = 0.67) and sitting (ICC = 0.66) positions . The ICC values for derived data were lower in both groups. The SEM and MDC values were small enough to confirm the absolute reliability of the primary data. This study supports the use of RUSI for examining the primary measures of the L4 MF and ES muscles in asymptomatic and AEP participants, but it should be used cautiously for assessing the derived measures.

Efficacy and safety of the combined use of celecoxib, diacerein and a combination of glucosamine and chondroitin for the control of musculoskeletal pain associated with osteoarthritis and nonspecific back pain

The combined use of drugs with different mechanisms of action is the main principle of musculoskeletal pain control in rheumatic diseases. However, there are few studies evaluating the efficacy of this approach in real practice.Objective: to determine the efficacy and safety of the combined use of celecoxib, diacerein, and the combination of glucosamine + chondroitin in osteoarthritis (OA) and chronic nonspecific low back pain (NSLBP). Material and methods. Statistical analysis of data obtained during a 3-month open observational study was performed. We included 1569 patients (63.6 % women and 36.4 % men, mean age 58.7 ± 11.0 years) with knee OA (kOA), hip OA (hOA), generalized OA (gOA), and chronic NSLBP with moderate/severe pain (≥ 4 on a numeric rating scale, NRS 0–10) who required nonsteroidal anti-inflammatory drugs. Celecoxib 200 mg twice daily was prescribed, with the dose reduced to 200 mg per day or taken “as needed" after significant pain relief; diacerein 50 mg twice daily; and a medication of glucosamine 250 mg and chondroitin 200 mg, 2 capsules 2–3 times daily. Outcomes were assessed after 3 months using the dynamics of pain, fatigue, dysfunction (according to NRS), and the “Patient Acceptable Symptom State” (PASS) indicator. Results and discussion. 80.2 % of patients completed the 3 month course of treatment, 4.4 % discontinued treatment due to adverse events (AEs), and for 15.4 % of patients there was no follow-up. After 3 months of treatment ≥ 50 % decrease (from baseline) in the severity of symptoms was noted in 83.4 % of patients for pain on movement, in 83.7 % for pain at rest, in 78.6 % for pain at night, in 80.8 % for dysfunction, and in 83.4 % for fatigue. 87.7 % of patients reported PASS. There were no significant differences in treatment outcomes for different localizations of OA and NSLBP: a ≥ 50 % pain reduction in kOA was achieved in 81.6 % of patients, in hOA – in 82.2 %, in gOA – in 85.0 %, in NSLBP – in 88.1 %. AEs were registered in 350 (22.4 %) patients, the most frequent was dyspepsia (n = 280, 17.8 %), diarrhea was recorded in 37 (2.4 %) cases. No serious AEs requiring hospitalization were registered. Conclusion. Combination therapy with celecoxib, diacerein, and a combination of glucosamine and chondroitin significantly reduces the severity of symptoms of OA and NSLBS.