AimsThis study examines the prevalence and distribution of Modic changes (MCs) in the lumbar spine and the association with low back pain (LBP) across different age and sex categories.MethodsA retrospective cross-sectional analysis was conducted based on MRI data from a UK orthopaedic centre of lumbar spine MRIs from January to December 2023. Demographics and clinical presentation, namely LBP, was analyzed for correlation with the presence of MC, which was categorized as Modic type I (M1) and II (M2), according to MRI signal intensity. Prior spinal surgery or spinal deformity were exclusion criteria.ResultsThe results showed a high frequency of M1 and M2 changes at lower lumbar levels, particularly at L4/L5 and L5/S1, known to be subject to greater mechanical stresses (p < 0.001). MCs were highly correlated with LBP, as 66% of the patients had both conditions. Females were more affected with 72% of females with MC having LBP compared to 58% of males, (p < 0.001). M1 changes were also more frequently associated with LBP in young and old age groups.ConclusionThese results show that not only are MC a common phenomenon, but that they are correlated with the presenting complaint of LBP in confirmation of previous studies. The work presented here adds to this by documenting the anatomical location, female predominance and age distribution where the presence of MC is more highly correlated with the presenting complaint of LBP.Cite this article: Bone Jt Open 2025;6(12):1560–1565.

Thoughts on spinal cord stimulation for non-surgical low back pain

Background: This study aimed to (a) determine how frequently chiropractors use postural assessment when treating patients with back or neck pain, (b) determine the rationale for the use of postural assessment by chiropractors, (c) examine the assessment methods employed, (d) explore which specific aspects of posture are assessed and (e) determine the types of back and neck conditions being treated. Methods: An 11-item online questionnaire was developed. A link to this survey was distributed using SurveyMonkey to the entire membership of the Royal College of Chiropractors. Results: There were 272 respondents to the survey. Of the respondents, 79% ‘almost always’ used postural assessment when treating patients with back or neck pain. Respondents reported using postural assessment to help determine whether a patient was making progress (61.8%), provide an outcome measure (57.1%) and help inform the diagnosis (89.2%) and treatment plan (81.8%); almost all respondents (98.1%) reported carrying out a postural assessment visually, with no aids. Most respondents reported assessing their patients posteriorly, anteriorly and from both left and right sides, observing 44 specific anatomical items. The conditions treated included sacroiliac pain (96.7%), stiff neck (95.6%), non-specific lowback pain (92.6%), lumbar disc herniation (91.5%), cervical arthritis (89.7%), lumbar strain (87.1%), lumbar arthritis (86.4%), thoracic pain (86.4%), neck strain (84.9%) and whiplash (79.8%). Conclusions: The findings suggest that the unaided visual assessment of posture using a large range of anatomical points is used by UK chiropractors for the purposes of aiding diagnosis and treatment of patients with back and neck pathologies.

Low back pain (LBP) is the primary contributor to disability worldwide, leading to a significant healthcare burden. Implementing evidence-based practice (EBP) can reduce this burden, as healthcare professionals (HCPs) working evidence-based reduce the number of treatments, the use of imaging and medication compared to HCPs not working evidence-based. Clinical practice guidelines have been published to help HCPs implement research evidence into practice. Unfortunately, studies have consistently shown a lack of adherence to guidelines in LBP care. This study aimed to investigate the implementation outcomes of a tailored programme for implementing key recommendations from LBP guidelines among Danish physiotherapists and chiropractors working in primary care. This study was conducted as a 'pre-post' implementation study among 80 physiotherapists and chiropractors from 15 primary care clinics. The implementation object was the two key guideline recommendations: 1) screening of psychosocial risk factors and 2) patient education, including reassuring information. The programme comprised multipronged strategies and was designed as a step-by-step implementation process comprising 16hours of activities distributed over 16weeks. Adoption was measured as changes in self-reported behaviour and perceptions of the professional role and culture from baseline to follow-up at 16weeks. Acceptability and appropriateness of the programme were measured weekly using a four-point Likert scale. Feasibility was measured at 16-week follow-up using a five-point Likert scale. Fidelity was measured as the number of strategies and implementation support delivered as planned and registered by the research team. An increase in the adoption of screening of psychosocial factors and offering patient education, including reassuring information, was seen in 38% and 33% of participants, respectively. Most participants reported that the programme was partly or overall acceptable and appropriate. The feasibility of the implementation programme was assessed as moderate to high, and the fidelity of the implementation programme was determined as high. The tailored implementation programme enhanced the adoption of the guidelines and changed the participants' professional identity and culture. Most participants found the programme partly or overall acceptable and appropriate. The programme was feasible, but the perspective requires refinements, as most participants rated it moderately feasible. Central Denmark Region, Registered November 11, 2021, act no. 1-16-02-93-19.

To analyze the correlation between paraspinal muscle atrophy, facet joint degeneration, and degenerative scoliosis (DS). A retrospective study included 231 chronic low back pain patients from Zhongda Hospital Affiliated to Southeast University (January 2023-January 2024). Radiographic diagnosis assigned 150 patients to DS group (subclassified into mild [n = 72], moderate [n = 56], severe [n = 22]) and 81 to non-DS control group. Using T2-weighted MRI at L3-S1 levels, ImageJ software measured multifidus (MF) and erector spinae (ES) cross-sectional area (CSA) and functional muscle ratio (LCSA/GCSA). Surgimap software quantified facet joint angle (FJA), facet overhang (FO) length, and facet joint space width (FJSW). Logistic regression analyzed risk factors with ROC curves determining diagnostic thresholds. The non-DS group demonstrated a significantly higher proportion of males (P = 0.023) and greater bone mineral density (P = 0.043) compared to the DS group. Regarding paraspinal muscle parameters, the non-DS group exhibited significantly larger MF CSA, MF + ES CSA, and LCSA/GCSA at the L3/4, L4/5, and L5/S1 levels, as well as a larger ES CSA at the L3/4 level (all P < 0.05). Conversely, the ES CSA at the L5/S1 level was significantly smaller in the non-DS group. For facet joint parameters, the non-DS group showed significantly smaller FJA, FO Length at the L3/4, L4/5, and L5/S1 levels, and smaller FJSW at the L3/4 and L4/5 levels (all P < 0.05). Within the DS group, significant differences were observed between the convex and concave sides at all L3-S1 levels for LCSA/GCSA, MF CSA, ES CSA, FJA, FO Length, and FJSW (all P < 0.05). With increasing severity of DS, there was a progressive decrease in LCSA/GCSA, MF CSA, and ES CSA, and a progressive increase in FJA and FO Length across the L3-S1 levels (all P < 0.01). Post-hoc analysis revealed significant differences in the majority of muscle parameters between severe DS and mild/moderate DS (P < 0.05). Correlation analysis indicated that, except for FJSW at L5-S1 (P = 0.526), the Cobb angle was negatively correlated with MF CSA, ES CSA, LCSA/GCSA, and FJSW, and positively correlated with FJA and FO Length (all P < 0.001). In both the DS and non-DS groups, most LCSA/GCSA and other CSA measurements demonstrated no significant correlations with FJA, FO length, and FJSW. Among the few statistically significant correlations observed, all were weak (rho < 0.30). Multivariate logistic regression analysis identified the following risk-associated factors for DS: lower BMD (OR = 0.802, P = 0.032), reduced LCSA/GCSA (OR = 0.005, P = 0.003), smaller MF CSA (OR = 0.969, P = 0.027), smaller ES CSA (OR = 0.973, P = 0.014), larger FJA (OR = 1.075, P = 0.016), and greater FO length (OR = 1.067, P = 0.001). ROC analysis yielded AUCs/cut-offs: BMD (0.581/-0.900T-score), LCSA/GCSA (0.712/0.805), MF CSA (0.608/635 mm2), ES CSA (0.463/832 mm2), FJA (0.627/57°), FO length (0.651/6.550mm). DS patients demonstrate progressive paraspinal muscle atrophy, sagittal-oriented facet joints, and advanced facet degeneration correlating with scoliosis severity. Diagnostic thresholds indicating DS probability are BMD < - 0.900T-score, LCSA/GCSA < 0.805, MF CSA < 635 mm2, ES CSA < 832 mm2, FJA > 57°, and FO length > 6.550mm.

The clinical course of low back pain (LBP) is highly variable. While some recover quickly, others experience prolonged or fluctuating disability. Understanding this heterogeneity, and the factors that influences it, is important for effective clinical management and for communicating realistic prognosis to patients. The aims of this study were to describe the variation in disability courses among chiropractic patients with LBP and to investigate how selected biopsychosocial characteristics measured at baseline can predict these courses and potentially explain the observed variation. Longitudinal data from 2,777 Danish adults consulting chiropractors for a new episode of LBP were analysed. Disability was measured at baseline, 2, 13, and 52weeks using the Roland Morris Disability Questionnaire (0-100 scale). Latent Class Analysis was applied to identify disability trajectories. Associations between baseline patient characteristics and trajectory class membership were examined across demographic, psychological and social domains. A post hoc composite index score was developed to summarize the cumulative burden of unfavourable baseline characteristics. Nine distinct disability trajectories were identified, ranging from rapid recovery to persistent high disability, and fluctuating patterns. Six classes accounted for approximately 90% of patients, while three smaller classes with more irregular trajectories accounted for 10%. Higher number of MSK pain sites, comorbidities, and higher levels of BMI, depression, anxiety, kinesiophobia, prescription analgesic use, and poorer general health were associated with increased likelihood of belonging to less favourable trajectories. Both individual baseline characteristics and the index score combining these characteristics showed a clear dose-response relationship with disability trajectories. Patients with higher burden were more likely to follow less favourable trajectories. However, substantial variation remained within index groups, indicating that baseline characteristics alone cannot fully predict individual outcomes. Among chiropractic patients with LBP, trajectories of disability over one year can vary substantially in pattern. Baseline biopsychosocial characteristics influence trajectories and prognosis in a cumulative, dose-dependent manner. Clinicians should be aware of this variability and tailor communication about expectations accordingly.

Menstrual low back pain (MLBP) can lead to functional limitations, including decreased flexibility and reduced range of motion. The age of menarche (early or late menarche) is suspected to influence this condition. Exercise interventions such as lumbo-pelvic exercises and yoga are known to improve flexibility and reduce muscle stiffness; however, their effectiveness based on menarche categories has not been widely studied. This study aimed to analyze the effect of lumbo-pelvic exercises and yoga on improving the range of motion in cases of menstrual low back pain, considering early and late menarche categories. This study was an experimental research with a 2x2 factorial design. The subjects were 20 female students from Respati University Yogyakarta with a history of primary dysmenorrhea and low back pain during menstruation, divided into four groups: A1B1 (early menarche + lumbo-pelvic exercise); A1B2 (late menarche + lumbo-pelvic exercise); A2B1 (early menarche + yoga); and A2B2 (late menarche + yoga). The interventions were conducted five times per week for six weeks. Pain intensity was measured using the Visual Analog Scale (VAS) before and after the intervention. Data were analyzed using the Shapiro–Wilk normality test, Levene’s test for homogeneity, and the Kruskal–Wallis test for hypothesis testing. The Kruskal–Wallis test showed a statistically significant difference in pain reduction among the treatment groups (p = 0.011). The group with the combination of late menarche and lumbo-pelvic exercise (A1B2) showed the highest pain reduction (Mean Rank = 18.00), while the group with late menarche and yoga (A2B2) had the lowest (Mean Rank = 7.50). These findings indicate that the effectiveness of the intervention on menstrual low back pain is influenced by the combination of menarche age and the type of exercise given. There was a significant difference in the effect of lumbo-pelvic exercises and yoga on reducing menstrual low back pain. Participants with late menarche experienced greater pain reduction compared to those with early menarche. Moreover, lumbo-pelvic exercises were proven to be more effective than yoga in reducing pain.

BackgroundThe United States faces significant challenges in physical therapy (PT) access due to high demand, a shortage of professionals, and patient-related obstacles, which can adversely affect recovery and function. Limited access to PT may lead to increased dependence on medications for pain management, highlighting the need for nonpharmacologic options to reduce opioid overprescribing. Low back pain, a leading cause of disability and high medical costs, is a common reason for requiring PT following surgery. Studies have shown that virtual reality (VR)–guided movements can improve motor function and reduce pain intensity.ObjectiveThe objective of this study was to design, develop, and evaluate a VR-based prototype for individualized postoperative PT for patients recovering from back surgery to investigate its potential to improve convenience, access, and health outcomes in future research.MethodsStudy methods involved participatory design and development of VR software for PT back exercises using the design box method, an inductive, problem-oriented collaborative design approach. A usability evaluation of the resulting prototype was conducted with patients recovering from back surgery using a think-aloud protocol and usability survey.ResultsSix participants evaluated the VR prototype and reported usability challenges that included mismatched VR boundaries, limited familiarity with VR, and difficulties with the headset and hand controls. The System Usability Scale resulted in a total usability score of 58.3 out of 100, indicating a below-average score (68 being average).ConclusionsIn the design and evaluation of a VR-based PT prototype, we found that while participants were enthusiastic, they faced usability challenges due to insufficient instructions and difficulties operating the VR device, highlighting the need for effective onboarding and extensive prototype testing to improve accessibility and engagement in health care. Future evaluations will investigate disparities among different groups to ensure accessibility and effectiveness for all users.

Peripheral Nerve Stimulation for Low Back Pain: A Review of the Recent Literature.

Objective Cauda equina syndrome (CES) is a rare but devastating condition in spine surgery. There are various surgical decompression methods, but the clinical outcomes are not always satisfactory. We introduce the surgical technique of non-pressurized percutaneous endoscopic transforaminal lumbar discectomy (PETD) technique in the treatment of cauda equina syndrome caused by lumbar disc herniation, and to evaluate its clinical efficacy compared to traditional transforaminal lumbar interbody fusion (TLIF). Methods A retrospective study was conducted on 51 cases diagnosed with lumbar disc herniation complicated by cauda equina syndrome. They were divided into two groups, 23 cases in the PETD group and 28 cases in the TLIF group. The surgical procedure and technical details of non-pressurized PETD technique were described. Visual analogue scale (VAS) for low back pain and leg pain, Japanese Orthopaedic Association scores (JOA), Oswestry Disability Index (ODI), and the cauda scale (TCS) were used to evaluate the clinical efficacy between the two groups. Results There were no significant differences in baseline data between the two groups. Significant improvements were observed at the final follow-up in both PETD and TLIF groups. The VAS for low back pain and ODI at discharge were lower in the PETD group than those in the TLIF group (both P &amp;lt; 0.05). There were no significant differences in low back pain VAS, leg pain VAS, JOA score, ODI score, and TCS score between the two groups at preoperative and final follow-up. The complications included two cases of intraoperative neck pain and one case of recurrent disc herniation in the PETD group, and one case showed adjacent segment degeneration at the final follow-up in the TLIF group. Conclusion In this preliminary retrospective study, the non-pressurized PETD technique was associated with similar medium-term outcomes and a faster short-term recovery compared to TLIF. These findings require validation in larger, prospective, randomized controlled trials to establish comparative efficacy.

Background: Low back pain is a common complaint among pregnant women and is related to biomechanical adaptations, weight gain, and hormonal changes during pregnancy. Health promotion efforts, such as structured home exercise programs that focus on core stability and flexibility, can help alleviate these symptoms. The aim of this study was to evaluate the effectiveness of a structured home exercise program in preventing and managing low back pain in pregnant women in the second and third trimesters. Methods: A pre-experimental design with a single group and pretest-posttest approach was utilized, involving 42 pregnant women chosen through purposive sampling. The participants engaged in a Structured Home-Based Core Stabilization and Flexibility Exercise Program twice a week, with each session lasting 30–45 minutes over a span of eight weeks. Pain intensity was measured using the Visual Analog Scale (VAS). Due to the non-normal distribution of the pre- and post-intervention scores, the Wilcoxon Signed Rank Test was used for analysis. Results: The VAS score significantly decreased from 4.81 ± 1.44 to 1.93 ± 0.84 (p &lt; 0.001), with an average reduction of 2.88 points. The effect size was very large (r = 0.87; 95% CI: 0.86–0.88), indicating a strong intervention effect on pain reduction. Conclusion: These findings indicate that the program is an effective non-pharmacological health promotion strategy and can be recommended for routine implementation in maternal health services to prevent and manage low back pain during pregnancy.

This study aimed to review and analyze the risk factors associated with osteoporotic vertebral compression fractures (OVCFs) accompanied by thoracolumbar fascia (TLF) injury. Data from 489 patients who were diagnosed with OVCFs between February 2017 and January 2020 at the Bone Injury Center of Yueyang Integrated Traditional Chinese and Western Medicine Hospital affiliated with Shanghai University of Traditional Chinese Medicine were included. Patients were divided into two groups with and without TLF injury) on basis of their diagnosis. We reviewed and analyzed the following data points from both groups to identify risk factors for OVCFs with TLF injury: sex, age, body mass index (BMI), bone density, cause of injury, time from symptom onset to diagnosis, season of onset, number and location of fractured vertebrae, degree of vertebral compression, extent of paraspinal muscle fat infiltration, history of chronic diseases (hypertension, diabetes), history of steroid use, and previous history of low back pain. Among the 489 patients, 230 were diagnosed with TLF injury. Univariate analysis revealed no significant association (P > 0.05) between the development of OVCFs with TLF injury and factors such as sex, BMI, cause of injury, history of chronic diseases (hypertension, diabetes), history of steroid use, or previous history of low back pain. However, age, bone density, time from symptom onset to diagnosis, season of onset, location of fracture, number of fractured vertebrae, vertebral compression ratio, and degree of paraspinal muscle fat infiltration were significantly correlated with the occurrence of OVCFs with TLF injury (P < 0.05). Multivariate logistic regression analysis further revealed that age, time from symptom onset to diagnosis, bone density, and degree of paraspinal muscle fat infiltration as independent risk factors for OVCFs with TLF injury in both groups (P < 0.05). Our findings suggest that clinicians should pay close attention to age, bone density, time from symptom onset to diagnosis, and the degree of paraspinal muscle fat infiltration when evaluating patients for OVCFs with potential TLF injuries.

Abstract Background Chronic low back pain (CLBP) is a prevalent condition affecting millions globally, often leading to disability and impaired quality of life. It is a leading cause of disability, with significant impacts on functionality, social participation, and mental health. Various interventions, including progressive postural control exercise (PPCE), yoga, and conventional physiotherapy, are used to manage CLBP, but their comparative efficacy remains unclear. This study aimed to compare the effectiveness of PPCE, yoga, and conventional therapy in improving pain, disability, and core muscle endurance in individuals with CLBP. Methods A total of 36 participants were recruited for the study and assigned to three groups: group A (PPCE), group B (yoga), and group C (control). The study utilized a comparative experimental design with convenience sampling. Interventions lasted for 6 weeks. Outcome measures included pain intensity (measured using the Numeric Pain Rating Scale), pain-related disability (Roland-Morris Disability Questionnaire), and core muscle endurance (Prone Plank Test). Statistical analysis was performed using one-way ANOVA and post hoc Tukey tests. Results Over 6 weeks, both PPCE and yoga significantly improved pain, disability, and core endurance compared to baseline. PPCE showed the largest reductions in NPRS (Δ = 5.08, 95% CI 4.14–6.03) and RMDQ (Δ = 12.17, 95% CI 8.21–16.12), while yoga produced the greatest increase in Prone Plank (Δ = 39.00 s, 95% CI −61.72 to −16.29). Post hoc analysis revealed PPCE reduced pain more than control ( P = 0.01), and yoga improved core endurance versus control ( P = 0.04). Conclusion At the end of 6 weeks, the PPCE group showed significant improvements in pain, disability, and core endurance, making it the most effective intervention. The yoga group showed significant gains in core endurance but not in pain or disability, while the control group showed minimal improvements. These findings suggest that progressive core exercises and yoga can be effectively integrated into conventional physiotherapy for managing chronic low back pain, enhancing overall outcomes through pain relief, functional improvement, and core stability.

Osteoporosis is a metabolic-based bone disease, which is one of the most frequent osteoarticular comorbidities, especially in countries with older populations, and is associated with an elevated risk of bone fractures with significant morbidity and mortality. We present a case of a 58-year-old man seen at a Primary Care facility complaining of acute low back pain. After persistence of the complaints for 3 weeks, an imaging study with lumbar computed tomography (CT) was performed, showing multiple fractures and rarefaction of bone trabeculation. The diagnosis of osteoporosis was confirmed after bone densitometry with a Z-score of -3.3 in the lumbar spine. The main secondary causes of osteoporosis have been excluded, and no family history is known. The only risk factor found was smoking (37 UMA). The patient was treated with denosumab and cholecalciferol + calcium carbonate. Assessment was requested at a Rheumatology hospital consultation and is now undergoing additional genetic study and monitoring of the disease.

Disc degeneration (DD) increases with age, but its onset and early progression remain poorly understood. This longitudinal study examined DD progression from adolescence into adulthood in healthy individuals. Forty participants with magnetic resonance imaging (MRI) at ages 11, 19, and 34 were included. Discs were graded using the Pfirrmann classification, and a Pfirrmann Summary Score (PSS, range 5-25) was calculated by summing individual disc grades. The primary outcome was progression of overall DD burden, defined as an increase in PSS. Participants were grouped by PSS at age 11: PSS = 5 (later-onset) vs. PSS 6 or higher (early-onset). Presence of at least one disc graded Pfirrmann 3 or higher was assessed at ages 19 and 34. Demographics, anthropometrics, and clinical characteristics were comparable between the groups. All participants showed DD progression. Early-onset individuals had higher PSS at ages 19 and 34, whereas later-onset individuals exhibited greater PSS change over time. By age 19, early-onset participants more frequently had at least one Pfirrmann 3 or higher disc; by age 34, occurrence was similar (72% vs. 73%). Later-onset DD was localized to lower lumbar spine, whereas early-onset DD was more widespread. DD progression trajectories were not associated with low back pain (LBP) by age 34. Progression of DD is an inevitable but individually variable process. Early-onset DD appears to lead to a more widespread pattern, whereas later-onset DD progresses more rapidly but remains confined to the lower lumbar spine. No direct relationship between structural progression and LBP could be determined.

Acute type A aortic dissection(aTAAD) complicated by mesenteric malperfusion (MMP) is associated with a high mortality rate due to bowel necrosis and subsequent multiorgan failure [(Yang Bet al. inJ Thorac Cardiovasc Surg158:675-687 e674, 2019), (Wang C et al. in Rev Cardiovasc Med24:127, 2023)]. The optimal management strategy remains controversial, particularly regarding the timing and extent of bowel resection. Extensive resection can lead to short bowel syndrome, resulting in chronic intestinal failure and poor nutritional outcomes. Here, we present a case of aTAAD successfully managed with staged bowel resection guided by intraoperative indocyanine green (ICG) fluorescence angiography. A 29-year-old man presented with acute lower back pain and sensory deficits in both legs. He was diagnosed with acute type A aortic dissection and multiple malperfusions, including MMP. Emergency total aortic arch replacement with frozen elephant trunk was performed as central repair. Postoperatively, ischemic necrosis of the ascending colon was identified and resected, while the viability of the ileum remained uncertain. Intraoperative ICG fluorescence angiography confirmed adequate perfusion of the vasa recta, indicating reversible ischemia. To minimize unnecessary bowel resection, a second-look laparotomy surgery was performed 16h later, leading to additional necrotic bowel resection. Ultimately, 180cm of the ileum from the ligament of Treitz was preserved. The patient resumed oral intake approximately one month postoperatively and achieved full enteral independence by four months. This case highlights the importance of integrating ICG fluorescence angiography and staged bowel resection in the management of aTAAD with MMP. Early central repair, combined with real-time assessment of intestinal perfusion, enabled the preservation of intestinal length and improved postoperative outcomes. A strategic, stepwise approach is essential to optimizing bowel viability while maintaining hemodynamic stability in such critical situations.

The knowledge about the improvement of body function, activity and participation in chronic low back pain (CLBP) over a period of over ten years is still insufficient. The study aimed to investigate the long-term change for body function, self-reported activity due to CLBP e.g. Roland Morris Disability Questionnaire (RMDQ) and work participation. A 13-year prospective longitudinal cohort study of women with CLBP seeking primary healthcare. Women (n = 130) with CLBP (> 12 weeks) were included in 2004 to 2005 (baseline), after two and 13 years. The assessment included questions about socio-demographic data, comorbidity, and pharmacological treatment, physical capacity-tests, and patient reported outcome questionnaires. Changes in measurements, for physical capacity, pain intensity, pain localisations, RMDQ, symtoms of anxiety and depression, clinical stress symptoms, and health-related quality of life, between baseline and the 13-year follow-up were calculated. Depending on the data level and distribution, either parametric or non-parametric tests were applied. A mixed effect model was used to analyse repeated measures of RMDQ from baseline to the two-year and 13-year follow-ups, comparing the group with localised CLBP and CLBP + widespread pain (WP) group. The RMDQ was dependent variable and age, education level, pain intensity, 6-Minute Walk Test, symptoms of stress, and depression were included as confounding factors. 67% (87/130) could be followed up after 13 years. 26% of the participants (22/86) fulfilled the criteria for WP at baseline. All measurements showed small improvements or were stable, except for hand grip strength. The mean change in RMDQ was - 3.3 (4.1) points. 73% (63/86) improved at least one point and 40% (34/86) improved ≥ 5 points on RMDQ from baseline. RMDQ improved in both the groups CLBP and CLBP + WP over the 13-year period (p < 0.001) when adjusting for age, education, pain intensity, 6-Minute Walk Test, symptoms of stress, and depression. All outcome measurements, except for hand grip force either showed small improvements or remained stable over a period of 13 years. For activity related to CLBP, no differences were found between the CLBP group and the CLBP + WP group when adjusting for pain intensity, physical capacity, stress, and depression. 40% improved with clinical important change in self-reported activity related to CLBP over a period of 13-years, which is important information to provide to individuals seeking primary healthcare for CLBP. ClinicalTrials.gov, ID: NCT03974191. Registration date: 27 May 2019.

Central sensitization of pain (CSP) is defined as the “increased responsiveness of nociceptive neurons in the central nervous system (CNS) to normal or subthreshold afferent input” The primary objective of this study is to compare the prevalence of CSP between patients presenting with foot and ankle conditions and those presenting with low back pain. Materials and Methods: A cross-sectional study was conducted comparing a cohort of patients with a first consultation for foot and ankle disorders to another cohort with a first consultation for lumbar spine pain at the same institution. Demographic variables, pain duration, main diagnosis, and a series of questionnaires assessing pain and disability were collected. The Central Sensitization Inventory (CSI) was administered to determine the presence of CSP within the groups. Statistical analyses were performed using STATA. Results: A total of 195 patients presenting with foot/ankle conditions and 252 patients with low back pain were included. Among the foot/ankle cohort, 16.4% (95% CI, 10.92–21.9%) were classified as having CSP, compared to 22.2% (95% CI, 16.85–27.6%) in the lumbar pain cohort. The difference in CSP prevalence between groups was not statistically significant (difference 5.79%, Chi2 = 2.357, p = 0.125). However, the difference in mean scores on Part A of the CSI was statistically significant (31.82 ± 13.88 vs. 25.20 ± 14.31, z = 4.237, p &lt; 0.001). Among foot/ankle pathologies, plantar fasciitis showed the highest prevalence of CSP (21.9%), followed by hallux valgus (18.8%). A significant association was observed between CSP and higher levels of pain and disability. Female patients demonstrated a higher prevalence of CSP. Conclusions: Patients with low back pain exhibited higher CSI scores and a greater prevalence of central sensitization compared with those with foot and ankle disorders. Recognizing these mechanisms may help clinicians tailor more effective, multidisciplinary treatment strategies.

Musculoskeletal brucellosis presenting as low back pain and a limp.

PurposeCardiovascular disease (CVD) and chronic pain substantially affect menopausal women. However, evidence is scarce regarding how the course of pain over time—specifically, whether it is persistent and affects multiple body sites—influences the future risk of CVD in this population. This study aimed to investigate the longitudinal association between these novel pain phenotypes and incident CVD, and to evaluate the mediating roles of depressive symptoms and body mass index (BMI).Patients and MethodsThis prospective analysis included 4,890 postmenopausal women from the China Health and Retirement Longitudinal Study (CHARLS). Pain status (location, intensity) and CVD were assessed at baseline (2013) and follow-up (2018). Persistent pain was defined as pain reported at both time points. We used regression models to examine the association between pain patterns and incident CVD, and mediation analysis to quantify the contribution of depressive symptoms and BMI.ResultsAt baseline (cross-sectional), pain presence, intensity, and multisite distribution were associated with higher CVD prevalence. Over five years (longitudinal), persistent pain phenotypes predicted incident CVD after adjustment: general persistent pain (OR = 1.05, 95% CI: 1.00–1.08, p = 0.012), persistent low back pain (OR = 1.08, 95% CI: 1.03–1.13, p = 0.001), and persistent multisite pain (OR = 1.06, 95% CI: 1.00–1.11, p = 0.020). Depressive symptoms mediated 21.6% of the association for persistent pain; for persistent low back pain, depressive symptoms (14.5%) and BMI (5.4%) were significant mediators.ConclusionAmong postmenopausal women, long-standing and multisite pain is associated with higher future CVD risk. A modest portion of these associations was statistically accounted for by depressive symptoms and, for low back pain, BMI. Assessing pain persistence and distribution may help identify women who could benefit from integrated appraisal of pain, mood, and metabolic health.