Pain Disability Research Articles

Remote patient-reported outcome measure triage score for monitoring disease activity and allocation of consultations in rheumatoid arthritis patients

Objective Currently, expedited by the coronavirus disease 2019 pandemic, there is high demand for allocating patients in a state of low disease activity to telehealth, ideally based on remote measurements. This cross-sectional study assesses the discriminative accuracy of the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire regarding high and low disease activity. Furthermore, we aimed to optimize this classification, developing a remote triage score based on RAID and other patient-reported outcome measures (PROMs). Method Data were acquired from an outpatient clinic cohort of chronic rheumatoid arthritis patients at a large trainee hospital in the Netherlands. Patients were divided into high and low disease categories, based on 28-joint Disease Activity Score–C-reactive protein. Least absolute shrinkage and selection operator logistic regression were performed, including RAID item scores and other PROMs. Receiver operating characteristics curves and areas under the curve (AUCs) were obtained, and cut-off scores were based on predefined criteria of 90% and 95% sensitivity. Results In total, 278 patients were analysed, of whom 77.2% were identified as having low disease activity. RAID results correlated with DAS28-CRP, showing good performance. The regression model included the RAID items pain and functional disability assessment, and the self-reported swollen joint count (SR-SJC). With an AUC of 0.88 (95% confidence interval 0.84–0.92), this model performed better than the RAID total score. Conclusion A remote triage score based on a composite score of pain, functional disability assessment, and SR-SJC can detect a sufficient proportion of patients with low disease activity who can be allocated to remote consultations.

Inpatient Rehabilitation is Effective for Severe Daily Activity Deficits Related to Chronic Low Back Pain

Background and Objective: Chronic low back pain disability (CLBPD) is a syndrome that includes pain, disability, emotional impairments, and social problems. The study was conducted to examine the effect of an inpatient rehabilitation program on the performance of everyday life tasks (daily activities), and report on pain in CLBPD patients with primary activities of daily living (ADL) deficits. Methods: In a retrospective cohort study, demographic and clinical data were retrieved from records of inpatients admitted consecutively to the program. Scores of the Spinal Pain Independence Measure (SPIM) and of changes in reported pain levels were used to assess improvement in the performance of daily activities and pain reduction. T-tests were used to assess the significance of score changes. Spearman’s correlations and analysis of variance were used to assess relationships of SPIM gain and affecting factors. Results: Ninety-nine patients were included. Daily task performance improved in 71 patients (71.7%). The SPIM score increased from 48.7 (SD 16.3) at admission to the rehabilitation program to 57.8 (SD 12.5) at discharge (P<0.001). The SPIM score at admission negatively affected SPIM gain (P<0.001). The SPIM gain was significant for admission SPIM scores of 50 or lower (P<0.05), but differences in SPIM scores were not as noticeable for patients with admission SPIM scores above 50. Relief in pain was reported in 59 patients (59.6%) and was not associated with function. Conclusions: The multidisciplinary rehabilitation program, which improved function and provided limited pain relief in inpatients with CLBPD primary ADL deficits, can be effective for the most severe CLBPD cases.

The Effectiveness Of Physical Therapy And Rehabilitation Approaches In Low Back Pain On Pain Severity And Disability; A Systematic Review

Low Back Pain encompasses nociceptive pain, neuropathic pain radiating to the legs, and nociplastic pain, often classified as non-specific due to central nervous system exaggeration. Globally, Low Back Pain is a leading cause of activity restriction and loss of productivity, significantly impacting finances. Objective; This study aimed to review the efficacy of physical therapy and rehabilitation approaches for LBP, focusing on pain intensity and disability. Materials and Methods; A literature review was conducted in PubMed and Web of Science databases up to January 30, 2024. English studies were required, using keywords: “low back pain,” “pain intensity,” “pain severity,” “disability,” and “physical therapy.” Pain intensity was measured using the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS), including the 11-point Pain Intensity Numerical Rating Scale (PI-NRS). Disability was assessed using ADL, IADL scales, Roland Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI). Results; Seven study met the inclusion criteria from 665 initial records. Interventions included osteopathic manipulative treatment (OMT), core muscle exercise with interferential current (IFC), cognitive functional therapy (CFT), dry cupping therapy, high-intensity machine-based core muscle resistance training (C-IPU), heat therapy, TENS, pelvic traction, Reiki, dynamic muscular stabilization technique (DMST), and McGill Big 3 (MB3). Sample sizes ranged from 30 to 1090 participants. IFC combined with core muscle exercises significantly reduced pain intensity compared to each method alone, though not statistically significant (p > 0.05). The C-IPU group had greater pain relief (P 0.05). Dry cupping did not outperform sham cupping. CFT reduced absenteeism in the first two years but not later. Reiki showed significant improvement in pain and ADL compared to drug therapy, but not to physiotherapy. Conclusions; Physical therapy interventions effectively alleviate symptoms and improve outcomes in LBP. However, variability in interventions and outcome measures necessitates cautious interpretation. Further research with standardized protocols is essential to understand the effectiveness and optimal duration of physical therapy for LBP. Keywords; low back pain; pain intensity; pain severity; disability; physical therapy

Relationship Between Serum Interleukin-6 Levels, Systemic Immune-Inflammation Index, and Other Biomarkers Across Different Rheumatoid Arthritis Severity Levels.

Background Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by joint inflammation, pain, and progressive disability. Identifying biomarkers that accurately reflect disease severity is crucial for effective management. Interleukin-6 (IL-6) is a pro-inflammatory cytokine involved in the pathogenesis of RA, and the systemic immune-inflammation index (SII) is emerging as a useful marker of systemic inflammation. This study aims to explore the relationship between serum IL-6 levels, SII, and various biomarkers to better predict disease severity in RA patients. Objective To determine the relationship between serum IL-6 levels and the SII, along with various biomarkers, across different severity levels for predicting the severity of RA in patients. Methods This cross-sectional, observational study was conducted at the Mardan Medical Complex from January 2024 to August 2024, involving 67 RA patients.Clinical assessments included demographic data, disease activity (DAS28), pain (VAS), joint damage (Larsen score), and functional status (HAQ-DI). Serum IL-6 levels, along with other biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and the SII, were measured through fasting blood samples. Statistical analyses, including density plots, scatter plots, boxplots with ANOVA, and random forest models, were performed to explore associations between IL-6 and all other variables. Significance was set at p < 0.05. Results The study included 67 RA patients (mean age: 41.79 ± 10.51 years, 53.73% male). Elevated IL-6 levels (mean: 80.28 ± 35.27 pg/mL) were strongly associated with disease severity. Patients with DAS28 > 5.5 had IL-6 levels over 100 pg/mL, while those in remission had around 40 pg/mL. IL-6 levels correlated with joint damage (100 pg/mL in severe cases) and pain (over 120 pg/mL for severe pain). Patients with metabolic and cardiovascular comorbidities had the highest IL-6 levels, particularly with diabetes and hypertension (98.6 pg/mL) or cardiovascular disease (119.3 pg/mL). IL-6 correlated strongly with CRP (r = 0.65), ESR (r = 0.51), and SII (r = 0.62). Regression confirmed IL-6 as an independent predictor of severity (p < 0.001), with comorbidities being key predictors. Conclusion Elevated IL-6 and SII levels serve as critical markers for predicting the severity of RA. Addressing these markers may lead to more targeted and effective therapeutic strategies for managing disease progression.

Pain resilience dimensions and regional gray matter volume as risk factors for poor outcomes of chronic pain: a prospective cohort study.

Pain resilience and regional gray matter volume (rGMV) are established correlates of adaptation to chronic pain within cross-sectional studies. Extending such work, this prospective cohort study tested the status of baseline pain resilience dimension scores and rGMV as risk factors for subsequent exacerbations in chronic pain disability and intensity. 142 adults with chronic musculoskeletal pain completed an initial assessment comprising a structural magnetic resonance imaging scan and self-report measures of cognitive/affective positivity and behavioral perseverance pain resilience dimensions, disability, pain intensity, and demographics. Disability and pain intensity were outcomes re-assessed at a 6-month follow-up. The impact of pain resilience dimension scores and identified rGMV sites on follow-up outcomes was examined after controlling for other baseline correlates of outcomes. Mediating effects of identified rGMV sites on pain resilience dimension-follow-up outcome relations were also evaluated. Aside from the significant multivariate effect of lower behavioral perseverance and cognitive/affective positivity scores, augmented left precuneus, temporal pole, superior temporal gyrus (STG), and precentral gyrus rGMV combined to predict higher follow-up disability levels, independent of covariates. Higher left fusiform gyrus rGMV levels predicted follow-up exacerbations in pain intensity, but pain resilience dimension scores did not. Finally, left precuneus and left temporal pole STG rGMV partially mediated cognitive/affective positivity-follow-up disability relations. Findings underscore deficits in pain resilience and increased rGMV as potential risk factors for poorer subsequent outcomes of chronic musculoskeletal pain and provide foundations for further prospective extensions as well as targeted intervention research.

Comparison of active release technique and post-isometric relaxation in treatment of plantar fasciitis among traffic police wardens: a quasi-experimental study

BackgroundPlantar fasciitis (PF) is a common cause of chronic foot pain that leads to functional limitations in individuals. There has been recent research on plantar fasciitis, but no studies have compared the effects of the active release technique and post-isometric relaxation in patients to determine which manual therapy technique improves foot pain and function.ObjectiveThis study aimed to compare the effectiveness of the active release technique and post-isometric relaxation on proximal foot pain and functional status and to assess muscular tightness among patients with traffic police wards and plantar fasciitis.MethodsA quasi-experimental study (pre-test, post-test) was conducted in the Physiotherapy Department of Police Hospital, Gujranwala, Pakistan, between October 2022 and April 2023. We included 30 consecutively aged 25- to 60-year-old symptomatic police wardens diagnosed with planter fasciitis, who complained of pain on walking and standing for more than 3 months and met the inclusion criteria. They were equally assorted into two groups (n = 15 in each group) using convenient sampling. Group A received an active release exercise technique, group B received a post-isometric relaxation technique, and the participants in both groups received a similar baseline treatment protocol that consisted of calf stretching and stretching of the plantar fascia (5 repetitions and holding for 15 s). In the outcome measures, we included the Foot Function Index to assess the function of the foot and the Visual Analog Scale to examine the pain intensity measured during rest. The participants in both groups performed the selective protocol 3 days per week for 3 weeks, and we calculated the results at baseline and on the third day of the third week. We analyzed the data using SPSS software version 24 (IBM Corp., Armonk, NY). We compared within-group differences in the VAS score and FFI using paired t tests and analyzed between-group differences in the VAS score and FFI before and after performing the ART and PIR using independent t tests.ResultsThe 8-week intervention therapy revealed a demographic age mean and standard deviation of 36.60 ± 6.11 for group A and 35.60 ± 4.85 for group B. Within-group analysis demonstrated a significant decrease in VAS (pain) score following ART intervention (1.80 ± 0.862, p < 0.01) compared to PIR (6.07 ± 0.884). Between-group analysis indicated a significant reduction in FFI (disability) scores for group A (30.33 ± 3.200, p < 0.03) compared to group B (56.93 ± 4.773). Moreover, ART intervention exhibited significant improvement in VAS scores (p < 0.05), with 95% CI [1.49, 2.11]. The mean difference in FFI scores was substantially greater in the ART group (86.00 to 30.33) compared to the PIR group (p > 0.05), suggesting non-significant differences.ConclusionThe active release exercise intervention is more effective than post-isometric relaxation in improving pain and foot function disability in patients with plantar fasciitis. The present study aimed to help physical therapists choose the most efficient manual therapy exercise intervention to improve functional limitations.

Italian versions of the optimal screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) and the Örebro Musculoskeletal pain screening questionnaire (ÖMPQ-21) and their short forms, in patients with low back pain: Cross-cultural adaptation, reliability and validity

BackgroundLow back pain (LBP) is a leading cause of disability worldwide. Early detection of prognostic factors using the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) or the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPQ-21) can predict improvement in pain and disability for patients with nonspecific LBP. ObjectivesTo translate and cross-culturally adapt the OSPRO-YF and the ÖMPQ-21 with their short versions into the Italian language and to test their measurement properties in patients with LBP. DesignClinimetric study. MethodsOSPRO-YF and ÖMPQ-21 were translated and administered to LBP patients with questionnaires on pain intensity, disability, pain self-efficacy, and pain catastrophizing. We evaluated test-retest reliability, measurement error, and construct validity. ResultsEighty-three patients with LBP were included. No floor or ceiling effects were reported. Test-retest reliability of the OSPRO-YF, the ÖMPQ-21, and their short forms were excellent. The measurement error analysis revealed a Standard Error of Measurement (SEM) of 6.7 points, a Minimal Detectable Change (MDC) of 18.6 points for ÖMPQ-21, a SEM of 2.3 points, and a MDC of 6.4 points for OSPRO-YF. The construct validity of the OSPRO-YF and ÖMPQ-21 and its 10-item short version was satisfactory and moderate. OSPRO-YF performed better than ÖMPQ-21 on all three measurement properties. ConclusionOSPRO-YF, ÖMPQ-21, and their short versions are reliable and valid for identifying ‘yellow flags’ in Italian patients with LBP, with the former generally performing better than the latter. Further research is needed to confirm their ability to predict outcomes in patients with LBP.

Assessment of Cervical Joint Position Sense and Head Posture in Individuals With Myogenic Temporomandibular Dysfunctions and Identifying Related Factors: A Case-Control Study.

Temporomandibular dysfunctions (TMDs) have the potential to cause changes in cervical muscle strength, muscle endurance and position sense by changing muscle activation patterns, especially as a result of forward head posture. The effects of TMDs on cervical joint position sense (CJPS) and head posture remain controversial. The aim of this study was to evaluate the head posture and CJPS of individuals with TMDs and compare them with healthy individuals. This research, which was designed as a case-control study, was concluded with the inclusion of total of 84 participants (42 individuals diagnosed with myogenic TMDs, 42 controls). The assessment of participants included pain severity, neck and jaw functionality and disability, CJPS, head posture and temporomandibular joint (TMJ) range of motion (ROM). Individuals with TMDs exhibited higher angular deviation in CJPS during flexion and extension (p < 0.001). Additionally, individuals with TMDs demonstrated higher TMJ pain, limitation and dysfunction severity, as well as a more limited TMJ ROM (p < 0.001). Head posture was similar between groups (p > 0.05). There is a significant relationship between VAS-TMJ with VAS-cervical, FAI, NDI, JFLS-8 and TMJ ROM (p < 0.05). Moreover, a significant correlation was observed between NDI with FAI and TMJ ROM (p < 0.05). These results indicate that in addition to higher pain severity, disability and lower jaw ROM, CJPS of individuals with TMDs is also negatively affected. Also, parameters related to disability and functionality of cervical and TMJ were significantly correlated. Further studies are needed to determine the factors contributing to these results.

Association Between Systemic Neuroinflammation, Pain Perception and Clinical Status in Fibromyalgia Patients: Cross-Sectional Study.

Fibromyalgia (FM) is characterized by chronic pain and a complex array of symptoms, with neuroinflammation implicated in its pathophysiology. This study aimed to explore the association between neuroinflammation, measured through interleukin levels (IL-1, IL-6, IL-8), and clinical outcomes in FM patients. Using a cross-sectional study design, blood levels of these interleukins were correlated with pain severity and disability, assessed via the Fibromyalgia Impact Questionnaire (FIQ) and pain measures. Results indicated that IL-6 and IL-8 may particularly serve as biomarkers for pain severity and disability in FM patients, showing significant associations with worse clinical outcomes. Elevated IL-8 levels, for instance, correlated strongly with increased pain perception and higher disability scores. These findings suggest that specific interleukins are not only elevated in FM but are actively involved in the modulation of pain and disability, underscoring the role of systemic neuroinflammation in the clinical severity of FM. This study contributes to a deeper understanding of the inflammatory mechanisms in FM and underscores the potential of targeting interleukins in therapeutic strategies.

Why do patients with chronic musculoskeletal pain reporting a clinically relevant change on disability not achieve such change in walking ability after interdisciplinary multimodal pain treatment?

Purpose Interdisciplinary multimodal pain treatment (IMPT) offers long-term benefits for patients with chronic musculoskeletal pain (CMP). Many patients, despite reporting a clinically relevant decrease of the self-reported Pain Disability Index (PDI), do not achieve such change for the 6-minutes walking test (6MWT). The objective is to identify factors that are associated with no clinically meaningful improvement on the 6MWT in patients with CMP who reported a clinically important improvement on disability (PDI) after 10-weeks of IMPT. Materials and methods Nine hundred and eighty-three patients reporting a clinically important change on the PDI (primary outcome) after IMPT were included. Logistic regression analysis was used to identify baseline and change scores of physiological and psychologic factors independently associated with a clinically important improvement on the 6MWT. Results Three hundred (32%) patients achieved a clinically important change on the 6MWT. A higher increase of the heart rate (HR) during the 6MWT at post-treatment compared to the HR increase at pre-treatment increases the probability of achieving a clinically relevant change on the 6MWT. Higher self-reported working capacity and anxiety at baseline resulted in a lower probability of achieving a clinically relevant increase of the metres walked. Conclusions None of the other factors targeted by IMPT contributed significantly to the final model. These results question the feasibility of the 6MWT as a secondary outcome measure as it merely seems to measure patient’s behaviour (performance) and not capacity.

Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk

Sciatica is commonly caused by herniated lumbar disc and contributes to severe pain and prolonged disability. Although acupuncture is widely used by patients with chronic sciatica, the evidence of its efficacy is scarce. To investigate the efficacy and safety of acupuncture compared with sham acupuncture in patients with chronic sciatica from herniated disk. This was a multicenter 2-arm randomized clinical trial conducted in 6 tertiary-level hospitals in China of patients with chronic sciatica from herniated disk. Participants were recruited from March 25, 2021, to September 23, 2021, with a final follow-up through September 22, 2022. Data analyses were performed from December 2022 to March 2023. Participants were randomly assigned to receive 10 sessions of acupuncture (n = 110) or sham acupuncture (n = 110) over 4 weeks. Participants, outcome assessors, and statisticians were blinded. The 2 coprimary outcomes were changes in visual analog scale (VAS) for leg pain and Oswestry Disability Index (ODI) from baseline to week 4. Secondary outcomes were adverse events. A total of 216 patients (mean [SD] age, 51.3 [15.2] years; 147 females [68.1%] and 69 males [31.9%]) were included in the analyses. The VAS for leg pain decreased 30.8 mm in the acupuncture group and 14.9 mm in the sham acupuncture group at week 4 (mean difference, -16.0; 95% CI, -21.3 to -10.6; P < .001). The ODI decreased 13.0 points in the acupuncture group and 4.9 points in the sham acupuncture group at week 4 (mean difference, -8.1; 95% CI, -11.1 to -5.1; P < .001). For both VAS and ODI, the between-group difference became apparent starting in week 2 (mean difference, -7.8; 95% CI, -13.0 to -2.5; P = .004 and -5.3; 95% CI, -8.4 to -2.3; P = .001, respectively) and persisted through week 52 (mean difference, -10.8; [95% CI, -16.3 to -5.2; P < .001; and -4.8; 95% CI, -7.8 to -1.7; P = .003, respectively). No serious adverse events occurred. This randomized clinical trial found that in patients with chronic sciatica from herniated disk, acupuncture resulted in less pain and better function compared with sham acupuncture at week 4, and these benefits persisted through week 52. Acupuncture should be considered as a potential treatment option for patients with chronic sciatica from a herniated disk. Chictr.org Identifier: ChiCTR2100044585.

Enhanced joint pain in diabetic patients with knee osteoarthritis is associated with increased synovitis, synovial immune cell infiltration, and erythrocyte extravasation.

Diabetes mellitus (DM) is an important risk factor for the development of osteoarthritis (OA), increasing OA progression and OA pain. To gain insight into the underlying mechanisms of how DM exacerbates OA processes and OA pain, this study analyzed histological differences of synovial tissues from non-DM and DM patients with OA and correlated these differences with knee pain severity. Synovial tissue was obtained from 12 non-DM and 10 DM patients with advanced knee OA who underwent total knee arthroplasty. Synovial inflammation was assessed using the Synovitis score developed by Krenn. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to assess knee pain intensity and disability in OA patients. The number of mast cells, macrophages, nerve fibers, capillaries, larger vessels and erythrocyte extravasation were analyzed microscopically in histological and immunostained synovial sections from non-DM and DM patients. Association analyses were performed to determine associations between OA knee pain and synovial changes affected by DM. Synovial tissue from OA patients with DM had a higher synovitis score, more erythrocyte extravasation, and contained higher numbers of mast cells and macrophages compared to non-DM patients. The number of capillaries and vessels in the lining/sublining layer of the synovial tissue was reduced in DM patients. OA patients with DM had more severe knee pain compared to non-DM patients. The KOOS pain score was associated with the synovitis score, the number of tissue macrophages, and the number of mast cells in the synovial tissue (adjusted for age, sex, and BMI). In addition, the erythrocyte extravasation score was associated with the KOOS pain score and with the synovitis score. The study suggests that increased OA progression and pain severity in patients with DM result from more pronounced synovitis and synovial vascular leakage and increased infiltration of macrophages and mast cells.

Impact of Advanced High-Power Pain Threshold Static Ultrasound and Muscle Energy Technique on Pain Thresholds and Functional Improvement in Myofascial Trigger Points

bands and hypersensitive Trigger Points (TrPs), contributing to musculoskeletal pain. The objective of this study is to investigate and assess the effectiveness of Advanced High-Power Pain Threshold Static Ultrasound (AHPPTSU) and Muscle Energy Technique (MET) in altering pain thresholds and enhancing functional outcomes in individuals with myofascial trigger points. Methods: In this randomized clinical trial involving 86 individuals with TrPs in the upper trapezius muscle, the participants were divided into experimental and control groups. 33 males and 53 females, underwent six sessions of treatment over two weeks. A repeated measure Analysis of variance was used to compare baseline values and altered values at 1 and 2 weeks. Results: The study demonstrated that the Pressure Pain Threshold (PPT) and the Neck Pain Disability Index (NPDI) score, showed a significant improvements in participants receiving AHPPTUS in experimental group compared to the other group. Experimental group showed a significantly greater improvement in PPT (p=0.001) and both groups experienced a significant enhancement in function. However, when comparing the two groups, experimental group showed a significantly greater improvement (p=0.001). Importantly, no adverse effects were reported in either group. Conclusion: In the treatment of myofascial trigger point, AHPPTSU can be considered as an alternative therapy method, which is more effective than previously used High-Power Pain Threshold Static Ultrasound (HPPTSU) therapy and it also shortens the total treatment protocol to 2 weeks.

Psychosocial Treatment Techniques to Augment the Impact of Occupational Therapy Interventions for Chronic Low Back Pain among School Teachers

Background: School teachers perform numerous tasks that contribute to low back pain and affect their activities of daily living, social and vocational abilities. Low back pain is multidimensional in nature constituting physical, psychological and social components. Psychosocial variables pose as an obstacle to rehabilitative recovery and have a role in development of chronicity, these factors are often neglected in the rehabilitation process, the present study integrates psychosocial factors with musculoskeletal factors and utilizes a rehabilitation program that focuses on overall recovery. Objectives: This study aims to find effective treatment for psychosocial variables and examines the physical and psychosocial changes that occur in school teachers suffering with CLBP when they receive occupational therapy augmented with psychosocial intervention. The intervention targets anxiety, perceived stress, and self-efficacy. Methodology: The study sample consisted of 60 school teachers, half of the sample was enrolled for occupational therapy intervention and other half for occupational therapy intervention augmented with psychosocial treatment techniques. Results: At post-treatment participants in the occupational therapy augmented with psychosocial treatment group showed significant difference in measures of anxiety, perceived stress and self-efficacy, pain intensity, pain severity, pain disability and 5-minute walk test distance compared to participants who received occupational therapy treatment only. The two groups did not differ significantly in finger-to-floor test. Conclusion: The findings of the study suggest that augmenting psychosocial variables is beneficial to person-environment factors of disability and result in better rehabilitation outcomes in terms of both psychosocial variables as well as pain related variables.

Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain

Background &amp; Objective: Low back pain (LBP) is an ever-increasing menace in the young men as well as women. Many factors causing it have been identified, the most common being improper spinal posture. LBP has been targeted by physicians, anesthetists, surgeons and rehabilitation medicine specialists. We compared the effects of Kinesio Taping and dry needling on pain reduction and disability improvement in patients diagnosed with mechanical chronic LBP. Method: A randomized control trial (RCT) was conducted at Rawal General and Dental Hospital and Al-Nafees hospital in Islamabad from January 2020 to October 2021. Probability-based sampling method was used to select participants for the study (simple random sampling). Thirty patients, aged 18 to 75 y were included. Sample size was calculated with Epitools. The selected patients were divided in two groups i.e., 15 patients in the Kinesio taping group (KT group) and 15 in the dry needling group (DN group). Two patients in the needling group were dropped. Numeric Pain Rating Scale (NPRS) and Roland-Morris Disability Index Questionnaire (RMDQ) were used to assess the pain and the disability at baseline, two weeks post-intervention and four weeks post-treatment. Chi-Square test was use to find association. Results: The mean age of the patients was 39.60 ± 13.69 y for KT group and 37.15 ± 12.54 y for DN group. The mean BMI for KT group was 27.15 ± 6.70 kg/m2 and for DN group 27.52 ± 5.13 kg/m2. Before treatment, there were no differences between the groups for NPRS and RMDQ. Both dry needling and Kinesio taping produced significant improvements in NPRS and RMDQ after two and four weeks of treatment (P &lt; 0.05). However, statistical analysis results showed that there was no association between pain and disability in patient with non-specific low back pain. (P &gt; 0.05). Conclusion: Both, Kinesio taping and dry needling, significantly reduced pain and disability after two- and four-weeks treatment in patients with low back pain, but there was no statistical differences between the pain and disability in both groups. Keywords: Disability; Dry Needling; Kinesio Tape; Low Back Pain; Numeric Pain Rating Scale; Physiotherapy Citation: Asad A, Irshad A, Hassan T, Kiran Q, Kouser S, Hassan F. Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain. Anaesth. pain intensive care 2024;28(5):933−938; DOI: 10.35975/apic.v28i5.2561 Received: April 26, 2024; Reviewed: July 16, 2024; Accepted: July 18, 2024

COMPARING THE CLINICAL OUTCOMES OF LUMBAR TRANSFORAMINAL VS INTERLAMINAR EPIDURAL STEROID INJECTIONS IN A REGISTRY COHORT

Epidural steroid injections are a safe and effective treatment for acute low back pain associated with radicular pain. Objective: The main objective of the study is to find the clinical outcomes of lumbar transforaminal vs interlaminar epidural steroid injections in a registry cohort. Methods: This prospective cohort study was carried out at Ghurki Trust Teaching Hospital, Lahore, over one year, from June 2023 to June 2024. A total of 185 patients were included in the study. Patients aged &gt;18 years and presented with symptoms of lumbar radiculopathy due to lumbar disc herniation, spinal stenosis, or degenerative disc disease were included in the study. Results: The mean age of the TFESI group was 45.6 ± 10.3 years, while the ILESI group had a mean age of 46.2 ± 9.8 years (p = 0.67). The gender distribution was also comparable, with 55 males and 37 females in the TFESI group, and 58 males and 35 females in the ILESI group (p = 0.78). Baseline pain intensity (VAS score) and disability (ODI score) were similar between the two groups, with no significant differences in VAS (7.6 ± 1.1 vs. 7.5 ± 1.2, p = 0.58) or ODI (52.4 ± 10.2 vs. 51.9 ± 9.9, p = 0.71). In the TFESI group, 52.2% of patients had lumbar disc herniation, compared to 49.5% in the ILESI group (p = 0.69). Lumbar spinal stenosis was diagnosed in 32.6% of patients in the TFESI group and 34.4% in the ILESI group (p = 0.81). Conclusion: It is concluded that both lumbar transforaminal epidural steroid injections (TFESI) and interlaminar epidural steroid injections (ILESI) are effective in the management of lumbar radiculopathy, leading to significant reductions in pain and improvements in functional outcomes.

Running is acceptable and efficacious in adults with non-specific chronic low back pain: the ASTEROID randomised controlled trial

ObjectivesRunning is one of the most accessible forms of exercise, yet its suitability for adults with chronic low back pain (LBP) is unknown. This study assessed the efficacy and acceptability...

7984 A Challenging Case Of Hyperphosphatemic Familial Tumoral Calcinosis

Abstract Disclosure: T.G. de Souza: None. T.J. Weber: None. Introduction: Hyperphosphatemic Familial Tumoral Calcinosis (hFTC) is a rare, autosomal recessive metabolic disorder characterized by elevated serum phosphate levels and the accumulation of calcium phosphate deposits in soft tissues. There are fewer that 150 genetically confirmed cases in the literature. There are no consensus guidelines; therapeutic approaches are guided by case reports or series. This case serves to heighten awareness of therapeutic strategies including global health considerations for the disabled adult with a rare bone disorder. Case: A 32-year-old African-American woman presented to establish care for hFTC, for which she takes ibuprofen for disabling bilateral hip pain. hFTC was diagnosed in early childhood and managed at a large children’s hospital. Therapeutic modalities relied on operative resection of skin lesions on eruption. She describes cosanguinous parentage, consignment to foster care as a child and homelessness as an adult. She has not had adult endocrine care for her hFTC. Her medical comorbidities include major depressive disorder, PTSD and suicide attempt. She reports one uncle with hFTC noting that his phenotype was not significantly disabling and apparent recession of his lesions with age. Her parents did not have symptoms of hFTC. Radiographically, she had amorphous calcium deposits over both hips (her primary sites of severe pain), upper back (site of painless spontaneous eruptions), and left elbow without pain or skin penetration, as well as hyperostosis of the ilium bilaterally. She noticed waxing and waning of her eruptions with her menstrual cycle, such that lesions worsen in the luteal phase. Megestrol acetate also induced new eruptions. Examination shows brown staining to all teeth with several missing teeth. She had a marked lower extremity limb length discrepancy with severe restriction of hip abduction. Blood chemistries were grossly normal, including renal function, calcium, uric acid and PTH. Serum phosphorous was elevated at 5.2 (2.3 - 4.5 mg/dL). CT showed bilateral nephrocalcinosis. We instituted treatment with a low phosphorous diet, sevelamer to reduce intestinal phosphate absorption and acetazolamide to increase urinary phosphate excretion. For her pain and functional disability, we recommended continued NSAIDs, physical therapy and social work consultation to facilitate continued access to care. Conclusions: This case uniquely describes hFTC symptom fluctuation with the menstrual cycle, worsening with increased progesterone, suggesting a possible role of gonadal hormones on FGF-23 biology. It also highlights the socioeconomic burdens that can accompany rare bone disease, which become more pronounced as the patient achieves adulthood. Successful transition of care from pediatric to adult endocrinologist, in addition to engaging multi-disciplinary support, is essential in optimizing life-long care in hFTC. Presentation: 6/1/2024

The Effect of 8 Weeks of Dynamic Neuromuscular Stabilization Training on Pain, Electromyography Activity of Lumbar Muscles, and Quality of Life in People with Chronic Low Back Pain

Objectives: To evaluate the effects of an 8-week DNS training program on pain, EMG activity, and quality of life in individuals with CLBP. Design: Semi-experimental study. Participants: Thirty male participants with non-specific CLBP, divided into DNS (n=15) and control (n=15) groups. Main Outcome Measures: Pain levels (Quebec Back Pain Disability Scale), lumbar muscle EMG activity (MegaWin EMG device), and quality of life (SF-36 questionnaire). Results: The DNS group showed significant pain reduction (P=0.00), increased EMG activity in rectus abdominis (P=0.000), erector spinae (P=0.002), and gluteus maximus (P=0.002), and improved quality of life (P=0.02). Conclusions: DNS exercises significantly reduce pain, enhance muscle activity, and improve quality of life in CLBP patients

Individualized Versus General Exercise Therapy in People with Subacromial Pain Syndrome: A Randomized Controlled Trial

ObjectiveTo evaluate the effect of individualized exercises based on movement fault (MF) control on pain intensity and disability in subjects with chronic subacromial pain syndrome (SAPS). DesignRandomized Controlled Trial (IRCT20221126056621N1) SettingRehabilitation clinics ParticipantsThirty-eight participants with chronic SAPS (aged 52.23(8.47), 60 %woman). InterventionsThe participants were randomly allocated to one of the intervention groups (individualized exercises based on MFs control test designed to target specific movement faults) or the control group (commonly prescribed general scapular stabilization exercises). Both groups received exercise sessions twice a week for four weeks. Main Outcome MeasuresThe primary outcome measures were pain intensity at rest (PR) and during arm raising (PAR) using a visual analog scale. Disability was assessed as a key secondary outcome, including the disabilities of the arm, shoulder, and hand (DASH) questionnaire and the Shoulder Pain and Disability Index (SPADI). ResultsFollowing completion of all exercise sessions, PAR was significantly lower in the intervention group compared to the control group (mean [CI]: 9.17 [0.31 to 18.03], p=0.04), with a large effect size [0.68]. The reduction of PAR remained significantly lower in the intervention group than in the control group after four months of follow-up (mean [CI]: 18.29 [9.09 to 27.48], p=0.00) with a large effect size [1.27]. Disability significantly decreased at two month (mean=14.58, p=0.002 on SPADI index; mean=10.26, p=0.006 on DASH index) and four month (mean=19.85, p=0.00 on SPADI index; mean=12.09, p=0.001 on DASH index) follow ups in the intervention group compared to the control group. ConclusionIndividualized exercises based on MFs control of the shoulder region was accompanied by decreased PAR and disability in subjects with SAPS.