Treatment Of Chronic Low Back Pain Research Articles

The feasibility of M-health for people with chronic low back pain in Shanghai, China: A qualitative study

Background: Mobile health (M-health) has emerged as a promising solution for enhancing the management of low back pain. However, the feasibility of M-health among the Chinese population and its influencing factors remain unclear. Objective: This study aimed to assess the acceptance of M-health among people with chronic low back pain (CLBP) and physiotherapists in Shanghai, China, and to explore the influencing factors of its utility in the treatment of CLBP. Methods: Semi-structured interviews and focus groups were conducted with 25 participants with CLBP and 20 physiotherapists, utilising a combination of group discussion and individual interview. Thematic analysis, supported by NVivo software, was employed to identify and examine the themes regarding the facilitators and barriers to the utility of M-health in Shanghai, China. Results: The focus group discussions revealed a broad spectrum of factors that drive or hinder participants’ acceptance of M-health. Three main themes related to the feasibility of M-health were identified from the interviews: (1) Reasons for embracing M-health; (2) Reasons for resisting M-health; (3) Recommendations to enhance the feasibility of M-health. In general, participants exhibited enthusiasm towards the prospect of offering M-health as a viable treatment. Conclusions: The findings of this study indicate that the feasibility of M-health depends on many factors in Shanghai, China. Efforts to promote the establishment of M-health policy or laws, rational integration of M-health and face-to-face model and improvement of the functions of M-health applications may increase its feasibility in Shanghai, China.

Many randomized trials in a large systematic review were not registered and had evidence of selective outcome reporting: a meta-epidemiological study

ObjectivesThe primary objectives were to describe characteristics of trial registration in the chronic low back pain (CLBP) field and assess the association of trial registration status (registered vs. unregistered, prospectively registered vs. retrospectively registered) with risk of bias, sufficient sample size, quality of reporting, and treatment effect estimates. Secondary objectives were to describe trial registration consistency with the final report and assess its association with risk of bias, sufficient sample size, and treatment effect estimates. Study design and settingA cross-sectional meta-epidemiological study of trials included in a large Cochrane review on exercise treatments for CLBP. We extracted relevant trial and registration information and assessed trials’ risk of bias using the Cochrane RoB 1 tool. We performed descriptive analyses, logistic regressions, and subgroup meta-analyses. ResultsWe included 361 trials, of which 23.3% were prospectively registered. Registered trials had lower risk of bias (OR 0.6; 95%CI 0.5, 0.7) and higher reporting quality (OR 1.6; 95%CI 1.4, 1.8) than unregistered trials. Prospectively registered trials were more likely to have low risk of reporting bias (OR 2.7; 95%CI 1.2, 6.5) and higher quality of reporting (OR 1.3; 95%CI 1.1, 1.6) than retrospectively registered trials. Trial registration status was not associated with effect estimates. Among prospectively registered trials, 64.3% clearly defined primary outcome(s) in their registration, 58.3% had consistent sample sizes, and 22.6% had no evidence of selective outcome reporting. Trials that clearly defined primary outcome(s) were more likely to report larger effect estimates for pain intensity (MD -15.8; 95%CI -22.7, -8.9 versus -6.0; 95%CI -10.6, -1.5; Q=6.7, p=0.01), although the difference was small, the 95%CIs overlapped, and no difference was found for functional limitations. ConclusionA small proportion of trials in the CLBP field were registered prospectively and many presented registration inconsistencies. Registered trials tend to have lower risk of bias and higher quality of reporting. Policies are needed to improve prospective registration and registration consistency in the field.

Elective Spinal Transpedicular Ablation of the Basivertebral Nerve of the Vertebral Segment in Adult Spinal Deformity Patients.

Ablation of the basivertebral nerve (BVNA) innervating the vertebral endplate has become a standard treatment of vertebrogenic chronic low back pain (CLBP) arising from vertebral endplate damage. BVNA treatment of CLBP in clinical trials was successful and durable for pain relief and return to daily activities. This case review adds new information about older patients with adult degenerative spinal deformity (ASD) and associated comorbidities not previously described in clinical trials. One hundred and eighteen ASD patients with vertebrogenic CLBP in a community practice setting underwent 503 levels of BVNA (average 4.3 levels). Forty-one patients with minimal comorbidities (Group A) were compared to 77 patients with significant comorbidities (Group B). Visual analog scale (VAS 10 cm) and Oswestry Disability Index (ODI 100-point scale) were obtained before BVNA and at a last follow-up (LFU). Group A VAS at LFU was an average of 2 cm, a 7 cm improvement. Group B VAS at LFU was 3 cm, a 6 cm improvement. At LFU, Group A ODI mean was 14 points or minimal disability, with a 39-point improvement, and Group B improved 28 points to 29 but remained moderately disabled. At LFU, the lumbar stenosis with laminectomy and BVNA subgroup of 26 had mean VAS 2 cm and ODI 28-point improvement but remained on average 21 points with a final low moderate disability. Eleven laminectomy and BVNA patients had continued posterior column pain related to radiculopathy, and or peripheral neuropathy, and sacroiliac joint pain in 30%. Mobile spondylolisthesis in 21 patients in Group B at LFU had a 6 cm improvement of VAS and 25-point improvement of ODI but remained moderately disabled on ODI. At LFU in group B, there was a 20% incidence of continued stenosis and radiculopathy symptoms. At LFU, Lumbar fusion was recommended in 9. Vertebral compression fracture (VCF) occurred in 9 after BVNA (10%) of Group B. These patients were older (mean 78 years), and all had significant osteoporosis. Eight fractures were within the area of the BVNA, and 1 was an S2 sacral fracture. These VCF patients were treated with vertebroplasty or kyphoplasty and continued preventive care with added teriparatide. At LFU, the VCF subgroup had a modest 6 cm improvement in VAS to 4 cm and continued to have significant severe to moderate disability (Oswestry Disability Index average of 38 points). Clinical trials of BVNA treatment of CLBP found success and durability for pain relief and daily activities. Patients with ASD without comorbidities showed durable pain relief of vertebrogenic CLBP and return of daily activities similar to clinical trials. In those with comorbidities, the result was an improvement in pain and disability that could be diminished by the complications related to the comorbidities. This is new information about BVNA for older patients with spinal deformity and other comorbidities. This study could impact research practice and policy to expand indications of BVNA to patients with adult spinal deformity. This case series represents the only literature regarding patients with adult spinal deformity treated with BVNA. The results were predictable and reproducible. Many patients were satisfied, would have the procedure again and would recommend BVNA to friends and family. This finding should encourage acceptance of patients with ASD for BVNA and, in fact, BVNA should probably be done before any fusion to limit and choose levels for inclusion in fusion.

Trends in Physiotherapy of Chronic Low Back Pain Research: Knowledge Synthesis Based on Bibliometric Analysis.

Physiotherapy and chronic low back pain (CLBP) form a broad and quickly developing research area. The aim of this article was to holistically, thematically and chronologically analyze and synthesize the literature production in this research area and identify the most prolific research entities and research themes. This article quantitatively and qualitatively analyzed research literature production harvested from the Scopus bibliometric database, using a triangulation of bibliometric and thematic analysis. For this, Excel 2024, Bibliometrix Biblioshiny 4.1 and VOSviewer version 1.6.20 softwares were used. In the Scopus database, 2843 data sources were found, which were published between 1974 and 26 February 2024. The growth trend has been linearly positive since the beginning of publication, and after 2018 exponential growth began. A review of the most prolific entities showed that the most literature was published in America, Europe and Australasia. The thematic analysis of the information sources identified six main themes (pathophysiology of CLBP and the quantification assessment tools, diagnostics and CLBP treatment, CLBP questionnaires and surveys, quality of life, complementary methods in physiotherapy and psychosocioeconomic aspects), while the chronological analysis revealed three main areas of development: assessment tools, CLBP processing and study methodology. The results of this bibliometric study present a good starting point for further research, providing taxonomy and research landscapes as a holistic framework offering multidisciplinary knowledge about CLBP, while chronological analysis provides a basis for identifying prospective research trends. This article offers an interdisciplinary view of the current issue of public health. The results of this study provide a basis for the development of both the physiotherapy and epidemiological fields.

Perceived social support impacts on exercise adherence in patients with chronic low back pain

BACKGROUND: Initiating and maintaining physical activity is particularly difficult for at-risk groups such as those with chronic low back pain (LBP). OBJECTIVE: This study aimed to assess whether there is a relationship between perceived social support (e.g., emotional and physical support) in individuals recently discharged from treatment for chronic LBP and the number of exercise sessions and total amount of exercise they perform over a 6-month period. This study also aimed to investigate a possible mediation effect of exercise self-efficacy on the relationship between perceived social support and exercise adherence (number of exercise sessions and total amount of exercise). METHODS: This prognostic study employed a secondary analysis of data collected for The Buddy Study; Data was collected through online weekly diaries over a 6-month period. Poisson regression analyses were used to quantify the relationship between social support at baseline and total number of exercise sessions, and total amount of exercise performed (frequency and duration) in the 6-month follow-up period. Where a relationship was observed, the Stata SEM command was used for the mediation analysis. RESULTS: A positive relationship was found between participants’ perceived levels of social support at baseline and the total number of exercise sessions they performed (IRR = 1.56, 95%CI: 1.18 to 2.06) and the total amount of exercise they performed (IRR = 1.57, 95%CI: 1.05 to 2.35) during the 6-month follow-up period. No mediating relationship was found between exercise self-efficacy at 3-months and the total number of exercise sessions performed (β 3.96, 95% CI: -4.91 to 12.84), or the total amount of exercise performed (β 243.96, 95% CI: -258.08 to 746.01). CONCLUSION: Social support is potentially an important aspect of exercise adherence, following discharge from treatment, for those with chronic LBP. People’s self-efficacy to exercise does not appear to mediate this relationship. Harnessing social support following physiotherapy treatment may increase exercise adherence and may therefore improve long term outcomes for those with chronic LBP.

Twelve-month results from a randomized controlled trial comparing differential target multiplexed spinal cord stimulation and conventional spinal cord stimulation in subjects with chronic refractory axial low back pain not eligible for spine surgery

BackgroundSuccessful treatments for intractable chronic low back pain (CLBP) in patients who are not eligible for surgical interventions are scarce. The superior efficacy of differential target multiplexed spinal cord stimulation (DTM SCS) to conventional SCS (Conv-SCS) on the treatment of CLBP in patients with persistent spinal pain syndrome (PSPS) who have failed surgical interventions (PSPS-T2) motivated the evaluation of DTM SCS versus Conv-SCS on PSPS patients who are non-surgical candidates (PSPS-T1). MethodsThis is a prospective, open label, crossover, post-market randomized controlled trial in 20 centers across the United States. Eligible patients were randomized to either DTM SCS or Conv-SCS in a 1:1 ratio. Primary endpoint was CLBP responder rate (percentage of subjects with ≥50% CLBP relief) at 3-month in randomized subjects who completed trialing (modified intention-to-treat population). Patients were followed up to 12 months. Secondary endpoints included change of CLBP and leg pain, responder rates, changes in disability, quality of life, patient satisfaction and global impression of change, and safety profile. An optional crossover was available at 6-month to all patients. Results121 PSPS-T1 subjects with CLBP and leg pain mostly associated with degenerative disc disease and radiculopathy and who were not eligible for spine surgery were randomized. CLBP responder rate with DTM SCS (93.5%) was superior to Conv-SCS (36.4%) at the primary endpoint. Superior CLBP responder rates (88.1-90.5%) were obtained with DTM SCS at all other timepoints. Mean CLBP reduction with DTM SCS (6.52 cm) was superior to that with Conv-SCS (3.01 cm) at the primary endpoint. Similar CLBP reductions (6.23-6.43 cm) were obtained with DTM SCS at other timepoints. DTM SCS provided significantly better leg pain reduction and responder rate, improvement of disability and quality of life, and better patient satisfaction and global impression of change. 90.9% of Conv-SCS subjects who crossed over were CLBP responders at completion of the study. Similar safety profiles were observed between the two groups. ConclusionDTM SCS for chronic CLBP in non-surgical candidates is superior to Conv-SCS. Improvements were sustained and provided significant benefits on the management of these patients.

European randomized controlled trial evaluating differential target multiplexed spinal cord stimulation and conventional medical management in subjects with persistent back pain ineligible for spine surgery: 24-month results.

Differential target multiplexed spinal cord stimulation (DTM SCS) was shown to be superior to conventional SCS for treating chronic low back pain (CLBP) in subjects with persistent spinal pain syndrome with previous spinal surgery (PSPS-T2) or ineligible for it (PSPS-T1). This study reports 24-month efficacy and safety of DTM SCS vs. conventional medical management (CMM) in PSPS-T1 subjects across four European countries. This is a prospective, multicenter, open-label, randomized, controlled trial with optional crossover. Subjects randomized 1:1 to DTM SCS or CMM. Primary endpoint was responder rate (% subjects reporting ≥50% CLBP relief) at 6 months. A superiority test compared responder rates between treatments. CLBP and leg pain levels, functional disability, quality of life (QoL), patient satisfaction and global impression of change were evaluated for 24 months. A Composite Responder Index (CRI) was obtained using CLBP relief, disability and QoL. Incidence of study-related adverse events evaluated safety. A total of 55 and 57 subjects were randomized to DTM SCS and CMM respectively. DTM SCS was superior, with CLBP responder rates ≥80% and CLBP relief >5.6 cm (>70% reduction) through the 24-month follow-up. Improvements with DTM SCS in other outcomes were sustained. The CRI was >80% for DTM SCS through 24 months. Opioid medication intake decreased in subjects treated with DTM SCS. Most patients treated with DTM SCS felt satisfied and improved at the end of the study. Safety was congruent with other studies. DTM SCS is efficacious and safe during 24 months for the treatment of CLBP and leg pain in PSPS-T1 patients ineligible for spine surgery. This randomized controlled trial shows that Differential Target Multiplexed SCS (DTM SCS) is an effective and safe long-term treatment for PSPS type 1 patients suffering from axial low back pain with or without leg pain and who are ineligible for spinal surgery. Currently, CMM treatments are their only option and provide limited benefits. Besides superior pain relief, DTM SCS provides significant improvements in functional disability, quality of life, high levels of satisfaction and perceived impression of change.

A prospective study to evaluate the role of repetitive trans-cranial magnetic stimulation in treatment of chronic low back pain

Introduction: Chronic Low Back Pain (CLBP) is a disabling musculoskeletal condition with a high prevalence in developing and developed countries. There are many treatment modalities but none of them provides a satisfactory and consistent cure. Recently focus has shifted to neuromodulation to cure chronic pains. The U.S. Food and Drug Administration (FDA) approved the use of Repetitive TMS (rTMS) in the management of Pain in 2013. Since then, centres across the world have been using Transcranial Magnetic Stimulation (TMS) as a noninvasive modality for the treatment of various pain conditions. rTMS is a variation of TMS where stimulation is provided in sessions to create long-term excitation in the brain cortex. Evidence on the effectiveness of rTMS for CLBP is scarce due to limited rigorous clinical trials. This study is the first of its kind undertaken in India to critically analyze the role of rTMS in the treatment of CLBP. Materials & Methods: In this single institutional prospective, single-blind study, we enrolled 40 patients of CLBP sharing similar clinical profiles. They were divided into a test group and a sham group. In the test group patients were given rTMS in addition to conventional treatment while in the sham group, patients were taken through the procedure of rTMS without actually being administered it. A figure-of-eight-shaped coil was used focusing on the Left M1 area and Dorsolateral prefrontal cortex to administer the rTMS by a trained physician. Visual Analogue Scores (VAS) were noted before and after the procedure. Each patient was continuously monitored during the procedure for any side effects. Subsequently, they were interviewed and followed up for 6 months. At the end of 6 months, data was compiled and conclusions were drawn. Result: In our study, we found that 90 per cent of patients in the test group reported a reduction in VAS score by 30 per cent reduction while the remaining had a 20 per cent reduction in pain scores. 90 per cent of subjects in the sham group reported a marginal improvement in VAS score which can be attributed to the placebo effect. Most patients in the test group reported an improvement in quality of life at the end of six months. None of the patients suffered any untoward side effects during or after the procedure. Conclusion: Based on our study we conclude that rTMS is a safe procedure and it can be used as a modality in treating CLBP with satisfactory outcomes. Although the sample size was small, it is the first study of its kind undertaken in India to evaluate the role of rTMS-based neuromodulation in treating this chronic disabling condition. However, to be accepted as a standard of care for CLBP it will require further multi-institutional robust clinical trials with long-term follow-up.

ARE THE ATTITUDES AND BELIEFS OF AUSTRALIAN EXERCISE-BASED PRACTITIONERS ASSOCIATED WITH THEIR USE OF, AND CONFIDENCE IN, TREATMENT MODALITIES FOR PEOPLE WITH CHRONIC LOW BACK PAIN?

BACKGROUND Practitioners’ attitudes and beliefs towards chronic low back pain (CLBP) influence their clinical decision making, but few studies have investigated decision making outside the context of patient vignettes, for a range of first- and second-line treatment options for CLBP, or in Accredited Exercise Physiologists (AEPs). METHODS Using an online survey, Australian AEPs and physiotherapists rated their use of different treatments for CLBP (exercise, education, manual therapy, cognitive behavioural therapy) and their confidence in these treatments for reducing pain and disability. Their biomedical and biopsychosocial beliefs were also assessed using the Pain and Attitudes Beliefs Scale for Physiotherapists. Differences between disciplines in treatment use and confidence were analysed using Mann-Whitney U tests and independent t-tests, respectively. Multiple linear regression was used to explore factors associated with treatment choices. RESULTS Two-hundred thirty-three practitioners (n=143 physiotherapists, n=90 AEPs) completed the survey. Most practitioners were confident treating CLBP, had a moderate-high level of confidence in the different treatments, and regularly used them in practice. Practitioners with higher biomedical beliefs had greater use of, and confidence in, specific exercise, manual therapy, and combined exercise and manual therapy. Practitioners with higher biopsychosocial beliefs were more confident in general exercise, cognitive behavioural therapy, pain education and combined exercise and pain education. CONCLUSION Practitioner beliefs influence their use of, and confidence in, different treatments for CLBP. These findings suggest a need for strategies to enhance biopsychosocial beliefs/reduce biomedical beliefs in Australian exercise-based practitioners.

360 Diffusion Imaging-Derived Structural Changes in Cerebral Pain Regions of Chronic Low-Back Pain Patients Implanted With Thoracic Spinal Cord Stimulation

INTRODUCTION: Thoracic spinal cord stimulation (tSCS) is an effective treatment of chronic low-back pain (cLBP). Although diffusion imaging has been conducted in this group of patients, the study of diffusion-derived structural imaging of regions involved in pain processing has not been conducted. METHODS: Diffusion-weighted imaging scans were acquired in five patients (1 female) post-tSCS with cLBP and five healthy subjects (2 female). Patient MRI scans were taken post-implantation with the SCS device turned off during the MRI session. Four DTI maps and four MAP maps were derived and normalized into MNI space and smoothed. DTI and MAP values for each measure from the pain ROI atlas were extracted and compared between patients and controls. RESULTS: Statistically significant differences were found in regions involved with sensory processing of pain (ASG, PSG) as well as affective pain experience (ACC) across the DTI measures. MAP measures showed significance across five ROIs involved with sensory processing of pain, affective pain experience, and fear response (AMYG). CONCLUSIONS: Diffusion-derived structural imaging of pain regions suggests that cLBP patients receiving SCS have differences in diffusion imaging-derived structural parameters involved with pain processing, cognition, and fear response.

349 Brain Functional Imaging of Pain States Using Resting-State fMRI and Multi-Delay PCASL in Chronic Low-Back Pain Patients Implanted With Thoracic Spinal Cord Stimulation

INTRODUCTION: A treatment of chronic low-back pain is implantation of a thoracic spinal cord stimulator (tSCS), which has been shown to reduce pain. The functional changes in pain processing regions of the brain as assessed by resting-state fMRI and multi-delay pseudocontinuous arterial spin labeling (PCASL) have never been studied. METHODS: PCASL data based on 5 post-label delays (0.5–2.5s) as well as rsfMRI were acquired in five patients (1F) post-tSCS with cLBP and five healthy subjects (2F). Patient MRI scans were taken post-implantation with the SCS device turned off. Three PCASL measures and four rsfMRI measures were derived and normalized into MNI space and smoothed. Averaged values for each measure from the pain ROI atlas were extracted and compared between patients and controls. Statistics were conducted following Box-Cox transformation of data. RESULTS: Arterial transit time derived from PCASL showed a significant difference in the OFC, SMA, and PSG of patients, but other ASL measures showed no effect. Several regions across the rs-fMRI measures showed significant differences, including those involved in cognition (DLPFC, PCC), and pain processing (PSG) and sensation (S2). CONCLUSIONS: Functional imaging showed that cLBP patients treated with SCS display differences in resting-state function and brain perfusion across several pain regions of the brain. These areas are mainly part of the cognitive and behavioral components of the pain circuitry.

Repetitive Transcranial Magnetic Stimulation Combined with Sling Exercise Modulates the Motor Cortex in Patients with Chronic Low Back Pain

The study aims to explore the effects of combining repetitive transcranial magnetic stimulation (rTMS) with sling exercise (SE) intervention in patients with chronic low back pain (CLBP). This approach aims to directly stimulate brain circuits and indirectly activate trunk muscles to influence motor cortex plasticity. However, the impact of this combined intervention on motor cortex organization and clinical symptom improvement is still unclear, as well as whether it is more effective than either intervention alone. To investigate this, patients with CLBP were randomly assigned to three groups: SE/rTMS, rTMS alone, and SE alone. Motor cortical organization, numerical pain rating scale (NPRS), Oswestry Disability Index (ODI), and postural balance stability were measured before and after a 2-week intervention. The results showed statistically significant differences in the representative location of multifidus on the left hemispheres, as well as in NPRS and ODI scores, in the combined SE/rTMS group after the intervention. When compared to the other two groups, the combined SE/rTMS group demonstrated significantly different motor cortical organization, sway area, and path range from the rTMS alone group, but not from the SE alone group. These findings highlight the potential benefits of a combined SE/rTMS intervention in terms of clinical outcomes and neuroadaptive changes compared to rTMS alone. However, there was no significant difference between the combined intervention and SE alone. Therefore, our research does not support the use of rTMS as a standalone treatment for CLBP. Our study contributed to optimizing treatment strategies for individuals suffering from CLBP.

The Emotion Regulation of Acupuncture in Chronic Low Back Pain: A Clinical Neuroimaging Protocol.

Acupuncture is effective for patients with chronic low back pain (CLBP), which can relieve pain intensity and regulate negative emotional states such as pain-related anxiety and depression. Previous studies mainly discuss the analgesic mechanism of acupuncture treatment of CLBP, but there are multiple dimensions to pain, including sensation, emotion and cognition. Therefore, this study aims to investigate the central mechanism of acupuncture for CLBP from the perspective of emotional regulation by functional magnetic resonance imaging (fMRI). A total of 72 patients with CLBP will be recruited in the study and randomly assigned to the verum acupuncture group or the sham acupuncture group. The trail will last for 18 weeks including a 2-week baseline, a 4-week treatment and a 12-week for follow-up period. The primary outcomes are the visual analog scale (VAS) and the Japanese Orthopaedic Association Scores (JOA) score. The secondary outcomes are the 12-item short form health survey (SF-12), the state trait anxiety inventory (STAI), the self-rating anxiety scale (SAS) and self-rating depression scale (SDS). The VAS, JOA, STAI SAS and SDS will be collected at baseline, week 2, week 4, and after follow-up. The SF-12 will be evaluated at baseline, week 2 and week 4. Functional magnetic resonance imaging (MRI) data will be collected at baseline and the end of treatment. Emotion-related brain regions will be chosen as regions of interest (ROIs). The gray matter volume (GMV), amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), functional connectivity (FC), and large-scale functional brain network based on these ROIs will be analyzed within and between the two groups. This study will verify the emotional regulation of acupuncture and explore the mechanism of acupuncture for emotion regulation in patients with CLBP. https://www.chictr.org.cn/showproj.html?proj=195486, identifier: ChiCTR2300070557.

Efficacy of Acupuncture in Chronic Low Back Pain Treatment: A Literature Review

Aims: To evaluate the effects of the use of acupuncture as a treatment of chronic low back pain.
 Methodology: This study follows the integrative methodology of literature review, seeking articles published on PubMed, using keywords from Medical Subject Headings (MeSH) to form the search Formula: Acupuncture AND "low back pain". Inclusion criteria were randomized controlled trials published between 2018 and 2023, with free full text available in english or portuguese. The exclusion criteria was not answering this review’s orienting question. 
 Results: Several studies analyzed the efficacy of different acupuncture and electroacupuncture approaches in the treatment of chronic low back pain. One study highlighted invasive laser acupuncture with different wavelengths, revealing improvements in pain and disability scales after 4 weeks. Another research compared electroacupuncture at various frequencies, observing similar reductions in pain between the groups. Combined acupuncture (hands and ear) was more effective than usual medical treatment, showing greater reduction in pain and cure rate. Both electroacupuncture and manual acupuncture also demonstrated efficacy in reducing pain intensity and quality. Acupuncture with embedded wires stood out, showing positive and rapid results in chronic low back pain. Another study revealed that both electroacupuncture and a placebo had positive impacts on pain intensity.
 Conclusion: Even though there are multiple forms of acupuncture used throughout the studies, and even those that appear on multiple studies are done differently on those appearances, all are used as a way to reduce CLBP. In that sense, the positive effects from using traditional acupuncture or some different form of acupuncture as a treatment for CLBP is highlighted by the results from the studies that were a part of this review.

DIAGNOSIS-RELATED BELIEFS OF FILIPINOS WITH CHRONIC BACK PAIN: A QUALITATIVE STUDY

Introduction: Patient education is needed in the effective management of chronic low back pain (CLBP). To be effective, education resources need to target key beliefs and attitudes around back pain. This study aimed to explore the diagnosis-related beliefs of Filipinos who are seeking treatment for CLBP. The specific objective is to explore patients’ understanding of their diagnoses and their beliefs about how health care professionals might help them. Methods: We used a qualitative research design with an interpretive description approach. We conducted a semi-structured phone interview strategy, using piloted questions. Patients’ understanding of diagnosis and their beliefs was explored using a thematic analysis. We had seven adult participants with non-specific CLBP of at least three months duration attending physiotherapy sessions at the Department of Rehabilitation Medicine outpatient clinic of a tertiary teaching hospital in Metro Manila. To the researchers’ judgement, these selected participants could provide information-rich data, communicate experiences and opinions in an articulate (self-reported ability to understand, speak and write in Filipino), expressive and reflective manner. Results: The analysis of data identified four themes with subthemes related to information that clinicians need to understand and consider when developing effective educational resources for patients with CLBP: (1) Beliefs about causes of back pain; (2) Experience of Back Pain; (3) Actions & Responses to Back Pain; and (4) What might help. Discussion: The overall finding of this study is that many of the beliefs and experiences in this group of Filipinos with back pain are similar to those from other populations and some of the findings were somewhat unique or at the least nuanced to Filipinos with back pain. One of the themes that appeared more unique to these participants were the beliefs about cold and damp weather causing back pain. These beliefs appear to inform the choices of treatment – hot pack, liniments, and avoidance behavior described by the participants in relation to cold weather. Another unique theme that emerged in this study is the role of faith and religion in managing back pain. Participants from this study appeared to portray prayer as a potential form of therapy to manage back pain rather than as a form of coping mechanism. When developing education resources for patients with CLBP, clinicians may consider integrating information that matches the beliefs and understanding of Filipinos with CLBP to make the education resources more suitable, relevant, and fit to the Filipino context.

Effects of breathing exercises on chronic low back pain: A systematic review and meta-analysis of randomized controlled trials.

A range of studies concerning the effects of breathing exercises on chronic low back pain (CLBP) have been proven inconclusive. The study aimed to evaluate the effectiveness of breathing exercises for the treatment of CLBP. We considered randomized controlled trials in English or Chinese that used breathing exercises for the treatment of CLBP. An electronic search was performed in the MEDLINE, EMBASE, Web of Science, Cochrane Library, CNKI, Wan Fang, and CBM databases for articles published up to November 2022. Two reviewers independently screened the articles, assessed the risk of bias using the Cochrane risk of bias tool, and extracted the data. The outcomes included pain, lumbar function and pulmonary function post-intervention. A total of thirteen studies (n= 677) satisfied the inclusion criteria. The meta-analysis results demonstrated a significant effect of breathing exercises on the Visual Analog Scale (VAS) score (SMD =-0.84, 95% CI: -1.24 to -0.45, P< 0.0001), the Oswestry Disability Index (ODI) score (SMD =-0.74, 95% CI: -0.95 to -0.54, P< 0.00001), Forced Vital Capacity (FVC) score (MD = 0.24, 95% CI: 0.10 to 0.37, P= 0.0006), Forced Expiratory Volume in 1 second /Forced Vital Capacity (FEV1/FVC) (MD = 1.90, 95% CI: 0.73 to 3.07, P= 0.001), although there was no significant difference between the breathing exercises and control interventions for Forced Expiratory Volume in the first second (FEV1) score (MD = 0.22, 95% CI = [0.00, 0.43], P= 0.05), and Maximal Voluntary Ventilation (MVV) score (MD = 8.22, 95% CI = [-4.02, 20.45], P= 0.19). Breathing exercises can reduce pain, assist people with lumbar disabilities, and improve pulmonary function, and could be considered as a potential alternative treatment for CLBP.

Chronic Low Back Pain Treatment

Chronic low back pain is the attachment point of lumbar muscle fascia and sola.t, and chronic inflammation damage. This is one of the common causes of low back pain. The main symptoms are lumbar or lumbar spine swelling pain, soreness, recurred, and pain changes with the degree of climate or accumulation. Lumbar pain can also from muscle pain to shooting, burning or stabbing. In addition, pain will emit legs. Bending, twisting, weightlifting, standing or walking will make the situation worse. Lumber muscles degeneration has a lot of different treatments like Muscle strengthening such as ab strengthening, gluteal strengthening, back strengthening to prevent muscle dystonia. Physical therapy, such as electromagnetic, ultrasonic, infrared, laser, acts on the human body through sound, light, electricity, heat, and plays the role of thinning tendons and activating complexions. Chinese medicine therapy such as electroacupuncture. This article is about the above three therapies, hope to provide reference for chronic low back pain treatment.

The effect of self-management techniques on relevant outcomes in chronic low back pain: A systematic review and meta-analysis.

Among many treatment approaches for chronic low back pain (CLBP), self-management techniques are becoming increasingly important. The aim of this paper was to (a) provide an overview of existing digital self-help interventions for CLBP and (b) examine the effect of these interventions in reducing pain intensity, pain catastrophizing and pain disability. Following the PRISMA guideline, a systematic literature search was conducted in the MEDLINE, EMBASE, PsychInfo, CINAHL and Cochrane databases. We included randomized controlled trials from the last 10 years that examined the impact of digital self-management interventions on at least one of the three outcomes in adult patients with CLBP (duration ≥3 months). The meta-analysis was based on random-effects models. Standardized tools were used to assess the risk of bias (RoB) for each study and the quality of evidence for each outcome. We included 12 studies (n = 1545). A small but robust and statistically significant pooled effect was found on pain intensity (g = 0.24; 95% CI [0.09, 0.40], k = 12) and pain disability (g = 0.43; 95% CI [0.27, 0.59], k = 11). The effect on pain catastrophizing was not significant (g = 0.38; 95% CI [-0.31, 1.06], k = 4). The overall effect size including all three outcomes was g = 0.33 (95% CI [0.21, 0.44], k = 27). The RoB of the included studies was mixed. The quality of evidence was moderate or high. In summary, we were able to substantiate recent evidence that digital self-management interventions are effective in the treatment of CLBP. Given the heterogeneity of interventions, further research should aim to investigate which patients benefit most from which approach. This meta-analysis examines the effect of digital self-management techniques in patients with CLBP. The results add to the evidence that digital interventions can help patients reduce their pain intensity and disability. A minority of studies point towards the possibility that digital interventions can reduce pain catastrophizing. Future research should further explore which patients benefit most from these kinds of interventions.

Are the attitudes and beliefs of Australian exercise-based practitioners associated with their use of, and confidence in, treatment modalities for people with chronic low back pain?

Practitioners' attitudes and beliefs towards chronic low back pain (CLBP) influence their clinical decision making, but few studies have investigated decision making outside the context of patient vignettes for a range of first- and second-line treatment options for CLBP, or in accredited exercise physiologists (AEPs). Using an online survey, Australian AEPs and physiotherapists rated their use of different treatments for CLBP (exercise, education, manual therapy, cognitive behavioural therapy) and their confidence in these treatments for reducing pain and disability. Their biomedical and biopsychosocial beliefs were also assessed using the Pain and Attitudes Beliefs Scale for Physiotherapists. Differences between disciplines in treatment use and confidence were analysed using Mann-Whitney U tests and independent t-tests, respectively. Multiple linear regression was used to explore factors associated with treatment choices. Two-hundred thirty-three practitioners (n=143 physiotherapists, n=90 AEPs) completed the survey. Most practitioners were confident in treating CLBP, had a moderate-high level of confidence in the different treatments, and regularly used them in practice. Practitioners with higher biomedical beliefs had greater use of, and confidence in, specific exercise, manual therapy, and combined exercise and manual therapy. Practitioners with higher biopsychosocial beliefs were more confident in general exercise, cognitive behavioural therapy, pain education and combined exercise and pain education. Practitioner beliefs influence their use of, and confidence in different treatments for CLBP. These findings suggest a need for strategies to enhance biopsychosocial beliefs/reduce biomedical beliefs in Australian exercise-based practitioners.

Efficacy of ultrasound versus short wave diathermy in the treatment of chronic low back pain in patients with lumbar disk herniation: a prospective randomized control study

BackgroundLumbar disk herniation (LDH) is a cause of chronic low back pain (CLBP) treated using physical therapy (PT), including exercise and physical modalities such as ultrasound (US) and short wave diathermy (SWD). Despite the use of US and SWD, there is inconclusive evidence on their efficacy. The aim of this study was to investigate the efficacy of US and SWD in the treatment of CLBP in patients with LDH.MethodsA prospective randomized control clinical study. Individuals with radicular CLBP and LDH on magnetic resonance imaging, presenting to the Physical and Rehabilitation Medicine Department were randomized into 3 treatment groups. All participants received 10 sessions of hotpack, transcutaneous nerve stimulation (TENS) and therapeutic exercises. In addition, Group 1 received 10 sessions of therapeutic US (1 MHz, 1.5W/cm2, 10 min), Group 2 SWD (27.12 MHz, wavelength 11.06 m, induction technique, 20 min) to the lower back. Group 3 (control group) received hotpack, TENS and therapeutic exercises alone. Visual analogue scale (VAS) for LBP, Modified Oswestry Disability Index (MODI) and Short Form 36 (SF-36) were evaluated pre and post treatment and at one and three months follow up.ResultsIn all groups, VAS for LBP and MODI improved with treatment and at the one and three month follow up (p < 0.001). In Groups 1 and 2, MODI scores continued to reduce at 1 and 3 months (p < 0.001 and p = 0.012 respectively). SF-36 physical, social function and pain parameters reduced in all groups (p < 0.05). Role limitation due to physical and emotional problems, emotional well-being, vitality and mental health improved in Groups 1 and 2 (p < 0.05).ConclusionsDeep heating agents can be used as part of the physical therapy for CLBP in those with LDH with positive mid-term effects.Trial registrationNCT03835182, 02/04/2019.