Low Back Pain Patients Research Articles

Postpanniculectomy Improvement in Low Back Pain: A Case Report

While panniculectomy is traditionally considered a cosmetic surgery, there is growing interest in the potential role of panniculectomy for the treatment of low back pain. We present a case of a 69-year-old man with a history of over 10 years of significant low back pain with radiculopathy rated as 7 out of 10 and resistant to conservative measures as well as multiple spinal decompression surgeries. He had undergone bariatric surgery 14 years prior and maintained a stable body mass index. He presented with a large pannus desiring panniculectomy for aesthetic purposes. He underwent an uncomplicated panniculectomy. As an unintended benefit of his procedure on his 1-month post-op visit, he reported near resolution of his low back pain and radiculopathy. His reported pain had been reduced to 1–2 out of 10. More research needs to be done to assess the potential of panniculectomy as a treatment for low back pain in patients with massive weight loss.

Comparative Efficacy of Three Methods of Lumbar Interbody Fusion for Lumbar Degenerative Diseases in a Tertiary Public Hospital.

To evaluate the clinical efficacy of large-channel endoscope-assisted posterior lumbar interbody fusion (Endo-PLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and open posterior lumbar interbody fusion in the treatment of degenerative diseases of the lumbar spine. The data of 110 patients with degenerative diseases of the lumbar spine were analyzed retrospectively: 31 cases had Endo-PLIF, 36 patients received MIS-TLIF, and 43 cases underwent modified-TLIF. We compared several parameters among the three groups: operative duration; intraoperative blood loss; latent blood loss; intraoperative radiation dose; visual analog scale (VAS) score; Oswestry Disability Index (ODI); anterior protrusion angle of the intervertebral space; postoperative ambulatory time; postoperative duration of hospital stay; complications. The prevalence of interbody fusion was observed at follow-up. The operative duration of Endo-PLIF was longer than that of MIS-TLIF and modified-TLIF (P <0.05). In terms of intraoperative blood loss, latent blood loss, and recovery time, Endo-PLIF and MIS-TLIF had clear advantages (P <0.05). The VAS score and ODI of the three groups were satisfactory, but the low-back pain of patients in the Endo-PLIF group and MIS-TLIF group was less than that in the modified-TLIF group (P <0.05). In terms of complications and prevalence of interbody fusion, there were no significant differences among the three groups (P >0.05). All three operative methods had satisfactory efficacy. Endo-PLIF can be employed to treat lumbar degenerative diseases more precisely and in a minimally invasive fashion, but a learning curve and improvement in surgical instruments are needed.

Reliability and concurrent validity of the iHandy level mobile application to measure thoracolumbar range of motion in low back pain patients

IntroductionThe use of smartphone technology and software (apps), in addition to an inclinometer and goniometer, has expanded the clinician’s assessment possibilities. However, the legitimacy and trustworthiness of these cell phones and applications are still questioned. This study aimed to determine the reliability and concurrent validity of the iHandy level mobile application to measure the thoracolumbar range of motion in people with low back pain.MethodsThis descriptive study included 40 participants, of which 20 were symptomatic, and 20 were asymptomatic for non-specific chronic pain in the lower back. Measurements were taken for extension, flexion, and left and right-side bending range of motion (ROM). Two investigators were involved. One measured ROM values with a Samsung iHandy level and inclinometer, and the second investigator registered the data. Two values were taken and the mean was used for further analysis. Measurements were taken at baseline and one-week follow-up.ResultsIn asymptomatic participants, the mobile application had ICC values of 0.81, 0.70, 0.79, and 0.85, while in symptomatic, regarding intra-rater reliability, these were 0.80, 0.78, 0.81Regarding the concurrent validity of mobile apps in asymptomatic patients, ICC values were 0.94, 0.93, 0.84, and 0.89, while in symptomatic patients, the ICC values were found to be 0.92, 0.89, 0.83, and 0.85 for flexion, extension, RLF, and LLF, respectively. These showed an excellent correlation between the inclinometer and mobile app regarding intra-rater reliability and concurrent validity.ConclusionsiHandy level smartphone applications might be considered reliable and valid for assessing thoracolumbar motion ranges in individuals with chronic pain in the lower back.

The STarT Back Screening Tool: The Nepali Translation, Cross-Cultural Adaptation and Measurement Properties in Adults With Non-Specific Low Back Pain.

The STarT Back Screening Tool (SBST) stratifies low back pain (LBP) patients based on their risk of chronicity to guide treatment accordingly. The absence of its validated Nepali version limits stratified LBP care in Nepal. The study aimed to translate and cross-culturally adapt the SBST into Nepali and evaluate its measurement properties in adults with LBP. The measurement properties of the Nepali SBST were evaluated in 102 Nepali adults with non-specific LBP. We assessed content validity, internal consistency, test-retest reliability, construct and discriminant validity. Item redundancy was evaluated using Cronbach's alpha (α>0.90), test-retest reliability using Intraclass Correlation Coefficient (ICC2,1) and Cohen's kappa using established cutoffs score for categorising patients into risk groups, construct validity using hypothesis testing (if a minimum of 75% of the hypotheses were supported), and discriminant validity using Area Under the Curve (AUC) with the reference scales administered at baseline. Cronbach's alphascores were 0.72 for the overall scale and 0.66 for the psychosocial subscale. Test-retest reliability values were good to excellent with ICC2,1 of 0.94 (95% CI: 0.87-0.97) for the overall scale and 0.87 (95% CI: 0.73-0.94) for the psychosocial subscale and Kappa values of 0.68 (95% CI: 0.43-0.93) for the overall scale and 0.79 (95% CI: 0.52-1.00) for psychosocial subscale. Construct validity was confirmed as 100% of a priori hypotheses were met. Acceptable discriminative validity was observed with reference scales with AUCs (0.75-0.80). Nepali SBST demonstrates the reliability and validity of screening for chronicity risk in Nepali adults with LBP. Future studies should evaluate its responsiveness, predictive abilities, and effectiveness in stratifying LBP patients in the Nepalese context.

The Alberta Back Care Pathway: The feasibility of implementing a novel care pathway to improve low back pain management for family physicians in primary care.

Family physicians in Canada's universal healthcare system often manage low back pain patients using interventions not recommended in clinical guidelines, such as pharmaceuticals, imaging and spinal injections, while guideline-based treatments like education and exercise remain unfunded. The Alberta Back Care pathway was developed to address this gap, offering funded, evidence-based care for low back pain patients in 5 streams (acute, sub-acute, chronic, chronic non-responsive and stable radiculopathy). To evaluate the feasibility of implementing the pathway in two urban Primary Care Networks in Alberta, Canada. Each of the 5 pathway streams provided physicians with information scripts, no-cost interventions (pharmaceuticals and otherwise) and interventions to avoid. From April 2021 to November 2023, the RE-AIM framework was used to assess implementation feasibility of the pathway. For the RE-AIM dimension of reach, 25% (n = 41/162) of eligible family physicians in Primary Care Network "A" and 12% (n = 26/221) in Primary Care Network "B" enrolled in the study. Over half of enrolled physicians (n = 21/41 and 21/26) referred at least one patient with most referrals to the GLA:D Back program for chronic low back pain stream (93% in network "A" and 88% in network "B"). Implementation, evaluated as the proportion of referrals by physician compared to their total low back pain caseload, was low (> 0-10% referred) for 52% (n = 11/21) of physicians in network "A", and medium-low (10-25% referred) for 52% (n = 11/21) of physicians in network "B". The number of pathway-appropriate patients in each physician's caseload was unknown. Maintenance at 12 months was 56% (n = 10/18) in network "A" and 39% (n = 7/18) in network "B". The Alberta Back Care pathway was feasible to implement during the pandemic and primarily serving patients with chronic low back pain by providing access to a guideline-based education and exercise group program (GLA:D Back).

Implementation of Pilates Exercises to Reduce Pain Scale in Low Back Pain Patient

Introduction: Low back pain or lower back pain is pain that occurs in the waist or buttocks area which usually persists for a long time. Working as a disabled person is the dominant cause of LBP, including the profession as a nurse. LBP is the third disease that often occurs in the world, including in Indonesia. Pain is a problem caused by LBP, so it will interfere with sufferers in carrying out daily activities. Pain is a term for a complex reaction caused by physiological reactions in the nervous system. Objective: This case study aims to reduce pain intensity in low back pain patients. Method: This research is in the form of a case study with a descriptive method with a nursing care approach which includes assessment, nursing diagnosis, nursing care plan, nursing implementation and nursing evaluation. Results: The results of the case study at the assessment stage showed that Ms. M with the problem that emerged was acute pain so the nursing diagnosis was obtained as acute pain related to a physiological injury agent (SDKI), with the criteria for decreased pain results (SLKI). The intervention used uses the Standard Nursing Intervention (SIKI). Conclusion: The intervention was carried out over four meetings. By using NRS (Numeric Rating Scale) and FPS (Face Pain Scale) measurements, after carrying out Pilates exercises, a decrease in pain was obtained with the result that there was a decrease in pain intensity from initially severe pain with a pain scale of 8 (0-10) to mild pain with a scale of pain 3 (0-10).

Efficacy of percutaneous endoscopic lumbar discectomy (PELD) combined with sinuvertebral nerve ablation versus PELD for low back pain in lumbar disc herniation

BackgroundPercutaneous endoscopic lumbar discectomy (PELD) has demonstrated variable efficacy in alleviating low back pain (LBP) associated with lumbar disc herniation (LDH). Sinuvertebral nerve ablation (SNA), which targets the nociceptive pathway implicated in discogenic LBP pathogenesis, has emerged as a potential adjunctive therapy. The efficacy of endoscopic radiofrequency ablation in enhancing PELD for the treatment of LBP in patients with LDH remains unclear.MethodsA retrospective cohort study was conducted on LDH patients with concomitant LBP treated at the Spinal Surgery Department, China-Japan Friendship Hospital, from June 2020 to June 2023. Participants were categorized into two groups: PELD combined with SNA (n = 51) and PELD alone (n = 46). Primary outcome measures included the Visual Analog Scale (VAS) for pain, the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index (ODI) at baseline and 1-, 3-, and 6-month follow-ups.ResultsBoth groups exhibited significant improvements in VAS, JOA, and ODI scores for LBP and leg pain postoperatively compared to preoperative assessments. Notably, the PELD combined with SNA group demonstrated statistically significant superior outcomes in VAS, JOA, and ODI scores specifically for LBP compared to the PELD group.ConclusionThe combination of PELD with SNA significantly improves LBP outcomes compared to PELD alone in LDH patients. While the observed improvements did not reach the minimal clinically important differences (MICD), these findings suggest that SNA may enhance the efficacy of PELD in LBP management.

Short-Term Efficacy of Repetitive Peripheral Magnetic Stimulation for Chronic Low Back Pain: A Double-Blinded Randomized Control Trial

Objective: To evaluate the efficacy of repetitive peripheral magnetic stimulation (rPMS) in alleviating pain and enhancing functional recovery in patients with chronic low back pain. Materials and Methods: The present study was a double-blinded randomized controlled trial conducted in 30 patients aged 18 to 60 years with chronic low back pain at the outpatient clinic of Department of Rehabilitation Medicine. Patients were randomly assigned to the rPMS group or the sham treatment group, receiving one session per week for three weeks. Visual analog scale (VAS) scores were assessed before treatment, after each session, and one-week post-treatment. The Roland-Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) were evaluated before and one week after treatment. Results: Baseline characteristics and scores for VAS, RMDQ, and ODI, were comparable between groups. VAS scores improved significantly in both groups at one-week post-treatment, with the rPMS group showing better outcomes. The mean VAS score decreased in the rPMS group after the second and third sessions was 2.5 (SD 1.6) and 2.5 (SD 1.4), respectively. A linear mixed-effects model indicated a significant reduction in VAS scores by the third session. The median improvement in RMDQ was 3.0 (IQR 3.0) for the rPMS group versus 2.0 (IQR 2.0) for the sham group (p=0.030). ODI scores improved by 5.6 (SD 3.5) in the rPMS group compared to 2.4 (SD 1.8) in the sham group (p=0.048). Conclusion: rPMS, combined with exercise and behavioral modifications, reduces pain and disability in chronic low back pain patients. However, the change in VAS scores did not exceed the minimal clinically important difference (MCID), suggesting limited clinical impact.

Fear of movement interacts with trunk mobility, and pain intensity to predict disability in patients with chronic low back pain: a classification and regression tree (CART) analysis.

Low back pain significantly impacts global health, particularly in low-income areas where primary care challenges are prevalent. Assessing both biophysical and psychological factors associated with low back pain-related disability is crucial for developing effective screening and management strategies. This study aimed to examine the association between fear of movement, trunk mobility, pain intensity, physical activity, and low back pain-related disability, and to identify key factors contributing to higher disability levels in patients with chronic low back pain. This cross-sectional study analyzed data from 381 chronic low back pain patients aged over 18, collected at a primary care ambulatory between 2015 and 2019. Variables measured included pain intensity, fear of movement, physical activity, trunk mobility, and disability. A Classification and Regression Tree approach was used to model disability predictors. Fear of movement was the main driver of high disability (OR = 17.3, 95%CI 8.9-33.7). Two profiles were particularly prone to higher disability: patients with high fear of movement (>47.5) and pain intensity > 1.5; and those with lower fear of movement but poor trunk mobility (>36.5 cm). Patients with better trunk mobility and low pain intensity (≤3.5) showed significantly less disability (OR = 0.06, 95%CI 0.02-0.17). The findings highlight the need for integrating better psychological and biophysical assessments in managing chronic low back pain. Understanding how fear of movement, trunk mobility, and pain interaction can improve screening accuracy and optimize care in resource-limited settings, using valid and feasible tools for these scenarios.

Factors associated with pain-related functional interference in people with chronic low back pain enrolled in a physical exercise programme: the role of pain, sleep, and quality of life.

To identify the factors associated with the pain-related functional interference level in people with chronic low back pain. Cross-sectional. Chronic low back pain patients. Sociodemographic data, pain intensity, pain-related functional interference, physical functioning and fitness, sleep quality, anxiety and depression, social support, and health-related quality of life were recorded. Descriptive and bivariate analyses were performed. A linear regression model was carried out to identify the factors associated with the pain-related functional interference level. 99 participants were involved (mean age: 54.37 SD: 12.44; women: 67.7%). 37.4%, 27.3%, and 35.4% were classified into low, moderate, and high pain-related functional interference level groups, respectively. Higher pain-related functional interference was associated with higher pain intensity (β: 0.724; p = 0.026), worse sleep quality (β: 0.077; p = 0.012), worse quality of life (physical (β: -0.539; p < 0.001) and mental (β: -0.289; p < 0.001), and lower consumption of weak opioids (β: -3.408; p = 0.037). Beyond the pain experience and intensity among people with chronic low back pain, several biopsychosocial factors associated with this condition has been identified. Furthermore, higher pain intensity, worse sleep quality, worse quality of life, and weak opioids' consumption have been related to the pain-related functional interference of this population.

Lumbar Facet Joint Disease: What, Why, and When?

Low back pain (LBP) affects over 60% of individuals in their lifetime and is a leading cause of disability and increased healthcare expenditure. Facet joint pain (FJP) occurs in 27% to 40% of LBP patients but is often overlooked or misdiagnosed. Additionally, there is no clear correlation between the clinical examination, radiological findings, and clinical presentation, complicating the diagnosis and treatment of FJP. This narrative review aims to provide an overview of the literature regarding facet joint pain and discusses the utility of medial branch blocks (MBBs) and intra-articular (IA) injections as diagnostic and therapeutic tools prior to radiofrequency ablation (RFA). RFA is considered the gold standard for managing FJP, employing techniques that include precise needle placement and stimulation parameters to disrupt pain signals. Promising alternatives such as cooled RFA and cryodenervation require further research on their long-term efficacy and safety. Endoscopic denervation and multifidus stimulation are emerging therapies that may benefit chronic LBP patients, but additional research is needed to establish their effectiveness. When conservative management fails, RFA provides significant and lasting relief in well-selected patients and has a favourable safety profile. The current literature does not support surgical interventions for FJP management.

About Distress in Chronic Pain Conditions: A Pre-Post Study on the Effectiveness of a Mindfulness-Based Intervention for Fibromyalgia and Low Back Pain Patients.

Chronic pain (CP) affects about 30% of the global population and poses significant challenges to individuals and healthcare systems worldwide. The interactions between physiological, psychological, and social factors are crucial in the onset and development of CP conditions. This study aimed to evaluate the effectiveness of mindfulness-based intervention, examining its impact on perceived stress (PSS), depression and anxiety (BDI-II, PGWBI/DEP, SAS, STAI Y), sleep quality (PSQI), and mindfulness abilities (MAAS) in individuals with CP. Participants (N = 89, 84.3% female) underwent one of two diagnoses [fibromyalgia (FM) or low back pain (LBP)] and took part in an MBSR intervention. The mindfulness program proved effective in reducing PSQI scores (F = 11.97; p < 0.01) over time, independently of the type of diagnosis. There was also a marginal increase in trait mindfulness as measured by MAAS (F = 3.25; p = 0.07) in both groups. A significant difference between the two groups was found for the effect on PSS: F (1,87) = 6.46; p < 0.05. Mindfulness practice also reduced anxiety in FM and depressive symptoms in LBP, indicating a reduction in psychological distress among participants. Our findings suggest that mindfulness-based interventions may offer promising avenues for personalized pain management in clinical settings.

Sacralization of lumbar vertebrae-prevalence and association with low back ache and radiculopathy

Background: Low back pain (LBP) is a prevalent condition, often associated with various anatomical anomalies, including lumbar sacralization, that is, the fusion of the fifth lumbar vertebra (L5) with the sacrum. This study aims to evaluate the prevalence of sacralization among LBP patients and its relationship with radiculopathy. Methods: A retrospective study was conducted at the department of orthopaedics, Justice KS Hegde charitable hospital, from January 1, 2023, to July 31, 2024. Patients aged 18-75 years presenting with LBP who underwent lumbosacral radiographs were included. Demographic and clinical data were collected, and sacralization types were classified using the Castellvi system. Statistical analyses were performed using the chi-square test. Results: Among 771 radiographs analysed, the prevalence of sacralization was 10.1%. Most subjects were over 41 years old (81.6%), with a majority being female (54.5%). Type I A was the most common form of sacralization (30.77%). A significant association between sacralization and radiculopathy was observed, with 70 of the 78 subjects with sacralization experiencing radiculopathy (p&lt;0.0005). Conclusions: This study indicates a noteworthy association between sacralization and radiculopathy in patients with LBP. Given the low prevalence of sacralization, the findings emphasize the importance of recognizing anatomical variations in clinical evaluations of patients with low back ache, particularly in older populations. Further research is warranted to explore the implications of these anatomical anomalies on treatment strategies and patient outcomes.

Minimal-invasive pain procedures are effective in different degenerative pain generators in CLBP: A prospective cohort study.

It is estimated that a significant number of spinal surgeries are performed, but many patients do not often benefit. Our aim was to determine how effective minimally invasive pain procedures (MIP) are in chronic low back pain (CLBP) patients with proven degenerative causes (specific low back pain). 386 eligible patients with CLBP/sciatica resistant to conservative therapy and scheduled for open surgery were screened, and 167 could be enrolled in this study. Indications for MIP in the remaining 150 individuals were made by one experienced spinal surgeon. Before and 6 months after the intervention, the numeric rating scale (NRS) and Oswestry Disability Index (ODI) were recorded. MIP was performed, such as radiofrequency of the facet and SI-joint, intradiscal electrothermal therapy in case of discogenic pain, as well as epidural neuroplasty in patients with disc herniation/epidural fibrosis. There was a statistically significant decrease in NRS (p< 0.05), as well as a significant increase in ODI (p< 0.001) 6 months after the procedures. This was also true for the results of all different pain generators and subsequent performed procedures alone. The indication of MIP should be routinely reviewed in patients with CLBP to avoid potentially open surgery and a burden on healthcare costs.

The effect of modified paramedian and median approaches of spinal anesthesia on postspinal acute low back pain in patients undergoing urological surgery: a prospective cohort study

Background: Low back pain after spinal anesthesia may be a complicated issue for many patients. We aimed to evaluate the incidence of postspinal low back pain in the modified paramedian approach of spinal anesthesia compared to the classical median approach.Materials and Method: The study is a prospective non-randomized observational trial. We included 297 patients aged 20 to 80 years who underwent urological surgery under spinal anesthesia. Patients were allocated into two groups: In Group P, patients underwent spinal anesthesia by using a modified paramedian approach and in Group M, the classical median approach was used. Primary outcome was the incidence of postoperative low back pain. Secondary outcomes were number of needle insertion attempts, needle bone contacts and patient satisfaction.Results: The incidence of low back pain in Group M was 70.3% on the first day, 39.5% on the 7th day and 5.9% at the end of one month after surgery. In Group P, the incidence of low back pain was 30.7% on the first day, 12.4% on the 7th day and 0.7% at the end of one month after surgery. The low back pain scores were significantly lower in group P at all-time points. Patient satisfaction was significantly higher in group P (p=0.038). The number of needle interventions (p=0.001) and bone contact (p=0.000) were significantly lower in group P.Conclusions: Low back pain was less common with the modified paramedian approach compared to the classical median spinal approach. We found lower number of needle insertion attempts and bone contacts in the modified paramedian technique. Patient satisfaction was also higher in the paramedian technique.

Association of Vitamin D with Haematological Inflammatory Indices in Patients with Back Pain.

To assess the relationship between vitamin D and haematological inflammatory indices (HII) in chronic low back pain (CLBP) patients. Descriptive study. Place and Duration of the Study: Harran University Hospital, Sanliurfa, Turkiye, between September 2023 and February 2024. A total of 100 CLBP patients were divided into three groups according to their vitamin D levels as deficiency (<20 µg/L), insufficiency (20-30 µg/L), and sufficiency (30-80 µg/L). Demographic characteristics, serum parameters, and HII were compared among the three groups. Additionally, the association between vitamin D and other parameters were investigated. The three groups were similar in terms of age (p = 0.640), gender distribution (p = 0.057), body mass index (BMI, p = 0.855), C-reactive protein (CRP, p = 0.965), leucocyte count (p = 0.979), neutrophil count (p = 0.525), lymphocyte count (p = 0.246), monocyte count (p = 0.485), platelet count (p = 0.878), and HII including neutrophil-to-lymphocyte ratio (NLR, p = 0.335), monocyte-to- lymphocyte ratio (MLR, p = 0.227), platelet-to-lymphocyte ratio (PLR) (p = 0.898), neutrophil-to-lymphocyte*platelet ratio (NLPR, p = 0.543), systemic inflammatory index (SII, p = 0.300), systemic inflammatory response index (SIRI, p = 0.187), and aggregate index of systemic inflammation (AISI, p = 0.219). No significant correlation was found between vitamin D concentration and other parameters (p >0.05). The coexistence of vitamin D deficiency and increased HII may accompany inflammatory conditions. However, no significant association was found between vitamin D level and HII in non-inflammatory CLBP. Inflammation, Low back pain, Neutrophil, Complete blood count, Vitamin D.

Association of Vitamin D with Haematological Inflammatory Indices in Patients with Back Pain.

To assess the relationship between vitamin D and haematological inflammatory indices (HII) in chronic low back pain (CLBP) patients. Descriptive study. Place and Duration of the Study: Harran University Hospital, Sanliurfa, Turkiye, between September 2023 and February 2024. A total of 100 CLBP patients were divided into three groups according to their vitamin D levels as deficiency (<20 µg/L), insufficiency (20-30 µg/L), and sufficiency (30-80 µg/L). Demographic characteristics, serum parameters, and HII were compared among the three groups. Additionally, the association between vitamin D and other parameters were investigated. The three groups were similar in terms of age (p = 0.640), gender distribution (p = 0.057), body mass index (BMI, p = 0.855), C-reactive protein (CRP, p = 0.965), leucocyte count (p = 0.979), neutrophil count (p = 0.525), lymphocyte count (p = 0.246), monocyte count (p = 0.485), platelet count (p = 0.878), and HII including neutrophil-to-lymphocyte ratio (NLR, p = 0.335), monocyte-to- lymphocyte ratio (MLR, p = 0.227), platelet-to-lymphocyte ratio (PLR) (p = 0.898), neutrophil-to-lymphocyte*platelet ratio (NLPR, p = 0.543), systemic inflammatory index (SII, p = 0.300), systemic inflammatory response index (SIRI, p = 0.187), and aggregate index of systemic inflammation (AISI, p = 0.219). No significant correlation was found between vitamin D concentration and other parameters (p >0.05). The coexistence of vitamin D deficiency and increased HII may accompany inflammatory conditions. However, no significant association was found between vitamin D level and HII in non-inflammatory CLBP. Inflammation, Low back pain, Neutrophil, Complete blood count, Vitamin D.

The effect of height of lifting on dynamic postural control in low back pain patients and healthy subjects

Objectives: The study investigated the influence of starting load position during lifting on postural control in nonspecific chronic low back pain (LBP) and healthy volunteers. Patients and methods: The cross-sectional study included 20 healthy males (mean age: 31.8±7.4 years; range, 18 to 55 years) and 52 male patients (mean age: 33.4±9.2 years; range, 18 to 55 years) with chronic LBP between February 2016 and April 2018. Postural control characteristics were assessed by a force plate system. Center of pressure signals were obtained at a frequency of 100 Hz, and the mean of three trials was calculated. The participants were told to place their feet hip-width apart on the force plate while standing barefoot. They were then asked to lift a box weighing 10% of their body weight from the ground to waist height and then from waist height to overhead with straight elbows. They moved the box at their selected speed. The examinations began upon the examiner's command. Results: Results indicated a significant difference (p&lt;0.001) in all postural control variables in chronic LBP patients who lifted a load at different heights. In addition, there was a significant difference between all of the postural control measures of this study in healthy participants during load lifting at different heights (p&lt;0.05), with the exception of the mediolateral standard deviation of velocity (p=0.067). Conclusion: Different lifting heights impact LBP patients' and healthy people's postural control differently. Postural control was more challenging during waist-to-overhead lifting in the patient group. This may be due to a stiffening strategy. The central nervous system reduces postural sway at higher centers of mass.

A Novel Labeling Method of Physiological-based Pressure Pain Assessment Among Patients With and Without Chronic Low Back Pain

Pain, especially chronic pain, is a complicated and subjective experience, threatening global healthcare as one of the most severe health problems. Traditionally, pain is assessed by Visual Analog Scale to indicate the pain intensity by the patient’s self-report, causing them to become biased by various psychosocial factors. In this study, we performed two distinct labeling methods to assess the pressure pain in Quantitative Sensory Testing and to differentiate healthy controls and chronic low back pain patients: time period labels and percentage timestamp labels. Physiological signals such as blood volume pulse and galvanic skin response were collected. The time period labeling method was to segment via fixed time windows. The percentage timestamp labeling method was to select the timestamp labels based on the percentage of the threshold or the tolerance time. Both methods demonstrate different advantages when visualizing the information of different pain states and different participant groups.

Combined Oxygen-Ozone and Porcine Injectable Collagen Therapies Boosting Efficacy in Low Back Pain and Disability.

Background/Objectives: Intervertebral disc degeneration is the most common cause of low back pain (LBP), and lumbosciatica is a major challenge to healthcare systems worldwide. For years, ozone therapy has been used with excellent results in intervertebral disc disease and in patients with LBP. In vitro studies have demonstrated the positive action of porcine collagen in extracellular matrix remodeling and homeostasis. These tissue changes, associated with LBP, may suggest an indication for combined ozone/collagen treatment in patients with LBP. However, no studies have been reported regarding this combination of treatments. Methods: The present work compared retrospective data of two treatment groups (each of 10 LBP patients): (A) oxygen-ozone therapy (OOT) vs. (B) OOT plus porcine collagen type 1 injections (COL I). Pain intensity and physiological function were assessed by the numerical rating scale (NSR) method. The Roland-Morris questionnaire was used to assess disability. Patient data were acquired before, during, and at the six-month follow-up. Significant differences were assessed by ANOVA and Student's t-test. Results: The analyses revealed significant statistical differences comparing the two arms, where the (OOT+COL I) treatment demonstrated a booster efficacy in pain (a reduction of 62% vs. 35%), while the questionnaire revealed a reduction in disability (70% vs. 31%). Conclusions: Therefore, this combination therapy (oxygen-ozone plus porcine injectable collagen) might be a promising approach for the management of patients with LBP.