Disability Questionnaire Score Research Articles

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.

Efficacy of Stand-Alone Anterior Lumbar Interbody Fusion With PEEK Cages, BMP-2, and Allografts for Treating Discogenic Low Back Pain: Assessing Clinical and Radiographic Outcomes.

Chronic low back pain secondary to degenerative disc disease is a significant public health issue worldwide, contributing to substantial health care burdens and patient disability. Anterior lumbar interbody fusion (ALIF) has emerged as a promising surgical solution, offering benefits such as disc height restoration, reduced neural compression, and improved spinal alignment. This study evaluates the efficacy of stand-alone ALIF using polyetheretherketone (PEEK) cages, structural femoral head allografts, and recombinant human bone morphogenetic protein-2 (rhBMP-2) in treating discogenic low back pain caused by degenerative disc disease. This prospective case series study included 1335 patients who underwent stand-alone ALIF by a single surgeon. The surgical construct involved PEEK cages with structural femoral allograft dowels and rhBMP-2, supplemented by anterior fixation. Patient-reported outcome measures, including the visual analog scale for back and leg pain, the Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and patient satisfaction, were monitored over 12 months. The overall fusion rate was 99.6%, with pseudoarthrosis occurring in 0.2% of patients. Lower fusion rates were observed in patients older than 65 years and those using the Brantigan cage. Significant improvements were seen in visual analog scale for back and leg pain, Oswestry Disability Index, and Roland-Morris Disability Questionnaire scores from baseline, with most scores exceeding the substantial clinical benefit thresholds. More than 85% of patients reported "Excellent" or "Good" outcomes. Stand-alone ALIF, augmented with rhBMP-2 and structural femoral head allografts, can enhance mechanical stability, fusion rates, and radiographic assessment. This integrated approach achieves successful spinal fusion and positive clinical outcomes for patients with refractory discogenic low back pain. Stand-alone ALIF with PEEK cages, structural femoral head allografts, and rhBMP-2 demonstrates high fusion rates and significant clinical improvements in patients with discogenic low back pain. This approach enhances spinal stability and promotes biological healing, making it a reliable and effective surgical option.

Can assessment of human assumed central sensitisation improve the predictive accuracy of the STarT Back screening tool in acute low back pain?

BackgroundThe STarT Back Screening Tool (SBT) is recommended to provide risk-stratified care in low back pain (LBP), yet its predictive value is moderate for disability and low for pain severity. Assessment of human assumed central sensitisation (HACS) in conjunction with the SBT may improve its predictive accuracy. ObjectivesTo examine whether assessment of HACS in acute LBP improves the predictive accuracy of the SBT for LBP recovery at six months in people with acute non-specific LBP. DesignA prospective longitudinal study. MethodData were drawn from the UPWaRD study. One hundred and twenty people with acute non-specific LBP were recruited from the community. Baseline measures included SBT risk status, nociceptive flexor withdrawal reflex, pressure and heat pain thresholds and conditioned pain modulation. Primary outcome was the presence of LBP (pain numeric rating scale ≥1 and Roland Morris Disability Questionnaire score ≥3) at six-month follow-up. Regression coefficients were penalised using the least absolute shrinkage and selection operator technique to select predictor variables. Internal validation was performed using ten-fold cross-validation. Results/findingsSBT risk status alone did not predict the presence of LBP at six months (area under receiver operating characteristic curve [AUC] = 0.58). Adding measures of HACS to the SBT did not improve discrimination for whether LBP was present at six months (AUC = 0.59). ConclusionsThis study confirmed the suboptimal predictive accuracy of the SBT, administered during acute LBP, for LBP recovery at six months. Assessment of HACS in acute LBP does not improve the predictive accuracy of the SBT.

Ultrasound-Guided Perineural Dextrose Injection for Superior Cluneal Nerve Neuropathy Treatment.

Superior cluneal nerve (SCS) entrapment neuropathy is an often overlooked cause of low back pain. Nerve block is usually applied to the sensitive point on the iliac crest where Tinel positivity is detected, with a mixture of a corticosteroid and a local anesthetic. Dextrose injection is one of the treatment methods. There are not enough studies comparing the effectiveness of dextrose and steroid injections. In this study, it was planned to compare these two methods. This retrospective study included 16 patients who underwent ultrasound-guided steroid injection and 17 patients who underwent ultrasound-guided dextrose injection with the diagnosis of SCS neuropathy at Elazığ Fethi Sekin City Hospital Polyclinics between 01.09.2023 and 28.03.2024. Patients were evaluated with visual analog scale (VAS) and Roland-Morris Disability Questionnaire (RMDQ) scores before and after the procedure at week 1 Results: While VAS and RMDQ scores were similar in both groups before the procedure, VAS and RMDQ scores at week 1 were significantly lower in the dextrose group. Perineural dextrose injection appears to be a safe and effective alternative to steroid injections in the treatment of SCS neuropathy.

A novel simplified sonographic approach with fluoroscopy-controlled L5 transforaminal epidural injections in patients with high iliac crest: a retrospective study

BackgroundTo explore a novel ultrasound (US) modality for lumbar transforaminal epidural injections (TFEIs) in patients with low back pain (LBP) and L5 radicular pain combined with high iliac crest (HIC).MethodsOne-hundred and forty-one patients were retrospectively stratified into two groups based on the treatment they received: novel group, receiving US-guided and fluoroscopy (FL)-controlled TFEIs using a sagittal oblique approach between the superior articular process of L5 and S1, and control group, receiving US-guided TFEIs with conventional transverse approach combined with FL confirmation. Accuracy of contrast dispersing into lumbar epidural space was set as the primary endpoint. Radiation dosages, procedure time, numeric rating scale (NRS) scores, Modified Oswestry Disability Questionnaire (MODQ) scores, adverse events, and rescue analgesic requirement were also recorded. The generalized liner mixed model (GLMMs) was employed to compare the repeatedly measured variables between groups, taking individual confounding factors as covariance.ResultsThe accuracy of TFEIs was 92.8% and 65.2% in novel and control group, with a significant difference of 26.7% (95% CI: 15.4%, 39.8%) between two modalities (p < 0.001). Significant pain relief was observed in novel group as opposed to control group after one injection. Procedure time in novel group (8.4 ± 1.6 min) was shorter than control group (15.8 ± 3.5 min) (p < 0.001) with less radiation dosage (3047 ± 5670 vs. 8808 ± 1039 μGy/m2, p < 0.001). Significantly, lower incidence of L5 paresthesia occurred in novel group. Statistical differences of NRS scores between the novel and control group were reached at 1 week after procedure (1 (IQR: − 1–3) vs. 3 (IQR: − 1–7), p = 0.006), while not reached at both 1- (1 (IQR: 0–2) vs. 1 (IQR: − 1–3), p = 0.086) or 3-month follow-up (0 (IQR: − 1–1) vs. 1 (IQR: 0–2), p = 0.094). Both groups showed similar functional improvement (F = 0.103, p = 0.749) during follow-up.ConclusionsThe novel sonographic technique provided superior accuracy needle placement and better pain-relieving effect through one injection as compared to the routine transverse approach. Consequently, in situations where the HIC imposed limitations for TFEIs performance on L5, the novel technique should be recommended to consider increasing accurate puncture, minimizing radiation exposure, consuming procedure time, and reducing the risk of neuraxial injury.

Efficacy of epidural steroid injection in the treatment of sciatica secondary to lumbar disc herniation: a systematic review and meta-analysis.

Epidural steroid injection for the treatment of sciatica caused by disc herniation is increasingly used worldwide, but its effectiveness remains controversial. The review aiming to analyze the efficacy of epidural steroid injection on sciatica caused by lumbar disc herniation. Randomized controlled trials (RCTs) investigating the use of epidural steroid injections in the management of sciatica induced by lumbar disc herniation were collected from PubMed and other databases from January, 2008 to December, 2023, with epidural steroid injection in the test group and epidural local anesthetic and/or placebo in the control group. Pain relief rate, assessed by numerical rating scale (NRS) and visual analogue scale (VAS) scores, and function recovery, evaluated by Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) scores, were recorded and compared. Meta-analysis was performed by Review Manager. In comparison to the control group, epidural steroid injections have been shown to be effective for providing short- (within 3 months) [MD = 0.44, 95%CI (0.20, 0.68), p = 0.0003] and medium-term (within 6 months) [MD = 0.66, 95%CI (0.09,1.22), p = 0.02] pain relief for sciatica caused by lumbar disc herniation, while its long-term pain-relief effect were limited. However, the administration of epidural steroid injections did not lead to a significant improvement on sciatic nerve function in short- [MD = 0.79, 95%CI = (0.39, 1.98), p = 0.19] and long-term [MD = 0.47, 95% CI = (-0.86, 1.80), p = 0.49] assessed by IOD. Furthermore, the analysis revealed that administering epidural steroid injections resulted in a reduction in opioid usage among patients with lumbar disc herniation [MD = -14.45, 95% CI = (-24.61, -4.29), p = 0.005]. The incidence of epidural steroid injection was low. Epidural steroid injection has demonstrated notable efficacy in relieving sciatica caused by lumbar disc herniation in short to medium-term. Therefore, it is recommended as a viable treatment option for individuals suffering from sciatica.

Comparison of diclofenac with tramadol, tizanidine or placebo in the treatment of acute low back pain and sciatica: multi-center randomized controlled trial.

Low back pain (LBP) is a leading cause of disability worldwide and has posed numerous health and socioeconomic challenges. This study compared whether nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with tramadol, tizanidine or placebo would be the best treatment regime to improve the Roland Morris Disability Questionnaire (RMDQ) scores at 1 week. This was a multi-center, double-blind, randomized, and placebo-controlled trial including adult patients with acute LBP and sciatica in three emergency departments in Hong Kong. Patients were randomized to the receive tramadol 50mg, tizanidine 2mg, or placebo every 6hours for 2weeks in a 1:1:1 ratio. The RMDQ and other secondary outcomes were measured at baseline, Day 2, 7, 14, 21, and 28. Data were analyzed on an intention to treat basis. Crude and adjusted mean differences in the changes of RMDQ and NRS scores from baseline to Day 7 between tizanidine/tramadol and placebo were determined with 95% confidence intervals. Two hundred and ninety-one patients were analyzed with the mean age of 47.4years and 57.7% were male. The primary outcome of mean difference in RMDQs on Day 7 (compared with baseline) was non-significant for tizanidine compared with placebo (adjusted mean difference - 0.56, 95% CI -2.48 to 1.37) and tramadol compared with placebo (adjusted mean difference - 0.85, 95% CI -2.80 to 1.10). Only 23.7% were fully compliant to the treatment allocated. Complier Average Causal Effect analysis also showed no difference in the primary outcome for the tizanidine and tramadol versus placebo. Among patients with acute LBP and sciatica presenting to the ED, adding tramadol or tizanidine to diclofenac did not improve functional recovery.

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).

Effect of Whole-Body Vibration Exercise on Pain, Disability, Balance, Proprioception, Functional Performance and Quality of Life in People with Non-Specific Chronic Low Back Pain: A Systematic Review and Meta-Analysis.

Background: Non-specific chronic low back pain (NSCLBP) presents significant treatment challenges due to its multifactorial nature. Whole-body vibration exercise (WBVE) has emerged as a potential therapeutic modality, offering benefits across various domains, including pain reduction, improved balance, and enhanced quality of life (QoL). The aim of this present systematic review and meta-analysis is to evaluate the effects of WBVE on pain, disability, balance, proprioception, functional performance, and QoL in individuals with NSCLBP. Methods: We comprehensively searched PubMed, Web of Science, Scopus, and CENTRAL databases from October 2023 to January 2024, including RCTs with a PEDro score of ≥5 for high-quality evidence. Outcome measures included pain intensity, Oswestry Disability Index (ODI) score, Roland-Morris Disability Questionnaire (RMDQ) score, balance, proprioception, functional performance (through a progressive iso-inertial lifting evaluation), and QoL (SF-36) in NSCLBP patients. The risk of bias was assessed using ROB-2, and the certainty of evidence for each outcome indicator was analyzed using GRADE. A meta-analysis was conducted using standardized mean differences (SMD) and mean differences (MD) for continuous outcomes. Results: Ten randomized controlled trials fulfilled the inclusion criteria for the systematic review, and nine were suitable for the meta-analysis. The qualitative synthesis revealed WBVE is effective in improving pain, disability, balance, proprioception, and functional performance and QoL. Further, the results of the quantitative review demonstrated WBVE significantly reduced pain [visual analogue scale: SMD = -0.81, 95% CI (-1.11, -0.50), I2 = 0%, p < 0.01], disability [ODI: MD = -3.78, 95% CI (-5.27, -2.29), I2 = 24%, p < 0.01]; RMDQ: MD = -1.43, 95% CI (-2.04, -0.82), I2 = 51%, p < 0.01], balance [SMD = -0.28, 95% CI (-0.52, -0.05), I2 = 0%, p = 0.02], and proprioception [SMD = -4.20, 95% CI (-7.50, -0.89), I2 = 99%, p = 0.01]. Conclusions: This review and meta-analysis indicate that WBVE significantly improves pain, disability, balance and proprioception in individuals with non-specific chronic low back pain. These findings suggest potential benefits of incorporating WBVE into the management strategies for NSCLBP.

Intradiscal administration of autologous platelet-rich plasma in patients with Modic type 1 associated low back pain: A prospective pilot study.

Various treatments for chronic low back pain (LBP) have been reported; among them, platelet-rich plasma (PRP) as a regenerative medicine has attracted much attention. Although Modic type 1 change (MC1) is associated with LBP, no treatment has been established so far. In addition, no studies have administered PRP to intervertebral discs (IVDs) in patients with LBP, targeting MC1 only. Thus, the purpose of this study was to determine the safety and efficacy of PRP administration to the IVDs in patients with MC1 experiencing LBP. PRP was injected intradiscally to 10 patients with MC1 experiencing LBP. Patients were followed prospectively for up to 24 weeks after primary administration. Physical condition, laboratory data, and lumbar x-ray images were evaluated for safety assessment. Furthermore, to evaluate the effectiveness of PRP, patient-reported outcomes were considered. In addition, changes in MC1 were assessed using magnetic resonance imaging (MRI). There were no adverse events in the laboratory data or lumbar X-ray images after administration. The mean visual analog scale, which was 70.0 ± 13.3 before the treatment, significantly decreased 1 week after PRP administration and was 39.0 ± 28.8 at the last observation. Oswestry disability index and Roland Morris disability questionnaire scores promptly improved after treatment, and both improved significantly 24 weeks after PRP administration. Follow-up MRI 24 weeks after treatment showed a significant decrease in the mean high-signal intensity of fat-suppressed T2-weighted imaging from 10.1 to 7.90 mm2 compared with that before PRP administration. The safety and efficacy of PRP administration to the IVDs of patients with MC1 experiencing LBP were identified. Post-treatment MRI suggested improvement in inflammation, speculating that PRP suppressed inflammation and consequently relieved the patient's symptoms. Despite the small number of patients, this treatment is promising for patients with MC1 experiencing LBP. The study protocol has been reviewed and approved by the Certified Committee for Regenerative Medicine and the Japanese Ministry of Health, Labor and Welfare (Japan Registry of Clinical Trials [jRCT] No. jRCTb042210159).

Percutaneous full-endoscopic transforaminal discectomy versus open microdiscectomy in the treatment of lumbar disc herniation: randomized controlled trial

BackgroundLumbar disc herniation is one of the most common degenerative spine conditions. In our center, the standard surgical technique for treatment of lumbar disc herniation is open microdiscectomy. The full-endoscopic transforaminal discectomy is done for selective cases of lumbar disc herniation under local anesthesia, achieving good results. This study aims to compare the clinical outcomes, operative data, and complications of the treatment of lumbar disc herniation with “percutaneous full-endoscopic transforaminal discectomy” (TED) and the gold standard “open microdiscectomy" (MD). This was a randomized controlled trial that included 65 patients with lumbar disc herniation: 32 in the TED group and 33 in the MD group.ResultsThere was no statistically significant difference between the two groups with regard to the visual analogue scale (VAS) for leg pain, the VAS for back pain, or the Oswestry Low Back Pain Disability Questionnaire (ODI) score at the end of the 1-year follow-up. The operative time in minutes was statistically shorter in the TED group, with a mean value of 50.38 (± 11.65) and 61.09 (± 12.32) in the MD group. The blood loss was 77.33 CC (± 23.14) in the TED group and 170 CC (± 56.06) in the MD group. The mean duration of hospital stay in days was statistically shorter in the TED group. Exposure to radiation in minutes was higher in the TED group: 1.09 (± 0.33) and 0.18 (± 0.08) in the TED group and MD group, respectively. There was no statistically significant difference in the rate of complications.ConclusionTED showed superiority over MD with regard to blood loss, operative time and shorter hospital stays, but with increased radiation exposure. There was no difference in clinical outcomes regarding VAS for leg and back pain and ODI score at 1 year follow-up with no significant difference in complications.

Fear-Avoidance Beliefs Associated with Non-Specific Chronic Low Back Pain in College Athletes.

This study aimed to determine the psychosocial factors associated with non-specific chronic low back pain (NS-CLBP) among college athletes. A cross-sectional study was performed at one university. A non-anonymous, self-administered online questionnaire was collected from each athlete. Participants with a history of orthopaedic spine disease or surgery were excluded. Online responses from 368 college athletes belonging to 18 clubs were collected, among which 263 were included in the analysis. In the 263 responses, 41 individuals were identified as having NS-CLBP. Multivariate logistic regression analyses were performed to determine factors associated with presence of NS-CLBP. Independent variables included the Fear-Avoidance Beliefs Questionnaire physical activity subscale (FABQ-PA) score, Tampa Scale for Kinesiophobia-11 (TSK-11) score, Roland-Morris Disability Questionnaire (RDQ) score, and body mass index (BMI). Additionally, the Mann-Whitney U-test was utilized to compare FABQ-PA, TSK-11, RDQ scores, and BMI between the NS-CLBP and non-NS-CLBP groups. The FABQ-PA (odd ratio = 1.096, P = 0.003) was significantly associated with NS-CLBP. No significant association was observed between NS-CLBP and TSK-11 (P = 0.776), RDQ (P = 0.074), and BMI (P = 0.296). The scores for FABQ-PA, TSK-11, RDQ, and BMI in the group with NS-CLBPwere found to be significantly higher compared to the group without NS-CLBP (P < 0.001, P = 0.034, P < 0.001, and P = 0.022, respectively). The present study revealed a significant relationship between higher FABQ-PA scores and NS-CLBP among college athletes. Conversely, TSK-11 and BMI values showed no significant association with NS-CLBP presence. The findings suggest that addressing fear-avoidance beliefs may be crucial in managing NS-CLBP among college athletes.

Comparison of the efficacy of Transcutaneous Electrical Nerve Stimulation and Short Wave Diathermy on Patients with Chronic Nonspecific Low Back Pain

Background: Transcutaneous electrical nerve stimulation (TENS) is widely used as a therapeutic adjunct in the management of low back pain. It is a relatively safe, non-invasive, and easy-to-use modality, making it an attractive treatment option. For more than four decades, TENS has been applied in the treatment of acute and chronic pain syndromes. Short wave diathermy (SWD) is a modality that produces deep heating by converting electromagnetic energy to thermal energy. Short wave diathermy (SWD) is also a popular therapy for low back pain. Methods: This randomized controlled clinical trial was conducted to evaluate the comparative efficacy between TENS and SWD on chronic nonspecific low back pain patients. 120 patients with chronic low back pain were treated according to inclusion &amp; exclusion criteria. Patients were equally distributed in three groups. Group-A patients (n=40) were treated with NSAID+ADL, Group-B patients (n=40) were treated with NSAID+ADL+TENS, and Group-C patients (n=40) were treated with NSAID+ADL+SWD. Written informed consent was obtained from all patients. Data were calculated and analyzed by computer-based software SPSS (Statistical Package for Social Science) Windows 16.0 version. Main outcome measure (s) Age, Sex, Occupational status, Socioeconomic status, Subjective pain intensity score, Visual Analogue Scale, Tenderness index, Disability due to pain, Spinal mobility index, and Oswestry disability Index. Results: The mean duration of pain was found to be 23.90±2.57 months in group A, 21.0+1.50 months in group B and 22.1±1.89 months in group C. The visual analog score was improved individually in group-A, group B and Group C after treatment, which was statistically significant (P&lt;0.05). Oswestry disability questionnaire score was also improved individually in group-A, group B and Group C after treatment, which was statistically significant (P&lt;0.05). In the case of comparison between group-B and Group C, this was not statistically significant (P&gt;0.05). In this current study, it was observed that the entire variable individually improved in Group-A, Group B, and Group C. So, all three treatment groups benefited from drugs and therapy. But, these were not statistically significant (P&gt;0.05) between Group B and Group C. Conclusion: Beneficial effects of TENS and SWD were seen in the study population, but no firm conclusion could be drawn. TAJ 2023; 36: No-2: 135-143

Effect of Transcutaneous Auricular Vagus Nerve Stimulation Addition on Disability in Chronic Low Back Pain Patients: A Randomized Controlled Study

Background &amp; objective: Low back pain is a common problem, especially in the young and middle-aged working people, and is often very resistant to the conventional management. We evaluated the impact of transcutaneous auricular vagus nerve stimulation (tVNS), applied in conjunction with an exercise treatment program, on disability in chronic low back pain patients.&#x0D; Methodology: The study was conducted from June to October 2022. Twenty-two patients aged 42.18 ± 9.91 y, with Numerical Pain Rating Scale (NPRS) score 5.64 ± 1.09 and Roland Morris Disability Questionnaire (RMDQ) score 10 ± 4.670, were randomly assigned to two groups. The control group received only exercise therapy (EXC group, n = 11), and the intervention group received exercise and tVNS therapy (EXC + tVNS group, n = 11). The primary outcome was RMDQ, measured before and after the intervention.&#x0D; Result: The mean RMDQ was significantly improved in both groups. In the intervention group the improvement was from 9.45 ± 4.44 to 2.18 ± 2.71 (P = 0.000), in the control group it was from 10.55 ± 5.05 to 2.36 ± 2.06 (P = 0.001). Inter-group comparison showed no significant difference. The effect size of the control group (2.12) was similar with the intervention group (1.98).&#x0D; Conclusion: Addition of 2-weeks tVNS to exercise therapy did not show superior effect on disability improvement compared to exercise only in chronic low back pain. Exercise alone was sufficient to improve the mean RMDQ.&#x0D; Abbreviations: CLBP: Chronic low back pain; EXC: Exercise; tVNS: Transcutaneous auricular vagus nerve stimulation; NPRS: Numerical pain rating scale; RMDQ: Roland Morris disability questionnaire&#x0D; Key words: Chronic low back pain; Disability; Exercise; Transcutaneous Auricular Vagus Nerve Stimulation&#x0D; Citation: Uzlifatin Y, Arfianti L, Wardhani IL, Hidayati HB, Melaniani S. Effect of transcutaneous auricular vagus nerve stimulation in addition to exercise on disability in chronic low back pain patients: a randomized controlled study. Anaesth. pain intensive care 2022;27(1):73−81; DOI: 10.35975/apic.v27i1.2084&#x0D; Received: December 07, 2022; Reviewed: December 28, 2022; Accepted: January 11, 2022

Effectiveness of unilateral percutaneous vertebroplasty for acute traumatic non-osteoporotic compression vertebral fractures.

Although vertebroplasty is a well-known treatment for osteoporotic and neoplastic compression fractures, there is limited evidence to support its use in traumatic compression fractures without osteoporotic degeneration. The purpose of this study was to evaluate the correlation of kyphosis and wedge angles with pain relief and functional outcome after percutaneous vertebroplasty. 38 patients who harbored acute traumatic non-osteoporotic compression vertebral fractures without neurological complications refractory to at least 5 days of conservative treatment were included in this study. Follow-up evaluations included pain (assessed with the visual analog scale) and medication use. Functional outcome was measured using Oswestry low back pain disability questionnaire. Cobb angles, Gardner angles and kyphotic angles were measured on the full-spine radiographs preoperatively and postoperatively. The axial pain visual analog scale score (8.05 ± 1.23 pre-op vs 1.18 ± 1.09 post-op, P < .05) and The Oswestry low back pain disability questionnaire score (33.45 ± 6.97 pre-op vs 4.47 ± 2.41 post-op, P < .05). The Cobb's angle (19.66° ± 8.68° pre-op vs 15.08° ± 7.51° post-op, P < .05), the Gardner's angle (17.72° ± 6.52° pre-op vs 14.13° ± 7.13° post-op, P < .05) and the kyphotic angle (17.51° ± 5.8° pre-op vs 8.81° ± 4.14°post-op, P < .05) were significantly reduced postoperatively therefore, local kyphosis was markedly restored after vertebroplasty. Our findings show that vertebroplasty for patients with traumatic spinal compression fractures reduces pain, improves mobility, reduces the need for painkillers, and significantly affects kyphotic angles.

Comparison of the Efficacy of Transcutaneous Electrical Nerve Stimulation and Short Wave Diathermy on Patients with Chronic Nonspecific Low Back Pain

Background: Transcutaneous electrical nerve stimulation (TENS) is widely used as a therapeutic adjunct in the management of low back pain. It is a relatively safe, non-invasive, and easy-to-use modality, making it an attractive treatment option. For more than four decades, TENS has been applied in the treatment of acute and chronic pain syndromes. Short wave diathermy (SWD) is a modality that produces deep heating by converting electromagnetic energy to thermal energy. Short wave diathermy (SWD) is also a popular therapy for low back pain.&#x0D; Methods: This randomized controlled clinical trial was conducted to evaluate the comparative efficacy between TENS and SWD on chronic nonspecific low back pain patients. One hundred twenty patients with chronic low back pain were treated according to inclusion &amp; exclusion criteria. Patients were equally distributed in three groups. Group-A patients (n=40) were treated with NSAID+ADL, Group-B patients (n=40) were treated with NSAID+ADL+TENS, and Group-C patients (n=40) were treated with NSAID+ADL+SWD. Written informed consent was obtained from all patients. Data were calculated and analyzed by computer-based software SPSS (Statistical Package for Social Science) Windows 16.0 version. Main outcome measure (s): Subjective pain intensity score, visual analogue scale, tenderness index, disability due to pain, spinal mobility index, and Oswestry disability index.&#x0D; Results: The mean duration of pain was found to be 23.90±2.57 months in group A, 21.0+1.50 months in group B and 22.1±1.89 months in group C. The visual analog score was improved individually in group-A, group B and Group C after treatment, which was statistically significant (P&lt;0.05). Oswestry disability questionnaire score was also improved individually in group-A, group B and Group C after treatment, which was statistically significant (P&lt;0.05). In the case of comparison between Group B and Group C, this was not statistically significant (P&gt;0.05). In this current study, it was observed that the entire variable individually improved in Group-A, Group B, and Group C. So, all three treatment groups benefited from drugs and therapy. However, these were not statistically significant (P&gt;0.05) between Group B and Group C.&#x0D; Conclusion: Beneficial effects of TENS and SWD were seen in the study population, but no firm conclusion could be drawn.&#x0D; TAJ 2022; 36: No-1: 63-73

Effect of Risk-Stratified Care on Disability Among Adults With Low Back Pain Treated in the Military Health System

Tailored treatments for low back pain (LBP) based on stratifying risk for poor prognosis have emerged as a promising approach to improve quality of care, but they have not been validated in trials at the level of individual randomization in US health systems. To assess the clinical effectiveness of risk-stratified vs usual care on disability at 1 year among patients with LBP. This parallel-group randomized clinical trial enrolled adults (ages 18-50 years) seeking care for LBP with any duration in primary care clinics within the Military Health System from April 2017 to February 2020. Data analysis was conducted from January to December 2022. Risk-stratified care, in which participants received physiotherapy treatment tailored for their risk category (low, medium, or high), or usual care, in which care was determined by participants' general practitioners and may have included a referral to physiotherapy. The primary outcome was the Roland Morris Disability Questionnaire (RMDQ) score at 1 year, with planned secondary outcomes of Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Physical Function (PF) scores. Raw downstream health care utilization was also reported within each group. Analysis included 270 participants (99 [34.1%] female participants; mean [SD] age, 34.1 [8.5] years). Only 21 patients (7.2%) were classified as high risk. Neither group was superior on the RMDQ (least squares [LS] mean ratio of risk-stratified vs usual care: 1.00; 95% CI, 0.80 to 1.26), the PROMIS PI (LS mean difference, -0.75 points; 95% CI -2.61 to 1.11 points), or the PROMIS PF (LS mean difference, 0.05 points; 95% CI, -1.66 to 1.76 points). In this randomized clinical trial, using risk stratification to categorize and provide tailored treatment for patients with LBP did not result in better outcomes at 1 year compared with usual care. ClinicalTrials.gov Identifier: NCT03127826.

An Open-Label, Randomized, Parallel-Group Study to Assess the Safety, Efficacy, and Tolerability of Tapentadol Versus Tramadol in Outpatients with Moderate to Severe Chronic Low Back Pain at a Tertiary Care Hospital in South India

Low back pain is a very common musculoskeletal symptom with multifactorial aetiology. Aims and objectives: Our study aimed at comparing the efficacy, safety, and tolerability of tapentadol versus tramadol in out-patients with moderate to severe chronic low back pain. Fifty-two patients with a diagnosis of chronic low back pain for &gt; 3 months were randomly assigned to receive either a 50 mg tablet of tapentadol (twice daily) or 50 mg tablet of tramadol (twice daily) for 1 week. The mean (±SD) difference in the reduction of pain (at end of 1 week) between the two groups was compared employing an independent student t-test for difference in mean values separately for the Visual Analogue Scale (VAS) and Roland Morris Disability Questionnaire (RMDQ) scores. The frequency of the different adverse events between the two groups was compared employing Chi-square test. Except for VAS scores, the baseline demographic parameters of the two groups were comparable. The study found that tapentadol reduced VAS and RMDQ scores more than tramadol (statistically significant p&lt;0.001) between baseline and the end of week 1. Regarding safety and tolerability, the tapentadol group experienced nausea/vomiting and dizziness/somnolence more frequently than the tramadol group, with p-values of 0.011 and 0.001 respectively. Both groups experienced similar rates of headache and constipation, with p-values of 0.668 and 0.610, respectively. When compared to tramadol (50 mg twice daily), tapentadol (50mg twice daily) was found to significantly improve pain and disability in patients with moderate to severe chronic low back pain, while tapentadol had greater frequencies of side effects like nausea, vomiting, dizziness, and somnolence.

Ultrasound-guided transforaminal epidural injection with fluoroscopy confirmation for the treatment of unilateral lumbar radiculopathy: A randomized controlled non-inferiority study

BackgroundUltrasound (US)-guided injections for chronic pain has multiple advantages over traditional radiologic method. The study was performed to exam the clinical outcomes of lumbar transforaminal epidural injection (LTFEI) between US and fluoroscopy (FL) guidance for lumbar radiculopathy (LRP). MethodsA total of 164 patients with LRP were randomly assigned into US and FL group to receive LTFEI in a 1:1 ratio. Pain relief and functional disability were assessed by numeric rating scale (NRS) and Modified Oswestry Disability Questionnaire (MODQ) scores before treatment, 1 month and 3 months post-intervention. Contrast spread pattern, fluoroscopic image number and complications were also recorded. The primary outcome was accurate rate of contrast dispersing into lumbar epidural space, and non-inferiority margin was predefined at −15 %. ResultsThe accuracy of LTFEI was 90.2 % and 91.5 % in US and FL group, and the lower limit of the 95 %CI of mean difference between two modalities (−4.9 % (95 %CI: −12.8 %, 3.1 %)) was above the non-inferiority margin. Procedure time in US group (531.90 ± 67.12 s) was shorter than FL group (904.20 ± 120.20 s) (p < 0.05), while radiation dosage in the US group was lower than in the FL group (3047.20 ± 569.53 vs. 8807.50 ± 1039.10 μGy m2, p < 0.001). Both groups didn’t differ in pain reduction (F = 1.050, p = 0.306) and functional improvement (F = 0.103, p = 0.749) during follow-up period. No severe complications occurred in both groups. ConclusionsUS-guided LTFEI confirmed by FL was not inferior to conventional FL method in terms of accurate rate of lumbar epidural contrast dispersion. Effective pain relief and functional ability improvement were comparable between two modalities, and US technique had advantages of less radiation exposure and possible facilitation of avoiding critical vessels around intervertebral foramen.

A Prospective Evaluation of Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fracture Patients.

Background Osteoporotic vertebral compression fracture (OVCF) is a common problem in old age, which causes incapacitating pain and leads to significant disability, morbidity, and mortality. Percutaneous vertebroplasty (PVP), a minimally invasive procedure, results in immediate pain relief with decreased morbidity. The primary aim of this study was to evaluate the quality of life (QOL), as denoted by the Roland-Morris Disability Questionnaire (RMDQ) score. In contrast, the secondary aims were determining pain relief using the 11-point Numeric Pain Rating Scale (NPRS) and vertebral height restoration and wedge angle measurements after PVP. Methodology This prospective, longitudinal, interventional study on the efficacy of PVP was conducted among patients with low back pain due to osteoporotic vertebral collapse in a tertiary care institute. Patients with OVCF were managed by PVP and followed at one week, one month, three months, and six months for improvement in QOL by the RMDQ score and pain relief using the NPRS. The pre and post-vertebroplasty wedge angle and vertebral height (anterior, middle, and posterior columns) at one week and six months were also compared by pre and post-vertebroplasty lateral view skiagrams. Results A total of 24 patients were included in this study based on the inclusion and exclusion criteria. The demographic data were comparable. The RMDQ score showed a statistically significant difference in post-PVP at one week (p = 0.044), one month (p = 0.031), three months (p = 0.022), and six months (p = 0.018). There was a statistically significant difference in the NPRS at six months compared to the pre-PVP status, showing drastic pain relief in patients after PVP. The mean wedge angle (20.5 ± 2.07) measurement was reduced with a statistically significant increase in anterior body height restoration from pre-PVP to six months. There was no significant change in height at the middle and posterior columns compared to the pre-PVP height. Conclusions PVP is an effective, safe, minimally invasive pain and spine intervention for OVCFs with improved QOL and restoration of vertebral height.