Treatment Of Chronic Low Back Pain Research Articles

Percutaneous pulsed radiofrequency applied to the L-2 dorsal root ganglion for treatment of chronic low-back pain: 3-year experience

The authors assessed the effectiveness of percutaneous pulsed radiofrequency treatment for providing pain relief in patients with chronic low-back pain with or without lower-limb pain. Data were obtained in 127 patients who had chronic low-back pain with or without lower-limb pain due to a herniated intervertebral disc or previous failed back surgery and who underwent pulsed radiofrequency treatment. Their conditions were proven by clinical features, physical examination, and imaging studies. Low-back pain was treated with pulsed radiofrequency applied to the L-2 dorsal root ganglion (DRG) and lower-limb pain was treated with pulsed radiofrequency applied to the L3-S1 DRG. Patients underwent uni- or bilateral treatment depending on whether their low-back pain was unilateral or bilateral. A visual analog scale was used to assess pain. The patients were followed up for 3 years postoperatively. In patients without lower-limb pain (Group A), 27 (55.10%) of 49 patients had initial improvement >or= 50% at 3-month follow-up. At 1-year follow-up, 20 (44.44%) of 45 patients in Group A had pain relief >or= 50%. An analysis of patients with pain relief >or= 50% for at least 1 month showed that the greatest effect was at 3 months after treatment. In patients with low-back pain and lower-limb pain (Group B), 37 (47.44%) of 78 patients had initial improvement >or= 50% at 3-month follow-up. At 1-year follow-up, 34 (45.95%) of 74 patients had pain relief effect >or= 50%. An analysis of patients in Group B with pain relief >or= 50% for at least 1 month showed that the greatest effect was at 1 month after treatment. The results of this prospective analysis showed that treatment with pulsed radiofrequency applied at the L-2 DRG is safe and effective for treating for chronic low-back pain. Satisfactory pain relief was obtained in the majority of patients in Group A with the effect persisting for at least 3 months. The results indicate that pulsed radiofrequency provided intermediate-term relief of low-back pain. Further studies with long-term follow-up are necessary.

A systematic review of multidisciplinary outcomes in the management of chronic low back pain

Previous research has provided an inconsistent message as to the effectiveness of multidisciplinary programs to improve employment outcomes in clients with Chronic Low Back Pain (CLBP). The primary aims of this review were to: 1) update the evidence for the multidisciplinary treatment of CLBP to improve employment outcomes 2) assess what knowledge supports occupational therapy as contributing to a multidisciplinary approach in the treatment of CLBP. Working-age adults experiencing CLBP who took part in controlled trials evaluating multidisciplinary programs between July 1998 and July 2009. Updated guidelines provided by the Cochrane Collaboration Back Review Group (BRG) were used to perform a systematic review to identify, appraise, and synthesize research evidence relevant to our research questions. Twelve unique articles were found, after a database search and citation tracking, only two of which were high quality. Our findings suggest that there is still conflicting evidence for the effectiveness of multidisciplinary programs to improve employment outcomes in CLBP. The results are discussed with reference to current methodological limitations found in the literature. Furthermore, occupational therapists were found to be underutilized in the included studies and future multidisciplinary programs should take advantage of the wide range of skills that occupational therapists can contribute in this practice area.

The effect of pelvic floor muscle exercise on women with chronic non-specific low back pain

Dysfunction of spinal stability seems to be one of the causes of low back pain (LBP). It is thought that a large number of muscles have a role in spinal stability including the pelvic floor muscle (PFM). The purpose of this study was to investigate the effect of PFM exercise in the treatment of chronic LBP. After ethical approval, a randomized controlled clinical trial was carried out on 20 women with chronic LBP. Patients were randomly allocated into two groups: an experimental and a control group. The control group was given routine treatment including electrotherapy and general exercises; and the experimental group received routine treatment and additional PFM exercise. Pain intensity, functional disability and PFM strength and endurance were measured before, immediately after intervention and at 3 months follow-up. In both groups pain and functional disability were significantly reduced following treatment (p<0.01), but no significant difference was found between the two groups (p>0.05). All measurements were improved in both groups (p<0.01) although patients in the experimental group showed greater improvement in PFM strength and endurance (p<0.01). It seems that the PFM exercise combined with routine treatment was not superior to routine treatment alone in patients with chronic LBP.

The Effectiveness of a Weak Opioid Medication versus a Cyclo-Oxygenase-2 (COX-2) Selective Non-Steroidal Anti-Inflammatory Drug in Treating Flare-Up of Chronic Low-Back Pain: Results from Two Randomized, Double-Blind, 6-Week Studies

Two 6-week studies compared the analgesic efficacy, tolerability and safety of a non-steroidal anti-inflammatory drug (celecoxib 200 mg twice a day [bid]) and an opioid (tramadol HCl 50 mg four times a day [qid]) in subjects with chronic low-back pain (CLBP). Successful responders (primary endpoint) were defined as subjects completing 6 weeks of treatment and having > or = 30% improvement on the Numerical Rating Scale for pain. A total of 796 and 802 subjects were randomized to treatment in study 1 and study 2, respectively. A significantly greater percentage of celecoxib-treated subjects were successful responders compared with tramadol HCl-treated subjects (study 1: 63.2% versus 49.9%, respectively; study 2: 64.1% versus 55.1%, respectively). Fewer adverse events (AEs) and serious AEs were reported in the celecoxib-treated group. Overall, celecoxib 200 mg bid was more effective than tramadol HCl 50 mg qid in the treatment of CLBP, with fewer AEs reported.

Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain.

BackgroundThe efficacy and safety of the association of celecoxib [a selective cyclooxygenase-2 (COX-2) inhibitor] and pregabalin (commonly used to control neuropathic pain), compared with monotherapy of each, were evaluated for the treatment of chronic low-back pain, a condition known to be due to neuropathic as well as nociceptive pain mechanisms.Materials and methodsIn this prospective randomized trial, 36 patients received three consecutive 4-week treatment regimes, randomly assigned: celecoxib plus placebo, pregabalin plus placebo, and celecoxib plus pregabalin. All patients were assessed by using a visual analogue scale (VAS, 0–100 mm) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale by an investigator blinded to the administered pharmacological treatment.ResultsCelecoxib and pregabalin were effective in reducing low-back pain when patients were pooled according to LANSS score. The association of celecoxib and pregabalin was more effective than either monotherapy in a mixed population of patients with chronic low-back pain and when data were pooled according to LANSS score. Adverse effects of drug association and monotherapies were similar, with reduced drug consumption in the combined therapy.ConclusionsCombination of celecoxib and pregabalin is more effective than monotherapy for chronic low-back pain, with similar adverse effects.

Correlación entre dolor, discapacidad y rango de movilidad en pacientes con lumbalgia crónica

Aim To analyze the correlation between pain, range of motion and disability of chronic low back pain patients coming from a public Primary Care service. Material and methods Descriptive study carried out in a primary care rehabilitation service of the Institut Català de la Salut. A total of 143 patients with chronic low back pain (more than 3 months), both genders and ages between 18 and 65 years were included. Pain (Visual Analog Scale), disability (Roland-Morris's Disability Questionnaire) and range of mobility in flexion, extension and side bending were measured. Results Pain shows a significant correlation with disability (r=0.37), range of motion in extension (r=−0.23) and side bending (r between −0.18 and −0.23) but not with flexion or the other demographic variables. Disability shows a statistically significant correlation with pain, range of motion in all directions (r between −0.19 and −0.33), age (r=0.26) and symptoms duration (r=0.21). It also shows significant differences depending on gender (p<0.05) and work situation (p<0.01). Conclusions Correlations between pain, range of motion and disability, although significant, are weak, so they must be considered as independent variables. To achieve better results in the conservative treatment of chronic low-back pain, analgesic drugs must be complemented with physical therapy and ergotherapy.

Are there indications (other than scoliosis) for rigid orthopaedic brace treatment in chronic, mechanical low back pain?

Objectives Mechanical low back pain (LBP) is a major public health problem. Today's standard care strategy involves a combination of drug-based and non-drug therapies. The use of conservative orthopaedic brace treatment is subject to debate. The lack of data and consensus in the literature on the value of this treatment in chronic LBP prompted to us to seek to estimate the modalities and indications for brace use in France. Materials and method We performed a questionnaire-based survey of physician members of the French Society of Physical Medicine and Rehabilitation (SOFMER). Results We received 55 completed questionnaires. Although the indications for this treatment were very heterogeneous (in both clinical and paraclinical terms), the prescribing behaviour was rather uniform. The brace is worn during the day for less than 3 months (with a progressive reduction in use over 1 to 2 months), together with physiotherapy before and after immobilization. The patient keeps the brace at the end of the treatment period. Orthopaedic treatment appears to be prescribed in many chronic LBP situations. Analysis of spinal posture and magnetic resonance imaging results (and Modic changes in particular) influence the therapeutic decisions. Conclusion Clinical and paraclinical indications of this treatment must be precisely defined and evaluated in prospective, multicenter studies with homogeneous cohorts.

Efficacy of Steroid and Nonsteroid Caudal Epidural Injections for Low Back Pain and Sciatica

Prospective, double-blind, randomized, case-control study. To evaluate the efficacy of caudal epidural injections (CEI) containing steroid versus nonsteroid preparations when treating patients suffering from low back pain (LBP) and sciatica. Literature seems to be deprived of well-designed randomized, controlled studies that evaluate the effectiveness of CEI in the treatment of chronic LBP; hence the value of CEI remains still the subject of controversy. Patients suffering from severe chronic LBP and sciatica were randomly allocated into 2 groups. Steroid-group's patients (n = 93) underwent CEI containing 12 mL of xylocaine 2% and 1 mL of betamethasone dipropionate and betamethasone phosphate (2 + 5) mg/dL. Water for Injection (WFI)-group's patients (n = 90) underwent CEI containing 12 mL of xylocaine 2% and 8 mL of WFI. Both groups were statistically comparable as far as their demographic data and the cause and duration of symptoms were concerned. Patients answered the Oswestry Disability Index questionnaire and underwent physical examination, before and at 1 week, 1 month, 6 months, and 1 year following the CEI. Symptoms improved in 132 patients (72.1%) following CEI. The mean Oswestry Disability Index questionnaire score of steroid-group's patients was statistically significant lower than that of the WFI-group at all postinjection re-evaluations. Patients receiving steroid CEI experienced faster relief during the first postinjection week. The Straight Leg Rising test improved in both groups following CEI; this improvement was faster among steroid-group's patients. Fifty-one patients (27.8%), noticed no improvement 1 week post-CEI and underwent a second CEI (with the same preparation) 7 to 14 days later. Nineteen of them reported improvement; 32 (steroid-group:13, WFI-group:19) did not respond well and underwent operative decompression (n = 15) or spinal fusion (n = 17). CEI containing local anesthetic and steroids or WFI seems to be effective when treating patients with LBP and sciatica. CEI containing steroid preparations demonstrated better and faster efficacy.

A randomized, double-blind study of OROS® hydromorphone extended release compared to placebo in opioid-tolerant patients with moderate-to-severe chronic low back pain

Chronic low back pain (LBP) contributes substantially to both individual and societal healthcare burden and work-related disability often requiring treatment with around-the-clock opioids. This was a 12-week, randomized, placebo-controlled, double-blind trial evaluating the efficacy and safety of once-daily OROS® hydromorphone extended-release (ER) in the treatment of chronic LBP in opioid-tolerant patients. Patients who had a diagnosis of moderate-to-severe chronic LBP and required daily scheduled opioid analgesics (oral morphine equivalent doses between 60 - 320 mg/day) for ≥2 months prior to screening, were eligible for inclusion.

Study on the effectiveness of a test-dependent osteopathic treatment for women with persistent post partum back pain: A randomized controlled trial

Introduction: Chronic Low Back Pain (CLBP) is a very common complaint in the general population and it is often managed by physicians by conservative means. Osteopathic manipulative treatment (OMT) has been recently been demonstrated to be an effective method to reduce pain in patients suffering with CLBP. The objective of this study was to compare the effects of OMT with sham manipulative treatment (SMT) on patient’s self reported pain and disability. Design: This was a randomized controlled investigation Methods: For this study ninety-four patients were recruited from the Orthopedic Department, Bassini Hospital (Italy) in the period between September 2006 and March 2008. Patients were randomly assigned to either usual care plus OMT (n 1⁄4 44) or usual care plus SMT (n 1⁄4 50). The main outcome variables were the Oswestry Disability Index and a 10-cm visual analog scale (VAS) for overall back pain. Data were analyzed using a two-factor ANOVA for repeated measures with an a level set at 0.05. Results: Overall, OMT significantly decreased pain and disability compared to SMT on this study. The change in VAS was -2.8 1.4 for OMT and 0 0.9 for SMT. The change in Oswestry Disability Index -8.4 8.5 for OMT and 0.3 7.2 for SMT). There was a significant interaction (group x time) for both visual analog scale (p <0.01) and for Oswestry Disability Index (p <0.01). No adverse events were recorded during the study. Discussion: Similarly to previous investigation in this area (Licciardone et al 2005) OMT appears to provide benefits over and above usual care for the treatment of CLBP. The improvement in the OMT compared to the SMT demonstrated that placebo effects such as interaction with patients and range of motion activities do not justify per se the results of this study. Future studies should aim to use less subjective outcome measures and focus on the mechanism through which OMT is able to reduce pain and disability in CLBP patients.

A randomised controlled trial on the effectiveness of osteopathic manipulative treatment of chronic low back pain

Introduction: Chronic Low Back Pain (CLBP) is a very common complaint in the general population and it is often managed by physicians by conservative means. Osteopathic manipulative treatment (OMT) has been recently been demonstrated to be an effective method to reduce pain in patients suffering with CLBP. The objective of this study was to compare the effects of OMT with sham manipulative treatment (SMT) on patient’s self reported pain and disability. Design: This was a randomized controlled investigation Methods: For this study ninety-four patients were recruited from the Orthopedic Department, Bassini Hospital (Italy) in the period between September 2006 and March 2008. Patients were randomly assigned to either usual care plus OMT (n 1⁄4 44) or usual care plus SMT (n 1⁄4 50). The main outcome variables were the Oswestry Disability Index and a 10-cm visual analog scale (VAS) for overall back pain. Data were analyzed using a two-factor ANOVA for repeated measures with an a level set at 0.05. Results: Overall, OMT significantly decreased pain and disability compared to SMT on this study. The change in VAS was -2.8 1.4 for OMT and 0 0.9 for SMT. The change in Oswestry Disability Index -8.4 8.5 for OMT and 0.3 7.2 for SMT). There was a significant interaction (group x time) for both visual analog scale (p <0.01) and for Oswestry Disability Index (p <0.01). No adverse events were recorded during the study. Discussion: Similarly to previous investigation in this area (Licciardone et al 2005) OMT appears to provide benefits over and above usual care for the treatment of CLBP. The improvement in the OMT compared to the SMT demonstrated that placebo effects such as interaction with patients and range of motion activities do not justify per se the results of this study. Future studies should aim to use less subjective outcome measures and focus on the mechanism through which OMT is able to reduce pain and disability in CLBP patients.

Effects of piroxicam-beta-cyclodextrin sachets on abnormal postural sway in patients with chronic low back pain

The clinical effects of piroxicam-beta-cyclodextrin (PBC) in sachet form have been surveyed in patients with osteoarthritic or acute pain in western countries, but scarcely studied in those with chronic low back pain (LBP), and never investigated in the field of postural sway. The aim of this study was to evaluate the clinical effects of PBC in sachet form prescribed in patients with chronic backache in local Asian when compared with those of plain piroxicam. After randomized allocation and experimental exclusion, a total of 42 eligible patients were randomized into two groups, the sachet group (n = 23) and the piroxicam tablet group (n = 19). Both groups were administered the same dosage, orally per day (daily dose = 20 mg). The duration of trial was 28 days. Efficacy was assessed with pain score, disability index and postural sway. The patients in sachet group showed greater improvement in pain score and disability index than those who took piroxicam tablets. There were significantly lower sway velocity and intensity at almost all different conditions than baseline profiles in both groups (P < 0.05). However, there was no significant difference of sway velocity and intensity in the piroxicam tablets group with regard to eyes open or eyes closed in 20 degrees dorsiflexion. Piroxicam-beta-cyclodextrin (PBC) sachet may have greater improvement in the treatment of chronic LBP and possess the extended effects on postural abnormality relevant to chronic LBP.

Differences across health care systems in outcome and cost-utility of surgical and conservative treatment of chronic low back pain: a study protocol

BackgroundThere is little evidence on differences across health care systems in choice and outcome of the treatment of chronic low back pain (CLBP) with spinal surgery and conservative treatment as the main options. At least six randomised controlled trials comparing these two options have been performed; they show conflicting results without clear-cut evidence for superior effectiveness of any of the evaluated interventions and could not address whether treatment effect varied across patient subgroups. Cost-utility analyses display inconsistent results when comparing surgical and conservative treatment of CLBP. Due to its higher feasibility, we chose to conduct a prospective observational cohort study.MethodsThis study aims to examine if1. Differences across health care systems result in different treatment outcomes of surgical and conservative treatment of CLBP2. Patient characteristics (work-related, psychological factors, etc.) and co-interventions (physiotherapy, cognitive behavioural therapy, return-to-work programs, etc.) modify the outcome of treatment for CLBP3. Cost-utility in terms of quality-adjusted life years differs between surgical and conservative treatment of CLBP.This study will recruit 1000 patients from orthopaedic spine units, rehabilitation centres, and pain clinics in Switzerland and New Zealand. Effectiveness will be measured by the Oswestry Disability Index (ODI) at baseline and after six months. The change in ODI will be the primary endpoint of this study.Multiple linear regression models will be used, with the change in ODI from baseline to six months as the dependent variable and the type of health care system, type of treatment, patient characteristics, and co-interventions as independent variables. Interactions will be incorporated between type of treatment and different co-interventions and patient characteristics. Cost-utility will be measured with an index based on EQol-5D in combination with cost data.ConclusionThis study will provide evidence if differences across health care systems in the outcome of treatment of CLBP exist. It will classify patients with CLBP into different clinical subgroups and help to identify specific target groups who might benefit from specific surgical or conservative interventions. Furthermore, cost-utility differences will be identified for different groups of patients with CLBP. Main results of this study should be replicated in future studies on CLBP.

The Experience of Low Back Pain in Iranian Women: A Focus Group Study

Chronic low back pain (CLBP) often proves resistant to treatment because there are different biological, psychological, and social factors that can affect its treatment. In this study, we explored Iranian women's beliefs regarding the cause of their LBP. Findings are based on four focus groups (N = 24 participants) with LBP patients. Participants articulated their causation beliefs (Explanatory Models) about low back pain through three themes: idioms of distress: stress in women's lives; lack of knowledge resulted in high-risk behaviors; and organic/biomedical. Given the difficultly regarding diagnosis and treatment of CLBP, understanding patients’ health beliefs, causation beliefs, and experiences are warranted.

(256) Subject’s and physician’s global assessment of chronic low-back pain status after treatment with 12-hour extended-release hydrocodone/acetaminophen tablets: A 3-week open-label, 12-week randomized double-blinded placebo-controlled withdrawal trial

Chronic pain patients and the physicians who treat them may have differing assessments of pain and the affect of treatment on their pain. The use of the Subject’s Global Assessment (SGA) and Physician’s Global Assessment (PGA) in clinical trials allows patients and physicians to assess pain with a standardized questionnaire during treatment. A phase-3 withdrawal study assessing 12-hour extended-release hydrocodone/ acetaminophen (HC/APAP CR) treatment in chronic low-back pain (CLBP) consisted of the following periods: Washout/Screening, 3-week Active-Drug Open-Label (OL), 12-week Double-Blind (DB), in which subjects were randomized to placebo, 1 or 2 tablets HC/APAP CR twice daily, and Taper/Follow-up. Primary endpoint results and study design details are reported elsewhere. Subject’s (SGA) and physician’s (PGA) global assessment of Back Pain Status are reported here. Subjects’ assessment of their Back Pain Status was evaluated using a 5-point categorical scale (ranges: very good to very poor). Physician’s assessment of subject’s back pain was evaluated based on a 5-point categorical scale (ranges: very mild to very severe). Both measures were evaluated at the OL-baseline, DB-baseline, week-2, week-6, and week-12 visits. At weeks 2, 6 and 12, statistically significantly greater proportions of subjects in the HC/APAP CR 2-tablet group assessed their CLBP favorably on the SGA compared with subjects in the placebo group. Additionally, statistically significantly greater proportions of subjects in the HC/APAP CR 1-tablet group assessed their CLBP favorably, at weeks 6 and 12, on the SGA compared with subjects in the placebo group. Similarly the distribution of PGA scores at weeks 2, 6, and 12, was statistically significantly superior for each HC/APAP CR treatment group compared to the placebo treatment group. Global assessments of CLBP status, as rated by both subjects and physicians, were more favorable in the both HC/APAP CR groups compared with the placebo group. Funded by Abbott Laboratories.

(248) Analgesic efficacy and safety of controlled-release hydrocodone and acetaminophen tablets, dosed twice daily, for moderate to severe mechanical chronic low-back pain: A randomized, double-blind, placebo-controlled withdrawal trial

Analgesic efficacy and safety of hydrocodone/acetaminophen extended-release (HC/APAP CR) was assessed in subjects with moderate-to-severe chronic low-back pain (CLBP). Subjects with CLBP (n 773) were enrolled at 62 sites; study protocol and informed consent were IRB-approved. Study periods were: Washout/Screening, 3-week Active-Drug Open-Label, 12-week Double-Blind inwhichsubjectswererandomizedtoplacebo,1or2tabletsHC/APAPCRtwice daily, and Taper/Follow-up. Primary efficacy endpoint was mean change from double-blind baseline to final evaluation in Subject’s Assessment of CLBP Intensity (VAS). Safety was evaluated by adverse-event (AE) assessment. All results reported are from the Double-Blind period. 511 subjects were randomized and received °Ý1 dose of study drug; data for 507 were evaluated for efficacy. Most subjects were women (59%) and white (87%); mean age 48 years. Baseline variables were similar among the 3 groups. Mean change from baseline CLBP intensity was statistically significantly lower in subjects in the HC/APAP CR groups than in the placebo group (8.6, 2-tablet; 13.3, 1-tablet vs 22.2, placebo; p 0.05); no statistically significant difference was observed between HC/APAP CR groups. The superiority of treatment with both HC/APAP treatments compared to placebo treatment was consistent across multiple secondary efficacy endpoints. 89/169 (53%) subjects in the HC/APAP CR 2-tablet, 75/170 (44%) in the 1-tablet, and 79/172 (46%) in the placebo group reported °Ý1 AE. AEs in °Ý5% of subjects in any treatment group were nausea, constipation, diarrhea, and headache. Nine subjects reported serious AEs (2 in each HC/APAP CR group; 5 in placebo group); 28 subjects discontinued due to AEs (3% in placebo; 6% in 1-tablet; 7% in 2-tablet group). Both HC/APAP CR doses given twice daily were effective treatment for CLBP over the 12-week period.ThesafetyprofileofHC/APAPCRwasconsistentwithknownprofilesof mu-opioid receptor agonists. Funded by Abbott Laboratories.

Étude comparative des résultats cliniques à court terme de la prothèse discale lombaire et de l’arthrodèse lombaire antérieure

The purpose of this study was to examine short-term clinical results with a lumbar disc prosthesis in comparison with anterior interbody fusion for the treatment of chronic low-back pain resulting from disc degeneration. This was a consecutive series of 32 patients who underwent surgery between 2002 and 2005 performed by the same surgeon. Patients were randomly assigned to one of two treatment arms: a Charité (Depuy) disc prosthesis was implanted in group 1; an intersomatic KLA cage (Scient'x) was implanted in group 2. All patients presented primary or postdiscectomy discopathy: Modic 1 or 2 on MRI and one level (L4-L5 or L5-S1) positive on discography. A visual analog scale (VAS) and the Oswestry test were noted preoperatively, at six months and at last follow-up and compared with Student's t test. The quantitative analysis was based on the rate of excellent results (60% gain on the VAS and 50% gain on the Oswestry), rate of return to work at three months and level of patient satisfaction. Patient follow-up ranged from one to three years. Mean age was 39 years in group 1 and 44 in group 2. The quantitative analysis showed an improvement in the VAS in both groups: 75% in group 1 and 67% in group 2. The difference was not statistically significant. For the Oswestry score, the gain in function was improved 51% in group 1 and 37% in group 2, with a statistically significant difference in favor of the prosthesis group (p=0.125). The qualitative analysis demonstrated that patient satisfaction (87 and 88%) was similar in the two groups, but with a clear difference for return to work at three months, with a better rate in the prosthesis group (61.5%) than the fusion group (42.8%). The rate of excellent outcome was greater in group 1 (77%) than in group 2 (55%). There is only one study in the literature, which can be compared with ours. Using the same methodology, that study observed less favorable results for the disc prosthesis than with anterior lumbar fusion. The lumbar disc prosthesis offers a possible alternative to lumbar arthrodesis for the treatment of severe disc degeneration at one level in the young subject. It has been found to enable more rapid and superior functional results.

Psychological Predictors of Substantial Pain Reduction after Minimally Invasive Radiofrequency and Injection Treatments for Chronic Low Back Pain

In this post hoc observational study, we investigated psychological predictors of outcome after radiofrequency and injection treatments, commonly performed in the management of chronic low back pain (CLBP). Data, comprising 161 patients (29 eventually lost to follow-up), were obtained from two randomized controlled trials on efficacy of radiofrequency treatment for back pain and sciatica. Subsequently patients were additionally treated in an open prospective follow-up period. Although all groups presented a significant visual analog scale reduction after 3 and 12 months, no additional pain relief after radiofrequency compared with injection treatment was found. Both trial populations showed sufficient similarities. A principal component (factor) analysis was performed on baseline psychometric tests, SF-36, and physical activity variables. We constructed five clinically relevant psychological profiles: "psychologically negative,""adaptive manager,""rigid qualities,""supporting partner," and "strong ego." These were examined as possible predictors of significant pain relief using logistic regression analysis. The "psychologically negative" dimension showed a negative and the "adaptive manager" dimension a positive prognostic effect on outcome. Minimally invasive treatment for CLBP leads to significant pain reduction, including potential placebo effects. However, psychologically vulnerable patients, characterized by, among others, reduced life control, disturbed mood, negative self-efficacy, catastrophizing, high anxiety levels, inadequacy, and poor mental health, tend not to respond to this treatment. Patients characterized by a.o. reduced pain and interference levels, positive expectations, and reasonable physical and social functioning, react more favorably. From both a clinical and a financial perspective, psychosocial evaluation and selection of patients seems appropriate, before applying minimally invasive procedures for CLBP.

Prolotherapy injections for chronic low-back pain.

Prolotherapy involves repeated injections of irritant solutions to strengthen lumbosacral ligaments and reduce some types of chronic low-back pain; spinal manipulation and exercises are often used to enhance its effectiveness. To determine the efficacy of prolotherapy in adults with chronic low-back pain. We searched CENTRAL 2006, Issue 3 and MEDLINE, EMBASE, CINAHL, and AMED from their respective beginnings to October 2006, with no restrictions on language, and consulted content experts. We included randomised (RCT) and quasi-randomised controlled trials (QRCT) that compared prolotherapy injections to control injections, alone or in combination with other treatments, which measured pain or disability before and after the intervention. Two review authors independently selected the trials and assessed methodological quality. Intervention protocols varied from study to study, making meta-analysis impossible. We identified five high quality studies with a total of 366 participants. All measured pain or disability levels at six months, and four measured the proportion of participants reporting a greater than 50% reduction in pain or disability scores. Three randomized controlled trials (206 participants) found that prolotherapy injections alone are no more effective than control injection for chronic low-back pain and disability. At six months, there was no difference between groups in mean pain or disability scores (2 RCTs; 184 participants) and no difference in proportions who reported over 50% improvement in pain or disability (3 RCTs; 206 participants). These trials could not be pooled due to clinical heterogeneity. Two RCTs (160 participants) found that prolotherapy injections, given with spinal manipulation, exercise, and other therapies, are more effective than control injections for chronic low-back pain and disability. At six months, one study reported a significant difference between groups in mean pain and disability scores, whereas the other study did not. Both studies reported a significant difference in the proportion of individuals who reported over 50% reduction in disability or pain. Co-interventions confounded interpretation of results and clinical heterogeneity in the trials prevented pooling. There is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.

The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy

The aim of this study was to determine the extent to which a number of distinct cognitive factors were differentially related to the levels of pain and disability reported by 183 chronic low back pain (CLBP) patients presenting for physiotherapy. After adjusting for demographics, the cognitive factors accounted for an additional 30% of the variance in pain intensity, with functional self-efficacy ( β = −0.40; P < 0.001) and catastrophizing ( β = 0.21; P < 0.01) both uniquely contributing to the prediction of outcome. The cognitive factors also explained an additional 32% of the variance in disability after adjusting for demographics and pain intensity (total R 2 = 0.61). Higher levels of functional self-efficacy ( β = −0.43; P < 0.001) and lower levels of depression ( β = 0.23; P < 0.01) were uniquely related to lower levels of disability. Our findings clearly show that there is a strong association between cognitive factors and the levels of pain and disability reported by CLBP patients presenting for physiotherapy. Functional self-efficacy emerged as a particularly strong predictor of both pain intensity and disability. In view of our findings it would seem that targeting specific cognitive factors should be an integral facet of physiotherapy-based treatments for CLBP.