Catastrophizing contributes to the association between posttraumatic stress symptoms and pain outcomes in individuals with chronic low back pain: Differential effects as a function of sex.

Background: Gymnasts are reported as a population at high risk of low back pain. The prevention and treatment of low back pain often rely on improving the effectiveness of deep stabilizer muscles efficiency through exercises that aim to reach spinal alignment and axial lengthening. However, the scientific evidence regarding the effect of the specific instructions used during exercises on the spinopelvic complex is still lacking. To address this gap of knowledge, the aim of this pilot study was to examine the effect of specific postural and breathing instructions (spine straightening, forced expiration and perineal contraction) on the sagittal alignment of the spine before and after fifteen weeks of a specific muscle strengthening program. Methods: Sixteen gymnasts consented to participate in this study. Low-dose biplanar radiographic images were taken in neutral position and in the five specific postures before and after the program and associated skeletal 3D reconstructions were performed allowing calculation of sacral slope, pelvic tilt, lumbar lordosis and thoracic kyphosis. Results: At the end of the program, most of the postures tested led to a decrease in sacral slope, an increase in pelvic tilt, a reduction in lumbar lordosis, and a decrease in thoracic kyphosis, but with varying efficiency; the condition combining spine straightening, perineal contraction and forced expiration appeared to be the most effective in influencing all parameters simultaneously. Conclusions: The results strongly encourage combining an instruction of spine straightening with instructions of both expiration and perineal contraction, which is information of interest for coaches, physiotherapists and medical professionals.

In cases of chronic non-specific neck and low back pain (CNLBP), where emotional disorders are identified, the involvement of a psychiatrist in patient management is considered. However, the effectiveness of this approach in patients with CNLBP and a confirmed anxiety or depressive disorder (F41, F33, F32) remains insufficiently studied. Objective: To conduct a comparative evaluation of the efficacy of a comprehensive approach (involving a psychiatrist, an educational programme incorporating elements of cognitive behavioural therapy (CBT), and personalised therapeutic exercise) versus a standard approach in the treatment of chronic non-specific low back pain (CNLBP) in patients diagnosed with an anxiety or depressive disorder (F41, F33, F32) by a psychiatrist. Material and methods. The study included 55 patients with CNLBP and anxiety (F41) or depressive disorder (F33, F32), who were randomized into two groups. The first group (comprehensive therapy – CT) consisted of patients (n=27) who received a comprehensive (multimodal) approach, including the involvement of a psychiatrist in patient management, 6 sessions of an individualized educational programme incorporating elements of CBT delivered by a certified specialist in chronic pain and emotional disorders, 4–5 individual sessions of therapeutic exercise (TE) with the development of a personalized exercise regimen, and recommendations on workplace ergonomics. The standard therapy (ST) group comprised patients (n = 28) who were treated using a standard therapy protocol (optimisation of drug therapy, a one-off educational programme to improve physical activity, and standard kinesiotherapy). The study protocol involved 6 months of therapy and fol-low-up with efficacy assessments at three time points – 1, 3 and 6 months after the start of treatment. A numerical rating scale (NRS) was used to assess pain intensity; the Spielberger test, which assesses state (ST) and trait (TT) anxiety, and the Beck Depression Inventory were used to assess anxiety and depressive disorders. The SF-12 questionnaire was used to assess quality of life, taking into account the division of this questionnaire into summary scales for physical (PCS-12) and mental health (MCS-12). To determine the impact of neck pain (NP), the Neck Disability Index (NDI) was used; to assess the impact of low back pain (LBP) on daily activities, the Oswestry Low Back Pain Disability Questionnaire was used. Results. Against the background of treatment, a more significant decrease in pain intensity according to the NRS was noted in the CT group than in the ST group – respectively, for NP to 1.46 ± 0.75 and 2.92 ± 1.0 after 3 months (p < 0.001) and to 0.69 ± 0.72 and 3.0 ± 1.41 after 6 months (p < 0.001), for LBP 2.04 ± 0.86 and 3.29 ± 1.31 after 3 months (p < 0.001), and to 1.04 ± 0.91 and 3.29 ± 1.48 after 6 months (p < 0.001), a decrease in functional impairment according to the Oswestry questionnaire to 15.57 ± 3.55 and 27.62 ± 3.27 after 3 months (p < 0.001) and up to 10.22 ± 2.54 and 29.67 ± 4.24 after 6 months (p < 0.001), a decrease in functional impairment according to the NDI to 12.54 ± 4.36 and 23.38 ± 4.5 after 3 months (p < 0.001) and up to 8.08 ± 2.81 and 25.23 ± 4.95 after 6 months (p < 0.001), an improvement in the quality of life according to PCS to 46.04 ± 4.31 and 43.21 ± 4.04 after 3 months (p < 0.05) and up to 50.07 ± 3.27 and 43.57 ± 3.17 after 6 months (p < 0.001), an improvement in the quality of life according to MCS to 47.3 ± 4.31 and 44.57 ± 3.13 after 3 months (p < 0.05) and up to 50.56 ± 2.86 and 44.75 ± 2.63 after 6 months (p < 0.001). During therapy, no significant differences were found between the CT and ST groups according to the Beck Depression Inventory, ST and TT, in both groups an improvement in the indicators was observed over time, however, when comparing the survey indicators after 3 and 6 months, the CT group showed a statistically significant improvement according to the Beck Depression Inventory (p = 0.04), while in the ST group no further changes were noted (p = 0.14). Conclusion. A comprehensive multidisciplinary approach (involving a psychiatrist) to the treatment of patients with chronic non-specific low back pain (CNLBP) and mental health disorders (anxiety and depressive disorders) leads to a more significant reduction in pain and an improvement in functional activity. Prescribed drug therapy for mental disorders improved the improvement in pain, functional activity and quality of life in the long term.

Nonspecific low back pain (NLBP) is a high-incidence condition in clinical orthopedics, rehabilitation, and acupuncture departments, accounting for 90%-95% of all low back pain patients, with an unclear etiology. After excluding specific spinal diseases and radicular pain, it is characterized by pain in the lumbar and sacroiliac regions as the core manifestation. Some patients may develop a chronic course, accompanied by lumbar stiffness and limited mobility, severely affecting daily work and quality of life [1]. According to relevant data, the annual prevalence of NLBP in China is 20.88%-29.88% [2]. The lifetime prevalence of NLBP is 40%-70%; the proportion of middle-aged patients seeking medical attention is higher than that of younger patients [3]. Current research proves that clinical treatment primarily uses exercise therapy as the main rehabilitation method [4-6]. Acupuncture therapies: local acupuncture, fire needle, electroacupuncture, etc., mostly focus on local lumbar and back acupoints. Although they can relieve pain by dredging local meridians, their intervention is insufficient for low back pain caused by abnormal central nervous system regulation and overall mechanical imbalance. The guideline clinical construction process and experience summarization are slow, and the progress of diagnostic scale research needs further exploration [7]. NLBP affects patients’ physical and mental health, quality of life, and social activities, so exploring safer, more effective, economical, and convenient treatment methods for this disease is a focus of discussion in the medical field. Although the term “nonspecific low back pain” is not directly recorded in ancient medical texts, it belongs to the categories of “low back pain” and “bi syndrome”. Analyzing the current research status of modern medicine on the TCM disease differentiation distribution of NLBP and the patient volume in our hospital’s outpatient department, the study includes patients who meet the TCM disease differentiation of “low back pain” after excluding factors [8]. The bone-reaching needle technique is a characteristic TCM applicable technology proposed by Dr. Zou Dehui, which is a new type of acupuncture technique with “needle tip reaching the bone” or “needle body touching the bone” as the core operation.

Efficacy and Risks of Intradiscal Electrothermal Therapy (IDET) for Treatment of Low Back Pain: A Narrative Review.

Antibiotic treatment for low back pain, radicular pain, or both.

Abstract No. 56 Efficacy and Safety of Allogeneic Mesenchymal Precursor Cells with and Without Hyaluronic Acid for Treatment of Chronic Low Back Pain: A Prospective, Randomized, Double-Blind, Concurrent-Controlled 36-Month Study

Chronic low back pain (CLBP) remains the leading cause of disability worldwide, yet lumbar structural abnormalities seldom account for reported symptoms. Prior neuroimaging studies often report reduced cerebral grey matter density (GMD) in CLBP but typically include patients with moderate-to-severe pain who are taking centrally acting medications, both of which can independently influence brain structure. This longitudinal observational cohort study assessed GMD in mostly mild-to-moderate CLBP individuals not using centrally acting medications. High-resolution T1-weighted MRI scans were acquired over three timepoints (baseline, 2 months, and 4 months) from 27 CLBP participants and 25 matched healthy controls. Voxel-based morphometry revealed significantly increased GMD in CLBP participants in the right middle frontal and temporal gyri, and left orbitofrontal cortex. Additionally, GMD in regions including the right inferior parietal lobule (rIPL) showed an inverse correlation with global pain severity across all timepoints (r up to -0.72, p < 0.0001). Participants with longer pain duration (≥ 5 years) showed lower GMD in the rIPL and reported greater symptom severity, independent of age. Brain structural alterations may be present even in mild, unmedicated CLBP and may vary depending on pain duration and intensity. Structural variation in the rIPL was consistently associated with pain severity, suggesting that this region may contribute to inter-individual differences in symptom burden. Given the correlational nature of these findings, future well-controlled longitudinal studies spanning the full spectrum of chronic low back pain severity and treatment exposure are warranted to clarify the temporal dynamics and clinical relevance of these structural differences. This study demonstrates that individuals with mild, unmedicated chronic low back pain show increased grey matter density in frontal and temporal regions and a robust inverse association between pain severity and parietal grey matter. By identifying the right inferior parietal lobule as a neural marker linked to symptom intensity, these findings refine our understanding of pain-related brain plasticity, highlight structural correlates present even in less severe clinical populations, and suggest novel targets for early intervention strategies in chronic pain.

Patients lack knowledge and have unhelpful beliefs about low back pain, which are associated with worse outcomes. Education may improve knowledge and modify beliefs and is recommended as a first-line low back pain treatment. However, low back pain guidelines are vague in their education recommendations and patients report rarely receiving education in from their family doctor. Those receiving education often report unclear and inconsistent information across resources that do not address their needs. Patient education materials can be used to facilitate the provision of credible, clear and consistent information to address patients' needs, but no tool has been developed to assess if they contain information patients want to know, or information providers want patients to know. To (i) identify a list of items describing information that patients want to know about and that educators want patients to know about related to low back pain and (ii) organize them into a checklist with a coding scheme for future pilot testing. We reviewed the literature to inform working definitions of patients' information needs (what patients want to know more about) and education needs (what experts identified patients lack knowledge about). Using these definitions, we found two recent systematic reviews investigating patients' information needs, attitudes, and beliefs about low back pain. We used the constant comparative method to conduct a content analysis of the data from these reviews into codes and categories relating to patients' needs, from which we generated items. Patient partners and clinician researchers assessed face validity. A clinician researcher pre-tested the checklist to minimize measurement error. We developed a checklist comprising 21 items about prognosis, diagnosis, treatment, causes, aetiology, prevention, functional anatomy, activities of daily living, and pain neuroscience education. A small group of patients and clinician researchers judged the checklist to have acceptable face validity. We developed a novel checklist comprising 21 distinct patient information and education needs about low back pain. It is intended to assess whether patient education materials about low back pain contain information about these needs, but its development is preliminary in nature and further validation is required.

BackgroundVirtual reality (VR) has proven effective in delivering nonpharmacological interventions to reduce acute and chronic pain. For the treatment of nonspecific chronic low back pain (CLBP), it offers benefits over traditional treatment options, such as the possibility of gamified movement exercises with real-time performance feedback and virtual embodiment. We implemented a novel immersive VR intervention (a serious game) that combined these elements.ObjectiveThis study evaluated the feasibility, tolerability, and initial clinical efficacy of the gamified VR intervention.MethodsPatients with CLBP (n=20; mean age 47, SD 14 years; symptom duration >3 months to ≤5 years; convenience sample) took part in a prospective, single-arm, and preregistered trial over 9 weeks. The VR therapy phase lasted 3 weeks, and there were 2 VR sessions per week conducted at the University Hospital Wuerzburg (Germany). Before the therapy phase, there was a 2-week baseline phase, and the posttherapy phase lasted 4 weeks. During the sessions, patients wore a head-mounted display. In VR, they embodied a virtual avatar and performed gamified movement exercises. Participants were immersed in a virtual toy factory, and they had the task of teaching 5 different toys how to move. They received real-time feedback on performance through a hologram overlaying their avatar. Based on performance, movements to be performed became gradually more difficult (graded exposure). Primary outcome measures were adherence and side effects for assessing feasibility and tolerability (Simulator Sickness Questionnaire), and pain intensity ratings (numerical rating scale 0‐10) were used for assessing initial clinical efficacy. Secondary outcomes included back- and task-specific functioning and questionnaires to further test initial clinical efficacy and assess fear-avoidance beliefs.ResultsAdherence was high (18/20, 90%). Participants indicated lower pain in the posttherapy phase compared with baseline levels (mean difference 0.73, CI 0.27-1.19; t16=3.38; P=.004; d=0.82). There were only few and minor side effects. Task- and back-specific functioning improved (ie, performing daily life activities; Back Performance Scale: F2,34=4.53; P=.02; η2g=0.04; Roland-Morris Disability Questionnaire: F2,26=4.73; P=.02; η2g=0.08), and movement restrictions decreased (F2,32=10.82; P<.001; η2g=0.06). There were no changes in the psychological outcome measures (eg, fear avoidance beliefs). Across all VR sessions, study participants reported high levels of fun (mean 8.07, SD 1.99).ConclusionsWe implemented a gamified immersive VR intervention for the treatment of CLBP. The combination of gamified movement exercises and virtual body illusions is unique, and for the first time, it included real-time feedback via a hologram overlaying the virtual avatar of the user. The study demonstrated the feasibility and safety of the intervention. Initial tests of the clinical efficacy revealed positive effects on pain, physical functioning, and daily activities. However, these did not reach the thresholds of clinical importance. A randomized controlled trial is needed to test the specificity of the effects.

Non-invasive brain stimulation (NIBS), including transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), is a potential treatment for chronic low back pain (CLBP). However, its efficacy and safety remain inconclusive. In this systematic review and meta-analysis, the clinical benefits of NIBS for pain relief, functional improvement, and quality of life (QoL) in patients with CLBP were evaluated. Five databases (PubMed, Web of Science, Cochrane Library, Embase and Scopus) were searched to identify randomised controlled trials (RCTs) of NIBS for CLBP. The final review included 21 RCTs involving 744 participants. The included studies assessed pain intensity, disability, and QoL outcomes, along with adverse events. Risk of bias (RoB) was evaluated using the RoB-2 tool, and meta-analyses were conducted using the R platform. NIBS was found to significantly reduce pain intensity (standardised mean difference [SMD] = − 0.85 [− 1.21, − 0.49]) and disability (SMD = − 0.52 [− 0.89, − 0.16]) compared with sham or control interventions. Subgroup analyses revealed that tDCS yielded broader benefits for both pain (SMD = − 0.80) and disability (SMD = − 0.59), while rTMS had the largest effect on pain reduction (SMD = − 1.09). tDCS targeting the primary motor cortex (M1) showed the strongest effects on pain relief (SMD = − 0.95) and functional improvement (SMD = − 0.59), while dorsolateral prefrontal cortex stimulation also yielded significant benefits for both pain (SMD = − 0.64) and disability (SMD = − 0.65). There is very low to moderate evidence that NIBS can help relieve pain and reduce disability in individuals with CLBP.

Exercise therapy is the most recommended treatment for chronic low back pain (LBP), with evidence supporting modest effects, likely due to the heterogeneity of patient presentations. Evidence suggests that matching individuals to the most appropriate exercise type could improve outcomes. Systematic reviews also emphasise that effective exercise interventions should be patient centred, target paraspinal muscle health and be of sufficient duration. This study addresses these gaps using a targeted care approach to identify a homogenous sample that is more likely to respond to our interventions. The inclusion of a sample with predominant nociceptive pain profile will be performed with the integration of the Pain and Disability Drivers Management Model (PDDM) and the Lumbar Spine Instability Questionnaire (LSIQ). The primary aim of this two-arm randomised controlled trial is to compare the effectiveness of motor control plus isolated lumbar extension exercises (MC+ILEX, arm 1) to free-weight resistance training (arm 2) in reducing LBP-related disability. Secondary aims include examining whether changes in multifidus composition mediate disability improvements comparing intervention effects on muscle size and quality, strength, mobility, pain, quality of life, sleep, physical activity and satisfaction; exploring baseline LSIQ scores and sex/gender as moderators of treatment response; and investigating participants' perceptions and experiences of exercise therapy. A total of 106 participants will be recruited through primary and secondary care and randomised (1:1) to receive either MC+ILEX or free-weight resistance training. Both groups will complete 48 exercise sessions over 16 weeks. The primary outcome will be disability at 16 weeks, measured by the Oswestry Disability Index. Secondary outcomes include multifidus muscle composition and size, lumbar and gluteal muscle strength, hip range of motion, pain, physical and mental function, satisfaction and recovery, health-related quality of life, sleep quality and physical activity levels. Linear mixed-effects models will be used to assess primary and secondary outcomes. Regression analyses will explore whether baseline LSIQ scores moderate treatment effects on multifidus composition and other outcomes. A subsample of participants will undergo semistructured interviews before and after the intervention to explore their illness perceptions, illness mindsets, perceptions of exercise therapy, as well as their experiences and satisfaction with the two exercise interventions. Reflexive thematic analysis will be used to analyse qualitative data. This study received ethics approval from the Central Ethics Research Committee of the Quebec Minister of Health and Social Services (CCER-25-26-14). Results will be submitted to peer-reviewed journals and scientific meetings. ISRCTN14864451.

Chronic nonspecific low back pain is defined as pain that persists for greater than 12 weeks and mainly occurs in the lower back with no evidence of associated underlying serious conditions [like malignancy, inflammation (like ankylosing spondylitis) or infection, vertebral fracture, etc.]. To compare the efficacy and safety of amitriptyline with duloxetine in treating chronic low back pain (CLBP). The present study was a two-arm observational study conducted over 18 months in a tertiary rehabilitation setting. A total of 254 patients were included in the study. The mean age was significantly higher in the amitriptyline group (34.78 ± 8.22 years) compared with the duloxetine group (29.98 ± 7.28 years, P < 0.0001). Baseline visual analog scale (VAS) scores were also significantly different between groups (amitriptyline: 7.92 ± 0.56; duloxetine: 8.46 ± 0.79; P < 0.0001). Within-group analysis showed a significant reduction in VAS scores over time in both groups (P < 0.001). At 12 weeks the duloxetine group showed significantly lower VAS scores (0.92 ± 0.78) compared with the amitriptyline group (1.87 ± 1.71; P < 0.0001). Analysis of variance, adjusting for age and baseline VAS, confirmed a significant group effect on pain reduction at 12 weeks (P < 0.001), favoring duloxetine. Side effects were generally mild. The most common in the amitriptyline group were dry mouth (17.3%) and drowsiness (7.9%) while in the duloxetine group, dry mouth (15.7%) and constipation (2.4%) were most reported. Amitriptyline and duloxetine effectively treat CLBP; however, considering side effects and more sustained pain relief, duloxetine appears to be the better option. Nonetheless, treatment choice should consider individual patient profiles.

Evaluating the accuracy of screening titles and abstracts for progressing to full-text screening by one vs two independent reviewers: part 1 of a meta-research study of rapid review methodological trade-offs.

Low back pain (LBP) is prevalent in 30-70% of populations in developed and industrialized nations, imposing substantial healthcare costs and work absenteeism. However, research addressing chronic nonspecific low back pain (CNLBP) within the Black population globally, remains limited, particularly studies considering the specific sociocultural and demographic factors affecting this group. Telerehabilitation offers a novel opportunity for physiotherapists to manage musculoskeletal conditions to facilitate remote care delivery. This study aims to evaluate the effect of graded activity (gradual increases in difficulty) on the Afro-Brazilian adult population with CNLBP through the use of telerehabilitation. This randomized, double-blind clinical trial employs a 1:1 allocation ratio with 102 Afro-Brazilian participants divided into two groups of 51 each. Eligibility criteria include both sexes, aged 18-65, with CNLBP persisting for ≥ 3months, residing in Brazil. Participants are allocated to the Experimental Group (Graded Activity and Educational Program; EG) or the Control Group (Educational Program; CG). The intervention consists of a telerehabilitation program delivered via a mobile health (mHealth) application, conducted across 12 sessions over 4weeks. Pain intensity serves as the primary outcome, while secondary outcomes include functional capacity, quality of life, anxiety, and fear-avoidance beliefs. We will also examine the extent to which the reduction in pain intensity varies by perceived discrimination. Assessments occur at baseline, post-intervention (4weeks), and follow-ups at 3 and 6months. Data are managed through a secure, web-based electronic data capture system. Telerehabilitation, as a remote, home-based intervention, holds promise for managing CNLBP, especially among historically underserved populations such as Afro-Brazilians. This study addresses gaps in research by focusing on racial and ethnic disparities in health access and outcomes, offering insights into the potential of telerehabilitation to mitigate inequities. The study protocol is registered with ClinicalTrials.gov (NCT06443229, June 5, 2024).

Nonspecific low back pain (NSLBP) is a significant global public health concern that affects the health and well-being of individuals across different age groups, limiting their daily activities and reducing their quality of life. As Tuina (Chinese therapeutic massage) therapy and medicated oil are widely used in China, it is necessary to design a randomized clinical trial to assess the effectiveness of Tuina combined medicated oil (TNO) in treating NSLBP. This study aims to evaluate the efficacy and safety of Tuina therapy combined with medicated oil in treating NSLBP. One hundred participants will be enrolled and randomly allocated to either a TNO group (n=50) or a Tuina combined water group (n=50). Treatment will last for 4 weeks, with sessions 3 times a week, followed by a 4-week follow-up. The visual analog scale score is the primary outcome; secondary outcomes include the evaluation of treatment Japanese Orthopaedic Association scores, infrared thermography, muscle tension tests, and tenderness scores. All adverse reactions will be recorded. The trial commenced in June 2023 and is expected to conclude in September 2025. In June 2025, key preliminary steps were completed, and the ethical review and clinical trial registration were concluded. Recruitment is proceeding as planned, with 100 participants enrolled to date. Data collection is underway, while formal data analysis has not yet commenced. The project's purpose is to evaluate the effectiveness of TNO in alleviating pain and improving lumbar function in patients with NSLBP.

Low back pain (LBP) is a leading cause of disability worldwide, affecting people of all ages while showing increasing prevalence among younger demographics. Patients may present with different symptoms and treatment responses despite identical magnetic resonance imaging results, making it difficult to determine whether surgical and medical interventions are appropriate. This study aimed to develop SPOILS (Software to Predict Outcome in Lumbar Spondylosis), an artificial intelligence-based decision support tool that merges clinical intelligence and radiomics to generate customized therapy plans for patients with LBP. The SPOILS system used deep learning models to perform automated segmentation, enabling the extraction of geometrical parameters, including disk height, disk width, vertebrae height, vertebrae width, canal diameter, disk height index, signal intensity, and disk volume. A labeled dataset was created using expert-verified Pfirrmann and spondylosis severity gradings to address the clinical issues stemming from manual grading variability and subjectivity. Machine learning algorithms were used with this combined dataset to predict outcomes and recommend personalized treatment plans. The DeepLabV3+ segmentation model with a ResNet50 encoder achieved 95.5% accuracy, which increased to 98.7% after 8-fold cross-validation and simultaneously improved precision (96.95%), recall (97.1%), Dice coefficient (96.9%), and intersection over union (IoU; 94.8%). The convolutional neural network with MobileNetV2 achieved 97.84% accuracy and 96.76% IoU for spondylosis severity prediction after cross-validation. The Gradient Boost classifier demonstrated the best results with geometrical data by achieving 91.65% accuracy and 84.59% IoU. SPOILS introduced an innovative method to customize LBP treatment through the combination of artificial intelligence technology with radiological data and clinical expertise.

To develop an anatomically verified protocol for ultrasound-guided analgesic interventions targeting the thoracolumbar fascia region for the treatment of both acute and chronic back pain. One cadaver was embalmed using the Fix-4-Life method, which preserves tissue properties suitable for subsequent ultrasound visualization. Under ultrasound guidance, a needle was inserted to the thoracolumbar fascia at the level of the transverse process of the fourth lumbar vertebra. Upon contact with the transverse process, 5 ml of diluted red latex dye was injected. The distribution of the injected fluid was then observed through anatomical dissection. This cadaveric study confirmed that ultrasound-guided injection into the middle layer of the thoracolumbar fascia is both accurate and technically feasible. The dye demonstrated substantial potential to spread within the targeted area, distributing mediolaterally among the structures of the m. erector trunci and cranio-caudally over a range exceeding 10 cm, encompassing nearly four spinal segments. Back pain of various etiologies remains a major interdisciplinary challenge. Refining therapeutic techniques may improve the outcomes. The thoracolumbar fascia represents a promising target for delivering local anesthetics, depot corticosteroids, and next-generation hyaluronic acid derivatives. This study confirms the accuracy and feasibility of ultrasound-guided interventions targeting the thoracolumbar fascia.

Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane reviews: Summary of a Cochrane review.

Current concepts in the conservative interventions for office workers with low back pain: A scoping review