Management Of Low Back Pain Research Articles

Effectiveness of telerehabilitation-based mckenzie method versus manual therapy in low-back pain management: a randomised controlled trial

Abstract Background Studies comparing the effectiveness of telerehabilitation and spinal manual therapy (SMT) for chronic non-specific low-back pain (NSLBP) are limited. This study aimed to compare the efficacy of the telerehabilitation-based McKenzie therapy (TBMT) and SMT among patients with NSLBP. Methods Forty-nine consenting patients randomised into either TBMT (n = 28) or SMT (n = 21) group completed the study. TBMT is a mobile phone-based telerehabilitation involving the ‘McKenzie extension protocol’. SMT is a grade II (10 oscillations) posterior-anterior central vertebral pressure on the offending spinous process. Both interventions were applied thrice weekly for eight weeks, and outcomes were assessed on Pain Intensity (PI), Activity Limitation (AL), Participation Restriction (PR), and Health-related Quality of Life (HRQoL) in the fourth and eighth weeks. Results Within-group comparison across baseline, 4th and 8th week indicate that SMT had a significant effect on PI (F = 132.804, p = 0.001), AL (F = 75.984, p = 0.001), PR (F = 99.428, p = 0.001) and for all the scales of SF-12 except for mental health domain (p > 0.05). Similarly, TBMT had a significant effect on PI (F = 243.631; p = 0.001), AL (F = 85.930; p = 0.001), PR (F = 48.425; p = 0.001), and for all the scales except also for mental health domain (p > 0.05). However, there were no significant differences (p > 0.05) in the treatment effects between SMT and TBMT, except for the ‘health perception’ (p = 0.045) scale at week four and the ‘mental health’ scale (p = 0.023) at week eight. Conclusion Telerehabilitation-based McKenzie method and SMT are effective in chronic NSLBP, with TBMT leading to significantly higher long-term health perception improvement. Trial Registration Pan African Clinical Trial Registry (PACTR202010667228786), Registered 27 October 2020-Retrospectively registered.

Toward facilitating the collection and utilization of patient-reported outcomes in the Military Health System: Lessons learned from a pragmatic clinical trial on physical therapy management for low back pain.

Toward facilitating the collection and utilization of patient-reported outcomes in the Military Health System: Lessons learned from a pragmatic clinical trial on physical therapy management for low back pain.

Stepping towards relief: a scoping review on the impact of unstable footwear in chronic low back pain management.

Chronic low back pain (CLBP) is a prevalent condition causing significant disability worldwide. Traditional treatments often have limited effectiveness, prompting research into alternative, non-invasive interventions. This review examines the impact of unstable footwear on CLBP management, exploring its potential to reduce pain and disability. We analyzed randomized controlled trials focusing on adults with CLBP. Studies comparing unstable footwear to standard care or conventional footwear were included. Main outcomes measured were pain reduction, functional improvement, and biomechanical changes. Methodological quality was assessed using the PEDro scale. Five studies met the inclusion criteria, showing a consistent trend towards pain reduction in participants using unstable footwear. Specifically, intervention groups reported significant improvements in pain levels and, in some cases, disability scores compared to control groups. However, findings on functional performance and long-term effects were mixed, with no significant differences in certain studies. Methodological quality varied, with an estimated PEDro score range of 6-7 across the reviewed studies. Unstable footwear may offer a beneficial non-invasive intervention for individuals with CLBP, contributing to pain reduction and possibly improving disability. Nonetheless, the evidence is tempered by methodological limitations and the need for further research. Future studies should focus on long-term outcomes, larger sample sizes, and clarifying the mechanisms behind the observed benefits. Clinicians should consider unstable footwear as part of a personalized treatment plan for CLBP, keeping abreast of new research to inform their practice.

Non-Invasive Therapeutic Approaches for Mechanical Low Back Pain: An Integrative Systematic Review

Background: Mechanical low back pain (LBP) is one of the most prevalent musculoskeletal conditions, affecting a significant portion of the global population at some point in their lives. It is characterized by pain in the lumbar region without an obvious inflammatory or infectious origin, typically exacerbated by movement, posture, or mechanical load. LBP, whether acute, subacute, or chronic, is a leading cause of temporary and permanent disability, with significant economic repercussions due to lost workdays and healthcare costs. Recent clinical guidelines, such as those from the American College of Physicians (ACP) and the National Institute for Health and Care Excellence (NICE), emphasize the importance of non-invasive interventions for managing mechanical LBP, particularly in acute and chronic cases. In this context, this systematic review aims to consolidate current evidence on available therapeutic interventions, focusing on non-invasive treatments. Objective: To evaluate the available evidence on non-invasive therapeutic interventions for the treatment of mechanical low back pain. The review aims to synthesize international clinical guideline recommendations and identify the most effective practices for reducing pain and improving functional outcomes. Methods: This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Randomized controlled trials, systematic reviews, and clinical guidelines published up to 2023 addressing the management of mechanical low back pain in adults were included. Databases such as PubMed, Cochrane Library, and grey literature sources, including guidelines from medical societies, were searched. The study selection process followed strict eligibility criteria, including publications in English and Portuguese focused on non-invasive treatments for LBP. The methodological quality of the studies was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool. A total of 15 studies met the inclusion criteria, covering a range of non-invasive interventions such as physical therapy, exercise, acupuncture, manual therapy, and pharmacological approaches. Results: Evidence suggests that exercise-based interventions, particularly programs focused on muscle strengthening and stretching, are effective in reducing pain and improving functional outcomes in patients with mechanical LBP. Manual therapies and acupuncture also demonstrated benefits, albeit with less robust evidence. Reviewed guidelines recommend caution in the use of pharmacological interventions, such as nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in chronic cases. Conclusion: This review highlights that non-invasive therapies, especially supervised exercise programs, represent the most effective and safe treatment for mechanical low back pain. The revised international guidelines reinforce the importance of avoiding early invasive interventions, except in cases of persistent or refractory pain. Appropriate management of mechanical LBP should be individualized, integrating evidence-based interventions to promote functional rehabilitation and minimize the impact of pain on patients' quality of life.

Diaphragm Function in Elite Weightlifters With and Without Chronic Low Back Pain and its Impacts on Sports Performance.

Zhou, EFM, Wong, AYL, Peng, J, Lin, G, Wen, T, Fang, J, Zhou, C, and Fu, SN. Diaphragm function in elite weightlifters with and without chronic low back pain and its impacts on sports performance. J Strength Cond Res XX(X): 000-000, 2024-The aim of this study was to compare diaphragm function between elite weightlifters with and without chronic low back pain (LBP) and to explore the associations between diaphragm function and sports performance. Forty-nine elite weightlifters aged 16-26 years were recruited, including 29 women (16-25 years, mean ± SD = 19.93 ± 2.70 years) and 20 men (16-26 years, mean ± SD = 20.95 ± 2.68 years). Of these, 23 subjects had chronic LBP. Diaphragm thickness and excursion were assessed using ultrasonography, and maximal inspiratory pressure (MIP), measured with POWERbreathe KH2, served as indicators of diaphragm contractility and strength, respectively. Sports performance was gauged through maximal snatch and clean and jerk lifts. Group differences and performance correlations were analyzed with consideration for confounders. The significance was set at p ≤ 0.05. Weightlifters with chronic LBP demonstrated significantly lower diaphragmatic contractility: diaphragm thickening fraction (by 21%; mean difference [MD] = 0.09, p = 0.04, Cohen's d = 0.69) and diaphragm excursion (by 18%; MD = 0.99, p < 0.01, Cohen's d = 0.89) compared with non-LBP controls. In addition, MIP was positively related to snatch (r = 0.34, p = 0.02) and clean and jerk (r = 0.43, p < 0.01) lifts. This study revealed that elite weightlifters with chronic LBP exhibit reduced diaphragm contractility, and inspiratory muscle force output (primary diaphragm) was associated with lifting performance. Incorporating diaphragm strengthening into training and rehabilitation might enhance performance and aid in LBP management, offering a dual benefit for athletes.

The feasibility of M-health for people with chronic low back pain in Shanghai, China: A qualitative study

Background: Mobile health (M-health) has emerged as a promising solution for enhancing the management of low back pain. However, the feasibility of M-health among the Chinese population and its influencing factors remain unclear. Objective: This study aimed to assess the acceptance of M-health among people with chronic low back pain (CLBP) and physiotherapists in Shanghai, China, and to explore the influencing factors of its utility in the treatment of CLBP. Methods: Semi-structured interviews and focus groups were conducted with 25 participants with CLBP and 20 physiotherapists, utilising a combination of group discussion and individual interview. Thematic analysis, supported by NVivo software, was employed to identify and examine the themes regarding the facilitators and barriers to the utility of M-health in Shanghai, China. Results: The focus group discussions revealed a broad spectrum of factors that drive or hinder participants’ acceptance of M-health. Three main themes related to the feasibility of M-health were identified from the interviews: (1) Reasons for embracing M-health; (2) Reasons for resisting M-health; (3) Recommendations to enhance the feasibility of M-health. In general, participants exhibited enthusiasm towards the prospect of offering M-health as a viable treatment. Conclusions: The findings of this study indicate that the feasibility of M-health depends on many factors in Shanghai, China. Efforts to promote the establishment of M-health policy or laws, rational integration of M-health and face-to-face model and improvement of the functions of M-health applications may increase its feasibility in Shanghai, China.

The prevalence of occupational-related low back pain among working populations in sub-saharan Africa: a systematic review and meta-analysis

IntroductionWork-related musculoskeletal disorders represent a major public health problem, contributing significantly to the global burden of disability-adjusted life years and affecting the quality of life of all population groups. The main problem in most musculoskeletal disorders is low back pain. Therefore, our study aims to identify the overall prevalence of work-related low back pain among the working population in sub-Saharan Africa.MethodsResearch published between 2010 and 2023 in English, conducted in Sub-Saharan Africa was included in this systematic review and meta-analysis. Using Boolean logic operators and targeted keywords, we searched for publications on a number of electronic databases (Web of Science, PubMed, Google Scholar, African Journals Online (AJOL), and Science Direct). The Joanna Briggs Institute Critical Appraisal techniques were utilized to conduct a quality assessment of the papers and ascertain their relevance to the study. The degree of heterogeneity among the included studies, the 95% confidence interval, and the pooled prevalence were estimated using a random effects model. Sensitivity studies were carried out to determine the causes of heterogeneity and the impact of outliers.ResultsIn this study, a total of 970 articles were retrieved, and 35 studies were included in the systematic review and meta-analysis. The overall estimated pooled prevalence of low back pain among the working population in sub-Saharan Africa was (55.05% [95% CI: 49.34, 60.76]). Based on a sub-group analysis by countries, the higher pooled prevalence of low back pain was found in Uganda at (61.48% [95% CI: 40.39, 82.57]), while the lower pooled prevalence of low back pain was in Ghana at (34.48% [95% CI: 17.96, 51.01]).ConclusionsThis systematic review and meta-analysis found that 55.05% of the included study participants experienced low back pain in the previous years. Therefore, it is recommended that policymakers incorporate and enhance strategies for the prevention and management of low back pain within the health system management guidelines of each country.

Examining Pain Reduction and Physiological Changes with Far-Infrared Graphene-Based Thermotherapy in Low Back Pain Management

Examining Pain Reduction and Physiological Changes with Far-Infrared Graphene-Based Thermotherapy in Low Back Pain Management

Tuina versus physiotherapy or a combination of both for the management of chronic nonspecific low back pain: A randomized controlled trial

ObjectiveTo rigorously evaluate the short-term and long-term effectiveness of Tuina (TN), alone and in combination with physiotherapy (PT), for Chronic nonspecific low back pain (CNLBP) through a comprehensive, high-quality clinical trial. MethodsThis randomized, single-blind trial was conducted from September 2020 to July 2023, involving 204 CNLBP patients from the First Affiliated Hospital of Jinan University. Participants underwent a baseline assessment, 6 treatment sessions over 8 weeks, a post-treatment evaluation in the 9th week, and a 20-week follow-up. Participants were randomly assigned to TN, PT, or a combination of TN and PT (TP) groups. Each treatment involved 6 sessions with a minimum 7-day interval, each lasting 30 minutes. Primary outcome was the change in Visual Analog Scale (VAS) for pain. Secondary outcomes included the Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), Range of Motion (ROM) of the spine, Traditional Chinese Medicine Syndrome Scale (TCMSS), and adverse events (AE). ResultsAmong the 204 participants, 67.16 % were female, and 88.73 % completed the 20-week follow-up. All groups showed significant reductions in VAS scores post-treatment and at follow-up. Secondary outcomes improved significantly, with notable decreases in ODI and TCMSS scores. Pairwise comparisons within groups indicated statistical significance, particularly in ODI scores, with clinical relevance. No significant differences were found between the groups. ROM and SF-36 showed statistical but not clinical significance. Only one AE (0.49 %) was reported, with no severe incidents. ConclusionAll treatment groups, including TN, TP, and PT, demonstrated significant reductions in VAS scores for CNLBP patients, with effects lasting up to 20 weeks. While TN and TP showed substantial improvements in secondary outcomes, particularly in ODI scores, no significant differences were found between the groups. These findings suggest that all treatments can be effective for managing CNLBP, supporting clinical practitioners in selecting appropriate interventions for patients, especially for those unable to engage in active exercises, utilizing passive movements like TN to enhance health outcomes.

Duration, Cost, and Escalation of Care Events for Physical Therapy Management of Low Back Pain in Service Members With Limb Loss.

Physical therapy (PT) is recommended as a primary treatment for low back pain (LBP), a common and impactful musculoskeletal condition after limb loss. The purpose of this brief report is to report the duration and cost of PT care, and subsequent escalation of care events, for LBP in service members with and without limb loss. This was a retrospective cohort, descriptive study. Service members with and without limb loss (matched) who received PT for LBP at a military treatment facility from 2015 to 2017 were included. Duration of PT care, number of PT visits, and escalation of care events 1 year after PT were extracted from medical records. Escalation of care events was identified as epidural steroid injections, referrals to specialists (e.g., orthopedists, spine surgeons, and pain management), and LBP-related hospitalizations.LBP-related PT encounters were queried; duration of care, number of visits, and cost of care were quantified. Escalation of care events, including opioid prescription, epidural steroid injections, specialty referrals, and hospitalizations, were identified up to 1 year after PT care. The average course of PT care for LBP was 12.9 more visits, 48.7 days longer, and $764.50 more expensive in service members with limb loss (n = 16) vs. those without limb loss (n = 48). Higher rates of opioid prescriptions and specialty referrals were observed in service members with limb loss. This study suggests that service members with limb loss and LBP received higher quantities and longer durations of PT than those without limb loss, yielding a nearly 4 times higher cost of PT.

Discogenic chronic low back pain management: intradiscal radiofrequency biacuplasty versus conservative treatment

BackgroundThis prospective bicentric study aims to evaluate and compare the efficacy of intradiscal radiofrequency biacuplasty (IDB) versus conservative management (CM) in treating chronic discogenic low back pain (CDLBP).MethodsForty-four patients with CDLBP were randomly assigned to either the biacuplasty group or the conservative management group. The biacuplasty group received treatment with two radiofrequency (RF) needles, positioned bilaterally on the annulus fibrosus under fluoroscopic guidance and local anaesthesia, to administer bipolar RF. Patients were monitored for 6 months, with the allowance of pain medication as needed. In the conservative management group, patients who continued to experience low back pain after three months were permitted to switch to the biacuplasty group. The study was conducted over two years, starting on July 1, 2020.ResultsThe studied groups had comparable age and gender distributions, with no significant difference in BMI. The Oswestry Disability Index (ODI) was assessed at baseline, 1 month, 3 months, and 6 months. At baseline, no significant difference was observed between the groups (p = 0.263). However, at the 1-month, 3-month, and 6-month follow-up, the biacuplasty group exhibited significantly lower ODI scores compared to the conservative management group (all p < 0.001), indicating that biacuplasty was more effective in reducing disability caused by chronic low back pain.ConclusionsIntradiscal radiofrequency biacuplasty is a minimally invasive interventional technique that has proven effective for patients with CDLBP who do not respond to conservative management.

Japanese Clinical Physical Therapists With the Mechanical Diagnosis and Therapy License Are More Competent and Confident in Pain Management Than Those Without It: A Cross-Sectional Study.

Background The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) has long been misunderstood as a biomedical approach. In fact, it is a biopsychosocial approach with an up-to-date evidence-based educational curriculum. Recently, it has become possible to partially measure competence in clinical decision-making based on contemporary pain understanding and confidence in pain management using the Pain Understanding and Confidence Questionnaire (PUnCQ). The primary aim of this study was to compare the following outcomes between physical therapists with and without credential license in MDT (Cred.MDT) and the PUnCQ as well as attitudes toward the biopsychosocial perspective, adherence to evidence-based management for low back pain (LBP), and knowledge of modern pain science. The secondary aim was to explore relevant factors in the PUnCQ. Methodology Clinical physical therapists who were managing patients with pain were recruited from two associations (the Japanese Society of Allied Health and Rehabilitationand the Japan Branch of the International McKenzie Institute, who had all acquired at least the Cred.MDT). The following outcomes were measured: (1) the PUnCQ-1 for partial competence in evidence-based clinical decision-making for pain management; (2) part 2 scores of the PUnCQ for confidence in pain management; (3) the Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT) biopsychosocial/biomedical ratio for treatment perspectives; (4) the Knowledge and Attitudes of Pain (KNAP) for knowledge of modern pain science; and (5) a questionnaire for adherence to LBP practice guidelines. Two group comparisons were conducted for the primary aim and a multiple regression analysis for the independent variable of the PUnCQ-1 was conducted for the secondary aim. Results Data from 122 physical therapists (63 and 59 participants with and without the Cred.MDT, respectively) were analyzed. Statistically significantly higher scores were detected for physical therapists with Cred.MDT compared to those without (all p<0.05) for all of the above outcomes. The multiple regression analysis demonstrated that statistically significant contributors to the PUnCQ-1 were part 2 scores of the PUnCQ for the pain management factor (p = 0.016) and acquisition of the Cred.MDT (p = 0.038) (R2 = 0.12). Conclusion Competence and confidence in pain management, attitudes toward biopsychosocial approaches, knowledge of modern pain science and guideline adherence are higher in physical therapists with the Cred.MDT than those without it. Confidence in pain management and acquisition of the Cred.MDT contributed to competence in evidence-based clinical decision-making for pain management.

Evaluation of comparative efficacy of Hijama bila shart (dry cupping) and Bukhoor (steam application) in the management of low back pain

IntroductionLow back pain is an important cause of disability. The aim of treatment is to reduce the pain and minimize its consequences. Management includes counseling and reassurance, use of analgesics, non-pharmacological therapies, and regular review. MethodAn open-label, randomized, and parallel-group clinical trial was conducted in which Group A patients received Hijama bila Shart (dry cupping) while group B patients received Bukhoor (medicated steam application); both therapies were given for 5 min in 3 sittings (day 1, 4 and 8). ResultOswestry LBP Total Scores in Group A decreased from 20.70 ± 0.49 to 6.77 ± 0.37, while in Group B it decreased from 20.07 ± 3.63 to 5.83 ± 2.36. The pain intensity also decreased from 3.10 ± 0.55 to 1.57 ± 0.57 in group A, while from 2.97 ± 0.61 to 1.30 ± 0.75 in group B. Improvement in disability was also found statistically significant. On comparing the improvement in disability between the group, the difference was significant (p < 0.05), and improvement in group A was a little better as compared to group B. DiscussionThe effect of dry cupping may be due to increased blood circulation; lymphatic channelization and dispersion of inflammatory chemicals from the site of pain. The effect of medicated steam application may be due to the anti-inflammatory and muscle relaxing effects of steam and heat of the steam itself; the drugs used for steam application are reported to reduce inflammation on local application. ConclusionDry cupping and Medicated Steam application both are beneficial, safe, and cost effective treatment modalities for the Low back pain.

Persistence, not avoidance, is associated with low back pain-An observational cohort study.

Low back pain (LBP) is increasingly understood as a long-lasting condition with a variable course. Avoidance and persistence behaviour have been described to mediate pain persistence by potentially linking psychosocial factors and biomechanics. The resulting maladaptive changes in musculoskeletal structures can result in movement control impairment (MCI). This investigation aimed to observe avoidance and persistence behaviour and MCI in participants with acute LBP over 1 year and explore their association with pain persistence. In this observational cohort study, 165 participants were assessed at five time points: ≤ 1 month (baseline), 2, 3, 6, and 12 months after the onset of acute LBP. Simultaneously collected clinical data such as self-reported outcomes at baseline for avoidance and persistence and assessments of MCI were filled in linear mixed-effects regression models. The mixed-effects analysis revealed for the adjusted model that a one-point increase in persistence scores resulted in a 3.31-point increase in pain intensity while interacting with state anxiety over time (p = 0.05, 95% confidence interval 0.07-6.07). This effect was not found for avoidance behaviour at baseline (p = 0.21) and MCI. The relationship between persistence and pain intensity throughout measurement suggests that continuing usual activities beyond pain, coupled with feelings of distress, may lead to persistent LBP. These results underscore the need for a therapeutic shift toward a multidimensional approach that considers the physical and psychological characteristics of persons with LBP. Screening for activity patterns in acute LBP is critical for providing tailored treatment and counselling. In acute low back pain (LBP), maintaining usual activities despite pain and distress can contribute to the continuation of LBP. Alongside a multidimensional approach that considers physical and psychological factors, attitudes toward daily activities are also important. Screening for both maladaptive and adaptive activity patterns in individuals with acute LBP is essential for effective LBP management, improving patient outcomes, and preventing persistent pain.

Enhancing chronic low back pain management: an initial neuroimaging study of a mobile interoceptive attention training.

Chronic low back pain (cLBP) poses significant challenges, often addressed through avoidance or distraction. Emerging evidence suggests that mind-body interventions, like our novel Mind Your Pain (MyP) smartphone mobile application, may offer relief. We conducted a single-arm, mixed-methods neuroimaging study to assess the degree to which treatment response to our 8-week intervention, as measured by the reduction in the Pain, Enjoyment of Life and General Activity Scale (PEG), was associated with enhanced pain-related insula activation over time. Twenty-nine individuals with cLBP completed patient-reported assessments, qualitative sensory testing (QST) measures, and neuroimaging pre- and post-MyP. Functional MRI data during experimental heat pain on the left forearm were collected and analyzed, comparing responders (≥50% reduction in PEG scores) and non-responders. MyP led to significant decreases in PEG scores overall. Furthermore, MyP responders exhibited increased pain-related activation in key brain regions, including the contralateral posterior insula, bilateral ventral anterior insula, ventral anterior cingulate, dorsolateral prefrontal cortex, and nucleus accumbens. Although baseline behavioral and sensory measures did not differ between the two responder groups, baseline neural differences related to the impact of the endogenous back pain were observed. MyP appears to modify pain response and underlying neural circuitry, suggesting neural changes in interoception may serve as biomarkers for mind-body interventions in cLBP. This study highlights the potential of MyP as a novel approach for cLBP management, warranting further investigation.

The Effectiveness of Ultrasound-Guided Infiltrations Combined with Early Rehabilitation in the Management of Low Back Pain: A Retrospective Observational Study.

Background and Aims: Low back pain is a prevalent condition affecting 60-85% of individuals during their lifetime. Despite various proposed mechanisms, the etiology of low back pain remains unclear. This study aims to evaluate the effectiveness of combining ultrasound-guided infiltrations with early rehabilitation in reducing pain and improving functional limitations in patients with chronic nonspecific low back pain. Methods: A retrospective observational study was conducted, reviewing data from January to April 2024 involving 40 patients with chronic nonspecific low back pain. Each patient received two cycles of ultrasound-guided lidocaine and corticosteroid infiltrations at the level of the posterior lower iliac spine, followed by 10 rehabilitation sessions. Patients were assessed at baseline (T0), after the first treatment cycle (T1), and after the second cycle (T2) using the Oswestry Disability Index, Quebec Back Pain Disability Scale, Roland Disability Questionnaire, and Numeric Rating Scale. Results: Significant improvements were observed across all assessment scales. The ODI scores decreased from 33.5 at baseline to 3.5 after treatment (p < 0.001). Similar reductions were noted in the QBPDS (from 61.5 to 10.3), RDQ (from 18 to 3.4), and NRS (from 7.4 to 1.3). The combination of ultrasound-guided infiltrations and early rehabilitation resulted in a significant reduction in pain and disability, with the most notable improvements occurring after the second treatment cycle. Conclusions: The integration of ultrasound-guided infiltrations with early rehabilitation is highly effective in managing chronic nonspecific low back pain, significantly reducing both pain and functional limitations.

Who Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings

Low back pain is a very common condition that affects most people at some point in their lives. It represents a burden on those affected, reducing their ability to participate in activities of normal life; at the same time, dealing with it increases the economic costs of healthcare. The aim of this guideline was to contribute to WHO activities for reducing the impact of low back pain in adults and to support the WHO approach to integrated care for older people in primary care. In December 2023, the World Health Organization (WHO) published the "WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings". It was developed following the process according to the WHO handbook for guideline development. The team at the WHO Collaborating Centre for Evidence-Based Medicine at the University for Continuing Education Krems (Austria) translated the summary of this guideline for its application in German-speaking countries. The guideline addresses 37 interventions for the treatment of chronic primary low back pain in primary care and provides 24 recommendations and one good practice statement. No recommendations were made regarding twelve interventions due to equivocation or lack of sufficient evidence. The recommended interventions are intended to provide a range of options to support and personalize care for adults with chronic primary low back pain.

A community health-coaching referral program following discharge from treatment for chronic low back pain – a qualitative study of the patient’s perspective

BackgroundGlobal policy and guidelines for low back pain (LBP) management promote physical activity and self-management yet adherence is poor and a decline in outcomes is common following discharge from treatment. Health coaching is effective at improving exercise adherence, self-efficacy, and social support in individuals with chronic conditions, and may be an acceptable, cost-effective way to support people in the community following discharge from treatment for LBP.AimThis qualitative study aimed to understand which aspects of a community over-the-phone health-coaching program, were liked and disliked by patients as well as their perceived outcomes of the service after being discharged from LBP treatment.MethodsA purposive sampling approach was used to recruit 12 participants with chronic LBP, from a large randomised controlled trial, who were randomly allocated to receive a health coaching program from the Get Healthy Service® in Australia. Semi-structured interviews were conducted, and a general inductive thematic analysis approach was taken.ResultsThe main themes uncovered regarding the intervention included the positive and negative aspects of the health coaching service and the relationship between the participant and health coach. Specifically, the participants spoke of the importance of the health coach, the value of goal setting, the quality of the advice received, the benefits of feeling supported, the format of the coaching service, and LBP-specific knowledge. They also reported the health coach and the coaching relationship to be the primary factors influencing the program outcomes and the qualities of the coaching relationship they valued most were connection, communication, care, and competence. The sub-themes uncovered regarding the outcomes of the intervention included positive impacts (a greater capacity to cope, increased confidence, increased motivation and increased satisfaction) and negative impacts (receiving no personal benefit).Clinical implicationsIn an environment where self-management and self-care are becoming increasingly important, understanding the patient’s experience as part of a coaching program is likely to lead to improved quality of health coaching care, more tailored service delivery and potentially more effective and cost-effective community-based care for individuals with chronic LBP in the community after being discharged from treatment.Trial RegistrationThe GBTH trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000889954) on 10/9/2020. Ethical approval was prospectively granted by the Western Sydney Local Health District Human Research and Ethics Committee (2020/ETH00115). Written informed consent was obtained from all participants. The relevant sponsor has reviewed the study protocol and consent form.

Multimodal Analgesia Approach in Acute Low Back Pain Management: A Phase III Study of a Novel Analgesic Combination of Etoricoxib/Tramadol.

Pain and disability management are crucial for a speedy recovery. Combining analgesics with different mechanisms of action provides greater pain relief with lower doses, promoting efficient multimodal analgesia. This study evaluated the efficacy and safety between two fixed-dose combinations (FDC): etoricoxib/tramadol compared to paracetamol/tramadol for the management of acute low back pain (LBP) in a 7-day treatment. We conducted a phase IIIb, prospective, randomized, and multicenter study in patients with acute LBP treated with etoricoxib 90mg/tramadol 50mg (one packet of granules diluted in 100ml of water, once a day [QD], for 7 days) or paracetamol 975mg/tramadol 112.5mg (one tablet of 325mg/37.5mg, three times a day [TID], for 7 days) to assess the efficacy (in terms of pain and disability improvement) and safety. One hundred and twenty-four patients were randomized to receive either etoricoxib/tramadol QD (n = 61) or paracetamol/tramadol TID (n = 63). From the magnitude of change in pain evaluations, differences were observed between the treatment groups at 3 [p = 0.054, CI 95% -0.648 (-0.010 to 1.306)] and 5days (p = 0.041). The proportion of patients with a 30% reduction in Visual Analogue Scale (VAS) score was statistically significant when comparing the treatment groups on the third day of follow-up [p = 0.008, CI 95% 0.241 (0.061-0.421)]. An improvement in LBP's disability to perform activities of daily routine (Oswestry and Roland-Morris questionnaires) was observed in both treatment groups. A total of 79 adverse events (AEs) (38 [48.1%] with etoricoxib/tramadol and 41 [51.9%] with paracetamol/tramadol) were reported. The most frequent AEs were nausea (17.7%) and dizziness (16.4%). The results show the clinical benefits of etoricoxib/tramadol FDC, such as the sparing effect of tramadol dose per day, early therapeutic response rate compared with paracetamol/tramadol; which translates into faster pain relief, better adherence, less tramadol drug dependency, and a reduction of related AEs incidence. ClinicalTrials.gov identifier, NCT04968158.

Pain neuroscience education is not superior to spinal physiology and ergonomics education within a short multidisciplinary rehabilitation program: A randomized controlled trial

IntroductionThere is little evidence to suggest that one educational intervention is superior to another when associated with a rehabilitation program in the management of persistent low back pain. The objective of the present study was to compare pain neuroscience education with spine physiology and ergonomics education as part of a one-week multidisciplinary rehabilitation program. MethodWe conducted a randomized, controlled trial among patients having experienced persistent low back pain for at least 1 year. The patients participated in a one-week multidisciplinary rehabilitation program with an educational component. The members of the experimental and control groups received pain neuroscience education and spine physiology and ergonomics education, respectively. Outcomes were assessed before the program (day 0), immediately afterwards (day 5), and on day 90 after the start of the program. The primary outcome measure was functional disability on day 90. ResultsA total of 88 patients were randomized. On day 90, a statistically significant mean [95% confidence interval] decrease in the level of disability was observed in the experimental (PNE) group (−3.4 [-5.0 to −1.8]). The mean [95%CI] difference versus the control group (−1.7 [-4.0 to 0.5]) was not statistically significant (p = 0.12). There were no statistically significant intergroup differences in the secondary outcome measures. ConclusionThere appears to be no advantage in replacing a conventional, non-neuroscientific educational program (based on spinal physiology and ergonomics) with a pain neuroscience education program as part of a one-week multidisciplinary rehabilitation program. Further research is needed to identify patients who will respond better to a pain neuroscience education module as part of a personalized care program.