Duration Of Back Pain Research Articles

Effect of platelet-rich plasma injections for chronic nonspecific low back pain: A randomized controlled study.

Background:Patient with chronic nonspecific low back pain is weakened ligament, and prolotherapy is the effective treatment but their use remains controversial. These ligaments can be strengthened by platelet-rich plasma injection. We hypothesized that the effectiveness of platelet-rich plasma injection and prolotherapy may decrease pain and improved disability of patient with chronic low back painMethods:This study was a prospective, double-blind, randomized controlled trial and was conducted for 3 years for patient enroll and follow-up. Thirty-four patients with chronic nonspecific low back pain (duration of at least 3 months) refectory to conventional management were randomized to platelet-rich plasma injection and lidocaine injection. Patients were treated with weekly platelet-rich plasma or lidocaine injections at the lumbopelvic ligaments for 2 weeks and then weekly prolotherapy with 15% glucose for 2 weeks and followed up 6 months. Visual analog scale, Oswestry Disability Index, and Roland–Morris Disability Questionnaire were evaluated at initial, 4 weeks, 3 months, and 6 months. Four patients did not complete this trial. Three were in the platelet-rich plasma injection and 1 was in the lidocaine injection.Results:The intensity of pain was significantly decreased in platelet-rich plasma injections at 6 months as compared lidocaine injections; between-group differences were 0.9 (95% confidence interval 0.10–1.75 [P = .027]). All participants were significantly decreased pain and disability index at 4 weeks, 3 months, and 6 months but there were no significant differences between groups except for visual analog scale at 6 months. The baseline parameters were no significant differences in both groups.Conclusions:In chronic nonspecific low back pain, the platelet-rich plasma injection in combination with prolotherapy is an effective intervention and either lidocaine or platelet-rich plasma injection significantly reduced disability. And injection at the lumbopelvic ligaments using the platelet-rich plasma and prolotherapy is also an effective treatment for pain.

Improving adherence to acute low back pain guideline recommendations with chiropractors and physiotherapists: the ALIGN cluster randomised controlled trial

BackgroundAcute low back pain is a common condition, has high burden, and there are evidence-to-practice gaps in the chiropractic and physiotherapy setting for imaging and giving advice to stay active. The aim of this cluster randomised trial was to estimate the effects of a theory- and evidence-based implementation intervention to increase chiropractors’ and physiotherapists’ adherence to a guideline for acute low back pain compared with the comparator (passive dissemination of the guideline). In particular, the primary aim of the intervention was to reduce inappropriate imaging referral and improve patient low back pain outcomes, and to determine whether this intervention was cost-effective.MethodsPhysiotherapy and chiropractic practices in the state of Victoria, Australia, comprising at least one practising clinician who provided care to patients with acute low back pain, were invited to participate. Patients attending these practices were included if they had acute non-specific low back pain (duration less than 3 months), were 18 years of age or older, and were able to understand and read English. Practices were randomly assigned either to a tailored, multi-faceted intervention based on the guideline (interactive educational symposium plus academic detailing) or passive dissemination of the guideline (comparator). A statistician independent of the study team undertook stratified randomisation using computer-generated random numbers; four strata were defined by professional group and the rural or metropolitan location of the practice. Investigators not involved in intervention delivery were blinded to allocation. Primary outcomes were X-ray referral self-reported by clinicians using a checklist and patient low back pain-specific disability (at 3 months).ResultsA total of 104 practices (43 chiropractors, 85 physiotherapists; 755 patients) were assigned to the intervention and 106 practices (45 chiropractors, 97 physiotherapists; 603 patients) to the comparator; 449 patients were available for the patient-level primary outcome. There was no important difference in the odds of patients being referred for X-ray (adjusted (Adj) OR: 1.40; 95% CI 0.51, 3.87; Adj risk difference (RD): 0.01; 95% CI − 0.02, 0.04) or patient low back pain-specific disability (Adj mean difference: 0.37; 95% CI − 0.48, 1.21, scale 0–24). The intervention did lead to improvement for some key secondary outcomes, including giving advice to stay active (Adj OR: 1.96; 95% CI 1.20, 3.22; Adj RD: 0.10; 95% CI 0.01, 0.19) and intending to adhere to the guideline recommendations (e.g. intention to refer for X-ray: Adj OR: 0.27; 95% CI 0.17, 0.44; intention to give advice to stay active: Adj OR: 2.37; 95% CI 1.51, 3.74).ConclusionsIntervention group clinicians were more likely to give advice to stay active and to intend to adhere to the guideline recommendations about X-ray referral. The intervention did not change the primary study outcomes, with no important differences in X-ray referral and patient disability between groups, implying that hypothesised reductions in health service utilisation and/or productivity gains are unlikely to offset the direct costs of the intervention. We report these results with the caveat that we enrolled less patients into the trial than our determined sample size. We cannot recommend this intervention as a cost-effective use of resources.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12609001022257. Retrospectively registered on 25 November 2009

Prevalence of depression among lower back pain adult patients in Taif city, Saudi Arabia, 2021

Background: Low back pain (LBP) is the leading cause of disability in the world with a high prevalence of 64%- 89% in different age groups in Saudi Arabia, and depending on the severity, it could have a heavy impact on the quality of life. Thereby, this study aimed to estimate the prevalence of depression among LBP patients and to assess severity of depression in Taif city, Saudi Arabia. Methods: This cross-sectional study was conducted among 105 participants in Prince Mansour Military Hospital. Every patient with LBP who attended family clinic was included in the study and were asked to fill an Arabic version of the LBP Oswestry Disability Questionnaire (ODQ) and Beck's Depression Inventory (BDI) for assessing the depression. Results: A total of 105 participants were included with an average age of 36.7 ± 12.2 years. Duration of LBP was from 4 to 12 weeks in 48.6% participants. The mean of BDI score was found to be 11.8 ± 10.8 with range of 0-48 out of a total score of 63. Around 58.1% had normal (BDI) score, whereas 14.3% had moderate depression. The mean of ODQ score was found to be 34.4 ± 16.6 out of a total score of 100. Almost 44.8% had moderate disability. Statistically significant association was found between duration of back pain and depression (p-value = 0.008). Conclusion: The overall prevalence of depression among study participants was found to be 41.2%, whereas 15% had mild depression according to BDI score.

CT-Guided Needle Biopsy in Vertebral Osteomyelitis: Study of Factors That Could Influence in Culture Yield

ObjectiveThe aim of this study was to analyze which are the main factors that could influence the result of a CT guided biopsy in vertebral osteomyelitis (VO) patients. MethodsA single center retrospective observational study was performed including adult patients who had been diagnosed with VO and undergone CT guided needle biopsy from January 2010 to January 2020. Demographical features, concurrent diseases, laboratory findings, microbiological diagnosis, radiological data, medical complications, antibiotic exposure were compiled. Multivariate analysis was performed with a logistic regression comparing the patients depending on the culture result. ResultsSeventy-seven patients were included in the study. Baseline characteristics were comparable between groups. Sample culture was positive in 43 cases (56%). Microorganism isolated were gram+(72%), gram−(14%), mycobacteria (7%) and fungi (7%). Delay in the procedure, antibiotic exposure and blood culture positivity were also similar among both groups. The biopsy results were not influenced by the CRP value, the presence of fever nor antibiotic exposure. The longer duration of back pain was associated to a lower probability of a positive culture. ConclusionsIn conclusion, our study displays an acceptable reliability of CT guided needle biopsy in VO patients, even in cases under antibiotic treatment. The presence of fever or CRP values did not predict a positive culture. Delay in diagnosis could impact negatively on culture yield.

Clinical Characteristics of Noncancer-Related Upper Back Pain on Initiation of Palliative Care in Patients with Incurable Cancer.

Background: Cancer patients experience various types of pain unrelated to their malignancy. However, no previous study has reported the prevalence of noncancer-related pain among patients with incurable cancer.Objective: We aimed to investigate the frequency of noncancer-related upper back pain, the type of noncancer disease, and pain intensity among patients.Design: This is a multicenter cross-sectional survey.Setting/Subjects: Subjects were patients with incurable cancer who underwent initiation of palliative care at two university hospitals in Japan.Measurements: Data for patient characteristics were recorded, and the upper back pain intensity, duration, analgesic use, and opioid drug use with dose were determined. Appropriate statistical tests were also performed.Results: Among the 103 patients with upper back pain, 20 (19.4%) had cancer-related pain, 28 (27.2%) had both cancer- and noncancer-related pain, and 53 (51.5%) had only noncancer-related pain. Myofascial pain was suspected in the 72 (88.9%) participants with noncancer-related pain. The median pain numerical rating scale score was four in the cancer-related pain group and seven in the other two groups (p = 0.005).Conclusions: A high proportion of outpatients with incurable cancer undergoing palliative care initiation had noncancer-related upper back pain. Severe pain at the initiation of palliative care in patients with incurable cancer may include noncancer-related pain. Trial Registration: UMIN000038371. Registered December 1, 2019.

EVALUATION OF RISK FACTORS OF PATIENTS WITH CHRONIC LOW BACK PAIN APPLYING TO THE PHYSICAL THERAPY AND REHABILITATION OUTPATIENT CLINIC

Objectives: To investigate the risk factors affecting these pains in patients with low back pain.
 Methods: In this retrospective observational study, the patients were asked about their age, gender, occupation, marital status, educational status, economic status and smoking status. The duration of low back pain was measured in months and the severity was 0-no pain and 10-unbearable pain on a 10 cm line with the Visual Analogue Scale (VAS) and the data were recorded.
 Results: Of 224 patients, 144 (64.3%) were female and 80 (35.7%) were male. The most common causes of chronic low back pain were lumbar spondylosis (120 patients, 53.6%) and discal hernia (68 patients, 30.4%). It was determined that the rate of low back pain was 72.3% higher in patients aged 60 and over. It was observed that as the education level increased, the rate of low back pain decreased significantly. 57.1% of the patients were found to be low-income; low back pain rate was higher in this group compared to the others. When we examined the relationship between smoking and low back pain, it was determined that 60.7% of the patients with low back pain were smoking.
 Conclusion: A significant relationship was found between low back pain and an advanced age female patient, low economic level, low education level, and smoking.

The effects of active break and postural shift interventions on recovery from and recurrence of neck and low back pain in office workers: A 3-arm cluster-randomized controlled trial

ObjectivesTo investigate the efficacy of active break and postural shift interventions aimed to reduce sitting discomfort on recovery duration and recurrence of neck and low back pain among high-risk office workers. MethodsA 3-arm cluster-randomized controlled trial with 12-month follow-up was conducted in 193 healthy but high-risk office workers. Participants in the intervention groups received custom-designed apparatus to facilitate either active breaks or postural shifts to reduce sitting discomfort at work. Participants in a control group received a placebo seat pad. Incidence of neck and low back pain with pain intensity and disability level was recorded monthly. Main outcome measures were recovery time and recurrent rate of neck and low back pain. Analyses were performed using log rank test and Cox proportional hazard models. ResultsMedian time to recovery in those receiving active break and postural shift interventions (1 month) was significantly shorter than those in the control group (2 months). Neck and low back pain recurrent rates for the active break, postural shift, and control groups were 21%, 18%, and 44%, respectively. Hazard rate (HR) ratios after adjusting for biopsychosocial factors indicated a protective effect of active break and postural shift interventions for neck and low back pain recurrence (HRadj 0.22, 95% CI 0.06–0.83 for active breaks and HRadj 0.35, 95% CI 0.16–0.77 for postural shift). ConclusionActive break and postural shift interventions shortened recovery time and reduced recurrence of neck and low back pain among high-risk office workers.

Durability of the Therapeutic Effect of Restorative Neurostimulation for Refractory Chronic Low Back Pain

ObjectivesThe purpose of the ongoing follow‐up of ReActiv8‐A clinical trial is to document the longitudinal benefits of episodic stimulation of the dorsal ramus medial branch and consequent contraction of the lumbar multifidus in patients with refractory mechanical chronic low back pain (CLBP). We report the four‐year outcomes of this trial.Materials and MethodsReActiv8‐A is a prospective, single‐arm trial performed at nine sites in the United Kingdom, Belgium, and Australia. Eligible patients had disabling CLBP (low back pain Numeric Rating Scale [NRS] ≥6; Oswestry Disability Index [ODI] ≥25), no indications for spine surgery or spinal cord stimulation, and failed conventional management including at least physical therapy and medications for low back pain. Fourteen days postimplantation, stimulation parameters were programmed to elicit strong, smooth contractions of the multifidus, and participants were given instructions to activate the device for 30‐min stimulation‐sessions twice daily. Annual follow‐up through four years included collection of NRS, ODI, and European Quality of Life Score on Five Dimensions (EQ‐5D). Background on mechanisms, trial design, and one‐year outcomes were previously described.ResultsAt baseline (N = 53) (mean ± SD) age was 44 ± 10 years; duration of back pain was 14 ± 11 years, NRS was 6.8 ± 0.8, ODI 44.9 ± 10.1, and EQ‐5D 0.434 ± 0.185. Mean improvements from baseline were statistically significant (p < 0.001) and clinically meaningful for all follow‐ups. Patients completing year 4 follow‐up, reported mean (±standard error of the mean) NRS: 3.2 ± 0.4, ODI: 23.0 ± 3.2, and EQ‐5D: 0.721 ± 0.035. Moreover, 73% of participants had a clinically meaningful improvement of ≥2 points on NRS, 76% of ≥10 points on ODI, and 62.5% had a clinically meaningful improvement in both NRS and ODI and 97% were (very) satisfied with treatment.ConclusionsIn participants with disabling intractable CLBP who receive long‐term restorative neurostimulation, treatment satisfaction remains high and improvements in pain, disability, and quality‐of‐life are clinically meaningful and durable through four years.

To Find out Depression Rate in Common Clinical Condition

Background and Purpose: Depression is a biological based mental illness that can have lastingemotional and physical effects. It frequently goes unrecognized in primary care, but screening has beenshown to increase detection and can lead to improved outcomes when linked to adequate treatment. TheHamilton Rating Scale for Depression has been commonly used for the assessment of depression inclinical practice. A finding of the depression following Stroke, COPD, Neck pain, Back pain and OAknee indirectly affect prognosis of the rehabilitation which is documented in many literatures but howmuch it is affected in particular disease is still controversy. So keeping this in the view the objectiveof the study is to find out depression rate in clinical condition of Stroke, COPD, Neck pain, Back painand OA knee.Method: Thirty patients of subacute and chronic conditions (&gt;3 months of duration) of COPD, Stroke,Back pain, Neck Pain and OA knee in each group were included for the study. The Hamilton Ratingscale for Depression was taken and the patient was categorized as mild, moderate and severe.Result &amp; Conclusion: Prevalence of depression was higher in COPD (21.23 ± 8.21(SD)) and Stroke(19.53± 7.54 (SD)) patients compared to other clinical condition whereas severely depressed patientswere found in COPD and Back pain (19.53± 7.54 (SD)) groups.

Evaluation of questionnaire in assessment of low back pain and disability and find correlation between disability score, clinical features and imaging findings

Introduction: To evaluate the utility of a questionnaire in assessment of low back pain and disability and the correlation between disability score, clinical features and imaging findings in patients with low back pain. Methodology: Here, we included 25 consecutive patients with duration of low back pain for 1 month who were not responding to conservative OPD treatment, and also had no reason to suspect any underlying organic disease. Each patient was analyzed on the basis of history and physical examination and a base line X-ray was taken. Results: Here, mean age of patients is 39.8 years with female predominance. According to Q-score there are 13 out of 25 patients are of modrate category, 11 in severe cateogory and rest in extreme category. We further divide these patients into 2 types i.e concavity right side and concavity left side. There are 5 patient of former category and 1 of later. Conclusion: A back-pain questionnaire should be designed and framed according to the life style of the patient i.e. if the patient cannot read or understand the questionnaire than it should be framed in the local language and should be read by investigator. Clinical examination is also an important tool for assessment of patients especially to support and exclude destructive and compressive lesions and also neurological diseases.

Outcome of Posterior Lumbar Interbody Fusion for Degenerative Lumbar Spine Spondylolisthesis in a Neurosurgical Centre in Nigeria

Introduction: Posterior lumbar interbody fusion (PLIF) is one of the options for the management of lumbar spine instability and is being increasingly used in Nigeria. The aim of the study is to assess the outcome of cases managed with PLIF in Enugu, Nigeria. Methods: Retrospective analysis of all patients that had PLIF for degenerative lumbar spine spondylolisthesis from the year 2016 to 2019 at a single centre the interbody fusion device was polyetheretherketone cage loaded with autologous bone graft. All patients presented with severe low back pain. Patients operated for traumatic spondylolisthesis and those managed with pedicle screw fixation alone were excluded. Patients were followed up for at least one year. The outcome was assessed using Japanese Orthopedic Association (JOA) scoring for back pain, visual analog score (VAS), fusion rate, and the 5-point patient-reported improvement scale. Results: A total of 57 patients were analyzed. The mean age was 56.5 ± 7.4 years and the mean duration of back pain was three years (1–15 years). The mean preoperative VAS was 7.9 ± 1.1, while the postoperative VAS score was 3.3 ± 1.7. The JOA scores before surgery and at least 12 months post-surgery were 12.9 ± 2.8 and 22.9 ± 4.9, respectively. The patient recovery rate was 63.3%. A satisfactory outcome was noted in 82.8% of patients, post-surgery. The average fusion rate postsurgery was 88%. The most common postoperative complication was cerebrospinal fluid leak (8.8%). Four obese patients had implant-related complications. Conclusion: PLIF for degenerative spine disease is associated with significant improvement in preoperative back pain and neurological outcome. It is also associated with good fusion, recovery, and patient-reported improvement.

Surgeons preference for lumbar disk surgery: a discrete choice experiment

PurposeMultiple surgical techniques are practiced to treat sciatica caused by lumbar disk herniation. It is unknown which factors surgeons find important when offering certain surgical techniques. The objective of this study is threefold: 1) determine the relative weight surgeons place on various characteristics of sciatica treatment, 2) determine the trade-offs surgeons make between these characteristics and 3) identify preference heterogeneity for sciatica treatment.MethodsA discrete choice experiment was conducted among members of two international neurosurgical organizations. Surgeons were asked on their preferences for surgical techniques using specific scenarios based on five characteristics: effectiveness on leg pain, risk of recurrent disk herniation, duration of postoperative back pain, risk of complications and recovery period.ResultsSix-hundred and forty-one questionnaires were filled in, the majority by neurosurgeons. All characteristics significantly influenced the preferences of the respondents. Overall, the risk of complications was the most important characteristic in the decision to opt-in or opt-out for surgery (35.7%). Risk of recurrent disk herniation (19.6%), effectiveness on leg pain (18.8%), postoperative back pain duration (13.5%) and length of recovery period (12.4%) followed. Four latent classes were identified, which was partly explained by the tenure of the surgeon. Surgeons were willing to trade-off 57.8% of effectiveness on leg pain to offer a treatment that has a 1% complication risk instead of 10%.ConclusionIn the context of this discrete choice experiment, it is shown that neurosurgeons consider the risk of complications as most important when a surgical technique is offered to treat sciatica, while the risk of recurrent disk herniation and effectiveness are also important factors. Neurosurgeons were prepared to trade off substantial amounts of effectiveness to achieve lower complication rates.

'Reassurance and healthcare seeking in people with persistent musculoskeletal low back pain consulting orthopaedic spine practitioners: A prospective cohort study'.

Guidelines recommend self-management for most people living with persistent musculoskeletal low back pain (PMLBP) when surgery is ruled out. Conveying this message to patients can be challenging. This study examined patients' perceptions of reassuring communications from surgical spine team practitioners attempting to deliver this message in a single consultation. Pre-consultation baseline measures included levels of pain, disability and previous consultation history. Patients' perceptions of reassuring communications were measured within 1-week post-consultation. The outcome variables, measured at 3-month follow-up, included patients' report of subsequent GP visits for back pain, the number of other healthcare providers consulted for back pain and distress. Data from 296 patients (9.8% loss to follow-up) were analysed using hierarchical regression models, controlling for demographic, clinical and study-related factors. In each model, perceived reassurance accounted for a small but significant variance, above and beyond other predictors. Further GP visits were predicted by disability at baseline and perceived reassurance (adjusted R2 of 14.6%). Subsequent consultations with any healthcare professionals were predicted by a shorter duration of back pain, disability at baseline and perceived reassurance (adj. R2 =10.6%). Distress was predicted by older age, disability and reassurance (adj. R2 =59.5%). Findings suggest that better communication in consultations with orthopaedic spine clinicians might help reduce unnecessary subsequent healthcare utilization and distress. Low back pain patients' perceptions of their communication with orthopaedic spine practitioners are associated with subsequent healthcare seeking and distress at follow-up. This study examines the intersection of two important but fairly neglected areas in the pain research: provider communication and patient healthcare utilization.

Psychological Profile of Patients with Chronic Low Back Pain

&#x0D; &#x0D; &#x0D; &#x0D; OBJECTIVES:&#x0D; To assess the frequency of depression, anxiety, and stress in patients with Chronic Low Back Pain (CLBP) using Depression Anxiety Stress Scale (DASS-42).&#x0D; METHODOLOGY:&#x0D; This descriptive study was performed from January 2019 to June 2019. All those patients with chronic low back pain with duration of more than 6 months were included. Patients below 20 and above 60 years were excluded to eliminate the effect of extreme ages. The Depression Anxiety Stress Scale (DASS-42) was used in this study.&#x0D; RESULTS:&#x0D; In this study, a total of 127 patients were successfully interviewed. The mean age of the sample was 36.46 (SD±7.38) with a minimum age of 22 years and maximum of 59 years. Out of these 127 patients, 83 (65.4%) were female while 44 (34.6%) were male patients. The minimum duration of chronic low back pain in our patients was 8 months while the maximum was 55 months with a mean of 28 months (SD 9.9). The mean DASS score for depression was 11.8 (SD±4.23), anxiety was 7.5 (SD±2.9), stress was 12.1 (SD±4.0). Similarly, both genders had equal level of depression and anxiety but females were more experiencing the stress. &#x0D; CONCLUSION:&#x0D; Abnormal levels of stress anxiety and depression are a common finding in our population with CLBP &#x0D; &#x0D; &#x0D; &#x0D;

Effect of the duration of chronic low back pain on pain sensitivity of patients undergoing lumbar fusion surgery

Background: chronic low back pain is a serious social problem. In recent years, patients who choose lumbar fusion surgery due to chronic low back pain has been increasing. Pre-existing chronic pain has been associated with severe postoperative pain. In this study, we have sought to prospectively analyze the association between the duration of chronic low back pain and pain sensitivity after lumbar fusion surgery. Methods: 400 patients who underwent lumbar fusion surgery were divided into three groups based on the duration of chronic pain. During the first postoperative day, the maximum pain scores of each patient day and night, the pain scores at the day of discharge, the consumption of postoperative analgesics and the length of hospital stay were recorded. Results: of 400 patients recruited, 369 patients completed the experiment. There was no significant difference in gender, age, height, weight, pre-operative pain at rest, and operation time in the three groups. During the day, the pain sensitivity of the three groups were 1.71 ± 0.66, 2.40 ± 0.74, 2.90 ± 0.80. During the night, the pain sensitivity of the three groups were 3.45 ± 0.81, 4.31 ± 1.06, 4.86 ± 1.05. At the day of discharge, the pain sensitivity of three groups were 1.26 ± 0.46, 1.47 ± 0.58, 1.96 ± 0.64. There were significant differences in pain sensitivity among the three groups during the day and night on the first postoperative day and at the day of discharge (p &lt; 0.05). The length of hospital stay (7.31 ± 1.36 days, 8.82 ± 1.48 days, 9.60 ± 1.61 days) and analgesic consumption (25.04 ± 36.56 mg, 33.52 ± 24.04 mg, 45.15 ± 24.89 mg, morphine equivalent) were also significant differences (p &lt; 0.05). Conclusion: we found the duration of chronic low back pain before lumbar fusion surgery affects patient’ postoperative pain sensitivity, consumption of analgesic drugs and hospital stay. The longer the preoperative chronic pain lasts, the higher the postoperative VAS score is, the more analgesic drugs were consumed, and the longer hospital stay is.

The Effect of Vertebral Augmentation Procedure on Painful OVCFs: A Meta-Analysis of Randomized Controlled Trials.

Study Design:Meta-analysis.Objective:To systematically compare the effectiveness and safety of vertebral augmentation procedure (VAP) with non-surgical management (NSM) for the treatment of osteoporotic vertebrate compression fractures (OVCFs).Methods:Systematic reviews and meta-analyses with the comparison between VAP and NSM were identified to extract randomized controlled trials from electronic database. Additionally, recently published RCTs were identified. Two researchers independently extracted the data. The primary outcome of this meta-analysis was pain relief evaluated by visual analogue scale (VAS).Results:Twenty RCTs involving 2566 patients with painful OVCFs were included. Significant differences were found between percutaneous vertebroplasty (PVP) and conservative treatment (CT) in VAS at each time point during follow-up period. The differences of VAS were not significant between PVP and sham procedure at most time points during follow-up period. In subgroup analysis based on fracture type and fracture location, significant differences of VAS were found between PVP and CT and were not found between PVP and sham procedure. In subgroup analysis of duration of back pain, significant differences were found between PVP and CT in VAS at 1 week, 3 month and 1 year. And the differences of VAS were not significant between PVP and CT at 1 month and 6 month.Conclusion:BKP is considered sufficient to achieve good clinical outcomes. PVP is associated with on beneficial effect on treatment of painful OVCFs compared with sham procedure. The indication and timing of VAP need further research. More independently high-quality RCTs with sufficiently large sample sizes reporting cost-effectiveness are needed.

An 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality Program for Chronic Low Back Pain: Double-Blind, Randomized, Placebo-Controlled Trial Conducted During COVID-19.

BackgroundChronic low back pain is the most prevalent chronic pain condition worldwide and access to behavioral pain treatment is limited. Virtual reality (VR) is an immersive technology that may provide effective behavioral therapeutics for chronic pain.ObjectiveWe aimed to conduct a double-blind, parallel-arm, single-cohort, remote, randomized placebo-controlled trial for a self-administered behavioral skills-based VR program in community-based individuals with self-reported chronic low back pain during the COVID-19 pandemic.MethodsA national online convenience sample of individuals with self-reported nonmalignant low back pain with duration of 6 months or more and with average pain intensity of 4 or more/10 was enrolled and randomized 1:1 to 1 of 2 daily (56-day) VR programs: (1) EaseVRx (immersive pain relief skills VR program); or (2) Sham VR (2D nature content delivered in a VR headset). Objective device use data and self-reported data were collected. The primary outcomes were the between-group effect of EaseVRx versus Sham VR across time points, and the between–within interaction effect representing the change in average pain intensity and pain-related interference with activity, stress, mood, and sleep over time (baseline to end-of-treatment at day 56). Secondary outcomes were global impression of change and change in physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, pain medication use, and user satisfaction. Analytic methods included intention-to-treat and a mixed-model framework.ResultsThe study sample was 179 adults (female: 76.5%, 137/179; Caucasian: 90.5%, 162/179; at least some college education: 91.1%, 163/179; mean age: 51.5 years [SD 13.1]; average pain intensity: 5/10 [SD 1.2]; back pain duration ≥5 years: 67%, 120/179). No group differences were found for any baseline variable or treatment engagement. User satisfaction ratings were higher for EaseVRx versus Sham VR (P<.001). For the between-groups factor, EaseVRx was superior to Sham VR for all primary outcomes (highest P value=.009), and between-groups Cohen d effect sizes ranged from 0.40 to 0.49, indicating superiority was moderately clinically meaningful. For EaseVRx, large pre–post effect sizes ranged from 1.17 to 1.3 and met moderate to substantial clinical importance for reduced pain intensity and pain-related interference with activity, mood, and stress. Between-group comparisons for Physical Function and Sleep Disturbance showed superiority for the EaseVRx group versus the Sham VR group (P=.022 and .013, respectively). Pain catastrophizing, pain self-efficacy, pain acceptance, prescription opioid use (morphine milligram equivalent) did not reach statistical significance for either group. Use of over-the-counter analgesic use was reduced for EaseVRx (P<.01) but not for Sham VR.ConclusionsEaseVRx had high user satisfaction and superior and clinically meaningful symptom reduction for average pain intensity and pain-related interference with activity, mood, and stress compared to sham VR. Additional research is needed to determine durability of treatment effects and to characterize mechanisms of treatment effects. Home-based VR may expand access to effective and on-demand nonpharmacologic treatment for chronic low back pain.Trial RegistrationClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177International Registered Report Identifier (IRRID)RR2-10.2196/25291

CT-Guided Needle Biopsy in Vertebral Osteomyelitis: Study of Factors That Could Influence in Culture Yield

The aim of this study was to analyze which are the main factors that could influence the result of a CT guided biopsy in vertebral osteomyelitis (VO) patients. A single center retrospective observational study was performed including adult patients who had been diagnosed with VO and undergone CT guided needle biopsy from January 2010 to January 2020. Demographical features, concurrent diseases, laboratory findings, microbiological diagnosis, radiological data, medical complications, antibiotic exposure were compiled. Multivariate analysis was performed with a logistic regression comparing the patients depending on the culture result. Seventy-seven patients were included in the study. Baseline characteristics were comparable between groups. Sample culture was positive in 43 cases (56%). Microorganism isolated were gram + (72%), gram − (14%), mycobacteria (7%) and fungi (7%). Delay in the procedure, antibiotic exposure and blood culture positivity were also similar among both groups. The biopsy results were not influenced by the CRP value, the presence of fever nor antibiotic exposure. The longer duration of back pain was associated to a lower probability of a positive culture. In conclusion, our study displays an acceptable reliability of CT guided needle biopsy in VO patients, even in cases under antibiotic treatment. The presence of fever or CRP values did not predict a positive culture. Delay in diagnosis could impact negatively on culture yield. El propósito del presente estudio es analizar qué factores pueden influir en el resultado del cultivo de las muestras obtenidas por punción guiada por TC en pacientes con osteomielitis vertebral. Se realizó un estudio en un único centro, retrospectivo y observacional en pacientes diagnosticados de osteomielitis vertebral, que fueron subsidiarios de punción-biopsia entre enero de 2010 y enero de 2020. Se recogieron para su análisis, variables demográficas, comorbilidades, resultados de laboratorio, radiología, el tratamiento previo con antibióticos y la demora previa a la realización de la técnica. Se realizó un análisis multivariante mediante regresión logística. Se incluyó a un total de 77 pacientes que fueron sometidos a la técnica. Sus características basales fueron similares. El cultivo fue positivo en 43 casos (56%). Los microorganismos aislados fueron gram + (72%), gram – (14%), micobacterias (7%) y hongos (7%). El retraso en la ejecución de la técnica y el tratamiento previo con antibióticos fue similar en ambos grupos. Ni el valor de PCR, la presencia de fiebre ni la antibioterapia tuvieron influencia en el resultado del cultivo. Se observó que una mayor duración del dolor lumbar se relacionó con una menor probabilidad de obtener un resultado positivo en el cultivo. Incluso bajo exposición antibiótica, la punción asistida por TC mostró una rentabilidad aceptable. La presencia de fiebre o valores elevados de PCR no fueron predictivos de positividad del cultivo. El retraso diagnóstico sí podría impactar negativamente en la rentabilidad diagnóstica del cultivo procedente de la biopsia.

Exploring the origin of pain subclassification, with emphasis on low back pain: a scoping review.

This scoping review aimed to explore the different working definitions for the duration of acute, subacute, and chronic pain, with emphasis on low back pain, and to establish where these definitions originated and the rationale provided for the time frames used. From a global perspective, low back pain is a major social and economic problem. One of the most commonly used methods to stratify and manage low back pain is the traditional duration-based classification (acute, subacute, and chronic). Where these time points lie to differentiate these transitions continues to be debated within the scientific community, which may engender a degree of heterogeneity in study findings. Therefore, applying these findings to clinical practice may be somewhat challenging. This review encapsulates the historical origins of the different duration categories to provide an understanding of how these variations were derived. Studies that included participants with low back pain were the focus of this review. Sources that included children or other specific pain pathologies, such as cancer pain, were excluded. The main concept of interest was that the publication proposed an original definition of the duration of acute, subacute, or chronic low back pain. All study designs were included provided they gave a rationale for the duration that they used. The following databases were searched: MEDLINE, Embase, CINAHL, and PsycINFO, from the inception of each database until September 18, 2019. This review was limited to studies published in English. Two independent reviewers screened the retrieved articles against the eligibility criteria. Additional studies were searched from the reference lists of studies to find the original source. Some original sources overlapped with general pain duration literature. This led to a deviation from the scoping review protocol, which originally intended to focus on definitions of low back pain duration only. Data extraction was undertaken using a charting table developed specifically for the review objectives. The findings were presented using narrative synthesis. Nineteen records were included in this review, and comprised three book chapters, four review articles, four articles that arose following pain expert group discussions, seven primary research studies, and a spinal guideline. Data were extracted from the included studies and categorized into four themes based on the origin of the classification of the duration. The themes included i) work/employment setting, ii) empirical studies, iii) expert reasoning, and iv) pathophysiological explanation. This scoping review compiled the existing literature on the working definitions of the duration of acute, subacute, and chronic low back pain and found a wide variation. These ranged from seven days, 14 days, and seven weeks for the acute and subacute transition points, and seven weeks to three years for chronic low back pain. The duration definitions specifically referring to the general pain literature focused on three and/or six months for the transition to chronic. Better integration of reasoning between the identified themes could facilitate the establishment of more ideal duration definitions in the future. Although inconclusive, the definition most commonly cited, with most consensus, was three months for the transition to chronic low back pain.

Comparison of proforma based history taking with descriptive history taking in the evaluation of low back pain: A hospital based study

Background: Lower back pain is the most common disorder in the population. It affects the both gender. Evaluation of lower back is the can be done with various methods. The present study aimed to compare the Proforma based history taking with descriptive history taking in the evaluation of low back pain. Materials and Methods: This study was done in the Department of Orthopedic Surgery, SUT Academy of Medical Sciences, Vattapara, Kerala. Based on the inclusion and exclusion criteria 105 patients were included in the study. Study procedure was explained to each patient and informed consent was obtained. All the patients demographic, clinical data was recorded. Each patient was given set of questions to fill. After filling they were subjected to physical and clinical examination. Both the results were analyzed with SPSS (16.0) version software. The data was expressed in number and percentage. Results: Males were more compared to females. 40 patients have age between 21-30 years and only 8 have age between 61-70 years. 57 give history of acute on set of pain. 53.33% had 3 weeks -3 months duration of lower back pain. 65.89% had radiation type of pain and 53.33% had pain due to stress. In the diagnosis of pain pattern 50 showed mechanical and 48 showed non-specific in MIND questionnaire. 80% patients had concurrence of diagnosis. Conclusion: The MIND questionnaire has been shown to provide a rapid and comprehensive proforma to evaluate low back pain patterns.