Management Of Non-specific Back Pain Research Articles

Functional analysis of postural spinal and pelvic parameters using static and dynamic spinometry

BackgroundSpinometry is a radiation-free method to three-dimensional spine imaging that provides additional information about the functional gait patterns related to the pelvis and lower extremities. This radiation-free technology uses the surface topography of the trunk to analyze surface asymmetry and identify bony landmarks, thereby aiding the assessment of spinal deformity and supporting long-term treatment regimes. Especially reliable dynamic spinometric data for spine and pelvis are necessary to evaluate the management of non-specific back pain. Research aimThis study aims to generate reliable dynamic spinometric data for spine and pelvis parameters that can serve as reference data for future studies and clinical practice. MethodsThis study assessed 366 subjects (185 females) under static and 360 subjects (181 females) under dynamic (walking on a treadmill at 3 km/h and 5 km/h) conditions. The DIERS Formetric 4Dmotion® system uses stripes of light to detect the surface topography of the spine and pelvis and identifies specific landmarks to analyze the spine during standing and walking. ResultsRelevant gender effects were calculated for lordotic angle (ηp2 = 0.22) and pelvic inclination (ηp2 = 0.26). Under static conditions, female subjects showed larger values for both parameters (lordotic angle: 41.6 ± 8.60°; pelvic inclination: 25.5 ± 7.49°). Regarding speed effects, three relevant changes were observed (sagittal imbalance: ηp2 = 0.74, kyphotic angle: ηp2 = 0.13, apical deviation: ηp2 = 0.11). The most considerable changes were observed between static condition and 3 km/h, especially for sagittal imbalance and lordotic angle. For these parameters, relevant effect sizes (d > 0.8) were calculated between static and 3 km/h for males and females. Concerning clinical vertebral parameters, only lordotic angle and pelvic inclination were correlated with each other (r = 0.722). ConclusionThis study generated a gender-specific reference database of asymptomatic individuals for static and dynamic spinometry. It demonstrated that the DIERS Formetric 4Dmotion® system could capture natural changes in static and dynamic situations and catalogue functional adaptations of spino-pelvic statics at different speeds. The lordotic angle is an indirect marker of pelvic inclination, allowing spinometry to identify individuals at risk even under dynamic conditions.

Efficacy of Muscle Energy Technique alone and in combination with Interferential Therapy for the Treatment of Non-specific Low Back Pain

Non-specific back pain is one of the prevalent musculoskeletal disorders in general population worldwide and also a major contributor of days lost from the work. It is considered one of the major causes of financial burden on the healthcare. Objective: To compare the effectiveness of muscle energy technique alone and in combination with interferential therapy in the management of non-specific back pain. Methods: After getting the review ethical committee approval from The Neurocounsel Clinics, current RCT was initiated from 21 May, 2023 to 20 September 2023 and registered at ClinicalTrails.gov under NCT06098053. Sample size was calculated by Epitool which came 30. Simple random sampling technique was used to randomize participants into two equal groups. Group A was given muscle energy technique and group B was given muscle energy technique plus interferential therapy. 2 sessions/week for 4 & half weeks. Evaluation was done at pain numeric scale & EQ-5D-5L (QoL). Pre and post-test analysis was done by use of SPSS version 21 and level of significance was kept p<0.05. Results: The mean age in group A was 31.40±10.91 whereas in group B it was 26.93±11.69. Mann Whitney U test showed significant difference (p<0.05) between groups on the basis of PNS and insignificant difference (p>0.05) between groups on the basis of QoL. Conclusions: It was concluded from the results of this study that MET and IFT are more effective in alleviating patient’s pain but are equally effective in improving quality of life in patients suffering from non-specific back pain.

‘You feel so hopeless’: A qualitative study of GP management of acute back pain

Abstract Background Biopsychosocial management of non-specific back pain in general practice has been problematical, with frequent inappropriate referral for imaging and secondary care interventions and lack of self-confidence in the ability to provide evidence-based care. Aims To examine GP attitudes to managing back pain as a biopsychosocial problem in order to inform future educational strategies that may improve practice. Methods Twenty-one GPs from separate practices within the Dorset and Somerset Strategic Health Authority area (UK) participated in telephone interviews leading to the development of vignettes to refine the theoretical framework for subsequent focus group interviews about evidence-based back pain management. Transcripts were analysed thematically. Results There were 5 main emergent themes. These were generally negative and dominated by concerns about doctor–patient interaction. They included feelings of frustration, mismatches of perceptions in the doctor–patient relationship, problems in relation to time, challenges and discord between stakeholders in the process (for example, over sickness certification) and a lack of resources for education, awareness and local services to refer to. Psychosocial aspects of the actual care process were rarely raised. Participants favoured education that is multidisciplinary, in small group format and involves the participation of patients. Conclusions This study illustrates the difficulties that GPs may have in applying the relevant evidence for the successful management of back pain. A desire to avoid conflict in the relationship with patients explained much of the problem of implementing evidence in general practice. This indicates a need for insightful educational strategies that involve active GP participation.

Red flags need more evaluation: reply

The response by Henschke and Maher to our review article on ‘The role of physiotherapy for non-specific back pain and neck pain’ presents a useful opportunity for a discussion on an important topic. Red flags are clearly important as ignoring them can, in rare cases, result in severe disability (such as cauda equina lesion) whilst on the other hand accepting them uncritically, can result in many unnecessary referrals and investigations. The latter could raise anxiety, increase reliance on health care professionals and be wasteful of limited resources. Unfortunately, the evidence for red flags is under-developed and, as Henschke and Maher point out, there is a dearth of primary research in this area. Many red flags cited may indeed be red herrings, as discussed in a recent review presented at the Society for Back Pain Research [1]. In particular, some red flags listed in national guidelines, such as thoracic pain or night pain, are contentious and should be considered in context. Henschke and Maher are right in warning that clinicians should not uncritically accept any one red flag in isolation—the context is crucial. It might therefore be wiser to recommend that a physiotherapist who identifies any red flags should consider whether a referral to a specialist is appropriate. As we stated in the article, any signs indicating a cauda equina lesion or widespread/progressive neurology would necessitate an urgent referral. The subject of the review article was ‘non-specific low back pain and neck pain’. We feel that there is a fine balance between the amount of attention that needs to be given to red flags and the physiotherapist's subsequent management of non-specific back pain. It is important that we do not unnecessarily over-medicalize back pain and make sure that the emphasis is on helping the individual as far as possible to return to usual activities. The authors have declared no conflicts of interest.

Implementation of neuroreflexotherapy for subacute and chronic neck and back pain within the Spanish public health system: Audit results after one year

Controlled randomized trials have demonstrated the efficacy, safety, effectiveness, and cost-effectiveness of neuroreflexotherapy (NRT) for the management of non-specific back pain. In this audit study, we describe the implementation of NRT into the routine practice of primary care within the Spanish public health service of the Balearic Islands and the results obtained after one year (2004). A referral protocol was made available to all general practitioners (GPs) who could refer eligible patients to specialized units in performing NRT interventions. A total of 1209 patients (median age 52 years, 68% women) were referred to NRT by 412 GPs (80% of all GPs), with a mean (standard deviation (S.D.)) referral rate of 1.57 (0.84) patients per month/10,000 persons affiliated to each practice, and an appropriate referral rate of 95.5%. Pain decreased from a median score (visual analog scale) of 8 at baseline to 1 at discharge, referred pain from 7 to 1, and disability (Roland–Morris Questionnaire) from 12 to 1. NRT was refused by 2.7% of patients. Adverse effects related to the procedure were only a skin reaction in 3.3% of patients. We conclude that it is feasible to implement NRT in the public health service complying with methods and application conditions used in previous randomized controlled trials (RCTs). In such conditions, implementation of this technology obtained positive audit results at one year.

“You feel so hopeless”: A qualitative study of GP management of acute back pain

Background Biopsychosocial management of non-specific back pain in general practice has been problematical, with frequent inappropriate referral for imaging and secondary care interventions and lack of self-confidence in the ability to provide evidence-based care. Aims To examine GP attitudes to managing back pain as a biopsychosocial problem in order to inform future educational strategies that may improve practice. Methods Twenty-one GPs from separate practices within the Dorset and Somerset Strategic Health Authority area (UK) participated in telephone interviews leading to the development of vignettes to refine the theoretical framework for subsequent focus group interviews about evidence-based back pain management. Transcripts were analysed thematically. Results There were 5 main emergent themes. These were generally negative and dominated by concerns about doctor–patient interaction. They included feelings of frustration, mismatches of perceptions in the doctor–patient relationship, problems in relation to time, challenges and discord between stakeholders in the process (for example, over sickness certification) and a lack of resources for education, awareness and local services to refer to. Psychosocial aspects of the actual care process were rarely raised. Participants favoured education that is multidisciplinary, in small group format and involves the participation of patients. Conclusions This study illustrates the difficulties that GPs may have in applying the relevant evidence for the successful management of back pain. A desire to avoid conflict in the relationship with patients explained much of the problem of implementing evidence in general practice. This indicates a need for insightful educational strategies that involve active GP participation.

The role of physiotherapy in the management of non-specific back pain and neck pain

This paper provides an overview of best practice for the role of physiotherapy in managing back pain and neck pain, based mainly on evidence-based guidelines and systematic reviews. More up-to-date relevant primary research is also highlighted. A stepped approach is recommended in which the physiotherapist initially takes a history and carries out a physical examination to exclude any potentially serious pathology and identify any particular functional deficits. Initially, advice providing simple messages of explanation and reassurance will form the basis of a patient education package. Self-management is emphasized throughout. A return to normal activities is encouraged. For the patient who is not recovering after a few weeks, a short course of physiotherapy may be offered. This should be based on an active management approach, such as exercise therapy. Manual therapy should also be considered. Any passive treatment should only be used if required to relieve pain and assist in helping patients get moving. Barriers to recovery need to be explored. Those few patients who have persistent pain and disability that interferes with their daily lives and work need more intensive treatment or a different approach. A multidisciplinary approach may then be optimal, although it is not widely available. Liaison with the workplace and/or social services may be important. Getting all players on side is crucial, especially at this stage.