Low Pain Research Articles

Socioeconomic Differences in Patient Reported Outcome Measures 3 Months After Stroke: A Nationwide Swedish Register-Based Study.

There is a well-known association between low socioeconomic status (SES), poor survival, and clinician-reported outcomes after stroke. We aimed to assess socioeconomic differences in Patient Reported Outcome Measures 3 months after stroke. This nationwide cohort study included patients registered with acute stroke in the Swedish Stroke Register 2015-2017. Patient Reported Outcome Measures included activities of daily living (mobility, toileting, and dressing), and poststroke symptoms (low mood, fatigue, pain, and poor general health). Information on SES prestroke was retrieved from Statistics Sweden and defined by a composite measure based on education and income tertiles. Associations between SES and Patient Reported Outcome Measures were analyzed using logistic regression adjusting for confounders (sex and age) and additionally for potential mediators (stroke type, severity, cardiovascular disease risk factors, and living alone). Subgroup analyses were performed for stroke type, men and women, and younger and older patients. The study included 44 511 patients. Of these, 31.1% required assistance with mobility, 18% with toileting, and 22.2% with dressing 3 months after stroke. For poststroke symptoms, 12.3% reported low mood, 39.1% fatigue, and 22.7% pain often/constantly, while 21.4% rated their general health as poor/very poor. Adjusted for confounders, the odds of needing assistance with activities of daily living were highest for patients with low income and primary school education, for example, for mobility, odds ratio was 2.06 (95% CI, 1.89-2.24) compared with patients with high income and university education. For poststroke symptoms, odds of poor outcome were highest for patients with low income and university education (eg, odds ratio, 1.79 [95% CI, 1.49-2.15] for low mood). Adjustments for potential mediators attenuated but did not remove associations. The associations were similar in ischemic and hemorrhagic strokes and more pronounced in men and patients <65 years old. There are substantial SES-related differences in Patient Reported Outcome Measures poststroke. The more severe outcome associated with low SES is more pronounced in men and in patients of working age.

Interventions to Improve Long-Term Adherence to Physical Rehabilitation: A Systematic Review.

To evaluate the impact of physical rehabilitation interventions, supplemented with one or more adherence-enhancing components, on outcomes among adults with hip or knee osteoarthritis or chronic lower back pain. Primary literature search from inception of each database to July 27, 2021, guided by relevant search terms and keywords to search titles and abstracts. All articles meeting eligibility criteria were included for data abstraction. MEDLINE, CINAHL Complete, and Embase. Randomized and nonrandomized trials evaluating adherence-focused intervention components conducted in addition to an index usual care or usual care-like physical rehabilitation program among adults with hip or knee osteoarthritis or chronic low back pain. Eligible studies included a comparator group of the same index physical rehabilitation intervention without the adjunctive adherence components. Included studies measured outcomes at least 3 months after the rehabilitation course. Of the 10 studies meeting inclusion criteria, 6 interventions were delivered concurrent to an index rehabilitation program and 4 were delivered sequentially. Of the 3 studies that reported a positive effect on long-term adherence, only 1 was a low risk of bias study. There is very limited evidence of a beneficial treatment effect of adjunct adherence interventions on long-term physical function, self-efficacy, or adverse events. We found inadequate evidence evaluating adherence-enhancing interventions for the specific promotion of long-term adherence to home rehabilitation programs. Future studies should consider testing interventions specifically built to target behavioral maintenance of home rehabilitation programs.

Safety and perioperative outcomes of uniportal versus multiportal video-assisted thoracoscopic surgery.

Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently become an alternative approach for many minimally invasive thoracic procedures, but although its surgical effectiveness has been proven, still its feasibility and safety are debated and unclear. the objective of this study was to compare the safety and perioperative outcomes of U-VATS versus multiportal VATS (M-VATS). This was a comparative follow-up randomised controlled clinical trial, carried out on 36 randomly selected eligible patients, and fulfilling the inclusion and exclusion criteria for VATS, they were assigned randomly into two groups: Study Group I including 18 patients undergoing U-VATS with conventional treatment using standard chest tube drainage and Control Group II including 18 patients undergoing M-VATS) with the same conventional treatment using standard chest tube drainage and served as a comparable control group. Patients in the U-VATS Group 1 had faster operation time, and with reduced blood loss, pleural drainage and post-operative hospitalisation, they also experienced lower average post-operative pain score on comparison with those in M-VATS Group II (P < 0.001), respectively. For either group, there were no hospital deaths or infections. There was no noticeable difference between the two groups in terms of the number of resected lymph nodes or the rates of intraoperative or post-operative complications (P > 0.05). U-VATS is feasible and safe in eligible selected patients with favourable short-term perioperative outcomes (operative time, duration of pleural drainage, post-operative pain, early ambulation, duration of hospital stay as well as the risk of perioperative complications), and it can be considered the preferred approach in minimally invasive thoracic procedures that open up for the possibility of fast-track thoracic surgeries.

Pericapsular Nerve Group Block Did Not Reduce Postoperative Pain or Opioid Use After Total Hip Arthroplasty

BackgroundThe pericapsular nerve group (PENG) block is a newly developed regional anesthesia technique designed to manage postoperative hip pain following a fracture or surgery while also maintaining quadriceps strength and mobility. The goal of our study was to compare postoperative pain scores and opioid usage during the postoperative period before discharge following total hip arthroplasty (THA) using the posterior approach between patients who received a PENG block and those who did not. MethodsWe conducted a retrospective study on patients undergoing elective, posterior approach THA at a single tertiary-care academic center. The 2 groups included a study group (THA with PENG block in 2021; n = 66) and a control group (THA before PENG block implementation in 2019; n = 70). ResultsThere were no significant differences in pain scores during postoperative minutes 0 to 59 (study group 6.8; control group 6.6; P = .81) or during postoperative minutes 60 to 119 (study group 6.2; control group 5.6; P = .40). There were no significant differences in total postoperative in-hospital morphine milliequivalent opioid consumption (study group 55.8 morphine milligram equivalents; control group 75.0 morphine milligram equivalents; P = .14). The study group was found to have a shorter length of stay (study group 17.0 hours; control group 32.6 hours; P < .0001) and faster mobilization (study group 3.0 hours; control group 4.9 hours; P < .0001) than the control group. ConclusionsOur results show that use of the PENG block did not result in lower postoperative pain scores or opioid consumption after THA using the posterior surgical approach. The study group had a shorter length of stay and time to mobilization than the control group, though this was likely due to standard hospital procedure shifting to same-day discharge for THA between 2019 and 2021 due to COVID-19.

Poster 382: Predictors of Clinical Outcomes and Quality of Life after Sternoclavicular Joint Reconstruction with Hamstring Tendon Autograft

Objectives: Instability of the sternoclavicular joint (SCJ) is a rare but potentially devastating pathologic condition, particularly when it occurs in young or active patients. SCJ reconstruction using hamstring tendon autograft is a commonly used treatment option, yet results are limited to small case series, to date. To date, studies on baseline preoperative demographic factors and their association with postoperative outcome are limited. The objective was to assess the clinical and sport specific outcomes and survivorship after SCJ reconstruction using hamstring tendon autograft in patients suffering from SCJ instability and to determine whether baseline demographic factors were associated with postoperative outcomes or patient satisfaction. Methods: Patients who underwent SCJ reconstruction with a hamstring tendon autograft for SCJ instability between October 2005 and October 2020 were enrolled in this retrospective, monocentric study. At a minimum of 2-years postoperatively, clinical outcomes were collected, including the following patient reported outcomes (PROs): the 12-Item Short Form Survey (SF-12) physical component summary (PCS) and mental component summary (MCS) scores, American Shoulder and Elbow Surgeons (ASES) score, Quick Disabilities of the Arm, Shoulder and Hand (DASH) score, Single Assessment Numeric Evaluation (SANE) score, VAS pain score, VAS pain at worst and subjective postoperative satisfaction with the procedure (0 = very unsatisfied to 10 = very satisfied). Sport specific parameters were investigated via questionnaire. The predictive role of patient demographic factors, including age, sex, and injury in dominant arm, on postoperative PROs and satisfaction at short term follow-up was evaluated using bivariate analysis. According to their respective distribution, continuous variables were compared employing a parametric unpaired t test or the non-parametric Mann–Whitney U test. Categorical variables were compared performing the binary Fisher’s exact test or the Chi-square test. The non-parametric Wilcoxon test for two related samples was used to compare pre- and postoperative values of each outcome parameter. Spearman rank correlations coefficients were calculated in the predictive factor analysis. Results: A total of 49 patients (age: 29.6 ± 16.2 years, range 13.8-67.1, 27 females) were included in the final analysis. Surgery was performed on the dominant shoulder in 26 (63.4%) of the cases. At a mean follow-up of 3.9 ± 2.1 years, all PROs had significantly improved. These included the SF12 PCS (40.4 ± 6.8 to 52.6 ± 6.9, p&lt;0.001), ASES (54.9 ± 20.4 to 91.0 ± 11.3, p&lt;0.001), QuickDASH (41.2 ± 18.5 to 10.2 ± 9.1, p&lt;0.001); SANE (50.2 ± 21.1 to 88.3 ± 8.8, p&lt;0.001), VAS pain (4.4 ± 2.6 to 0.8 ± 1.4, p&lt;0.001) and VAS pain at its worst (7.4 ± 2.5 to 3.3 ± 2.6, p&lt;0.001). The median postoperative satisfaction score was 9 (1-10). Revision-free survivorship was 95.9%. Of those, all patients returned to athletic activity. However only 45% of the overhead athletes returned to their preinjury level. Male patients had a significantly lower VAS pain at worst compared to female patients (2.6 ± 2.6 vs. 4.1 ± 2.4; p=0.045), higher age was significantly correlated with a worse Quick-DASH score (correlation coefficient: 0.314*; p=0.036) and overhead athletes had a significantly lower propensity to return to sports compared to non-overhead athletes (p=0.043). Conclusions: The significant improvements in clinical and sports specific outcomes and high patient satisfaction after SCJ reconstruction with a hamstring autograft demonstrate the success of this procedure in treating SCJ instability. Male sex and younger patient age are associated with superior outcomes, while overhead athletes have to be counseled about difficulties of returning to preinjury level of sport, postoperatively.

BackTrAC: A Digital Care Pathway for People Presenting to Emergency with Lower Back Pain. A Development and Feasibility Study Protocol

ObjectivesBack pain is a prevalent condition that affects 1 in 6 Australians at any time, with high associated health care costs. To date, there is limited information relating to symptom severity and recovery trajectory in people with back pain who present to the emergency department for care. A digital care pathway (DCP) can track patient outcomes following presentation with back pain. The primary aim of this protocol is to outline the co-development, implementation, and evaluation of a DCP for back pain patients who present to the emergency department. MethodsThe primary aim will be addressed in 3 overlapping phases:Phase 1 (co-design) will include interviews with back pain patients and health care professionals from the Northern Hospital Emergency Department. Interview findings will inform education resources featured on the DCP and establish questionnaire content and frequency acceptability.Phase 2 (implementation) will include the rollout of the DCP and tracking of patient-reported outcome measures, which will be collected over 12 weeks.Phase 3 (evaluation) will include interviews with a subset of back pain patients who have participated in Phase 2 to evaluate the acceptability of the DCP and the barriers and facilitators of using the DCP. Ethics and DisseminationThis project has been approved via the National Health and Medical Research Council of Australia’s National Mutual Acceptance Scheme by St Vincent’s Hospital Human Ethics Committee (2022/PID06476), La Trobe University Research Governance (HEC#206/22), and Northern Health Research Governance (NH-2023-372687). We plan to publish the findings in a peer-reviewed journal and present them at conferences.

A cross-sectional study to assess the impact of lower back pain on activities of daily living among pregnant women attending antenatal clinic

A cross-sectional study to assess the impact of lower back pain on activities of daily living among pregnant women attending antenatal clinic

Functional outcomes of arthroscopic frozen shoulder release in diabetic and nondiabetic patients: a comparative study

Background Adhesive capsulitis (Frozen shoulder) is a disorder that remains poorly understood in terms of pathology and optimal treatment. Frozen shoulder is common among diabetic patients, with diabetes being a significant risk factor. This study evaluated the shoulder function (utilizing Oxford score and range of motion) and visual analogue scale (VAS) pain score after performing arthroscopic 360° capsular release and biceps tenotomy in diabetics versus nondiabetics with primary frozen shoulder. Patient and methods This prospective comparative analysis was conducted at Ain Shams University Hospitals between September 2022 and September 2023. Twenty patients with an established diagnosis of idiopathic frozen shoulder, with symptoms for a minimum of three months and failed conservative management were enrolled. All patients underwent arthroscopic 360° capsular release and biceps tenotomy with at least a 6-month follow-up period. Clinical, and functional data (Oxford Shoulder Score and range of motion), VAS pain score, and perioperative data were recorded and analyzed. Results The study population included 15 (75%) females and five (25%) males, they were divided into two age and sex-matched groups, 10 patients diagnosed with diabetes in group 1 and 10 nondiabetic patients in group 2, with a mean age of 53 years in group 1 and 48 years in group 2. Both groups demonstrated significant postoperative improvement in VAS pain score, Oxford shoulder score, and range of motion with a P value less than 0.001. When comparing the magnitude of benefit between the two groups, no statistically significant difference was detected (P value ˃ 0.05). Conclusion Arthroscopic 360° capsular release and biceps tenotomy effectively lower VAS pain score and improve shoulder function and range of motion in idiopathic frozen shoulder. Both nondiabetic patients and diabetic benefit equally from the procedure.

Short-Term Outcomes of Intraarticular Corticosteroid Injection into the Lumbar Facet Joint According to the Findings of Single-Photon Emission Computed Tomography Imaging.

Bone single-photon emission computed tomography (SPECT) preferentially localizes areas exhibiting greater bone remodeling and enhanced perfusion, which helps identify areas of pain and inflammation in the lumbar facet joints (LFJs). Herein, we investigated the treatment outcome of intraarticular (IA) corticosteroid injection in patients with LFJ-origin lower back pain (LBP) depending on the presence of increased LFJ uptake on bone SPECT. We retrospectively recruited 38 patients with LFJ-origin LBP. Of the 38 patients, 22 patients showed increased uptake on bone SPECT (SPECT+ group), and 16 patients did not show increased uptake on bone SPECT (SPECT- group). A numeric rating scale (NRS) was used to assess pain reduction 1 month after treatment with a corticosteroid injection. Treatment was considered successful when the posttreatment NRS score was ≥50% lower than the pretreatment NRS score. The NRS scores of the SPECT+ group at the 1-month follow-up were significantly lower than those of the SPECT- group. Additionally, the degree of change in the NRS scores was larger in the SPECT+ group than that in the SPECT- group. In addition, 18 of the 22 patients (81.8%) in the SPECT+ group underwent successful treatment. Eight of the 16 patients (50%) in the SPECT- group underwent successful treatment. The ratio of successful treatment was significantly higher in the SPECT+ group than in the SPECT- group. Bone SPECT could help predict the therapeutic outcome after IA LFJ corticosteroid injection and determine the treatment plan for patients with LFJ-origin LBP.

Altered Corticobrainstem Connectivity during Spontaneous Fluctuations in Pain Intensity in Painful Trigeminal Neuropathy.

Chronic neuropathic pain can result from nervous system injury and can persist in the absence of external stimuli. Although ongoing pain characterizes the disorder, in many individuals, the intensity of this ongoing pain fluctuates dramatically. Previously, it was identified that functional magnetic resonance imaging signal covariations between the midbrain periaqueductal gray (PAG) matter, rostral ventromedial medulla (RVM), and spinal trigeminal nucleus are associated with moment-to-moment fluctuations in pain intensity in individuals with painful trigeminal neuropathy (PTN). Since this brainstem circuit is modulated by higher brain input, we sought to determine which cortical sites might be influencing this brainstem network during spontaneous fluctuations in pain intensity. Over 12 min, we recorded the ongoing pain intensity in 24 PTN participants and classified them as fluctuating (n = 13) or stable (n = 11). Using a PAG seed, we identified connections between the PAG and emotional-affective sites such as the hippocampal and posterior cingulate cortices, the sensory-discriminative posterior insula, and cognitive-affective sites such as the dorsolateral prefrontal (dlPFC) and subgenual anterior cingulate cortices that were altered dependent on spontaneous high and low pain intensity. Additionally, sliding-window functional connectivity analysis revealed that the dlPFC-PAG connection anticorrelated with perceived pain intensity over the entire 12 min period. These findings reveal cortical systems underlying moment-to-moment changes in perceived pain in PTN, which likely cause dysregulation in the brainstem circuits previously identified, and consequently alter the appraisal of pain across time.

Comparison of the effects of single injection and continuous infusion popliteal nerve block on pain and hemodynamics in diabetic foot surgery; prospective randomized clinical trial

ObjectivesIn patients undergoing surgery due to diabetic foot complications from uncontrolled diabetes may lead to neuraxial or general anesthesia-related issues. Regional anesthesia techniques can be preferred to prevent these complications. This study aimed to compare the hemodynamic effects and outcomes in terms of pain of continuous infusion and single injection methods of popliteal nerve block in patients undergoing surgery due to diabetic foot. Materials and methodsSixty-three patients in ASA II-IV risk group scheduled for diabetic foot surgery were randomized into two groups for popliteal nerve block as the anesthesia method. Group 1 (n:32), 30 mL of local anesthetic was administered around the popliteal nerve under ultrasound guidance and nerve stimulator. Group 2 (n:31) had a catheter placed beyond the needle tip by 4–5 cm. An elastomeric pump was prepared for the infusion of 2 mL/h of 0.25 % bupivacaine through the catheter. Hemodynamic parameters before and after the block, onset, block duration times, postoperative pain scores, time to analgesic requirement, patient satisfaction, and discharge time were recorded. ResultsPain scores were higher in Group 1 after 12 h postoperatively and in Group 2 after 60 h postoperatively (p = 0.006, p < 0.01, respectively). The time to the first analgesic requirement was not statistically different between Group 1 (mean 804.64 ± 1020.8 min) and Group 2 (mean 2012.78 ± 1424 min) (p = 0.072). There was no significant difference in systolic, diastolic, mean arterial blood pressure, and heart rate between groups before and after successful blockade (p > 0.05). ConclusionsContinuous infusion method of popliteal nerve block provides a longer pain-free period. Both methods showed similar hemodynamic data and low pain scores. Although continuous infusion method provides better analgesia, its procedural cost, technical difficulties, and adverse effects on patient comfort should also be considered.

Clinical analysis of ultrasound‐guided microwave ablation for pediatric thyroid nodules‐ a single center research

AbstractTo provide a new minimally invasive treatment for children with benign thyroid nodules, and to provide clinical data for applying microwave ablation (MWA) to children. A retrospective analysis was conducted on the clinical data of 21 pediatric patients with benign thyroid nodules who underwent ultrasound‐guided MWA at the Children's Hospital affiliated with Chongqing Medical University from July 2022 to August 2023. The safety, clinical efficacy, volume reduction ratio and prognostic value of the treatment were evaluated. The participants were followed for at least 4 months (median 7 months, range 4–16 months). The average (range) ablation time for the 21 patients was only(233.90 ± 184.97) (40–660)seconds, with intraoperative bleeding less than 0.5 mL. No complications such as hoarseness, seizures or coughing during drinking water were observed after ablation treatment. All the participants' hormone reflecting thyroid function remained in the normal ranges after treatment. Besides, these hormones at 12 h after surgery and 1 month after surgery were not statistically different from those before surgery. Immediate postoperative ultrasound imaging showed a significant decrease in volume of benign thyroid nodules, the volume of nodules at 1 month postoperatively (M, 1.39), and the volume of nodules at 4 months postoperatively (M, 0.40) significantly smaller than that before surgery (M, 4.94). Ultrasound‐guided MWA is a new option for the treatment of benign thyroid nodules in children, with advantages such as minimal invasiveness, good clinical effect, high safety, little damage to thyroid function, short operation time, less intraoperative bleeding, low pain sensation and aesthetic appearance.

Evaluation of Post-Operative Pain Management Techniques in Oral Surgery

ABSTRACT Objective: This prospective research directed to estimate the efficacy and safety of different post-operative pain management techniques in oral surgery subjects. Methods: Patients scheduled for various oral surgical procedures were recruited from a single oral surgery clinic between January 2022 and December 2023. Inclusion criteria encompassed adult subjects undergoing elective oral surgery under local or general anesthesia. Subjects were randomly assigned to one of three post-operative pain management protocols: Group A received standard analgesics, Group B received combination analgesics, and Group C received non-pharmacological interventions. Pain intensity scores, analgesic consumption, adverse events, and patient satisfaction were assessed at specified intervals post-operatively. Results: Non-pharmacological interventions demonstrated lower pain intensity scores and analgesic consumption compared to standard and combination analgesics. Additionally, the incidence of adverse events was lower in the non-pharmacological intervention group. Statistical analysis revealed significant differences in pain outcomes among the three groups. Conclusion: This prospective research suggests that non-pharmacological interventions may provide effective pain relief with fewer adverse events compared to traditional analgesics in post-operative oral surgery subjects. Implementation of multi-modal pain management approaches tailored to individual patient needs may improve overall pain control and enhance patient outcomes.

Clinical and Radiographic Outcomes of Nitinol Compression Staples for Midfoot and Chopart Arthrodesis

Nitinol staple use in orthopedic surgery has increased in recent years. Biomechanical studies provide useful data for use in foot/ankle; however, clinical data is limited. This study's purpose is to determine the efficacy of nitinol staples to achieve stable, bony arthrodesis in midfoot and Chopart joints, and examine their clinical outcomes and pain scores. A retrospective chart review was performed on 127 midfoot/Chopart joint arthrodeses (71 patients) using nitinol staples in isolation. The primary outcome variable was radiographic evidence of healing. Radiographs were blinded, randomized, and independently reviewed by three board certified foot and ankle surgeons. Complete/partial union was seen in 89% of all joints (113/127), increasing to 93% when including only midfoot joints (98/106). Chopart joints had significantly lower healing rates (15/21; 71%) compared to all midfoot joints (p = 0.01) and isolated tarsometatarsal joints (86/91; 95%) (p = 0.006). Neuropathy and smoking did not affect arthrodesis, but diabetes did (p = 0.004). Joints requiring bone grafting had worse rates of arthrodesis (38/49; 76%) (p = 0.002). For all joints, post-operative visual analog scale scores were significantly lower than pre-operative (p < 0.001). Pre-operative midfoot and Chopart pain scores were similar (p= 0.30). Midfoot joints had significantly lower pain scores post-operatively than pre-operatively (p < 0.001). No such significance existed in Chopart joints (p = 0.07). Isolated nitinol staples are a viable option for midfoot arthrodesis, especially tarsometatarsal joints, and offer significant pain improvement. Chopart joints may require more rigid fixation than nitinol staples, given the lower healing rate. Level of Clinical EvidenceIV

Prevalence, characteristics, and impact of spinal and lower limb recurrent pain at age 13

Objectives: To compare spinal and lower limb pain in adolescents regarding prevalence, characteristics, causes, and impact. Methods: A descriptive cross-sectional study was conducted in 13-year-old adolescents (female n=2210; male n=2353) from the Portuguese Generation XXI birth cohort. Data were collected between 2018 and 2020 through personal interviews by applying the Luebeck Pain Questionnaire. The pain features examined in each anatomical location (back and lower limb) were recurrence, duration, frequency, intensity, perceived causes, and impact on school and leisure activities. Frequencies and the Chi-square test were used. Results: Questionnaires from 4563 adolescents were analysed, 57.9% had pain in the last three months (main pain in the spine: 11.6%; main pain in the lower limb: 29.0%). Of those, 69.4% and 62.4% reported recurrent pain in the spine and lower limb, respectively. Recurrent pain was more frequent in girls than in boys (spine: 80.0%; 57.0%; lower limb: 70.4%; 58.1% respectively). Pain lasted more than three months in most adolescents (spine: about 60%; lower limb: above 50%); frequency was similarly high in both regions and both sexes (girls: 47.0%; boys: 45.7% in the spine; girls: 45.7%; boys: 40.3% in the lower limb); intensity was rated as high by girls (spine: 45.5%; lower limb: 47.3%) and moderate by boys (spine: 42.0%; lower limb: 41.0%). The leading causes of pain were daily living activities, both for the spine (girls: 65.9%; boys: 76.5%) and the lower limb (girls: 62.2%; boys: 72.1%). Psychosocial causes were the second most common cause of spinal pain (girls: 25.0%; boys: 21.0%). Other causes of lower limb pain were traumatic (girls: 25.5%; boys: 16.6%) and physical factors (girls: 20.7%; boys: 23.8%). Absences from school (girls: 11.7%; boys: 4.8%) and restrictions of leisure activities (girls: 20.7%; boys: 25.2%) were more related to pain in the lower limb. Conclusion: More than half of the adolescents reported spinal or lower limb recurrent pain, which presents a higher frequency, higher intensity, and longer duration in the spine. However, lower limb pain led to more concurrent limitations.

Comparative analysis of two different physiotherapy intervention programs in individuals experiencing chronic lower back pain

Background and objectives. Physiotherapy programs in individuals experiencing chronic lower back pain (CLBP) aim to improve function, disabilities from worsening. As per clinical practice guidelines, many methods are applied, such as the McKenzie method, therapeutic exercises, transcutaneous electrical nerve stimulation (TENS), traction, thermotherapy etc. The effectiveness of these methods is supported by a wide range of evidence and studies, making them some of the most diverse and well-established approaches. These physiotherapeutic treatments are combined every day. Therefore, the aim of this research is to provide a comparative investigation on two different physiotherapy programs containing a combination of these treatment modalities in individuals with CLBP. Materials and methods. This research involved 60 patients who were separated into two groups. Group I received the McKenzie treatment method, passive modalities, lumbar traction, and a walking program. Group II received therapeutic exercises, passive modalities, lumbar traction, and a walking program. Both groups underwent treatment for six weeks. Subjects were tested using research instruments at the beginning, at the end of three weeks, and at the end of six weeks of treatment. The evaluation instruments used were the visual analog scale, Finger-to-Floor test, the Oswestry Low Back Pain Disability Questionnaire, and the Rosenberg self-esteem scale. Results. Pain intensity, functional disability, lumbar flexibility, and self-confidence showed greater improvement after six weeks of treatment in both programs (p &lt;0.0001), without any significant statistical difference among the groups (p &gt;0.05). Conclusions. The data obtained from both groups support the effectiveness of both treatment programs and suggest that they can be considered as options for viable programs treatment for patients with CLBP.

Influence of Work Posture and Work Duration on the Incidence of Low Back Pain Among Batik Artisans: a Cross-sectional Study

Background: Batik artisans, particularly those involved in the "nyanting" process, are susceptible to lower back pain due to non-ergonomic working postures. These craftsmen sit for long durations as they meticulously apply wax to fabric. They utilize dingklik, which compels them to sit in a slightly hunched position. The repeated adoption of such postures can heighten the risk of lower back pain. This research aims to investigate the relationship between work posture, years of service, and the incidence of low back pain among "nyanting" batik artisans in Pulorejo Village Methods: This observational analytical research employed a cross-sectional approach with 42 "nyanting" batik artisans chosen through a total sampling technique. Conducted in Pulorejo Village in January 2024, the research assessed work posture using the Rapid Entire Body Assessment (REBA) instrument, while the occurrence of low back pain was evaluated through history taking and physical examination. Statistical analysis was performed using IBM SPSS version 25.0 software. Results: A significant positive correlation was found between years of service and the occurrence of low back pain (LBP) (p=0.002; r=0.471). The risk of LBP increases with the length of service. Additionally, there was a significant positive correlation between working posture, as indicated by the REBA score, and the occurrence of LBP (p=0.010; r=0.395). A higher REBA score corresponds to a greater risk of LBP. Conclusions: the Years of service and the working posture were associated to the incidence of low back pain (LBP) among "nyanting" batik artisans in Pulorejo Village.

A Rare Manifestation of Migrated Intrauterine Contraceptive Device: A Case Study Highlighting Symptoms and Ultrasound Detection

Ultrasonography is a widely used and cost-effective imaging modality, but its effectiveness can be operator dependent. We present the case of a 29-year-old para 3A woman who experienced intermittent low abdominal pains and skin rash following the insertion of a copper-T intrauterine contraceptive device (IUCD). Ultrasound, performed by an experienced operator, was crucial in diagnosing a migrated IUCD with adnexal and skin complications. This case highlights the importance of skilled ultrasound operators in detecting migrated IUCDs and associated complications.

An Analysis of the Effectiveness of Strengthening or Stretching Exercises in Patients Performing Prolonged Sedentary Work with Non-Specific Lower Back Pain.

Non-specific LBP refers to back pain which arises from the spine, intervertebral discs and surrounding soft tissues in the absence of pathologic lesions. Most cases of non-specific LBP are not the result of a single injury from a high load, but the result of repetitive, cumulative micro-injuries. The aim of the study was to assess the effectiveness of strengthening, stretching and mixed exercises in patients with non-specific LBP and their impact on pain intensity. We analysed 90 patients with non-specific LBP who performed prolonged sedentary work. Patients were qualified following history-taking, a physical examination and radiological evaluation if no pathology had been revealed on examination or on the available diagnostic imaging scans. The participants were randomly divided into 3 groups of 30 individuals each. The patients in each group performed one type of exercise (strengthening, stretching, mixed) for a period of 3 months. Both before starting and on completion of the exercise period, the patients were assessed with an original questionnaire as well as the Rolland-Morris, Oswestry and SF-12 scoring systems. Strengthening exercises were the most effective in reducing pain; on completion of the exercise period, pain assessed with the NRS scale was 2 points in the strengthening exercise group, 3 points, in the mixed group, and 4 points in the stretching group. The SF-12 questionnaire showed an improvement in the patients' health (increase in "excellent" and "very good" scores from 7% to 60%). According to the Oswestry disability questionnaire, strengthening exercises were the most effective (mean disability score of 4). 1. The use of strengthening exercises in patients with non-specific LBP most effectively improves function and reduces back pain. 2. The use of stretching and mixed exercises in patients with non-specific LBP improves function and reduces back pain, but to a lesser extent than strengthening exercises.

Effects of transcutaneous auricular vagus nerve stimulation (tVNS) on balance in patient with chronic lower back pain

Background. tVNS is a technique of electrical stimulation of vagus nerve afferents that is used as a therapy for chronic pain. This study aims to analyze the effect of adding tVNS to exercise therapy on dynamic balance in chronic LBP patients measured by Maximized Reach Distance (%MAXD) and composite score of Modified Star Excursion Balance Test (MSEBT). Method. The method is an experimental study with a pretest-posttest randomized control group study. 22 people with mechanical chronic LBP aged 16-55 years who were randomly allocated into an exercise group (control group) and an exercise plus tVNS group (intervention group). MSEBT dynamic balance was measured before and after intervention. Results. In the intervention group the average MSEBT anterior right and left leg before (74.57±14.72;73.53±15.0) after (86.45±15.98; 86.98±15.9), posteromedial right and left before (88.23±16.76; 75.15±15.04) after (99.65±14.56, 92.19±11.91), right and left posterolateral before (76.66±13.89, 78.02±13.44) after (84.00±17.25, 84.30±13.90) there was a significant difference (p &lt;0.05). Comparing anterior ΔMSEBT, right composite score and left posteromedial posterolateral ΔMSEBT between groups, there was a significant difference (p &lt;0.05), not significant in right posteromedial posterolateral ΔMSEBT. Conclusion. The addition of tVNS to exercise therapy after 2 weeks on dynamic balance with MSEBT assessment showed a significant improvement in the intervention group. The results were better in the intervention group than in the control group. Further research is still needed to investigate the potential of adding tVNS to chronic LBP.