Lumbar Pain Research Articles

The Role of Orthoses in Chronic Axial Spinal Conditions.

Bracing represents a prevalent conservative, non-surgical approach used in the management of chronic spinal conditions such as spondylosis, degenerative disc disease, and spondylolisthesis. A wide variety of orthoses are available to aid in addressing cervical, thoracic, lumbar, thoracic, and SI joint pain. In this review, we aim to comprehensively examine brace types with their current applications and implications of usage. There are multiple cervical bracing options, such as soft and rigid collars, to assist in managing acute trauma and chronic degenerative conditions. The review highlights the nuanced decision-making process between hard and soft collars based on the severity of bone or ligamentous injury and neurological findings. Orthoses for low back pain are commonly used. The review highlights the challenges of chronic neck and lower back pain, emphasizing the importance of clinicians exploring all treatment strategies including braces which can improve function and reduce pain.

Superficial back line release versus trigger points release in chronic nonspecific low back pain patients

The aim of this study was to investigate the effect of Superficial back line (SBL) release on pain, Pressure Pain Threshold (PPT), lumbar function, lumbar ROM, and balance in chronic nonspecific low back pain (CNSLBP) patients. Additionally, it aims to compare the effect of SBL release versus myofascial trigger points (MTrPs) release on the same variables. This was a Randomized Controlled Trial (RCT) involving forty-eight male and female patients with CNSLBP. They were randomized via an online randomization web service into 3 groups: group A (n=16) received SBL release and exercises, group B (n=16) received MTrPs release and exercises, while group C (n=16) received exercises only. There were statistically significant improvements in all outcomes post-treatment in comparison to pre-treatment within the three groups (p<0.05). After treatment, significant differences emerged between the groups in pain, PPT, lumbar extension ROM, and left anterior balance (p < 0.05). Group A showed the most favorable results in pain reduction, lumbar extension ROM, and left anterior balance compared to groups B and C, while Group B demonstrated the most favorable results in PPT compared to groups A and C. In conclusion, SBL release and MTrPs release are effective in improving pain, lumbar function, MTrPs PPT, lumbar ROM, and balance in patients with CNSLBP. SBL release is particularly effective for pain, lumbar extension ROM, and left anterior balance, while MTrPs release is most effective for improving PPT.

Molecular mechanism of residual lumbago and leg pain after transforaminal endoscopic treatment of lumbar disc herniation

To observe the residual of lumbago and leg pain with contained type （CT） and non-contained type （NCT） lumbar disc herniation （LDH） after transforaminal endoscopic treatment, and to explore the role of hypoxia-inducible factor-1α（HIF-1α） and transient receptor potential vanillate 1（TRPV1） pathway. A total of 68 single-segment LDH patients were selected from July 2021 to October 2022, including 44 males and 24 females；aged 26 to 67 years old with an average of（43.63±11.94） years old；course of disease was 4 to 36 （18.91±10.34） months；body mass index was （24.45±4.00） kg·m-2；there were 7 cases of L3,4 segments, 32 cases of L4,5 segments, and 29 cases of L5S1 segments. All of them were performed with percutaneous intervertebral endoscopic extraction of nucleus pulposus and were divided into contained group（CT group） and non-contained group （NCT group） with 34 cases respectively according to the integrity of outer layer of fibrous annulus observed during operation. A total of 17 patients who underwent open surgery for scoliosis or vertebral fracture were selected as control group, including 12 males and 5 females；aged 21 to 65 years old with an average of （39.41±12.80） years old；body mass index was （24.86±4.11） kg·m-2. The relative mRNA expression quantity of HIF-1α, TRPV1 in nucleus pulposus were measured by quantitative real-time PCR. The contents of neurokinin 1 receptor （NK1R）, nerve growth factor （NGF）, vascular endothelial growth factor （VEGF） in nucleus pulposus and the serum substance P （SP） and calcitonin gene-related peptide （CGRP） were detected by enzyme linked immunosorbent assay （ELISA）. The threshold of lumbar tenderness was detected by a pressure pain meter. The degree of lumbago and lumbar function were evaluated by visual analog scale （VAS） and Oswestry disability index （ODI） separately. The residual rate of postoperative lumbago and leg pain was assessed. The mRNA relative expression quantity of HIF-1α and TRPV1, and the contents of NK1R, NGF and VEGF in nucleus pulposus, and the levels of serum SP and CGRP before surgery in the NCT group were higher than those in the CT group（P<0.05）, and those in the CT group were higher than the control group（P<0.05）. At day 7 after surgery, the serum SP and CGRP levels, lumbago and leg pain VAS scores and lumbar ODI index in two LDH groups were lower than before surgery （P<0.05）, and those in the NCT group were higher than the CT group（P<0.05）, and the threshold of lumbar tenderness in the NCT group was lower than the CT group（P<0.05）. The differences of lumbago and leg pain VAS scores, lumbar ODI index and lumbar tenderness threshold between preoperative and postoperative 7 days in the NCT group were lower than those in the CT group（P<0.05）. The residual rate of lumbago and leg pain at 7 days after surgery in the NCT group was higher than that in the CT group（P<0.05）. HIF-1α and TRPV1 pathway promoted the excessive production of NGF, VEGF, NK1R in nucleus pulposus and serum neuropeptides SP and CGRP, which may lead to the higher residual rate of lumbago and leg pain with non-contained lumbar disc herniation postoperative.

Efficiency of dry needling along with standard physical treatment in people with lumbar pain syndrome

Introduction: The complaints that occur in the area of the lumbar spine are summarized under the term lumbar pain syndrome. These include lumbar discopathy, lumbago, lumboischialgia, sciatica, and other complaints associated with the lumbar region of the spine. The purpose of this study is to evaluate sociodemographic characteristics, assess the degree of disability patients experience due to lumbar pain syndrome, evaluate how many patients catastrophize their pain, and assess the effectiveness of the dry needling technique along with other physical therapy modalities in people with lumbar pain syndrome. Methods: The study was designed as a prospective study conducted from March 2022 to June 2022. 35 subjects of both sexes, aged 25-83, agreed to participate in the study. The subjects who enrolled were pre-dominantly suffering from chronic lumbar pain syndrome, and there were also a smaller number of subjects with acute lumbar pain syndrome. Results: The majority of respondents suffer from lumbar pain syndrome, which falls into the chronic category in 29 or 82.9% of cases. The mean score after the application of therapy on the Oswestry Disability Index (ODI) scale was 22.0 ± 16.23% and was statistically significantly lower. The average score after the application of the therapy on the visual analog scale (VAS) was 3.06 ± 2.31 and is statistically significantly lower (p &lt; 0.05) compared to the period before the therapy. Conclusion: Dry needling in combination with standard physical procedures led to statistically significant improvements. The mean score on the pain catastrophe scale, VAS, and ODI was significantly lower than in the pre-therapy period.

Etiology, pathogenesis, clinical presentation and differential diagnosis in Lower Back Pain with comparison of possible methods of treatment

Introduction and purpose Non-specific and specific lower back pain syndrome is one of the leading causes of musculoskeletal disability and affects more than half of the population worldwide. The aim of this paper is to confront the problem of lumbar pain, possible diagnostic options, conservative and surgical opportunities with long term satisfactory rate. State of knowledge The paper reviews literature on lower back pain syndrome, sciatica, radiculopathy and lumbar disc herniation in regards to detection of the problem, classifying it and possible methods of resolvement. The WHO defines lower back pain as one of the leading causes of musculoskeletal dysfunction and it focuses on reducing the occurrence by programs like WHO Rehabilitation 2030 Initiative, UN Decade of Healthy Ageing and others. The paper also focuses on non surgical options of treatment. Material and method A review of the literature available in the “PubMed” and Google Schoolar was conducted. We focused on differential diagnosis depending on clinical presentation and possible treatment methods depending on symptoms, pathogenesis of the disorder and available procedures. Summary Our review managed to present the current state of development, possible differential diagnosis, prevalence of neural compressions, sciatica and radiculopathy in different diagnostic options. By receiving multiple studies we confront varied opinions of specialists regarding the approach to lower back pain syndrome and favorable forms of care. Additionally we came to the conclusion that the difference of patients' long term satisfactory rate in regards to nonoperative and operative treatment is not significant, and flattens over the years.

A randomized controlled trial: The efficacy and safety of Bushen Huoxue formula in the management of lower back pain from lumbar disc herniation.

Lower back pain (LBP) arising from lumbar disc herniation (LDH) poses a challenging health issue, often necessitating therapeutic interventions. Bushen Huoxue formula (BSHXF) has proved as a potential treatment option with great clinical effect. However, comprehensive investigations into its efficacy and safety in conjunction with celecoxib for managing LBP from LDH are lacking. The objective of this article is to investigate the efficacy and safety of BSHXF in the management of patients with LBP from LDH. This single center, randomized clinical trial was conducted from March 2023 to September 2023 and all patients suffered from LBP of LDH. Participants were randomly assigned to the BSHXF group (celecoxib and BSHXF) or the control group (celecoxib and placebo). The patients received treatment for 2 weeks. Assessment was conducted before treatment, the last day of the treatment, 4 weeks and 8 weeks after the treatment. Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Roland-Morris Disability Questionnaire (RMDQ), Timed up and go test (TUGT), trunk range of movement (Trunk ROM), Hospital Anxiety and Depression Scale (HADS) were used for the evaluation. A total of 206 subjects completed treatment, among whom 104 participants were randomized to the BSHXF group and 102 participants were randomized to the control group. There were no significant differences between groups in terms of the observed indicators (P > .05). After treatment, patients in BSHXF group obtained significant lower scores at 2-week, 4-week, 8-week of VAS, ODI, RMDQ, TUGT, Trunk ROM and HADS than the baseline data (P < .05). The ODI score was significantly lower than the control group at 2-week, 4-week, 8-week (2w: 11.30 ± 5.80 vs 14.23 ± 6.33, P < .001; 4w: 10.95 ± 4.93 vs 13.54 ± 6.35, P < .001; 8w: 10.27 ± 5.25 vs 12.84 ± 6.57, P = .002). Similarly, the scores of VAS, RMDQ, TUGT, Trunk ROM scores of the BSHXF group markedly decreased at 2, 4, and 8-week when compared to their control group (P < .05). Furthermore, no significant difference showed up in the score of HADS between the between the BSHXF and the control group after treatment (P > .05). This randomized clinical trial found that BSXHF can help significantly improve the clinical outcomes of celecoxib including pain intensity reduction and lumbar function improvement in LBP patients.

Long COVID Symptoms vs. Back Pain and Physical Activity among Students in Poland-Cross-Sectional Study.

Back pain (BP) is a common condition that affects people of all ages. Moderate- and vigorous-intensity physical activity (PA) is a key element in maintaining health. The purpose of this research was to determine the level of physical activity and back pain (BP) in students with long COVID symptoms and to determine the relationship between the level of PA and BP in students with and without long COVID. A survey was carried out among 402 students from Poland. The inclusion criteria were as follows: student status, age of over 18 years, history of COVID-19, and consent to participate in the study. The International Physical Activity Questionnaire (IPAQ) was used to determine the level of PA. The Oswestry Disability Index (ODI) and the Neck Disability Index (NDI) were used to assess BP. We found that at least half of the students surveyed did not experience any lumbosacral or cervical spine pain. The authors found no association between the level of PA in women and a history of long COVID symptoms, while there were statistically significant differences in intense PA in men (p = 0.0263), with those who did not report long COVID symptoms being more active. With regard to cervical and lumbar spine pain complaints, in our study, these were statistically significantly stronger in students who were observed to have long COVID symptoms. The difference was not significant only for lumbosacral complaints among men. No strong correlations were found between PA level and the severity of BP. Additional investigation is required to comprehend the complex interaction between long COVID symptoms and levels of PA and BP. Special attention should be paid to the prevention of back pain mainly in the COVID-19 group of students.

The Water Element, Zang-fu Kidney and Jin Gui Shen Qi Wan

The Water Element, as part of the Traditional Chinese Medicine (TCM) Five Elements, is associated with winter, coldness, darkness and the Zang-fu organs Kidney and Bladder. The TCM Kidney, encompasses far more than the Western concept of an organ which produces and excretes the waste product urine. It controls water and fluid metabolism; a primordial generator (Ming-men Fire, Essence, Jing, promotes growth, skeleton, marrow, innate constitution); Yin-Yang dynamics (innate Yin and Yang); receives Qi; life functions (sexual behavior, reproduction, neuroendocrine axis, nervous system, urinary system, manufacture Blood, acute sense of hearing, controls the 2 lower orifices, assists respiration); as well as supports good life/living (houses commitment, will power, memory). Diseases of the Kidney can manifest as congenital deficiencies, fearful attitude, pathological changes (Yin and Yang Deficiencies, chronic debilitation), and physiological deficiencies associated with senescence. Some of the more common clinical signs of Kidney (Water Element) disease include renal/reproduction disorders, lumbar pain, hind end weakness, teeth/hair loss, deafness, lassitude, neuroendocrine disorders, asthma, congenital disease and bone disorders. One of the most famous formulas to treat Kidney Yang Deficiency and decline of Ming-men Fire is the classical herbal formula Jin Gui Shen Qi Wan. The strategy of this formula is to tonify Kidney Yin to raise Kidney Yang, (since Yin and Yang are mutually dependent), with the addition of warm herbs to ignite the Fire of Ming-men. From a Chinese medical perspective, Kidney Yang Deficiency syndrome may cause endocrine system disorders, immune-deficiency, neurological, renal, and reproductive disorders. This paper will review the Zang-fu Kidney function, and the classic Chinese herbal medicine, Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet).

In subjects with chronic low back pain, does neuropathia exclusively correlated to neuronal compression? A correlation study of PainDETECT questionnaire and corresponding MRI and X-ray findings

IntroductionUnderstanding the complex nature of low back pain (LBP) is crucial for effective management. The PainDETECT questionnaire is a tool that distinguishes between neuropathic (NeP), nociceptive (NoP), and ambiguous pain. This study aimed to investigate the relationship between pain classification and lumbar intervertebral degenerative parameters obtained from imaging.MethodsA cohort study was conducted involving 279 patients, aged 18 years and above, who completed PainDETECT questionnaires and underwent lumbar MRI and/or X-ray scans.ResultsThe study included 102 patients with NoP, 78 with ambiguous pain, and 99 with NeP. The NeP group had lower mean age (58.21 vs. 53.63, p < 0.05) and higher mean numerical rating scale score (7.9 vs. 5.9, p < 0.001) compared to the NoP group. A negative correlation was found between PainDETECT scores and pelvic incidence (τ = − 0.177, p = 0.043). The NeP group exhibited significantly higher severity of foraminal stenosis (U = 18.962, p = 0.002), spinal stenosis (U = 14.481, p = 0.005), and Pfirrmann grade (U = 14.221, p = 0.028) compared to the NoP group. A higher proportion of NeP patients had intervertebral disk bulge (96% vs. 78% vs. 78%, p = 0.002) and high-intensity zones (51% vs. 41% vs. 19%, p < 0.001) compared to those with NoP and ambiguous pain.ConclusionNeP, as determined by the PainDETECT questionnaire, is associated with more severe neural compression, increased presence of discogenic disease and inflammatory disk severity, and decreased pelvic incidence. This pioneering study establishes a connection between pathological findings and pain categorization, providing clinicians with valuable guidance for formulating tailored management plans and reducing the need for unnecessary pharmacotherapy, imaging, and non-targeted surgical interventions.

Return to Play Criteria After Adult Lumbar Spinal Fractures: A Review of Current Literature and Expert Recommendations.

Understanding the management of lumbar spinal fractures and return to play (RTP) criteria is an essential component of care for adult athletes. Appropriate management of lumbar spinal fractures must balance minimizing time away from physical activity while also minimizing risk of reinjury. The purpose of this review is to summarize current recommendations on lumbar spinal fracture management and RTP guidelines and to provide expert opinion on areas of discrepancy in the field. There is a paucity of high-level evidence on the management and return to play criteria for adult lumbar spine fractures in athletes. Much of the data and recommendations are based on expert opinion and studies in pediatric or osteoporotic patients, which may not be applicable to adult athletes. These data presented here may be used to aid patient-physician conversations and provide guidance on expectations for patients, coaches, and athletic trainers. In general, we recommend that patients be free of lumbar pain, neurologically intact, and have full strength and motion of the lumbar spine and lower extremities before returning to play. Adequate protective equipment is recommended to be worn at all times during practice and play.

Effects of Tailored Stabilization Exercise Regimens on Lumbar Instability

Effects of Tailored Stabilization Exercise Regimens on Lumbar Instability

Evaluation of the Efficacy of Caudal Epidural Neuroplasty in Patients With Lumbar Epidural Fibrosis.

Introduction Lumbar and leg pain can be caused by many factors, including scar tissue in the epidural space. Epidural fibrosis may cause chronic radicular low back pain. Adhesions in the epidural space may occur due to surgical or non-surgical reasons. Epidural adhesiolysis, i.e., neuroplasty, eliminates the pain-causing effects of scar tissue by releasing the nerve from the scar tissue or decompressing the nerve. In light of this information, this study was conducted to evaluate the effectiveness of percutaneous epidural neuroplasty interventions performed in the algology clinic in patients with lumbar epidural fibrosis who have and have not undergone lumbar surgery. Methods The sample of this retrospective study consisted of 72 patients with chronic radicular low back pain, finding fibrosis in the epidural region on contrast-enhanced magnetic resonance imaging (MRI), filling defect after epidurogram, and caudal epidural neuroplasty. Patients' visual analog scale (VAS) and Oswestry disability index (ODI) scores, pregabalin, duloxetine, and opioid doses were evaluated before and one month and six months after having neuroplasty. Results The VAS and ODI scores and pregabalin, duloxetine, and opioid doses decreased significantly in patients who had had caudal epidural neuroplasty at post-procedure endpoints compared to before the procedure (p<0.001). The paired temporal comparisons of the data of the patients who underwent epidural neuroplasty procedures before the procedure, one month after the procedure, and six months after the procedure revealed significant differences in the VAS and ODI scores (p<0.001). Additionally, the analysis of patients' VAS scores revealed that the pre-procedure VAS scores decreased significantly more one month after the procedure in patients without a history of lumbar surgery than in patients with a history of lumbar surgery. Conclusions The findings of our study demonstrated that fluoroscopy-guided percutaneous epidural neuroplasty alleviated pain and improved physical functions and quality of life. In conclusion, percutaneous epidural neuroplasty is a safe and effective treatment method for patients with lumbar epidural fibrosis.

PUNCTURE LASER MICRODISCECTOMY IN THE TREATMENT OF SEQUESTERED HERNIATION OF LUMBAR INTERVERTEBRAL DISCS

Objective. to improve the results of treatment of sequestered herniation of lumbar intervertebral discs by the puncture laser microdiscectomy (PLM) method. Methods. During the period from 2000 to 2023, 132 patients with sequestered lumbar disc herniations were operated on by the PLM method. There were 88 males and 34 females. The age of the patients was from 23 to 64 (42.3 ± 3.5) years. Surgeries were performed using a C-arc operating fluoroscope. The laser pulse duration — 0.3–0.5 sec, and radiation exposure — 500–600 J. Approach to the sequestrum was mainly posteromedian transdural. For laterally located sequestra, posterolateral approach was used. The efficacy of PLM was assessed by pain intensity reduction according to the VAS scale one month after surgery, and according to the McNab scale 3 months after surgery. Results. One month after PLM, the maximum reduction of radicular pain intensity was noted in patients with posteromedian hernias, to a lesser extent — with paramedian hernias, and the least pronounced — with lateral hernias. However, no statistically significant differences in pain intensity one month after surgery depending on hernia location were found (p &gt; 0.05). As for the intensity of lumbar pain, in all groups, regardless of hernia location, it significantly decreased and did not exceed 1 point after one month. 3 months after surgery, 95 (71.9 %) patients had an excellent result according to the McNab scale, 13 (9.8 %) — good, 7 (5.3 %) — satisfactory, 17 (12.8 %) — unsatisfactory, indicating that the PLM method of sequestered hernias can be quite effective in a certain selection of patients. According to our data, positive results can reach 81.8 % (95 % CI 74.2–87.9 %) (CI — confidence interval). Conclusions Sequestered hernias, which can be operated by the PLM method, should not exceed 9 mm in height on axial sections, should have a smooth rounded lenticular shape without signs of migration. The positive effect of PLM of sequestered hernias reached 81.7 %. The results were better with PLM of posteromedian hernias.

Clinical effects and biological mechanisms of exercise on lumbar disc herniation.

Lumbar Disc Herniation (LDH) is a syndrome in which lumbar disc degeneration, rupture of the annulus fibrosus, and herniation of the nucleus pulposus irritate and compress the nerve roots and cauda equina, resulting in the main manifestations of lumbar pain and/or lower extremity pain. There is evidence in various clinical areas that exercise is effective in treating LDH, and exercise intervention for more than 2weeks reduces disease activity in LDH. However, the mechanism of exercise's action in reducing disease activity in LDH is unclear. In this article, we first summarize and highlight the effectiveness of exercise in treating LDH and provide guideline recommendations regarding exercise type, intensity, frequency, and duration. Then, we integrate the existing evidence and propose biological mechanisms for the potential effects of exercise on neuromechanical compression, inflammatory chemical stimuli, and autoimmune responses from the perspective of LDH pathogenesis as an entry point. However, a large body of evidence was obtained from non-LDH populations. Future research needs to investigate further the proposed biological mechanisms of exercise in reducing disease activity in LDH populations. This knowledge will contribute to the basic science and strengthen the scientific basis for prescribing exercise therapy for the routine clinical treatment of LDH.

Effectiveness of spinal traction in degenerative spine diseases. (A literature review)

To analyze sources of scientific and technical literature and study materials of meta-analyses, systematic reviews on the issues of evaluation of the spinal traction effectiveness (dry and underwater, horizontal and vertical) in the treatment of patients with degenerative spine diseases. An analysis of 67 sources, including 54 periodical articles, 5 meta-analyses and 8 systematic reviews was conducted. The search depth was 20 years. The ability of the spinal traction method to influence on the pain intensity, functional state, general improvement or return to work in patients with degenerative spine diseases has been identified. There has been a statistically significant regression of lumbar and radicular pain under the influence of «dry» horizontal tractions of the spine (13389 patients with degenerative spine diseases received them), including in combination with physiotherapy (vibration, impulse currents, laser therapy), and there has been an improvement in the motor function of the spine, a decrease in the disability rate in patients with herniated disks. These results were also obvious in short-term observation (up to 3 months after intervention). Underwater traction (5533 patients received it) had a positive impact on pain syndrome at rest and during activity, increased the activity of patients. All registered effects were related to short-term effect for up to 3 months after the intervention. The evidence, based on the materials of meta-analyses and systematic reviews of medium and low quality, that «dry» and underwater spinal traction can be considered as a therapeutic tool for short-term (within 3 months) reducing pain and disability in patients with lumbar pain and lumbar radiculopathy, is presented.

Image of a Right Renal Angiomyolipoma Complicated by Hemorrhage

A 55 years old female patient with no specific medical history consulted in our unity for isolated severe right lumbar pain.

Assessment of the impact of working under COVID-19 conditions on the psychophysical state of nurses

Aim: The COVID-19 pandemic caused many unfavorable changes in nurses’ daily work, which affected their health and well-being. The objective of the study was to assess the impact of working under COVID-19 conditions on the psychophysical condition of nurses. Materials and Methods: The study included a group of 100 nurses from the Łodź Voivodeship working under COVID-19 conditions. A survey questionnaire consisting of questions on health status, the occurrence and severity of symptoms resulting from work in covid conditions was used. Results: Statistically significant (p&lt;0.001) increases in physical ailments were found in nurses after a change in working conditions. The largest effect was observed for dyspnoea, headache and lumbar pain. The severity of physical ailments was mainly affected by the age of the respondents and the presence of chronic diseases. There was also a statistically significant (p&lt;0.001) deterioration in the mental state of the respondents, primarily in terms of feelings of mental fatigue, mood decrease and feelings of fear for the health of relatives. An increase in fear for one’s own health was also observed, particularly in nurses with older age, higher BMI, longer work experience and chronic diseases. Conclusions: The change of working conditions during the COVID-19 pandemic adversely affected the psychophysical health of nurses. The respondents showed an increase of the symptoms of chronic diseases, headaches and back pain. Working in difficult conditions and chronic stress resulted in a depressed mood and fear for one’s own life and that of relatives. Thermal treatment may be recommended to improve the psychophysical condition of nurses.

Patients' experiences with musculoskeletal spinal pain: A qualitative systematic review protocol.

Musculoskeletal (MSK) spinal pain encapsulates various conditions including lumbar (low back), cervical (neck), and thoracic pain that significantly impact individual and global health. While clinical aspects of spinal pain have been well-studied, understanding patients' personal narratives and lived experiences remains essential for enhancing patient-centered care, improving treatment adherence, and informing healthcare policies. It provides deep insights into the impacts of spinal pain, guiding more effective and empathetic treatment approaches. This systematic review aims to synthesize qualitative evidence on patients' experiences with MSK spinal pain, providing insight into the challenges faced, coping strategies, daily life impacts, and healthcare interactions. The objective of this review is to synthesize the qualitative evidence regarding the lived experiences of patients with MSK spinal pain. This systematic review will use a meta-aggregation approach to synthesize data from qualitative studies, that will be identified through a comprehensive search of electronic databases and supplemented by grey literature searches. Two independent reviewers will screen, identify, and extract data from eligible studies. In cases of disagreement, conflicts will be resolved by consulting a third reviewer. These same reviewers will then use the Joanna Briggs Institute (JBI) qualitative quality assessment tool to evaluate the methodological quality of the identified studies, with the derived scores informing the synthesis process, that will involve extracting each study's findings along with their supporting illustrations, then grouped into categories based on similarity in meaning. These categories will then be aggregated to form synthesized findings. Synthesized findings on patients' lived experiences with MSK spinal pain including key themes, patterns, and insights will be presented. By emphasizing patient narratives, the results of the review can contribute to the optimization of outcomes, and to enhance patient-provider relations and improve quality of care in MSK spinal health.

Hip-spine syndrome: Diagnostic difficulties

Introduction. Hip-spine syndrome (HSS) is a combination of coexisting hip osteoarthritis (OA) and degenerative lumbar spine stenosis (LSS). Main difficulties in treating patients with HSS are in early diagnostics and in choosing right surgery, because mistakes lead to pain maintenance. Existing diagnostic algorithms show right surgery choosing failure in 15–20%. We present results of examination patients with HSS in our survey.The aim – to present clinical and instrumental results of examination of patients with hip-spine syndrome.Materials and methods. We have examined 378 patients with typical pain pattern (buttocks, low back spine, groin and lateral hip) and difficulties in pain source definition. We performed hip X-rays and low back spine MRI.Due to results we divided patients into three groups – patients with HSS (n=100), with hip OA (n=172) and patients with LSS (n=106). We used Harris Hip Score, Oswestry Disability Index and Visual Analogue Score to determine hip and lumbar spine functional status and pain level.Results. Patients with HSS had higher (p&lt;0.05) pain levels (76.5±9.1 mm) than patients with hip (68.3±7.9 mm) or lumbar spine pathology (67.4±7.9 mm). Harris Hip Score in patients wirh HSS (52.7±8.1 points) was same as in patients with hip OA (55.5±9.1 points), Oswestry Disability Index in these patients (44.2±7.6%) was same as in patients with LSS (43.2±7.8%).Conclusion. High pain level and low Harris Hip Score and Oswestry index, along with clinical examination, on first visit can help suspect hip-spine syndrome and recommend both hip and lumbar spine imaging.

Effect of Combination of Isotonics Technique of Posterior Oblique Sling With Conventional Physiotherapy on Patients With Mechanical Low Back Pain

This study was an experimental type of study. Sample size was determined by simple non probability sampling method. Sample size was taken to be 36. The persons who were diagnosed with Mechanical low back pain and persons who came under the inclusion criteria are selected for the study. A clear explanation about the study and consent form were given to the patients who are willing to participate. Assessment of the patient included NPRS score, Lumbar flexion and extension measurement. Their evaluation was taken at the start of treatment and after 4 weeks of treatment. Consent was obtained from the subject and the procedure was explained to them. All the subjects in these group were given combination of isometrics technique for posterior oblique sling. This study examined the Numerical pain rating scores (NPRS) and Lumbar flexion measurement before and after the treatment of Mechanical low back pain with combination of isotonics technique on posterior oblique sling and conventional physiotherapy. The mean of NPRS scores pretreatment is 6.35 score out of 10 with standard deviation 1.13. Therefore, mean with standard deviation of pretreatment NPRS scores is 6.35±1.13. The post treatment Mean of NPRS scores with the standard deviation is 3.23±1.03.The mean and standard deviation of Lumbar flexion measurement Pretreatment is 3.94±0.97. The mean and standard deviation of Lumbar flexion measurement Post treatment is 6.82±0.75. Hence, there is significant improvement of lumbar flexion in the patients treated.