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American Family Physician Oct 2018Low back pain is usually nonspecific or mechanical. Mechanical low back pain arises intrinsically from the spine, intervertebral disks, or surrounding soft tissues.... (Review)
Review
Low back pain is usually nonspecific or mechanical. Mechanical low back pain arises intrinsically from the spine, intervertebral disks, or surrounding soft tissues. Clinical clues, or red flags, may help identify cases of nonmechanical low back pain and prompt further evaluation or imaging. Red flags include progressive motor or sensory loss, new urinary retention or overflow incontinence, history of cancer, recent invasive spinal procedure, and significant trauma relative to age. Imaging on initial presentation should be reserved for when there is suspicion for cauda equina syndrome, malignancy, fracture, or infection. Plain radiography of the lumbar spine is appropriate to assess for fracture and bony abnormality, whereas magnetic resonance imaging is better for identifying the source of neurologic or soft tissue abnormalities. There are multiple treatment modalities for mechanical low back pain, but strong evidence of benefit is often lacking. Moderate evidence supports the use of nonsteroidal anti-inflammatory drugs, opioids, and topiramate in the short-term treatment of mechanical low back pain. There is little or no evidence of benefit for acetaminophen, antidepressants (except duloxetine), skeletal muscle relaxants, lidocaine patches, and transcutaneous electrical nerve stimulation in the treatment of chronic low back pain. There is strong evidence for short-term effectiveness and moderate-quality evidence for long-term effectiveness of yoga in the treatment of chronic low back pain. Various spinal manipulative techniques (osteopathic manipulative treatment, spinal manipulative therapy) have shown mixed benefits in the acute and chronic setting. Physical therapy modalities such as the McKenzie method may decrease the recurrence of low back pain and health care expenditures. Physical therapy modalities such as the McKenzie method may decrease the recurrence of low back pain and use of health care. Educating patients on prognosis and incorporating psychosocial components of care such as identifying comorbid psychological problems and barriers to treatment are essential components of long-term management.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Diagnosis, Differential; Humans; Low Back Pain; Manipulation, Spinal; Primary Health Care
PubMed: 30252425
DOI: No ID Found -
The Journal of Orthopaedic and Sports... Apr 2012The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical...
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF). The purpose of these low back pain clinical practice guidelines, in particular, is to describe the peer-reviewed literature and make recommendations related to (1) treatment matched to low back pain subgroup responder categories, (2) treatments that have evidence to prevent recurrence of low back pain, and (3) treatments that have evidence to influence the progression from acute to chronic low back pain and disability.
Topics: Humans; Low Back Pain; Orthopedic Procedures; Physical Therapy Modalities; Secondary Prevention
PubMed: 22466247
DOI: 10.2519/jospt.2012.42.4.A1 -
European Spine Journal : Official... Jan 2006Pain usually is the major complaint of patients with problems of the back, thus making pain evaluation a fundamental requisite in the outcome assessment in spinal... (Review)
Review
Pain usually is the major complaint of patients with problems of the back, thus making pain evaluation a fundamental requisite in the outcome assessment in spinal surgery. Pain intensity, pain-related disability, pain duration and pain affect are the aspects that define pain and its effects. For each of these aspects, different assessment instruments exist and are discussed in terms of advantages and disadvantages. Risk factors for the development of chronic pain have been a major topic in pain research in the past two decades. Now, it has been realised that psychological and psychosocial factors may substantially influence pain perception in patients with chronic pain and thus may influence the surgical outcome. With this background, pain acceptance, pain tolerance and pain-related anxiety as factors influencing coping strategies are discussed. Finally, a recommendation for a minimum as well as for a more comprehensive pain assessment is given.
Topics: Adaptation, Psychological; Anxiety; Back Pain; Humans; Pain Measurement; Surveys and Questionnaires
PubMed: 16320034
DOI: 10.1007/s00586-005-1044-x -
JAMA Neurology Jul 2018Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs.
OBJECTIVE
To compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain.
DESIGN, SETTING, AND PARTICIPANTS
Multicenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months.
INTERVENTIONS
Participants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy).
MAIN OUTCOMES AND MEASURES
Primary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health).
RESULTS
There were 22 men and 38 women in the experimental group (mean [SD] age, 39.9 [12.0] years) and 25 men and 35 women in the control group (mean [SD] age, 40.5 [12.9] years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal [EM] mean, 0.971; 95% CI, -0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, -5.684; 95% CI, -10.589 to -0.780) and 12 months (EM mean, -6.053; 95% CI, -10.781 to -1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, -5.113; 95% CI, -9.994 to -0.232), 6 months (EM mean, -6.351; 95% CI, -11.153 to -1.550), and 12 months (EM mean, -5.779; 95% CI, -10.340 to -1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical health at 3 months (EM mean, 39.263; 95% CI, 9.644-66.882), 6 months (EM mean, 53.007; 95% CI, 23.805-82.209), and 12 months (EM mean, 32.208; 95% CI, 2.402-62.014).
CONCLUSIONS AND RELEVANCE
Pain neuroscience education combined with cognition-targeted motor control training appears to be more effective than current best-evidence physiotherapy for improving pain, symptoms of central sensitization, disability, mental and physical functioning, and pain cognitions in individuals with chronic spinal pain. Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population.
TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT02098005.
Topics: Adult; Back Pain; Central Nervous System Sensitization; Chronic Pain; Cognition; Exercise Therapy; Failed Back Surgery Syndrome; Female; Gray Matter; Humans; Low Back Pain; Male; Middle Aged; Neck Pain; Neurosciences; Patient Education as Topic; Physical Therapy Modalities; Whiplash Injuries
PubMed: 29710099
DOI: 10.1001/jamaneurol.2018.0492 -
Acta Ortopedica Mexicana 2021The purpose of this review is to provide an overview of current literature on the diagnosis and treatment of sacroiliac pain. Designation as a source of lower back pain... (Review)
Review
The purpose of this review is to provide an overview of current literature on the diagnosis and treatment of sacroiliac pain. Designation as a source of lower back pain has been controversial; However, as knowledge about the joint increases, its role as a generator of chronic pain has become better elucidated. The literature states that sacroiliac joint is the cause of pain in up to 30% of patients. Clinically, diagnosing sacroiliac pain can be difficult to assess; However, pain semiology, patient posture/movement and manual testing are useful for making the presumptive diagnosis of sacroiliac dysfunction. The most effective diagnostic test is image-guided injection of anesthetic solutions into the joint, which is considered positive if there is at least 75% acute symptom relief. Treatment begins with physiotherapy and/or intra-articular infiltration of steroids. If these fails, a possible option is radiofrequency (rizotomy) denervation of the joint. If this does not provide adequate relief, surgery may be considered, in the form of fusion; various work supports favorable outcomes in selected patients.
Topics: Humans; Injections, Intra-Articular; Low Back Pain; Sacroiliac Joint
PubMed: 34480446
DOI: No ID Found -
A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis.Pain Medicine (Malden, Mass.) Dec 2019Lumbar spinal stenosis (LSS) is a degenerative spinal condition affecting nearly 50% of patients presenting with lower back pain. The goal of this review is to present... (Review)
Review
OBJECTIVE
Lumbar spinal stenosis (LSS) is a degenerative spinal condition affecting nearly 50% of patients presenting with lower back pain. The goal of this review is to present and summarize the current data on how LSS presents in various populations, how it is diagnosed, and current therapeutic strategies. Properly understanding the prevalence, presentation, and treatment options for individuals suffering from LSS is critical to providing patients the best possible care.
RESULTS
The occurrence of LSS is associated with advanced age. In elderly patients, LSS can be challenging to identify due to the wide variety of presentation subtleties and common comorbidities such as degenerative disc disease. Recent developments in imaging techniques can be useful in accurately identifying the precise location of the spinal compression. Treatment options can range from conservative to surgical, with the latter being reserved for when patients have neurological compromise or conservative measures have failed. Once warranted, there are several surgical techniques at the physician's disposal to best treat each individual case.
Topics: Back Pain; Decompression, Surgical; Humans; Intermittent Claudication; Low Back Pain; Lumbar Vertebrae; Spinal Stenosis
PubMed: 31808530
DOI: 10.1093/pm/pnz161 -
BMJ (Clinical Research Ed.) Feb 2015To assess the long term effects of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the long term effects of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain.
DESIGN
Systematic review and random effects meta-analysis of randomised controlled trials.
DATA SOURCES
Electronic searches of Cochrane Back Review Group Trials Register, CENTRAL, Medline, Embase, PsycINFO, and CINAHL databases up to February 2014, supplemented by hand searching of reference lists and forward citation tracking of included trials.
STUDY SELECTION CRITERIA
Trials published in full; participants with low back pain for more than three months; multidisciplinary rehabilitation involved a physical component and one or both of a psychological component or a social or work targeted component; multidisciplinary rehabilitation was delivered by healthcare professionals from at least two different professional backgrounds; multidisciplinary rehabilitation was compared with a non- multidisciplinary intervention.
RESULTS
Forty one trials included a total of 6858 participants with a mean duration of pain of more than one year who often had failed previous treatment. Sixteen trials provided moderate quality evidence that multidisciplinary rehabilitation decreased pain (standardised mean difference 0.21, 95% confidence interval 0.04 to 0.37; equivalent to 0.5 points in a 10 point pain scale) and disability (0.23, 0.06 to 0.40; equivalent to 1.5 points in a 24 point Roland-Morris index) compared with usual care. Nineteen trials provided low quality evidence that multidisciplinary rehabilitation decreased pain (standardised mean difference 0.51, -0.01 to 1.04) and disability (0.68, 0.16 to 1.19) compared with physical treatments, but significant statistical heterogeneity across trials was present. Eight trials provided moderate quality evidence that multidisciplinary rehabilitation improves the odds of being at work one year after intervention (odds ratio 1.87, 95% confidence interval 1.39 to 2.53) compared with physical treatments. Seven trials provided moderate quality evidence that multidisciplinary rehabilitation does not improve the odds of being at work (odds ratio 1.04, 0.73 to 1.47) compared with usual care. Two trials that compared multidisciplinary rehabilitation with surgery found little difference in outcomes and an increased risk of adverse events with surgery.
CONCLUSIONS
Multidisciplinary biopsychosocial rehabilitation interventions were more effective than usual care (moderate quality evidence) and physical treatments (low quality evidence) in decreasing pain and disability in people with chronic low back pain. For work outcomes, multidisciplinary rehabilitation seems to be more effective than physical treatment but not more effective than usual care.
Topics: Back Pain; Chronic Disease; Humans; Occupational Therapy; Psychotherapy; Randomized Controlled Trials as Topic; Social Support
PubMed: 25694111
DOI: 10.1136/bmj.h444 -
BMC Musculoskeletal Disorders Mar 2017Among the working population, non-specific low-back pain and neck pain are one of the most common reasons for sickness absenteeism. The aim was to evaluate the effects... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Among the working population, non-specific low-back pain and neck pain are one of the most common reasons for sickness absenteeism. The aim was to evaluate the effects of an early intervention of yoga - compared with strength training or evidence-based advice - on sickness absenteeism, sickness presenteeism, back and neck pain and disability among a working population.
METHODS
A randomized controlled trial was conducted on 159 participants with predominantly (90%) chronic back and neck pain. After screening, the participants were randomized to kundalini yoga, strength training or evidence-based advice. Primary outcome was sickness absenteeism. Secondary outcomes were sickness presenteeism, back and neck pain and disability. Self-reported questionnaires and SMS text messages were completed at baseline, 6 weeks, 6 and 12 months.
RESULTS
The results did not indicate that kundalini yoga and strength training had any statistically significant effects on the primary outcome compared with evidence-based advice. An interaction effect was found between adherence to recommendations and sickness absenteeism, indicating larger significant effects among the adherers to kundalini yoga versus evidence-based advice: RR = 0.47 (CI 0.30; 0.74, p = 0.001), strength training versus evidence-based advice: RR = 0.60 (CI 0.38; 0.96, p = 0.032). Some significant differences were also found for the secondary outcomes to the advantage of kundalini yoga and strength training.
CONCLUSIONS
Guided exercise in the forms of kundalini yoga or strength training does not reduce sickness absenteeism more than evidence-based advice alone. However, secondary analyses reveal that among those who pursue kundalini yoga or strength training at least two times a week, a significantly reduction in sickness absenteeism was found. Methods to increase adherence to treatment recommendations should be further developed and applied in exercise interventions.
TRIAL REGISTRATION
Clinicaltrials.gov NCT01653782, date of registration: June, 28, 2012, retrospectively registered.
Topics: Adult; Back Pain; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Education as Topic; Resistance Training; Single-Blind Method; Treatment Outcome; Yoga
PubMed: 28356091
DOI: 10.1186/s12891-017-1497-1 -
MMW Fortschritte Der Medizin Nov 2022
Topics: Humans; Back Pain; Low Back Pain
PubMed: 36413297
DOI: 10.1007/s15006-022-1873-0 -
Best Practice & Research. Clinical... Sep 2023With back pain as one of the most common complaints in the population and with no single disease feature with sufficient sensitivity and specificity to diagnose axial... (Review)
Review
With back pain as one of the most common complaints in the population and with no single disease feature with sufficient sensitivity and specificity to diagnose axial spondyloarthritis (axSpA) on its own, diagnosing axSpA can be challenging. In this article, we discuss clinical, laboratory, and imaging spondyloarthritis features that can be used in diagnosis and explain the general principles underlying an axSpA diagnosis. Moreover, we discuss three pitfalls to avoid when diagnosing axSpA: i) using classification criteria as diagnostic criteria, ii) making a diagnosis by simple counting of spondyloarthritis features, and iii) over-reliance on imaging findings. Finally, we have some advice on how to build diagnostic skills and discuss new developments that may help facilitate the diagnosis of axSpA in the future.
Topics: Humans; Spondylarthritis; Back Pain; Axial Spondyloarthritis; Spondylitis, Ankylosing; Magnetic Resonance Imaging
PubMed: 37714776
DOI: 10.1016/j.berh.2023.101871