Low Back Pain Patients Research Articles

Changes in physical activity, sedentary behaviors, and associated motivation after multidisciplinary rehabilitation program for chronic low back pain patients.

Physical activity (PA) is recommended as a primary treatment to reduce pain and improve function in chronic low back pain (cLBP). However, adherence to PA guidelines and the limitation of sedentary behavior (SB) remain challenging for cLBP patients. While some studies focus on PA promotion, past results are mixed, and the role of SB has not been thoroughly investigated. This observational study aims to assess changes in PA and SB levels among cLBP patients participating in a rehabilitation program (RP) and explore related changes in both explicit and implicit motivational factors. Patients wore an accelerometer for 1 week before the RP (T1) and 3 months afterward (T4) to measure PA and SB. At the start (T2) and at the end (T4) of the RP, we measured motivation, including implicit attitudes, toward these two behaviors. Between T1 and T4 (n = 33), the results show a significant decrease in SB. Between T2 and T3 (n = 62), all motivational variables were significantly more in favor of an active lifestyle, but implicit attitudes did not significantly change. This study shows that an RP can transform behavior determinants and reduce SB but is less efficient to increase PA levels. It also emphasizes the need to work with patients to enhance adherence and objectively measure behaviors in the future.

Sex-specific trunk movement coordination in participants with low-back pain and asymptomatic controls.

Trunk posture and lumbo-pelvic coordination can influence spinal loading and are commonly used as clinical measures in the diagnosis and management of low-back pain and injury risk. However, sex and pain specific characteristics have rarely been investigated in a large cohort of both healthy individuals and low-back pain patients. It has also been suggested that the motor control of trunk stability and trunk movement variability is altered in individuals with low-back pain, with possible implications for pain progression. Nonetheless, clear links to low-back pain are currently lacking. To investigate trunk posture, lumbo-pelvic coordination, trunk dynamic stability and trunk movement variability in an adequately large cohort of individuals with low-back pain and asymptomatic controls and to explore specific effects of sex, pain intensity and pain chronicity. We measured lumbo-pelvic kinematics during trunk flexion and trunk dynamic stability and movement variability during a cyclic pointing task in 306 adults (156 females) aged between 18 and 64 years, reporting either no low-back pain or pain in the lumbar area of the trunk. Participants were grouped based on their characteristic pain intensity as asymptomatic (ASY, N = 53), low to medium pain (LMP, N = 185) or medium to high pain (MHP, N = 68). Participants with low-back pain that persisted for 12 weeks or longer were categorized as chronic (N = 104). Data were analyzed using linear mixed models in the style of a two way anova. Female participants showed a higher range of motion in both the trunk and pelvis during trunk flexion, as well as an increased lumbar lordosis in standing attributed to a higher pelvic angle that persisted throughout the entire trunk flexion movement, resulting in a longer duration of lumbar lordosis. The intensity and chronicity of the pain had a negligible effect on trunk posture and the lumbo-pelvic coordination. Pain chronicity had an effect on trunk dynamic stability (i.e., increased trunk instability), while no effects of sex and pain intensity were detected in trunk dynamic stability and movement variability. Low-back pain intensity and chronicity was not associated with lumbo-pelvic posture and kinematics, indicating that lumbo-pelvic posture and kinematics during a trunk flexion movement have limited practicality in the clinical diagnosis and management of low-back pain. On the other hand, the increased local instability of the trunk during the cyclic coordination task studied indicates control errors in the regulation of trunk movement in participants with chronic low-back pain and could be considered a useful diagnostic tool in chronic low-back pain.

Comparing ChatGPT 3.5 and 4.0 in Low Back Pain Patient Education: Addressing Strengths, Limitations, and Psychosocial Challenges.

Comparing ChatGPT 3.5 and 4.0 in Low Back Pain Patient Education: Addressing Strengths, Limitations, and Psychosocial Challenges.

Coccygodynia combined with lumbosacral pain syndromes. A case series and clinical recommendations

Coccygodynia (CD) is characterized by pain in the coccyx area, but in some cases the pain radiates to the sacrum, perineum, anus, genitals, gluteal area, sacroiliac joint, lower lumbar spine and thighs. The association of СD with other pain syndromes can lead to complicated diagnosis and non-targeted treatment, which will not improve the patient's condition. Objective: To investigate the frequency of the combination of low back pain in patients with CD who underwent spinal surgery and to evaluate the effectiveness of their treatment. Materials and methods: An analysis of the results of 62 interventions on Ganglion Impar (GI) in 54 patients was performed. Interventions were performed in the three medical centers in Kyiv, Ukraine in the period from 2017 to 2024: Main Medical Clinical Center of the Ministry of Internal Affairs of Ukraine, Romodanov Neurosurgery Institute and MedClinic Medical Center. Results. 14.8% of all study participants had post-traumatic CD (history of falling on the coccyx), in one case CD was caused by pelvic cancer, the vast majority of 83.3% had idiopathic CD. 21 (38.9%) of the study participants were male and 33 (61.1%) were female aged 23 to 84 years (mean age 48.0±15.4 years). In our series, 16 (29.6%) patients had lumbar or sciatic syndrome. Following treatment for CD, all patients noted a significant reduction of low back pain. In 4 (7.4%) observations, the intervention on GI was performed after lumbosacral spine stabilization surgery. Conclusions: Surgical treatment of spinal pathology in patients with СD partially reduced the intensity of the pain syndrome. The execution of the GI steroid block ensured the achievement of a stable analgesic effect during the six-month follow-up. Patients presenting with CD accompanied by lumbago or radiating pain require an integrated approach to ensure accurate differential diagnosis and optimal treatment outcomes.

Comparison of Kinesiophobia and Disability Among Lower Back Pain Patients with or Without Weightlifting Practices

Background: Low back pain (LBP) is a prevalent musculoskeletal condition with significant global health implications. While physical activity is generally advocated for its management, the psychological impact of exercise, particularly weightlifting, on disability and fear-avoidance beliefs in LBP remains underexplored in the Pakistani context. Objective: To compare kinesiophobia and functional disability levels among individuals with chronic non-specific LBP who engage in regular weightlifting versus those with sedentary lifestyles, assessing whether structured resistance training offers protective or changing effects. Methods: This comparative cross-sectional study included 308 participants aged 20–50 years (n = 155 weightlifters; n = 153 sedentary). Inclusion criteria were non-specific LBP ≥3 months, while those with spinal surgery, deformities, pregnancy, or neurological conditions were excluded. Data were collected via structured interviews using the Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire (FABQ-Brazil), and Back Pain and Body Posture Evaluation Instrument (BackPEI-A). Ethical approval was obtained from the Institutional Review Board [IRB no.], and procedures followed the Helsinki Declaration. Statistical analysis was conducted using SPSS v27, employing independent t-tests and Chi-square tests. Results: Weightlifters reported significantly lower mean ODI scores (18.3 ± 11.6 vs. 27.6 ± 14.2; p < 0.001) and lower kinesiophobia prevalence (7.1% vs. 14.9%; p = 0.013). Mild pain was more frequent among weightlifters (55.1%) compared to sedentary individuals (15.6%). Conclusion: Regular weightlifting is associated with reduced disability and fear-avoidance behavior in individuals with LBP, supporting its integration into rehabilitation protocols to enhance psychological and functional outcomes in musculoskeletal healthcare.

OP3.3 Hip Arthroscopy Patients with Lower Back Pain Show Delayed Clinical Improvement and Inferior Time Dependent Survivorship: A Propensity Matched Study at Mid-Term Follow-Up

Abstract Purpose: To evaluate patient-reported outcomes (PROs) and survivorship at mid-term follow-up after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) in patients with and without preoperative lower back pain (LBP). Methods: Patients with self-endorsed preoperative LBP who underwent HA for FAIS with mid-term follow-up were identified and propensity matched 1:1 to patients without back pain by age, sex, and body mass index. PROs collected preoperatively and at postoperative years 1, 2, and 5 included: Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports Subscale (HOS-SS), International Hip Outcome Score 12 (iHOT-12), modified Harris Hip Score (mHHS), Visual Analog Scale (VAS) for Pain. Achievement of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were compared. Survivorship was compared with Kaplan-Meier analysis. Results: 119 patients with LBP were matched to 119 patients without LBP. Group demographic factors were as follows, age (37.4±11.9 years vs 37.6±12.6, p=0.880), sex (64.4% female vs 67.7%, p=0.796), and BMI (25.3±5.1 kg/m2 vs 25.3±5.4, p=0.930). Average follow-up duration was 6.0 ± 1.9 years. LBP patients showed similar preoperative PROs, yet lower 1-year scores for all PROs (p ≤ 0.044). At final follow-up, similar PROs were shown between groups (p ≥ 0.196). LBP and non-LBP patients had similar MCID achievement for HOS-ADL (59.3%vs.63.1%,p=0.640), HOS-SS (73.9%vs.70.8%,p=0.710), mHHS (66.7%vs.73.4%, p=-.544), iHOT-12 (85.1%vs.79.4%,p=0.500), and VAS-Pain (75.6%vs.69.9%,p=0.490). Groups also had similar PASS achievement for HOS-ADL (63.5%vs.61.3%,p=0.777), HOS-SS (57.0%vs.62.5%,p=0.461), mHHS (81.9%vs.79.1%, p=0-.692), iHOT-12 (54.6%vs.61.2%,p=0.570), and VAS-Pain (51.0%vs.55.4%,p=0.570) with similar MCID (p ≥ 0.490) and PASS (p ≥ 0.386) achievement. Conversion to total hip arthroplasty occurred in 3.4% of hips with LBP and 0.8% of hips without LBP (p=0.370), Back pain patients demonstrated inferior time-dependent survivorship compared to patients without back pain on Kaplan-Meier survival analysis (p = 0.023). Conclusions: Patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome with LBP achieve comparable PROs and CSOs to patients without back pain at mid-term, despite lower 1-year PRO scores. LBP patients show inferior reoperation-free time-dependent survivorship compared to those without LBP. Keywords: Femoroacetabular Impingement Syndrome, Hip Arthroscopy, Back Pain Level of Evidence: III, Retrospective Comparative Case Series.

Relationship between neutrophil lymphocyte ratio and interleukin-17A levels with pain intensity and degree of herniated nucleus pulposus in low back pain patients

Background and objectives. Low back pain (LBP) affects 80% of individuals globally and causes significant disability. Intervertebral disc disorders (IDDs), a major LBP contributor, result in chronic pain, impaired function, and economic challenges. Degenerative processes, inflammatory cytokines, and disrupted extracellular matrix play key roles in IDD pathology. This study aims to investigate the relationship between serum neutrophil-lymphocyte ratio (NLR) and interleukin-17A (IL-17A) levels in patients with LBP due to herniated nucleus pulposus (HNP), neuropathic, and nociceptive pain intensity. Materials and methods. This observational cross-sectional study was conducted in patients with HNP. HNP diagnosis is based on radiological findings. The NRS assessment tool was used to measure pain intensity. NLR was calculated from routine blood tests, and IL-17A levels were measured with an ELISA method. Results. This study included 62 HNP patients, predominantly male (51.6%), with a mean age of 45.5 years. HNP severity showed extrusion (40.3%), protrusion (38.7%), and bulging (21.0%). The median NLR was 2.34, and IL-17A was 129.65 pg/mL. NLR correlated positively with nociceptive (r = 0.472) and neuropathic NRS (r = 0.345), while IL-17A correlated with nociceptive (r = 0.518) and neuropathic NRS (r = 0.390). NLR significantly differed across HNP degrees (p = 0.010). However, IL-17A showed no significant result (p = 0.144). Conclusions. Significant correlations were found between NLR levels and nociceptive/neuropathic pain NRS in HNP patients, and IL-17A levels. NLR varied significantly across HNP severity, suggesting its potential as a biomarker. However, IL-17A showed no significant relationship with HNP severity, indicating its role in inflammation rather than disease progression.

Lumbar Muscle Fatty Infiltration and Atrophy in Patients with Low Back Pain and Degenerative Spinal Pathologies: A CT Imaging Study.

Background/Objectives: Low back pain (LBP) may be related to intramuscular fatty infiltration (FI), the topography of which has been the subject of only a few studies. Our goal is therefore to determine the importance and topography of FI at the lumbar level and evaluate its correlation with LBP. Methods: We conducted a retrospective study and compared 254 LBP patients who underwent a lumbosacral CT scan with a sample of 115 healthy subjects, all classified into three age groups (≤35, 36-55, and >55 years old). In CT scan images from L2 to S1, muscle density (Hounsfield unit values ranging from -29 to +150), reflecting intramuscular FI, was measured. LBP was further divided into five subgroups of pathologies. Results: There was a significant difference in muscle density between the small and large circles at the L4/L5 and L5/S1 levels in LBP patients, which was not observed in the healthy subjects. In both LBP patients and healthy subjects, a decreasing density gradient was observed from L2 to S1, with a significant difference in density across age groups. LBP patients exhibit lower muscle densities compared to healthy subjects. Conclusions: In LBP patients, fatty infiltration (FI) of the paraspinal muscles is most pronounced in the lower lumbar region and appears to be localized at the level of muscle insertion. This localized muscle deficit differs from the age-related process of FI and may contribute to the development of LBP and discopathies.

Impact of lumbar support on pain reduction in low back pain patients: A systematic review and meta-analysis of randomized control trials

Impact of lumbar support on pain reduction in low back pain patients: A systematic review and meta-analysis of randomized control trials

Sex-based differences in biomechanical function for chronic low back pain and how it relates to pain experience.

The relationship between pain experience and biomechanical impairment in chronic low back pain (LBP) is unclear. Among the broader pain literature, sex-based differences in pain experience have been established. However, it is unknown if sex-based differences in pain experience relates to compromised movement patterns for patients with chronic LBP. This study examined sex differences and whether there are sex-based associations between pain experience and biomechanical function in patients with chronic LBP. To capture the biomechanical variability among LBP patients, we quantified full-body movement quality based on the extent that 3D postural trajectories deviated from matched controls during a sit-to-stand task (Kinematic Composite Score, K-Score). For both males and females, the K-Score was compared to pain measures, including patient-reported metrics and quantitative sensory testing (pressure pain threshold, PPT). There were significant sex-based differences in pain experience and biomechanical function in patients with LBP. Specifically, males exhibited ~ 8% lower trunk K-Scores, indicating biomechanical function that deviated more from controls when compared to female participants (p < 0.001). However, females exhibited PPT values 29% and 41% lower than males at the control and pain sites, respectively (p < 0.0001). There was a weak but significant negative association between PPT and K-Scores for males (R2 = 0.14, p < 0.01), while females lacked an association. Overall, males with LBP exhibited worse movement quality, driven by trunk motion, but higher PPTs. Possible explanations include reduced interoceptive awareness or increased kinesiophobia in males, which may influence movement patterns. This research is an initial step in uncovering the complex relationship between patient-specific factors influencing LBP disability, laying the groundwork for further exploration, and paving the way for improving outcomes with patient-specific treatments.

Profile of Female Individuals with Chronic Low Back Pain

Background: When low back pain (LBP) persists for at least 12 weeks, it becomes chronic. In 90% of cases, LBP is satisfactorily resolved within 6 weeks. LBP becomes chronic in 7% to 10% of cases. Among various populations, females tend to experience a higher prevalence and severity of chronic LBP compared to males, attributed to a combination of anatomical, hormonal, psychosocial and occupational factors.Objective: To see the profile of individuals with chronic low back pain (CLBP) in female patients. Materials and Methods: This observational study was carried out at the Department of Physical Medicine and Rehabilitation, BSMMU, Dhaka in 2016. 150 female patients of low back pain attending the Physical Medicine and Rehabilitation department, BSMMU were enrolled. Purposive sampling was done according to availability of the patients. All the data were compiled and sorted properly and the quantitative data was analyzed statistically by using SPSS. Results: Most of the patients belonged to low educational group (n=60, 40%). Obesity was an important risk factor for developing chronic low back pain. Patients with overweight were found, 43.33% (n=65). The most of the patients were in 5000 to15000 taka income group (n=90, 60%) whereas 41 patients (27.33%) family members were suffering from CLBP, and 76.0% (n=114) were inactive from physical exercise (Grade 1). 121 patients (80.66%) had the experience of grade 3 bad posture. Conclusion: People in the grade 1 level of exercise group had the highest risk of developing CLBP. People in the grade 3 (regular) bad posture group had the highest risk of developing CLBP. KYAMC Journal. 2024; 15(02): 77-82

Prevalence and Impact of Gastrointestinal Symptoms in Patients with Chronic Low Back Pain -Systematic Review

Introduction: Low back pain encompasses a variety of pain categories (e.g., nociceptive, neuropathic, neoplastic, or non-specific) that commonly overlap. Recent research suggests a link between gastrointestinal (GI) symptoms and musculoskeletal pain, specifically CLBP. However, the prevalence and nature of GI symptoms in CLBP patients are little characterized. Objectives: This study examines the prevalence, severity, and impact of gastrointestinal symptoms among patients with chronic low back pain. Methods: A complete search was undertaken across numerous databases, including PubMed, PEDro, and The Cochrane Database, until August 2024. The search yielded 4,065 results, with four research selected for qualitative and quantitative synthesis. Results The searches retrieved 47 records, of which were selected for full-text screening. four reviews were included. The findings say that gastrointestinal (GI) symptoms in the chronic stage of low back pain. It occurs due to a convergence of viscerosomatic pathways and dysfunction in trunk muscles, which leads to reduced gastrointestinal motility. Conclusions There is strong evidence indicating a connection between gastrointestinal (GI) symptoms and chronic lower back pain (CLBP. The results of this suggested study could aid physiotherapists in managing low back pain patients with GI discomfort. GI symptoms as part of CLBP therapy may improve patients' physical functioning and quality of life.

Acupuncture combined with thunder-fire moxibustion for low back pain with cold-damp: a randomized controlled trial

To observe the clinical efficacy of acupuncture combined with thunder-fire moxibustion in treating low back pain with cold-damp. Seventy-two patients of low back pain with cold-damp were randomly divided into an observation group (36 cases, 1 case was eliminated) and a control group (36 cases, 1 case dropped out). The control group received acupuncture at Jizhong (GV6), Yaoyangguan (GV3), ashi points, bilateral Shenshu (BL23), Dachangshu (BL25), and Weizhong (BL40) for 30 min daily. The observation group was treated with thunder-fire moxibustion in addition to the same acupuncture regimen as the control group, once daily. Both groups were treated for 6 consecutive days followed by one rest day, for a total duration of 4 weeks. The visual analog scale (VAS) score, Oswestry disability index (ODI) score, Japanese Orthopedic Association (JOA) score, present pain intensity (PPI) score, and serum levels of β-endorphin (β-EP), 5-hydroxytryp tamin (5-HT), and substance P (SP) were compared before and after treatment, and the clinical efficacy was also compared between the two groups. Compared before treatment, the VAS scores, ODI scores, PPI scores, and serum levels of 5-HT and SP were decreased (P<0.01), while JOA scores and serum levels of β-EP were increased (P<0.01) in both groups after treatment. The observation group showed lower VAS, ODI, and PPI scores and serum levels of 5-HT and SP than those in the control group (P<0.05), as well as higher JOA score and serum level of β-EP (P<0.05). The total effective rate in the observation group was 94.3% (33/35), higher than 82.9% (29/35) in the control group (P<0.05). Acupuncture combined with thunder-fire moxibustion could effectively alleviate pain and improve lumbar function in patients of low back pain with cold-damp, possibly by regulating β-EP, 5-HT, and SP levels.

Characterizing a new rat model of chronic pain after spine surgery

Chronic pain after spine surgery (CPSS) is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40% of patients undergoing lumbar spine surgery. We aimed to develop a rat model that mimics clinical CPSS conditions by taking two sequential surgical procedures. Step 1: A plastic rod was inserted into the left L5 intervertebral foramen to produce a steady compression on the dorsal root ganglion (DRG) and the spinal nerve, a common cause of low back pain (LBP). Step 2: The rod was removed after 7 days when rats exhibited mechanical and heat hypersensitivity in the ipsilateral hindpaw, followed by a full L5 laminectomy to mimic spine decompression surgery in LBP patients. The retention of the rod induced a prolonged LBP-like behavior but was quickly resolved after rod removal without laminectomy. However, rats that received laminectomy after rod removal developed heightened mechanical and heat sensitivity in the hindpaw, impaired gait, and reduced spontaneous exploration activity, indicating CPSS. Patch clamp recording revealed a significant augmentation in the intrinsic excitability of small-diameter DRG neurons in CPSS rats. Administration of Dermorphin [D-Arg2, Lys4] (1–4) amide (DALDA, 5 mg /kg, i.p.), a peripherally acting mu-opioid receptor (MOR)-preferred agonist, attenuated pain hypersensitivity, capsaicin-induced [Ca2+]i rising and the increased intrinsic excitability of DRG neurons from CPSS rats. Our findings suggest that this new model, which mirrors the nature of CPSS developed in patients, may be useful for future studies of the underlying mechanisms.

Comparison of Combined Motor Control Training and Isolated Extensor Strengthening Versus General Exercise on Lumbar Paraspinal Muscle Health and Associations With Patient-Reported Outcome Measures in Chronic Low Back Pain Patients: A Randomized Controlled Trial.

Study DesignProspective Randomized Controlled Trial.ObjectivesTo investigate the effect of combined motor control and isolated lumbar strengthening exercise (MC + ILEX) vs general exercise (GE) on upper lumbar paraspinal muscle volume and composition, strength and patient outcomes in individuals with chronic low back pain (LBP).Methods50 participants with nonspecific chronic LBP were randomly allocated (1:1) to each group (MC + ILEX or GE) and underwent a 12-week supervised intervention program 2 times per week. Magnetic resonance imaging was performed at baseline, 6-weeks and 12-weeks to examine the impact of each intervention on multifidus (MF) and erector spinae (ES) muscle volume (cm3) and fatty infiltration (%FI) at L1-L2, L2-L3 and L3-L4.ResultsOur results revealed no significant between-groups findings for MF and ES %FI and volume, and patient-reported psychosocial measures. However, both groups had significant within-groups decreases in MF %FI at L1-L2, L2-L3 and L3-L4, with concomitant decreases in MF volume at L1-L2 and L2-L3, and at L3-L4 in the GE group. Each group displayed significant improvements in Kinesiophobia, while only MC + ILEX had significant improvements in pain catastrophizing, anxiety, depression and sleep. Lastly, significant correlations were found between change in Kinesiophobia and upper lumbar MF %FI, and between change in strength and lower lumbar MF and ES size.ConclusionsBoth exercise interventions may help reduce upper lumbar MF %FI in individuals with chronic LBP, while MC + ILEX could significantly improve important patient outcomes. Our results support the idea that improvements in paraspinal muscle health associate with better patient outcomes. Further high-quality imaging studies are needed to explore these relationships.

The In Vitro and Vivo Validation of a New Ultrasound Method to Quantify Thoracolumbar Fascia Deformation.

Background: A new method for quantifying thoracolumbar fascia deformation (TLFD) and its shear capacity has been introduced, and its reliability for discriminating patients with low back pain (LBP) from healthy controls has been demonstrated in a recent paper. The aim of this study was to investigate the method in terms of criterion validity. Methods: First, the concurrent validity of the TLFD ultrasound measurement method (TLFD_US) was tested in vitro, using a custom-made tissue sliding device that mimics tissue shearing and generates ground truth data. Second, ultrasound images and videos of TLFD were acquired from 10 acute LBP patients and 10 healthy controls by a blinded assessor. In vivo, the concurrent validity of TLFD_US and speckle tracking analysis was then tested. Third, the contribution of the surrounding tissue layers of the erector spinae muscle and dermis to TLFD was calculated using multiple linear regression. Results: The in vitro concurrent validity between TLFD_US and ground truth was excellent (ICC = 0.99; p < 0.001). In vivo, the concurrent validity between TLFD_US and speckle tracking analysis was large (r = 0.701; p < 0.001). Multiple linear regression revealed a large effect regarding the relationship between dermis shear and TLFD (R2 = 0.353; p = 0.01). Conclusions: TLFD_US showed excellent criterion validity. Its suitability for capturing morphological parameters of the thoracolumbar fascia is further reinforced.

Observational Parameter of Lower Back Pain of Patients at the General Hospital UKI, Jakarta, Indonesia

Aims: To find out about the characteristics of lower back pain (LBP) in patients at the UKI General Hospital's Neurology Polyclinic from January 2021–Deadline 2022. Study Design: Retrospective descriptive research with a cross-selective design. Place and Duration of Study: The research was carried out at the Neurology Polyclinic, Ulmulm Ulnivelrsitas Hospital, Kristeln Indonesia in March 2024. Methodology: This research is a retrospective descriptive research using a cross-sector design. Data collection is carried out by collecting patient medical record data. This research uses a total sampling technique. The research sample consisted of 53 patients. Results: Analysis of the results is mostly based on age, gender, body mass index, type of work, type of pain, and LBP onset as well as treatment, namely: aged 56 - 65 years with a total of 19 patients (35.8%), a total of 41 patients. patients (77.4%), BMI 25 – 29.9 kg/m2 (the weight I) totaling 17 patients (32.1%), working as entrepreneurs totaling 21 patients (39.6%), radicular pain types totaling 28 patients (52.8%), acute LBP as many as 31 patients (58.5%), and co-infective management as many as 50 patients (94.3%) Conclusion: LBP patients are dominated by women with an age range of 56-65 years. BMI 25 – 29.9 kg/m2 has the highest frequency and the type of work most frequently carried out by LBP patients is work in the private sector. Based on the type of pain and symptoms most frequently experienced are radicular pain and acute LBP. Based on the management that is most frequently obtained is conservative management.

NON-SURGICAL MANAGEMENT OF CHRONIC RADICULAR PAIN IN LUMBAR CANAL STENOSIS: A CASE REPORT ON THE EFFICACY OF PULSED RADIOFREQUENCY

Background: Low back pain (LBP) is a prevalent condition, particularly in adults aged 40 to 80 years, and is often associated with lumbar canal stenosis. This condition leads to nerve compression, causing radicular pain that radiates to the lower extremities. Non-surgical options such as Pulsed Radiofrequency (PRF) have emerged as effective treatments for patients with chronic radicular pain who do not respond to conservative therapy. Case: We report a case of a 49-year-old female presenting with a three-year history of progressively worsening LBP, radiating to both legs. MRI revealed mild lumbar canal stenosis and posterior listhesis grade I at L3-L4, with bilateral nerve root compression at L4-L5 and S1. Conservative therapy, including physical therapy and pharmacological treatment, provided minimal relief. PRF therapy was subsequently applied to the L4-L5 and S1 nerve roots, resulting in significant pain reduction (NRS 7-8 to 5-6) and improved function. Discussion: Lumbar canal stenosis often leads to neurogenic claudication and radicular pain due to nerve compression. Posterior listhesis exacerbates this condition by contributing to spinal instability. PRF offers a minimally invasive alternative to surgery, with studies showing its efficacy in modulating nociceptive pathways and reducing pain. In this case, PRF effectively reduced pain and improved mobility, offering a safe and efficient treatment option. Conclusion: PRF is an effective non-surgical intervention for managing chronic radicular pain due to lumbar canal stenosis. Its integration into chronic low back pain management protocols and patient education offers significant benefits.

Different Spatial Characteristic Changes in Lumbopelvic Kinematics Before and After Fatigue: Comparison Between People with and Without Low Back Pain.

The lumbopelvic region plays a pivotal role in enabling various functional activities. This study quantified and compared the kinematic changes between healthy individuals and patients with recurrent low back pain (LBP) in both rested and fatigued states to gain insight into the kinematic adaptation and mechanisms underlying kinematic variations that occur in the presence of these factors. Participants were divided into two groups: the LBP (n = 23) and healthy control groups (n = 19). Dynamic lumbopelvic measurements were taken using a biplane radiography image system while the participants performed weight-bearing forward-backward bending before and after fatigue. All lumbopelvic kinematics were described as the three-dimensional motion of the vertebra relative to the pelvis and were measured at normalized time intervals from maximum extension to approximately 45° of flexion. Repetitive lifting- and lowering-induced fatigue significantly affected lumbopelvic kinematics in the anterior/posterior translation (mm) and rotation around the z-axis in both healthy individuals and patients with LBP (p < 0.05). In healthy individuals, significant differences occurred in approximately 13-83% of the forward-backward bending cycle (0-100%), whereas, in patients with LBP, significant differences mainly occurred in 61-93% of the cycle (p < 0.01). The lumbopelvic kinematic changes observed in both LBP patients and healthy individuals after fatigue may indicate protective compensation or vulnerability and could play a role in LBP dysfunction.

Sex-specific asymmetry in lumbar paraspinal muscles among chronic low back pain patients: correlation with pain duration and intensity

Chronic low back pain (cLBP) is a multifactorial condition, including paraspinal muscle asymmetry. Understanding the relationship between muscle asymmetry and cLBP and how this varies by sex is crucial for targeted interventions. From January 2022 to December 2023, 250 participants were enrolled: 117 without back pain (no-BP) (61 females, 56 males) and 133 with cLBP (69 females, 64 males). MRI assessed the cross-sectional area (CSA), functional CSA (FCSA), and fat infiltration (FI) of the paraspinal muscles, including the psoas major (PM), quadratus lumborum (QL), erector spinae (ES), and multifidus (MF), at all lumbar levels. Asymmetry indices were calculated for CSA (CAI), FCSA (FCAI), and FI (FIAI). Data were analyzed using multiple linear and logistic regression. Muscle asymmetries were observed in both sexes and groups, with significant differences in the CSA and FCSA of the QL in males and notable FI asymmetries in the cLBP group. In women with cLBP, higher ES CAI and FCAI at L5/S1 (p < 0.05) and lower PM FCAI at L4/5 (OR 0.869, 95% CI 1.008–1.150, p = 0.03) were observed. FIAI was significantly higher in cLBP for ES at L2/3 and PM, MF, and ES at L4/5 (p < 0.05). Men with cLBP had lower PM CAI and FCAI at L1/2 and L4/5 (p < 0.05), with varying FIAI levels. FIAI correlated with cLBP duration and intensity in both sexes (p < 0.05). Paraspinal muscle asymmetry, particularly in fat infiltration, is associated with cLBP and varies by sex. These findings support sex-specific approaches to managing cLBP.