Chronic Back Pain Intensity Research Articles

Effect of craniosacral therapy on the intensity of chronic back pain of nurses: A randomized controlled trial

Background & Aim: Chronic low back pain is a common disease among nurses. According to the literature, complementary medicine can reduce low back pain, one of which is craniosacral therapy. This study was designed to investigate the effect of craniosacral therapy on the intensity of chronic back pain of nurses. Methods & Materials: This randomized clinical trial study was conducted on 60 nurses with chronic back pain. The participants were randomly assigned into intervention and control groups. The intervention group’s participants received eight individual sessions of craniosacral therapy. In the control group, a light-touch in the lumbar region was performed as a placebo. The therapist met each participant separately in a private room of the hospital. The two groups completed the McGill Pain Questionnaire at the baseline, immediately after the intervention, and one month after the intervention. The collected data was analyzed in SPSS (v.16) using descriptive and analytical tests such as t-test, Chi-Square, ANCOVA, and repeated measures ANOVA. Results: The ANCOVA test results showed a significant difference between the two groups’ mean scores of pain intensity and its subscales (P<0.05). The results of repeated measures ANOVA showed that the mean scores of pain intensity and its subscales (sensory, affective, pain evaluation, and miscellaneous) decreased over the three time points in the intervention group (P<0.05). Conclusion: The findings affirmed the positive effects of the craniosacral therapy on the intensity of pain in nurses with chronic back pain. Therefore, it is recommended that this approach be performed as a complementary, effective, non-invasive intervention to decrease chronic back pain.

Cupping therapy and chronic back pain: systematic review and meta-analysis.

ABSTRACTObjectives:to evaluate the evidence from the literature regarding the effects of cupping therapy on chronic back pain in adults, the most used outcomes to evaluate this condition, the protocol used to apply the intervention and to investigate the effectiveness of cupping therapy on the intensity of chronic back pain. Method:systematic review and meta-analysis carried out by two independent researchers in national and international databases. Reference lists of systematic reviews were also explored. The quality of evidence was assessed according to the Jadad scale. Results:611 studies were identified, of which 16 were included in the qualitative analysis and 10 in the quantitative analysis. Cupping therapy has shown positive results on chronic back pain. There is no standardization in the treatment protocol. The main assessed outcomes were pain intensity, physical incapacity, quality of life and nociceptive threshold before the mechanical stimulus. There was a significant reduction in the pain intensity score through the use of cupping therapy (p = 0.001). Conclusion:cupping therapy is a promising method for the treatment of chronic back pain in adults. There is the need to establish standardized application protocols for this intervention.

Studying the Effect of Relaxation Training on Chronic Low Back Pain Intensity and Daily Functioning in the Elderly

Relaxation is a natural blessing & everyone can activate it. Medical science has recently linked psychological speculations with physiological & measurable information. The present research aims to analyze the effect of relaxation training on the intensity of chronic back pain & daily functioning of the elderly. This study is applied in terms of goal using semiexperimental (quasi-empirical) method with pre-test & post-test design. The statistical community consists of all old people staying in Sari-based Saraye Mehr nursing home in 2013 including 117 ones .To select the sample, simple random sampling method has been conducted. Thus one class has been chosen for performing the training method employing relaxation (30 individuals) & the other for performing traditional training (30 individuals).The measuring tool has been pain intensity standard scale (VAS) & health assessment questionnaire (HAQ).In order to analyze the data, descriptive statistics method (calculating mean & standard deviation) & inferential statistics (covariance analysis test) have been employed via SPSS software. The findings indicated that training relaxation results in reducing the orderly's chronic backache intensity. Also, training relaxation brings about increasing basic & average daily activities in the aged. Relaxation is of the methods used for lowering pain intensity & increasing the efficiency of the individuals in societies .Therefore, simultaneously using medical & pharmaceutical approaches, self-discovery, and mind-body interaction methods in treatment process can lead to optimal effects.

EEG and Functional MRI on Back Pain

Pain is a major health care problem worldwide. It affects the well-being of millions of individuals, and its financial burden upon our societies is considerable.1 Back pain (BP) is a particularly substantial health problem. It affects up to 70% of the adult population, and poses a considerable health care and socioeconomic burden. The diagnosis, evaluation, and treatment of BP is a major challenge, which leads to the limited effectiveness for the most commonly applied interventions and approaches.2 Evidence showing significant changes within the brain in chronic BP patients indicated that BP may be accompanied by cognitive abnormalities3 brain chemical changes,4 and cortical reorganization or degeneration.5 In recent years, this has been investigated using both advanced neuroimaging and electrophysiology. The advent of modern neuroimaging and electrophysiological techniques has enabled researchers to examine the pain processing network. There is important evidence that local cerebral blood flow (CBF) changes reflect variations in local synaptic activity, as measured using positron emission tomography (PET).6,7 This dramatic change in blood flow during neuronal activity is also detected using functional magnetic resonance imaging (fMRI), in which signal changes reflect alteration in local CBF and, more specifically, variations in the ratio of deoxyhemoglobin to oxyhemoglobin (termed blood oxygenation level dependent [BOLD] contrast). The BOLD fMRI, which has been widely successful in brain functional research, is based on the biological mechanism that neurovascular coupling exists between neuronal activity and the cerebral vascular response. Using a type of BOLD fMRI that shows when certain parts of the brain are activated, Wager et al recently addressed the critical question of the existence of a specific brain activity pattern for heat pain.8 The authors assessed this question in a rigorous and systematic approach. Their research leads to more objective assessments of pain. In addition to fMRI neural image technology, electroencephalography (EEG) is a more practical and cost effective technology to investigate the brain activity, which is generated by the firing of neurons within the brain.9 EEG is a direct measurement of neuronal activity with a sampling frequency as high as dozens of kHz (e.g., short-latency somatosensory evoked potentials),10,11 thus resulting in extremely high temporal resolution (only a tenth of a millisecond). Recently, we developed a new method to achieve robust single-trial estimate of even smaller ERP components.12 More advanced single-trial approaches, which make use of the temporal, frequency, and spatial information of multichannel EEG recordings based on this approach, will be developed to detect single-trial parameters and brain network accurately and reliably. In this new method, we may investigate those pain-related EEG features for specific EEG signature of pain perception, which may be used for objective and quantitative assessment for BP. Disclosure of Interest None declared References Brooks J, Tracey I. From nociception to pain perception: imaging the spinal and supraspinal pathways. J Anat 2005;207(1):19–33 Papageorgiou AC, Rigby AS. Review of UK data on the rheumatic diseases—7. Low back pain. Br J Rheumatol 1991;30(3):208–210 Giesecke T, Gracely RH, Grant MA, et al. Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis Rheum 2004;50(2):613–623 Baliki MN, Chialvo DR, Geha PY, et al. Chronic pain and the emotional brain: specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain. J Neurosci 2006;26(47):12165–12173 Wand BM, O’Connell NE. Chronic non-specific low back pain - sub-groups or a single mechanism? BMC Musculoskelet Disord 2008;9:11 Apkarian AV, Bushnell MC, Treede RD, Zubieta JK. Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain 2005;9(4):463–484 Disbrow E, Baron R, Baron Y. Examination of the role of the cerebral cortex in the perception of pain using functional magnetic resonance imaging. Curr Rev Pain 1999;3(4):281–290 Wager TD, Atlas LY, Lindquist MA, Roy M, Woo CW, Kross E. An fMRI-based neurologic signature of physical pain. N Engl J Med 2013;368(15):1388–1397 Niedermeyer E, Lopes da Silva FH. Electroencephalography: basic principles, clinical applications, and related fields. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005 Inoue K, Hashimoto I, Nakamura S. High-frequency oscillations in human posterior tibial somatosensory evoked potentials are enhanced in patients with Parkinson's disease and multiple system atrophy. Neurosci Lett 2001;297(2):89–92 Ozaki I, Suzuki C, Yaegashi Y, Baba M, Matsunaga M, Hashimoto I. High frequency oscillations in early cortical somatosensory evoked potentials. Electroencephalogr Clin Neurophysiol 1998;108(6):536–542 Hu L, Mouraux A, Hu Y, Iannetti GD. A novel approach for enhancing the signal-to-noise ratio and detecting automatically event-related potentials (ERPs) in single trials. Neuroimage 2010;50(1):99–111

Effects of eye movement desensitization and reprocessing (EMDR) on non-specific chronic back pain: a randomized controlled trial with additional exploration of the underlying mechanisms

BackgroundNon-specific chronic back pain (CBP) is often accompanied by psychological trauma, but treatment for this associated condition is often insufficient.Nevertheless, despite the common co-occurrence of pain and psychological trauma, a specific trauma-focused approach for treating CBP has been neglected to date. Accordingly, eye movement desensitization and reprocessing (EMDR), originally developed as a treatment approach for posttraumatic stress disorders, is a promising approach for treating CBP in patients who have experienced psychological trauma.Thus, the aim of this study is to determine whether a standardized, short-term EMDR intervention added to treatment as usual (TAU) reduces pain intensity in CBP patients with psychological trauma vs. TAU alone.Methods/designThe study will recruit 40 non-specific CBP patients who have experienced psychological trauma. After a baseline assessment, the patients will be randomized to either an intervention group (n = 20) or a control group (n = 20). Individuals in the EMDR group will receive ten 90-minute sessions of EMDR fortnightly in addition to TAU. The control group will receive TAU alone. The post-treatment assessments will take place two weeks after the last EMDR session and six months later.The primary outcome will be the change in the intensity of CBP within the last four weeks (numeric rating scale 0–10) from the pre-treatment assessment to the post-treatment assessment two weeks after the completion of treatment.In addition, the patients will undergo a thorough assessment of the change in the experience of pain, disability, trauma-associated distress, mental co-morbidities, resilience, and quality of life to explore distinct treatment effects. To explore the mechanisms of action that are involved, changes in pain perception and pain processing (quantitative sensory testing, conditioned pain modulation) will also be assessed.The statistical analysis of the primary outcome will be performed on an intention-to-treat basis. The secondary outcomes will be analyzed in an explorative, descriptive manner.DiscussionThis study adapts the standard EMDR treatment for traumatized patients to patients with CBP who have experienced psychological trauma. This specific, mechanism-based approach might benefit patients.Trial registrationThis trial has been registered with ClinicalTrials.gov (NCT01850875).

Chronic Pain and the Emotional Brain: Specific Brain Activity Associated with Spontaneous Fluctuations of Intensity of Chronic Back Pain

Living with unrelenting pain (chronic pain) is maladaptive and is thought to be associated with physiological and psychological modifications, yet there is a lack of knowledge regarding brain elements involved in such conditions. Here, we identify brain regions involved in spontaneous pain of chronic back pain (CBP) in two separate groups of patients (n = 13 and n = 11), and contrast brain activity between spontaneous pain and thermal pain (CBP and healthy subjects, n = 11 each). Continuous ratings of fluctuations of spontaneous pain during functional magnetic resonance imaging were separated into two components: high sustained pain and increasing pain. Sustained high pain of CBP resulted in increased activity in the medial prefrontal cortex (mPFC; including rostral anterior cingulate). This mPFC activity was strongly related to intensity of CBP, and the region is known to be involved in negative emotions, response conflict, and detection of unfavorable outcomes, especially in relation to the self. In contrast, the increasing phase of CBP transiently activated brain regions commonly observed for acute pain, best exemplified by the insula, which tightly reflected duration of CBP. When spontaneous pain of CBP was contrasted to thermal stimulation, we observe a double-dissociation between mPFC and insula with the former correlating only to intensity of spontaneous pain and the latter correlating only to pain intensity for thermal stimulation. These findings suggest that subjective spontaneous pain of CBP involves specific spatiotemporal neuronal mechanisms, distinct from those observed for acute experimental pain, implicating a salient role for emotional brain concerning the self.

The effectiveness of calcitonin on chronic back pain and daily activities in postmenopausal women with osteoporosis

The aim of this study was to investigate the effect of nasal calcitonin on chronic back pain and disability attributed to osteoporosis. The study design involved three groups of osteoporotic postmenopausal women suffering from chronic back pain. Group I consisted of 40 women with vertebral fractures, group II of 30 women with degenerative disorders and group III of 40 patients with non specific chronic back pain and without abnormality on plain X-rays. Pain intensity was measured using a numerical rating scale (NRS) and disability due to back pain was measured using the Oswestry disability questionnaire. The patients were randomly assigned to receive, for three months, either 200 IU intranasal salmon calcitonin and 1,000 mg of oral calcium daily (groups IA, IIA, IIIA) or 1,000 mg of oral calcium daily (groups IB, IIB, IIIB). Repeated measures ANOVA showed that there were no significant time, group or interaction effects for pain intensity and disability in any of the groups studied. Mean Oswestry and NRS scores were reduced during the follow-up period in the groups IA, IIIA, but the differences between the two time points were not statistically significant. Intranasal calcitonin has no effect on chronic back pain intensity and functional capacity of osteoporotic women regardless of the presence of fractures, degenerative disorders or chronic back pain of non-specific etiology.