Low back pain (LBP) is a key source of medical costs and disability, impacting over 31 million Americans at any given time and resulting in US$100-US$200 billion per year in total healthcare costs. LBP is one of the leading causes of ambulatory care visits to US physicians; problematically, these visits often result in treatments such as opioids, surgery or advanced imaging that can lead to more harm than benefit. The American College of Physicians (ACP) Guideline for Low Back Pain recommends patients receive non-pharmacological interventions as a first-line treatment. Roadmaps exist for multidisciplinary collaborative care that include well-trained primary contact clinicians with specific expertise in the treatment of musculoskeletal conditions, such as physical therapists and doctors of chiropractic, as first-line providers for LBP. These clinicians, sometimes referred to as primary spine practitioners (PSPs) routinely employ many of the non-pharmacological approaches recommended by the ACP guideline, including spinal manipulation and exercise. Important foundational work has demonstrated that such care is feasible and safe, and results in improved physical function, less pain, fewer opioid prescriptions and reduced utilisation of healthcare services. However, this treatment approach for LBP has yet to be widely implemented or tested in a multisite clinical trial in real-world practice.

The Implementation of the American College of Physicians Guideline for Low Back Pain trial is a health system-embedded pragmatic cluster-randomised trial that will examine the effect of offering initial contact with a PSP compared with usual primary care for LBP. Twenty-six primary care clinics within three healthcare systems were randomised 1:1 to PSP intervention or usual primary care. Primary outcomes are pain interference and physical function using the Patient-Reported Outcomes Measurement Information System Short Forms collected via patient self-report among a planned sample of 1800 participants at baseline, 1, 3 (primary end point), 6 and 12 months. A subset of participants enrolled early in the trial will also receive a 24-month assessment. An economic analysis and analysis of healthcare utilisation will be conducted as well as an evaluation of the patient, provider and policy-level barriers and facilitators to implementing the PSP model using a mixed-methods process evaluation approach.

The study received ethics approval from Advarra, Duke University, Dartmouth Health and the University of Iowa Institutional Review Boards. Study data will be made available on completion, in compliance with National Institutes of Health data sharing policies.

NCT05626049.

ObjectiveThe purpose of this study was to compare the contractile properties of posterior chain muscles and isokinetic trunk strength in females with or without non-specific chronic low back pain (NSCLBP).MethodAll participants (control group: n = 22, NSCLBP group: n = 22) were assessed using tensiomyography to evaluate the contractile properties of the posterior chain muscles, and all participants were also assessed for isokinetic trunk strength. An independent t-test was performed to compare the tensiomyography variables and isokinetic trunk strength test results between group.ResultsResult of tensiomyography, we found that the contraction time significant differences in the maximal radial muscle displacement, and velocity of contraction between groups in erector spinae. Semitendinosus revealed significant differences in all variables between groups. Additionally, the isokinetic trunk strength test revealed significant differences in all variables between groups.ConclusionThese findings suggest that due to the characteristics of NSCLBP, such as increased muscle stiffness, fat infiltration, and muscle fatigue, kinesiophobia, physical deconditioning syndrome, the posterior chain muscles of the NSCLBP group showed higher muscle stiffness and slower contraction speed than the control group. Also in the NSCLBP group, trunk isokinetic muscle strength was lower than in the control group, and flexor and extensor muscles were unbalanced.

The use of electrical neuromodulation has often been limited to those with previous back surgery, peripheral neuropathy, and complex regional pain syndrome. Many patients with severe intractable low back pain were thought to be candidates for spinal cord stimulation (SCS), dorsal root ganglion stimulation, or peripheral nerve stimulation but did not meet the criteria. Recently, additional high-level data has supported the use of SCS in non-surgical low back pain (NSLBP), and United States Food and Drug Administration approval has been granted. The American Society of Pain and Neuroscience (ASPN) executive committee realized an unmet need to develop criteria for patient selection for this specific patient population. This is a NEURON project (neuroscience, education, utilization, risk mitigation, optimal outcomes, and neuromodulation), a living guideline for evolving therapies and indications, and is focused on the use of neuraxial stimulation for the treatment of refractory pain.

After board approval, the society accepted nominees for the project, with an emphasis on experience, publication, research, and diversity. The team created an outline for discussion, chose a grading system based on published guidelines, and created consensus points.

The evidence led to several consensus points to best guide patient selection based on the level of evidence and expert opinion. The results will lead to improved safety and efficacy in implanted patients, and to a new standard for best practices.

The selection of patients for implantation in those who have NSLBP should be based on published literature, best practice, and expert opinion. This NEURON project will allow for regular updates to create a living guideline that will allow for better assimilation of information to improve safety and efficacy going forward.

Paraspinal muscle pathology is often accompanied by skeletal abnormalities and is frequently associated with low back pain. While magnetic resonance imaging (MRI) can accurately assess muscle atrophy, the utility of musculoskeletal ultrasound remains under evaluation. A direct comparison between these imaging modalities has not been conducted.

To compare musculoskeletal ultrasound and MRI in evaluating fatty atrophy and cross-sectional area in patients with chronic low back pain and to assess their correlations with clinical symptoms.

The degree of fatty atrophy and cross-sectional area were measured using ultrasound at symptomatic and control levels in patients with chronic low back pain. A prone instability test was also performed. Ultrasound findings were compared with recent lumbar MRI results. Fatty atrophy was graded using the Kjaer system, and cross-sectional area was measured. Interobserver agreement and correlation with the available imaging were calculated.

Strong agreement was observed with MRI for the degree of atrophy at the symptomatic level (weighted Kappa = 0.83), but only fair agreement at the control level. Cross-sectional measurements showed poor correlation between the imaging studies at both levels (Rho = 0.03-0.07). The prone instability test was negative for all participants.

Ultrasound reliably assesses fatty atrophy at symptomatic levels but is less accurate for circumferential measurements.

Common non-surgical treatment approaches for chronic low back pain (CLBP) include pharmacologic, interventional and behavioral therapies, but there is no consensus treatment approach. Despite studies that show the effectiveness of interventional and behavioral approaches individually and evidence-based recommendations for multimodal treatment approach, specific stacking and sequencing strategies used to combine both approaches haven't been studied.

The objectives of this scoping review were to: 1) explore how interventional and behavioral approaches to CLBP treatment are stacked or sequenced; 2) evaluate the feasibility of utilizing interventional and behavioral treatments in an integrative manner, and 3) assess whether optimal combinations of interventional and behavioral approaches to CLBP treatment exist.

A literature search of indexed and gray literature was conducted for studies involving the combination of interventional and behavioral therapies for treatment of CLBP. 374 abstracts and 72 records of gray literature were independently screened followed by 60 that underwent full-text review.

A total of three studies were included in this review, all of which found the integration of modalities to be feasible. Two studies that utilized non-conventional interventions found no significant treatment effect by combining modalities. One study demonstrated a non-significant additive effect of combining radiofrequency ablation with cognitive behavioral therapy.

Despite known individual benefits, there are limited studies exploring combined interventional and behavioral approaches to CLBP. Given the feasibility and the additive effects of combining interventions with behavioral therapy seen in the studies included this review, further exploration of this subject is needed to guide clinical practice.

This study aimed to investigate the differences in postural control effects due to plantar flexor fatigue between individuals with chronic low back pain (CLBP) and healthy controls.

A total of 36 individuals with CLBP and 36 healthy participants took part in the study. Postural stability was evaluated using a force plate before and after a fatigue protocol that involved heel raises. Center-of-pressure (CoP) data were recorded during quiet standing on a rigid surface with eyes open (EO), a rigid surface with eyes closed (EC), and a foam surface with eyes closed (FC). Measurements included mean velocity, the area of the 95% confidence ellipse, and the standard deviation of velocity in both the anteroposterior and mediolateral directions.

After fatigue, individuals with CLBP exhibited greater variability in sway velocity in the mediolateral direction on the foam surface with eyes closed (p = 0.035) and a larger sway area in the eyes closed condition (p = 0.027) compared to healthy controls. All participants demonstrated increased postural sway after fatigue in the more challenging task (EC) compared to the easier task (EO) (p < 0.01). However, the reduction in postural stability due to plantar flexor fatigue was not influenced by the increased difficulty of the postural task in the foam condition compared to the EO condition (p > 0.05).

Localized fatigue in the plantar flexor muscles negatively affected postural control in both CLBP and healthy groups, with a more significant impact observed in individuals with CLBP. This effect was particularly pronounced when visual input was removed.

The diaphragm is an important respiratory muscle that also plays a crucial role in developing intra-abdominal pressure and assisting in spinal stability. Chronic low back pain (CLBP) is a complex musculoskeletal condition and has been associated with respiratory problems and altered breathing mechanics. The purpose of this comparative cross-sectional study is to investigate whether diaphragm fatigue affects breathing mechanics and function in individuals with CLBP.

Volunteers were recruited between the ages of 35-65 years old with and without CLBP. Participants performed 30 minutes of exercises intended to fatigue the diaphragm. The following respiratory parameters were measured: Breathing mechanics (chest and abdominal movement and respiratory rate), diaphragm function (forced expiratory volume in 1 second (FEV1) using a handheld spirometer), and diaphragm movement as measured by sub-diaphragm (L1 to diaphragm domes) volume changes at the end of exhalation and inhalation using MRI scans.

A total of 36 participants were recruited (n = 21M; n = 15F), with 18 participants suffering from CLBP (n = 10M; 8F) and 18 participants serving as a comparison group (n = 11M; n = 7F). There were no differences in breathing mechanics, diaphragm function or excursion (volumetrics) between people with and without CLBP after 30 minutes of exercises intended to fatigue the diaphragm.

The lack of differences suggests that the diaphragm, regardless of its fatigue status as a spinal stabilizer, will not relinquish or weaken its function as a breathing muscle, though it may be less effective as a spinal stabilizer. Individuals with chronic or recurrent low back pain might therefore be more susceptible to subsequent pain flare-ups than non-symptomatic individuals. A potential clinical implication of these findings is that incorporating diaphragmatic breathing exercises to enhance diaphragm function may offer an effective treatment option for patients with CLBP.

Nonspecific low back pain (LBP), a prevalent condition with a lifetime prevalence of up to 84%, presents a considerable burden on individuals and healthcare systems. Isolated lumbar extension (ILEX) has been studied for its ability to exercise the lumbar region with more controlled activation of the erector spinae and other paravertebral muscles. It aims to serve as a specific resistance training method to improve outcomes related to pain, disability, and physical functionality in adults with nonspecific low back pain (LBP). This systematic review and meta-analysis aimed to evaluate and summarize the effects of ILEX in alleviating pain, reducing disability, and improving physical functionality in adults with chronic LBP. Searches were conducted on October 14, 2024, across key databases, including PubMed, Scopus, and Web of Science. Eligibility criteria included adults (> 18 years old) with chronic LBP participating in resistance training focused on ILEX, with comparators comprising true control or active control groups, all from randomized clinical trials. The RoB2 was used to assess the risk of bias in the studies, while the GRADE scale was employed to evaluate the certainty of the evidence. The meta-analysis calculated Hedges' g effect sizes (ES) with 95% CIs and PIs for main outcomes, using the DerSimonian and Laird random-effects model to address inter-study variability, I² for heterogeneity, and the extended Egger's test for publication bias, all performed with SPSS Software. After screening, a total of 8 randomized studies were included, with 381 participants overall. The results indicated a significant favorable effect of ILEX compared to the true control group in pain-related outcomes (ES = - 0.633, p = 0.004). However, there was a non-significant effect of ILEX compared to the true control group in disability-related outcomes (ES = - 0.292, p = 0.190) and isometric strength outcomes (ES = 0.967, p = 0.150). The GRADE scale indicated that the certainty of the evidence is very low.ILEX significantly reduces pain intensity in individuals with low back pain, indicating its potential as an effective intervention, but its impact on disability and physical functionality is less consistent, warranting cautious use alongside pelvic stabilization to optimize rehabilitation outcomes.

Chronic back pain (CBP) is a major cause of disability, contributing significantly to healthcare costs and primary care visits. Pharmacotherapy alone is insufficient in managing CBP. Integrated behavioral health interventions that include psychoeducation are critical for a more holistic, sustainable treatment of CBP.

This review explores CBP treatments that includes psychoeducation as part of patient care.

In the Fall of 2024, the first author searched Google Scholar, PubMed, and Scopus using search terms related to chronic back pain and integrated behavioral interventions to increase patients' self-efficacy to manage CBP. The team included articles in the review that were published more recently and seminal articles in the field of managing CBP.

Given the complex biopsychosocial factors influencing CBP, and the individualized nature of each patient's pain experience, patient psychoeducation should include a multimodal approach, which may include cognitive behavioral strategies to address pain, pain neuroscience education, and education related to lifestyle behaviors such as physical activity, sleep, nutrition, and stress management. Patient education and behavioral interventions integrated within primary care can significantly improve patient engagement and self-reported improvements in pain intensity, functionality, and quality of life.

Psychoeducation is foundational for integrative programs aimed at managing CBP.

To analyze the evolution of chronic neck and low back pain prevalence in the general Spanish population (≥ 15 years) from 2006 to 2020, examining differences by sex, age, social class, and the potential influence of the COVID-19 pandemic.

A repeated cross-sectional observational study was conducted based on data from six health surveys conducted in Spain between 2006 and 2020, with samples ranging from 21,007 to 29,478 subjects per survey, reported by the European Statistical System and the National Statistical Institute. Overall and specific prevalence rates were calculated, and linear trends were assessed over time. The potential influence of the COVID-19 pandemic was evaluated using the Mann-Kendall test, along with prevalence forecasts up to 2020, derived from S-curve models.

Between 2006 and 2020, the prevalence of chronic neck pain ranged from 23.64 to 12.3%, while chronic low back pain ranged from 24.01 to 14.73%. A decreasing trend was observed in both conditions, slightly more pronounced for neck pain. This trend persisted even when excluding 2020 data, which was potentially influenced by the COVID-19 pandemic, and was independent of health surveys. Forecasts indicated that the actual 2020 prevalence rates were lower (by 3.1-4.4%) than predicted. The prevalence was consistently higher among women, older individuals, and lower social classes, though all subgroups showed similar decreasing trends.

The prevalence of chronic neck and low back pain in the Spanish population declined between 2006 and 2020. Subgroup analyses revealed consistent decreases across sex, age, and social class. The COVID-19 pandemic may have impacted the 2020 prevalence rates.

Non-specific low back pain is a common and clinically significant condition with substantial socioeconomic implications. Pulsed electromagnetic field (PEMF) therapy has shown benefits in pain reduction and improvement of physical function in patients with pain-associated disorders like osteoarthritis. However, studies had heterogeneous settings. The aim of this study was to assess the effects of PEMF on pain and function on patients with non-specific low back pain.

A systematic literature search of randomized controlled trials in PubMed, MEDLINE, EMBASE, Cochrane Library, and PEDro was performed (from inception until 15/5/2023). Outcome measures assessed pain and function.

Nine randomized controlled trials with 420 participants (n = 420) were included. The studies compared PEMF vs. placebo-PEMF, PEMF and conventional physical therapy vs. conventional physical therapy alone, PEMF and conventional physical therapy vs. placebo-PEMF and conventional physical therapy, PEMF vs. high-intensity laser therapy (HILT) vs. conventional physical therapy, and osteopathic manipulative treatment (OMT) and PEMF vs. PEMF alone vs. placebo-PEMF vs. OMT alone. Five of the nine included studies showed statistically significant pain reduction and improvement in physical function in comparison to their control groups (p < 0.05). There was substantial heterogeneity among the groups of the study, with a wide range of duration (10-30 min), treatments per week (2-7/week), applied frequencies (3-50 Hz), and intensities (2mT-150mT). No serious adverse event had been reported in any study. The included studies showed solid methodological quality, with an overall score of 7.2 points according to the PEDro scale.

PEMF therapy seems to be a safe and beneficial treatment option for non-specific low back pain, particularly if used as an addition to conventional physical therapy modalities. Future research should focus on standardized settings including assessment methods, treatment regimens, frequencies, and intensities.

Exergaming is increasingly popular, but its impact on chronic low back pain (CLBP) remain unclear.

To evaluate the effectiveness of exergaming versus traditional exercise for managing CLBP using the International Classification of Functioning, Disability and Health (ICF) framework.

This single-blind, randomized controlled trial included 70 participants with CLBP, who were assigned to either the exergaming or traditional exercise group. Both groups received 2 weeks of treatment with six sessions. Assessments included the Oswestry Disability Index (ODI), range of motion, Hospital Anxiety and Depression Scale (HADS), balance (Biodex Stability System), Fear-Avoidance Beliefs Questionnaire (FABQ), and physical performance tests.

After six sessions over 2 weeks, the exergaming group showed significant improvements over the exercise group in ODI (p < 0.001), chair-rising time (p = 0.001), stair ascent (p = 0.025) and descent times (p < 0.001), flexion (p = 0.005), extension (p = 0.001), balance (p = 0.012), and FABQ subscales (physical activity: p = 0.003; work: p < 0.001) at the 3-month follow-up. Group × time interaction effects favored exergaming for ODI (p = 0.012), chair-rising (p = 0.045), stair ascent (p = 0.010), and descent (p = 0.002) times. While these changes did not meet clinical significance, exergaming was not inferior to traditional exercise in improving spinal motion, physical performance, fear-avoidance beliefs, and disability.

Exergaming appears to be a viable supplementary therapy for patients with CLBP, offering benefits across all ICF domains. Future studies with longer intervention durations are needed to assess its long-term effects.

The US National Institutes of Health (NIH) has produced a minimal data set to promote more accurate and consistent reporting of clinical trials, facilitating easier comparison of research on low back pain patients worldwide. The NIH-minimal dataset has not been previously translated into Turkish, and its features are currently unknown. This study aimed to adapt the NIH-Minimal Data Set into Turkish and investigate its validity and reliability in Turkish-speaking patients with chronic low back pain (CLBP).

In the study, 245 patients with CLBP were included. Test-retest and internal consistency analyzes were performed to evaluate the reliability of the NIH-minimal dataset. The intraclass correlation coefficient (ICC2,1) value was used to assess test-retest analysis. Cronbach's alpha value was calculated for internal consistency. Total impact scores of the NIH-minimal dataset were compared with total scores of the Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) to assess construct validity. The minimal detectable change (MDC95) was calculated based on the standard error of measurement (SEM95).

The NIH-Minimal Data Set was found to have high test-retest reliability (ICC2,1 = 0.928) and high internal consistency (Cronbach α = 0.905). The NIH-minimal dataset correlated well with RMDQ and ODI (r = 0.750 and 0.810, respectively). There were no floor or ceiling effects. Also, SEM95 and MDC95 for the total score were 4.57 and 12.55, respectively.

Considering all these data, it was concluded that the Turkish version of the NIH-minimal dataset is a valid and reliable outcome measure for evaluating patients with CLBP.

Background: Chronic low back pain (LBP) has been associated with intervertebral disc (IVD) degeneration, but its association with abnormal morphology at the discovertebral junction (DVJ) is unclear. The goal of this study was to evaluate the DVJ morphology in asymptomatic (Asx) and symptomatic (Sx) subjects for LBP using ultrashort echo time (UTE) MRI. Methods: We recruited 42 subjects (12 Asx and 32 Sx). Lumbar IVD degeneration was assessed using Pfirrmann grading (1 to 5), while the abnormality of DVJ (0 = normal; 1 = focal; 2 = broad abnormality) was assessed using UTE MRI. The effects of LBP and level on the mean IVD and DVJ grades, the correlation between IVD and DVJ grade, and the effect of LBP and age on the number of abnormal DVJs within a subject were determined. Results: IVD grade was higher in Sx subjects (p = 0.013), varying with disc level (p = 0.033), adjusted for age (p < 0.01). Similarly, DVJ grade was also significantly higher in Sx subjects (p = 0.001), but it did not vary with DVJ level (p = 0.7), adjusted for age (p = 0.5). There was a weak positive (rho = 0.344; p < 0.001) correlation between DVJ and IVD grade. The total number of abnormal DVJs within a subject was higher in Sx subjects (p < 0.001), but not with respect to age (p = 0.6) due to a large spread throughout the age range. Conclusions: These results demonstrate the feasibility of using in vivo UTE MRI of the lumbar spine to evaluate the DVJ and the correlation of DVJ with LBP. This study highlights the need for a better understanding of DVJ pathology and the inclusion of DVJ assessment in routine lumbar MRI.

Multidisciplinary programs are the first recommendation for non-specific chronic low-back pain, but implementing this type of program is complicated to get up and running. The primary aim of this study was to assess the feasibility and appropriateness of the PAINDOC multidisciplinary program for subjects with chronic low-back pain. The secondary objectives were to evaluate the decrease in pain intensity, pain-related disability and pain catastrophizing, as well as the improvement in quality of life with this program. Furthermore, another of the secondary objectives was to calculate the sample size for a future randomized clinical trial.

This study was conducted in a hospital pain unit using two successive recruitment waves. First, the feasibility outcomes (recruitment, completion, and drop-out rates) of a 5-month non-random prospective cohort (n = 227) were recorded. Then, the clinical outcomes (pain intensity, quality of life, disability, and pain catastrophizing) were recorded from a prospective, controlled, two-armed and single-blind feasibility study (ClinicalTrials.gov, NCT05974072). It included 41 participants that were randomly allocated to either the pharmacological treatment (n = 21) arm or PAINDOC program (n = 20) arm.

The recruitment rate was 66%, with the completion rate standing at 80.7% and the drop-out rate at 19.3%. Significant differences and a medium size effect were observed between groups in terms of pain intensity (p = .017, r = .408) at the 4-month follow-up. The intragroup analysis of the PAINDOC group revealed significant lessening in pain intensity (p = < 0.001) and improvements in quality of life (p = .030).

This study showed that the PAINDOC multidisciplinary program is a feasible treatment for patients with non-specific chronic low-back pain. Furthermore, the exploratory results of this study suggest that it could be an effective treatment to reduce pain intensity and improve on self-reported quality of life in these patients, although a future randomized clinical trial is needed to determine its effectiveness.

NCT05974072 (registration date July 11, 2023; retrospectively registered; ClinicalTrials.gov).

This clinical study aimed to assess the effectiveness and safety of Vuong Hoat (VH) natural health supplement for reducing the negative impact of low back pain, improving the quality of life, and enhancing functional activities in patients with lumbar degenerative disc disease (LDD). The open-label, randomized, controlled clinical trial involved 60 patients suffering from low back pain caused by LDD. The participants were randomly assigned to either a study group (SG) comprising 30 subjects or a control group (CG) comprising 30 subjects. Patients in the CG received treatment with electro-acupuncture, while those in the SG were administered VH in conjunction with the same electro-acupuncture protocol for 28 days. The clinical progression and tolerability of both groups were compared based on seven objective measurements: visual analog scale index, Schober test, fingertip-to-floor distance, spinal flexion, spinal extension, spinal tilt, and spinal rotation. After 14 days of treatment, the SG showed a significant improvement in overall outcomes compared to the CG. Specifically, 43.3% of SG patients achieved very good results, 53.3% had good results, and 3.4% had moderate results, whereas corresponding figures for the CG were 6.7%, 76.7%, and 16.6%, respectively (P < .05). After 28 days of treatment, both groups demonstrated a shift toward very good results, with the SG continuing to show better outcomes than the CG (P < .05). In the SG, the very good results increased to 76.7%, good results decreased to 20%, and moderate results were 3.3%. On the other hand, the CG had 46.7% very good results, 43.3% good results, and 10% moderate results. Notably, no side effects were reported from the VH treatments during the study. The findings of this study indicate that VH health supplement is a safe and effective approach for managing low back pain and limited spinal movement in patients with LDD.

The American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Values (TLVs) for lifting provides risk zones for assessing two-handed lifting tasks. This paper describes two computational models for identifying the lifting risk zones using gyroscope information from five inertial measurement units (IMUs) attached to the lifter. Two models were developed: (1) the ratio model using body segment length ratios of the forearm, upper arm, trunk, thigh, and calf segments, and (2) the ratio + length model using actual measurements of the body segments in the ratio model. The models were evaluated using data from 360 lifting trials performed by 10 subjects (5 males and 5 females) with an average age of 51.50 (±9.83) years. The accuracy of the two models was compared against data collected by a laboratory-based motion capture system as a function of 12 ACGIH lifting risk zones and 3 grouped risk zones (low, medium, and high). Results showed that only the ratio + length model provides acceptable estimates of lifting risk with an average of 69% accuracy level for predicting one of the 3 grouped zones and a higher rate of 92% for predicting the high lifting zone.

Chronic low back pain (cLBP) is a global public health problem and a leading cause of disability among older adults. Recent years have seen a burgeoning interest in promoting resilience in individuals with chronic pain; however, therapeutic strategies that focus on positive psychological resources and individual strengths are understudied among older adult populations. The aim of this study was to examine the feasibility and acceptability of a resilience-promoting intervention among older adults with cLBP, and to assess preliminary treatment effects on pain severity, pain interference, and quality of life.

Participants included 50 adults, ages ≥50 years, with back pain rated (at minimum) of moderate intensity and having a significant impact on daily activities. This single-arm trial included seven weekly group sessions targeting positive psychology concepts and techniques that have established benefits in pain management.

Results suggest high credibility and engagement in the intervention program. Participants found the weekly session content to be beneficial and global treatment satisfaction was high. Pain intensity (-4.3 [-6.14, -2.54]), pain interference (-3.3 [-4.83, -1.80]), depression (-1.6 [-3.16, -0.04]) and QoL-health satisfaction (0.3 [0.01, 0.55]) improved from pre- to post-intervention. At the 3-month follow-up, improvements were also observed for pain intensity (-2.1 [-9.29, -5.04]), pain interference (-5.3 [-6.54, -2.86]), and QoL-physical health (0.9 [0.11, 1.74]).

Results support the feasibility, acceptability, and potential efficacy of a resilience intervention for older adults with cLBP. These findings may be a step toward the advancement of therapeutic pain modalities and provide a foundation for future research on resilience-promoting interventions for aging populations with chronic pain.

This study examined the erector spinae contractile properties, trunk isokinetic strength, and differences in acute muscle fatigue response after exercise in young females with and without non-specific chronic low back pain (NSCLBP). This study evaluated participants using tensiomyography and isokinetic trunk strength tests. An independent t-test compared the control group and the NSCLBP group, while a two-way mixed ANOVA analyzed differences in the erector spinae's acute muscle fatigue response before and after exercise within and between groups. The results of the tensiomyography indicated that the NSCLBP group exhibited significantly lower Dm and Vc (p < 0.05) compared to the control group, while Tc showed no significant difference between groups. Significant differences in all variables were observed between the groups in the isokinetic trunk strength test (p < 0.05). Furthermore, the two-way mixed ANOVA revealed significant group main effects in Dm and Vc of the erector spinae (p < 0.05). This study found that non-specific chronic low back pain is linked to a decrease in Dm, Vc, and trunk isokinetic strength in both extensor and flexor muscles. It suggests that future research should further investigate the acute muscle fatigue response in individuals with and without NSCLBP.

Objectives: The aim of this systematic review and meta-analysis was to compare whether osteopathic manipulative treatment (OMT) for somatic dysfunctions was more effective than sham or placebo interventions in improving pain intensity, disability, and quality of life for patients with neck pain (NP) or low-back pain (LBP). Methods: A systematic review and meta-analysis was carried out. Searches were conducted in PubMed, Physiotherapy Evidence Database, Cochrane Library, and Web of Science from inception to September 2024. Studies applying a pragmatic intervention based on the diagnosis of somatic dysfunctions in patients with NP or LBP were included. The methodological quality was assessed with the PEDro scale. The quantitative synthesis was performed using random-effect meta-analysis calculating the standardized mean difference (SMD) with RevMan 5.4. The certainty of evidence was evaluated using GRADEPro. Results: Nine studies were included in the qualitative synthesis, and most of them showed no superior effect of OMTs compared to sham or placebo in any clinical outcome. The quantitative synthesis reported no statistically significant differences for pain intensity (SMD = -0.15; -0.38, 0.08; seven studies; 1173 patients) or disability (SMD = -0.09; -0.25, 0.08; six studies; 1153 patients). The certainty of evidence was downgraded to moderate, low, or very low. Conclusions: The findings of this study reveal that OMT is not superior to sham or placebo for improving pain, disability, and quality of life in patients with NP or LBP.

The costs of low back pain (LBP) are complex and difficult to estimate. This study aims to adapt the Cost for Patients Questionnaire (CoPaQ) for use in LBP populations.

In a cross-sectional qualitative study, we conducted cognitive interviews to assess the CoPaQ's suitability for addressing costs related to LBP. Three groups of participants were included (n = 5 each): (i) persons with a history of LBP or primary caregiver, (ii) researchers with expertise in LBP, and (iii) primary care providers specialized in treating LBP. The interpretation, analysis, and summary of results used Knafl et al.'s qualitative content analysis method.

Persons with a history of LBP (n = 5), had a median age of 60 years (Interquartile Range (IQR): 26-71.5), and varying durations of LBP, the median duration of LBP 7 years (IQR: 4-32.5). Researchers (n = 5) had a median age of 33 years (IQR: 29-45). Primary care providers (n = 5) had a median age of 40 years (IQR: 37.5-65), and a background in chiropractic care (n = 3) and physiotherapy (n = 2). Content analysis of the interviews revealed sources of error with five pre-determined themes (clarity/comprehension, relevance, inadequate response definition, reference point, perspective modifiers) and one developed theme (organization). We modified the questionnaire for LBP populations based on the feedback.

Our study evaluated the content validity of a questionnaire that assesses the direct and indirect costs associated with LBP. Future studies should pilot this questionnaire with persons of varying LBP severity and compare it with cost diaries.

The Oswestry disability index (ODI) is widely utilized as a patient reported outcome (PRO) tool to assess patients presenting with low back pain (LBP) and following thoracolumbar spine surgery. No primary study has calculated the baseline range of ODI values in the diverse American population. Establishing age-adjusted normative values for ODI in the American population is crucial for assessing the utility of treatment strategies.

The purpose of this study is to describe the baseline range of functional low back disability as measured by the ODI in an American population.

Cross-sectional observational study.

A total of 1214 participants were recruited from the United States in January 2024 using a combination of the Connect and PrimePanel platforms by CloudResearch to complete a survey administered on a RedCap online database. The survey consisted of 10 demographic questions and the 10 ODI survey questions. The distribution of the survey was designed to obtain approximately 100 respondents in each of the following age groups: 18-29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, 70 to 79, and 80 to 89. The distribution of the sample was similarly designed to match the United States Census racial data with 78.1% White, 13.9% Black, and 7.9% other.

Oswestry disability index (ODI).

A crowd-sourcing platform called Cloudresearch was used to collect a representative sample of the US population by answering questions of the Oswestry disability questionnaire (ODQ), a 10-question survey.

The final sample size was 797 participants including 386 (48.4%) males and 411 (51.6%) females; 169 participants were excluded that did not complete the survey and an additional 248 were excluded for failing attention check questions. The overall mean ODI score for the combined age groups was 14.35 (95% CI [13.33, 15.37]). The mean ODI scores increased with age, with the highest mean ODI in ages 70 to 79 at 18.0 (95% CI [14.76, 21.24]). Female participants reported higher mean ODI scores than their male counterparts in the 18 to 29 age group (p=.01), 50 to 59 age group (p=.01), and 60 to 69 age group (p=.02). Additionally, a weak positive correlation was found between Body Mass Index (BMI) and ODI scores (r = 0.22, p<.001).

Our findings demonstrate a clear trend of increased disability with age. This study describes the baseline range of functional low back pain disability in the United States population. By defining these parameters, healthcare professionals can better tailor age and sex-specific interventions to manage disability in the aging US population, ultimately improving patient care and both operative and nonoperative treatment plans for LBP-related thoracolumbar pathology.

Chronic low back pain (CLBP) is a common musculoskeletal disorder. Effect of massage in the management of CLBP has been documented, but it is not clear which massage regimen is more effective. This study was carried out to compare the effect of connective tissue massage and classical massage on pain, lumbar mobility, function, disability, and well-being among patients with CLBP.

The study included 30 participants who were randomly assigned to one of three intervention groups: the connective tissue massage group (CTMG; n = 10), the classical massage group (CMG; n = 10), and a standard physiotherapy/control group (CG; n = 10). The interventions were administered three times a week for four consecutive weeks. Assessments were conducted at baseline and at the end of the fourth week. Pain severity (Visual Analog Scale), lumbar mobility (Modified Schober Test), function (Back Pain Functional Scale), disability (Roland Morris Disability Questionnaire), and well-being (Short Form-36/SF-36) was evaluated.

All groups exhibited improvements in pain, lumbar mobility, function, and disability after 4 weeks (p < 0.05). The CMG showed enhancements in physical function, bodily pain, role physical, and role emotional subgroups of SF-36. The CTMG demonstrated improvements in all subgroups of SF-36 except general health (p < 0.05), while the CG only improved in the physical function subgroup (p < 0.05). A 2-way repeated measures ANOVA revealed a significant group-time interaction for MST (p = 0.04), Bodily Pain (p = 0.025) and Role Physical (p = 0.015).

The findings obtained from this study showed that CTMG was superior to CMG and CG in increasing lumbar mobility, and both massage applications were superior to the CG in increasing the well-being.

Chronic low back pain (CLBP) negatively impacts quality of life and contributes to a significant economic burden. One conservative management strategy for CLBP is lumbar back bracing. Despite the benefits of back bracing for improving pain and function, there remains hesitance to use the therapy long term due to unfounded fear related to muscle weakness, deconditioning, or joint contracture.

The purpose of this study was to examine the outcomes for patients with CLBP who were managed with lumbar back bracing and physical therapy.

This was a single-site, retrospective chart review.

Patients were included in the study if they were treated for CLBP with back bracing for at least one hour daily and physical therapy for twelve weeks. Pain was assessed at three, six, and twelve months using the 11-point Visual Analogue Scale (VAS). Function was assessed at three months using the Oswestry Disability Index (ODI). The VAS score reduced from 6.28 +/- 2.32 to 3.96 +/- 2.66 at three months (p < 0.001) for 198 patients. At six and twelve months, the VAS score reduced to 3.74 +/- 2.73 (p < 0.001) and 3.23 +/- 2.29 (p < 0.001), respectively. The total ODI score for 199 patients improved from 46.56 +/- 15.30 to 33.13 +/- 19.99 (p < 0.001) at three months.

Back bracing in combination with physical therapy is effective for treating low back pain.

Work-related musculoskeletal disorders represent a major public health problem, contributing significantly to the global burden of disability-adjusted life years and affecting the quality of life of all population groups. The main problem in most musculoskeletal disorders is low back pain. Therefore, our study aims to identify the overall prevalence of work-related low back pain among the working population in sub-Saharan Africa.

Research published between 2010 and 2023 in English, conducted in Sub-Saharan Africa was included in this systematic review and meta-analysis. Using Boolean logic operators and targeted keywords, we searched for publications on a number of electronic databases (Web of Science, PubMed, Google Scholar, African Journals Online (AJOL), and Science Direct). The Joanna Briggs Institute Critical Appraisal techniques were utilized to conduct a quality assessment of the papers and ascertain their relevance to the study. The degree of heterogeneity among the included studies, the 95% confidence interval, and the pooled prevalence were estimated using a random effects model. Sensitivity studies were carried out to determine the causes of heterogeneity and the impact of outliers.

In this study, a total of 970 articles were retrieved, and 35 studies were included in the systematic review and meta-analysis. The overall estimated pooled prevalence of low back pain among the working population in sub-Saharan Africa was (55.05% [95% CI: 49.34, 60.76]). Based on a sub-group analysis by countries, the higher pooled prevalence of low back pain was found in Uganda at (61.48% [95% CI: 40.39, 82.57]), while the lower pooled prevalence of low back pain was in Ghana at (34.48% [95% CI: 17.96, 51.01]).

This systematic review and meta-analysis found that 55.05% of the included study participants experienced low back pain in the previous years. Therefore, it is recommended that policymakers incorporate and enhance strategies for the prevention and management of low back pain within the health system management guidelines of each country.

Spinal adhesive arachnoidopathy (SAA) is a chronic pathology associated with persistent inflammatory responses in the arachnoid. Adhesive arachnoiditis (AA) is one of the major forms of SAA, with accompanying secondary complications. Therefore, we aimed to systematically review both clinical and animal model studies related to SAA to gain a deeper understanding of this unique pathology.

A literature search was conducted in PubMed, EMBASE, and Cochrane Library databases to retrieve relevant publications up to October 2022. Clinical manifestations, etiologies, imaging modalities, treatments, and prognosis in patients with SAA were collected. Data from animal experiments related to SAA were also extracted.

A total of 176 studies, including 147 clinical and 29 animal model studies, with a total of 510 patients were enrolled in this study. Pain (37.5%), abnormal nerve sensations (39.58%), and abnormal motor function (78.75%) were the top three common symptoms of SAA. Major etiologies included trauma (22.7%), infection (17.73%), surgery (15.37%), and hemorrhage (13.48%). MRI was widely used to confirm the diagnosis. AA could be involved in cervical (96/606, 15.84%), thoracic (297/606, 49.01%), lumbar (174/606, 28.71%), and sacrococcygeal (39/606, 6.44%) vertebral segments. Patients with AA in cervical segments had a higher post-surgery recovery rate (p = 0.016) compared to that of other segments. The common pathological diagnoses of SAA were AA (80.82%), AA combined with arachnoid cyst (12.79%), arachnoid calcification/scars (3.43%), and arachnoid web/fibrosis (2.97%). Patients with AA were more likely to develop syringomyelia, compared with patients with other forms of SAA (p < 0.001). Animal studies mainly focused on new AA therapeutic agents (n = 14), the pathomechanism of AA (n = 14), and the development of new MRI sequences for improved diagnosis (n = 1).

The pathological consequences of SAA are more complex than AA and manifest in different forms, such as AA combined with arachnoid cyst, arachnoid calcification/scars, and arachnoid web/fibrosis. In many instances, AA was associated with secondary syringomyelia. Unspecific clinical manifestations of SAA may easily lead to misdiagnosis and missed diagnosis. Although SAA may result from multiple etiologies, including spinal trauma, meningitis, spinal surgery, and hemorrhage, the pathogenesis and treatment of SAA have still not been standardized.

This study aimed to evaluate the prospective associations of baseline personal characteristics with utilization frequency and expenditure of chiropractic care in US adults (≥18 years).

Data are from the 1358 respondents to the 2014 to 2016 Medical Expenditure Panel Survey who utilized chiropractic care. Individual, familial, health-related, and behavioral factors were included as covariates in the multivariate analytic model. Poisson and multinominal logistic regressions were modeled to examine the associations between the predictors and chiropractic utilization and expenditure.

The mean annual number of visits was 8.2 visits (95% confidence interval [CI]: 7.9, 8.5), with annual expenditure of $677.43 U.S. dollars (95% CI: $595.47-$759.39) and $84.84 (95% CI: $77.89-$91.78) per visit. Female sex was associated with a 19% higher number of visits (rate ratio [RR] = 1.19, 95% CI: 1.01, 1.41) than males. Publicly insured and uninsured were associated with a 44% higher (RR = 1.44, 95% CI: 1.14, 1.82) and 36% lower (RR = 0.64, 95% CI: 0.48, 0.86) visit frequency, respectively, than those privately insured. Rheumatoid arthritis was associated with 7.38 times the risk of high expenditure (95% CI: 2.61, 24.67) than medium expenditure, compared to no arthritis. Relative to physically active individuals, physical inactivity was associated with a 27% higher visit frequency (RR = 1.27, 95% CI: 1.09, 1.49) and an 82% higher risk (relative risk ratio = 1.82, 95% CI: 1.05, 3.14) of high expenditure than low expenditure.

This analysis found distinct usage and expenditure patterns that vary according to specific baseline predictors. Female sex, being publicly insured, having rheumatoid arthritis, and physically inactive were associated with variance in expenditure. Results from this study may help identify chiropractic patients with tendencies for higher utilization or spending and may indirectly assist in predicting patients with slower response to care.

Chronic low back pain (cLBP) is characterized by biopsychosocial determinants that collectively result in a substantial burden at the individual, community, and health care system levels. A growing body of literature suggests that childhood adversity is longitudinally associated with the development and maintenance of various chronic pain conditions in adulthood. Little research has investigated the psychological processes that might underlie the association between adverse childhood experiences (ACEs) and cLBP. Emotion regulation comprises a substantive part of the subjective experience of pain and may be a potential mechanism through which ACEs contribute to cLBP etiology and maintenance. Thus, the current study examined the extent to which emotion dysregulation mediated the relationship between ACEs and pain severity (pain at rest and movement-evoked pain) in adults with cLBP. Participants included 183 adults (53.0% female, 62.5% non-Hispanic Black) between the ages of 18 and 85 with cLBP. Participants self-reported on ACEs, pain, difficulties in emotion regulation (DER), depression, and completed brief physical function tasks. In data analytic models, sociodemographic variables were included as covariates. Analyses revealed that emotion regulation mediated the relationship between ACEs and cLBP severity at rest (indirect effect = .15 [95% CI {.06-.25}]) and with movement (indirect effect = 1.50 [95% CI {.69-2.57}]). Findings suggest ACEs are linked to cLBP severity in adulthood through DER. This aligns with research demonstrating that childhood maltreatment can lead to DER, which perpetuate over the lifespan to impact adult health outcomes. PERSPECTIVE: This study presents emotion dysregulation as a psychological pathway through which childhood adversity may contribute to cLBP in adulthood. This work may bolster our understanding of social experiences as risk factors for chronic pain, while identifying targets for clinical intervention. TRIAL REGISTRATION: This study utilized baseline data collected as part of a parent trial titled "Examining Racial and SocioEconomic Disparities in Chronic Low Back Pain" (ClinicalTrials.gov ID: NCT03338192).

Low back pain (LBP) is a common condition affecting up to 84% of people in their lifetime, with a prevalence of 11.9% and a high recurrence rate within the first year. Furthermore, chronic low back pain syndrome has been described in up to 7%, making it a significant health and socioeconomic problem. Among nonoperative treatment options, the recently used focused extracorporeal shockwave therapy (ESWT) devices generate waves that converge at a precise depth in the body, thereby revealing the potential to affect pathology remotely from the contact surface. The article aims to present a systematic literature review with a critical discussion on treating low back pain using this modality.

A search for randomized controlled trials (RCT) of focused ESWT for low back pain published before April 1, 2024, in PubMed, Web of Science, Scopus, Google Scholar, and trial registries (WHO International Clinical Trials Registry Platform and ClinicaTrials.gov) was performed.

Only three studies against conservative treatment comprising 94 patients met the selection criteria and were further analyzed. Comparative clinical studies regarding the effectiveness of radial and focused ESWT for low back pain were missing. The results revealed that all treated patients had significantly reduced pain and improved functional impairment immediately after the procedures and 1 month later. At the third month time point, the pain levels remained better in the experimental than in the control group without achieving statistical significance. None of the studies had a long-term follow-up.

Focused ESWT is a modern physiotherapeutic method that can potentially treat a broad spectrum of conditions responsible for low back pain. Despite the small number of low-evidence studies, there is sufficient data on the effectiveness and safety of this therapeutic modality. With future well-designed trials, the bias risks would be diminished, the indications for its use would expand, and the treatment protocols would be clarified.

Chronic pain rehabilitation helps to reduce pain and restore valued life roles. Patients may have more positive outcomes when they perceive rehabilitation to be personally meaningful. This study examined associations between self-reported, personally meaningful rehabilitation and well-being. A pilot study was conducted using an online survey of people with chronic pain and experiences of rehabilitation. The PROMIS Pain Interference Short Form 8a and The Flourishing Scale were used to explore well-being. A modified self-report measure, the Meaningfulness in Rehabilitation Scale, was pilot-tested for construct validity and used in the survey. Of the 48 participants (81% female; 19% male), most attended a generalist therapy practice (62%) once per week (33%) or once per fortnight (29%). No statistically significant relationship was found between self-reported meaningfulness in rehabilitation and pain interference or other patient and therapy characteristics (duration of chronic pain category, type of therapy practice, resolution of rehabilitation category, and frequency of appointments). The nonparametric analysis identified a statistically significant moderate positive correlation between self-reported meaningfulness in rehabilitation and the flourishing aspect of well-being. This raises important questions and suggests that patients' perception of rehabilitation as meaningful warrants further research. This pilot study provides valuable guidance to inform a larger investigation.

To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-specific low back pain.

Randomised placebo-controlled study with three intervention groups.

The patients recruited for this study were sent for physiotherapy treatment at primary care between May and July 2022.

Eighty-one patients with chronic non-specific low back pain aged 18-80 years with pain for ≥3 months and pain intensity ≥3 were randomly recruited for the study.

The patients received a single intervention of radial shockwave therapy with 2000 discharges at 100 mJ energy and 5 Hz frequency using concave or convex tips or placebo treatment.

The primary outcome was pain intensity immediately post-intervention. The secondary outcomes were pressure pain threshold, temporal summation of pain, and functional performance. Data were collected at baseline and post-intervention.

The post-intervention pain intensity in the concave tip group is an average of two points lower (95% CI = -3.6, -0.4; p < 0.01) than that in the placebo group. The post-intervention pressure pain threshold for the concave tip group was an average of 62.8 kPa higher (95% CI = 0.4, 125.1; p < 0.05) than for the convex tip group and 76.4 kPa higher (95% CI = 14, 138.7; p < 0.01) than in the placebo group.

The concave tip shockwave therapy is effective in reducing pain and local hyperalgesia in patients with chronic non-specific low back pain.

Though pain sensitivity impairments contribute to chronic pain in younger adults, it is unclear if pain hypersensitivity manifests with aging and is heightened in the geriatric chronic low back pain population. The cross-sectional study preliminarily addressed this gap by measuring pain sensitivity in older adults with chronic low back pain (n = 25) as well as pain-free sex-matched older (n = 25) and younger adults (n = 25). Pain sensitivity was quantified by 8 distinct measures that were subdivided as static (ie, pressure pain thresholds, heat pain thresholds, fixed mechanical pain, and fixed cold pain) and dynamic pain sensitivity (ie, mechanical temporal summation, thermal ramp and hold, heat pain aftersensations, and conditioned pain modulation). Test-retest reliability values for pain sensitivity ranged from moderate to excellent (intraclass correlation coefficients ≥ .500; p's < .05). The main effect for the group was significant (partial η2 = .413, P < .001), revealing between-group differences in pain sensitivity on 5 out of 8 tests (p's ≤ .043). Predominantly, both older adult groups demonstrated increased pain facilitation and decreased pain inhibition during dynamic pain sensitivity testing compared to pain-free younger adults (p's ≤ .044). Despite qualitative differences, static and dynamic pain sensitivity responses were statistically similar between older adults with and without chronic LBP (p's > .05). Findings suggest pain sensitivity can be reliably measured in older adults and that pain hypersensitivity develops with chronological aging, providing partial support for the theory that pain hypersensitivity may impact geriatric chronic pain populations. Further study is needed to more definitively parse out whether pain hypersensitivity is comparatively heightened in older adults with chronic LBP beyond the influence of chronological aging. PERSPECTIVE: This article establishes that surrogate measures of centrally mediated pain sensitization are heightened with aging. Impaired endogenous pain modulation may influence chronic pain development, maintenance, treatment efficacy, and/or ensuing disability, necessitating research to comprehensively characterize how pain hypersensitivity contributes to geriatric chronic pain conditions.

Knowledge of the factors affecting pain intensity and pain sensitivity can inform treatment targets and strategies aimed at personalizing the intervention, conceivably increasing its positive impact on patients. Therefore, this study aimed to investigate the association between demographic factors (sex and age), body mass index (BMI), psychological factors (anxiety and depression, kinesiophobia and catastrophizing), self-reported physical activity, pain phenotype (symptoms of central sensitization, and nociceptive or neuropathic pain), history of COVID-19 and pain intensity and sensitivity in patients with chronic non-specific low back pain (LBP).

This was a cross-sectional secondary analysis with 83 participants with chronic non-specific LBP recruited from the community between August 2021 and April 2022. BMI, pain intensity (Visual Analog Scale), pain sensitivity at the lower back and at a distant point [pressure pain threshold], catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia), anxiety and depression (Hospital Anxiety and Depression Scale), pain phenotype (Central Sensitization Inventory and PainDetect Questionnaire), physical activity (International Physical Activity Questionnaire), and disability (Roland Morris Disability Questionnaire) were assessed. Multiple linear regression analyses with pain intensity and sensitivity as the dependent variables were used.

The model for pain intensity explained 34% of its variance (Adjusted R2 = -0.343, p < 0.001), with depression and anxiety (p = 0.008) and disability (p = 0.035) reaching statistical significance. The model for pain sensitivity at the lower back, also explained 34% of its variance (Adjusted R2 = 0.344, p < 0.001) at the lower back with sex, BMI, and kinesiophobia reaching statistical significance (p < 0.05) and 15% of the variance at a distant body site (Adjusted R2 = 0.148, p = 0.018) with sex and BMI reaching statistical significance (p < 0.05).

This study found that different factors are associated with pain intensity and pain sensitivity in individuals with LBP. Increased pain intensity was associated with higher levels of anxiety and depression and disability and increased pain sensitivity was associated with being a female, higher kinesiophobia, and lower BMI.

Chronic low back pain (cLBP) is a global health crisis that disproportionately burdens non-Hispanic Black (NHB) individuals, compared with those who identify as non-Hispanic White (NHW). Despite the growing personal and societal impact of cLBP, its biological underpinnings remain poorly understood. To elucidate the biological factors that underlie the racial disparities in cLBP, this study sought to determine whether inflammatory mediators associated with pain interference (PI), pain at rest (PAR), and movement-evoked pain (MEP) differ as a function of racial identity. Blood samples were collected from 156 individuals with cLBP (n = 98 NHB participants, n = 58 NHW participants). Enzyme-linked immunosorbent assay and multiplex assays were used to quantify concentrations of proinflammatory (fibrinogen, C-reactive protein [CRP], serum amyloid A, tumor necrosis factor α [TNF-α], and interleukin [IL]-1α, IL-1β, and IL-6) and anti-inflammatory markers (IL-4 and IL-13). Spearman rho correlations were used to assess associations among markers of inflammation and PI, PAR, and MEP using the Brief Pain Inventory-Short Form. Analyses revealed that for NHW patients, CRP, serum amyloid A, and IL-6 were positively associated with cLBP outcomes and IL-4 was inversely associated with PAR and MEP. However, for NHB patients, only IL-1α was positively associated with PAR. Our findings suggest that, while there are associations between inflammation and cLBP outcomes, the biomarkers that underlie the inflammation could very well differ as a function of racialized minority group. However, more research with racially inclusive samples is needed to elucidate the mechanisms that may contribute to racial disparities in cLBP.

To assess individual- and neighborhood-level sociodemographic factors associating with providers' ordering of nonpharmacologic treatments for patients with low back pain (LBP), specifically physical therapy, image-guided interventions, and lumbar surgery.

Our cohort included all patients diagnosed with LBP from 2000 to 2017 in a statewide database of all hospitals and ambulatory surgical facilities within Utah. We compared sociodemographic and clinical characteristics of (1) patients with LBP who received any treatment with those who received none and (2) patients with LBP who received invasive LBP treatments with those who only received noninvasive LBP treatments using the Student's t test, Wilcoxon's rank-sum tests, and Pearson's χ2 tests, as applicable, and two separate multivariate logistic regression models: (1) to determine whether sociodemographic characteristics were risk factors for receiving any LBP treatments and (2) risk factors for receiving invasive LBP treatments.

Individuals in the most disadvantaged neighborhoods were less likely to receive any nonpharmacologic treatment orders (odds ratio [OR] 0.74 for most disadvantaged, P < .001) and received fewer invasive therapies (0.92, P = .018). Individual-level characteristics correlating with lower rates of treatment orders were female sex, Native Hawaiian or other Pacific Islander race (OR 0.50, P < .001), Hispanic ethnicity (OR 0.77, P < .001), single or unmarried status (OR 0.69, P < .001), and no insurance or self-pay (OR 0.07, P < .001).

Neighborhood and individual sociodemographic variables associated with treatment orders for LBP with Area Deprivation Index, sex, race or ethnicity, insurance, and marital status associating with receipt of any treatment, as well as more invasive image-guided interventions and surgery.

Lumbar facet pain is generally considered to be one of the major causes of chronic low back pain. Each lumbar facet joint is innervated by the medial branch of the posterior spinal nerve from its own level and above. Radiofrequency (RF) of the medial branch of the posterior branch of the spinal nerve is an effective method for the treatment of lumbar facet pain. RF technology is diverse, including traditional radiofrequency (TRF), pulsed radiofrequency (PRF), cooled radiofrequency (CRF), low-temperature plasma radiofrequency ablation (CA), and other treatment methods. The purpose of this paper is to compare the efficacy of different radiofrequency techniques and to analyze the reasons for this in the context of anatomy.

There have been studies confirming the differences in efficacy of different RF techniques. However, most of the studies only compared two RF techniques, not four techniques, TRF, CRF, PRF, and CA, and did not analyze the reasons for the differences in efficacy. This article reviews the differences in the efficacy of the above four RF techniques, clarifies that the differences are mainly due to the inability to precisely localize the medial branch of the posterior branch of the spinal nerve, analyzes the reasons for the inability to precisely localize the posterior branch of the spinal nerve in conjunction with anatomy, and proposes that the development of RF technology for lumbar facet pain requires more in-depth anatomical, imaging, and clinical studies.

There is little information about predictors of physical therapy (PT) use among injured workers with back pain. The primary objective of this study is to investigate the associations between PT use and baseline factors not routinely captured in workers' compensation (WC) data.

We conducted a secondary analysis using the Washington State Workers' Compensation Disability Risk Identification Study Cohort, which combines self-reported surveys with claims data from the Washington State Department of Labor and Industries State Fund. Workers with an accepted or provisional WC claim for back injury between June 2002 and April 2004 were eligible. Baseline factors for PT use were selected from six domains (socio-demographic, pain and function, psychosocial, clinical, health behaviors, and employment-related). The outcome was a binary measure for PT use within 1 year of injury. Bivariate and multivariable logistic regression models were conducted to evaluate the associations between PT use and baseline factors.

Among the 1370 eligible study participants, we identified 673 (49%) who received at least one PT service. Baseline factors from five of the six domains (all but health behaviors) were associated with PT use, including gender, income, pain and function measures, injury severity rating, catastrophizing, recovery expectations, fear avoidance, mental health score, body mass index, first provider seen for injury, previous injury, and several work-related factors.

We identify baseline factors that are associated with PT use, which may be useful in addressing disparities in access to care for injured workers with back pain in a WC system.

Back pain is a common health problem that affects both workers and older people, reducing their quality of life. The primary objective was to assess the effect of dietary supplementation with plant extracts of rosemary, ashwagandha, and sesame consumed for 12 weeks on the intensity of back pain.

A single-center randomized double-blind study with three parallel arms depending on the product consumed. The duration of treatment was 12 weeks. The investigational product, Berelief®, contained a blend of three polyphenolic standardized extracts: rosemary (Rosmarinus officinalis L.), ashwagandha (Withania somnifera L.), and sesame (Sesamum indicum L.) seed. Two doses were tested: low dose (400 mg) and high dose (800 mg). There were 42 subjects in the placebo group, 39 in the low dose and 42 in the high dose groups. Study variables included back pain intensity [VAS score, Patient-Reported Outcomes Measurement Information System (PROMIS-29), and Cornell Musculoskeletal Discomfort Questionnaire; functionality Roland-Morris Disability (RMD) questionnaire]; quality of life (QoL) [36-item Short Form Survey (SF-36), the Beck Depression Inventory-II (BDI-II), the State-Trait Anxiety Inventory (STAI), and the Perceived Stress Scale (PSS)]; sleep quality [accelerometer and Pittsburgh Sleep Quality Index (PSQI)].

The improvement in back pain recorded by the visual analogue scale (VAS) at the study visits after the beginning of treatment, as well as on a weekly basis recorded in the diary card was significantly higher in the intervention group than in the placebo group (p < 0.044 dose-low; p < 0.005 dose-high). Significant differences in pain intensity of the PROMIS-29 (p = 0.002) and upper back pain in the Cornell questionnaire (p = 0.011) in favour of the investigational product were found. Furthermore, benefits in improving health-related quality of life, mood and sleep quality were also detected.

Dietary supplementation for 12 weeks of a blend of polyphenolic standardized extracts of rosemary, ashwagandha, and sesame was effective in reducing the intensity of pain in subjects with chronic myofascial cervical and back pain.

Chronic lower back pain is a leading cause of disability and healthcare spending worldwide. Discogenic pain, pain originating from the intervertebral disk, is a common etiology of chronic lower back pain. Currently, accepted treatments for chronic discogenic pain focus only on the management of symptoms, such as pain. There are no approved treatments that stop or reverse degenerating intervertebral discs. Biologic therapies promoting disc regeneration have been developed to expand treatment options. VIADISC™ NP, is a viable disc allograft supplementation that, in a recent trial, demonstrated a significant reduction in pain and increased function in patients suffering from symptomatic degenerative disc disease.

This manuscript summarizes the epidemiology and etiology of low back pain, the pathophysiology of degenerative disc disease, current treatments, and a need for newer therapies. The rationale behind intradiscal biologics for the treatment of symptomatic degenerative disc disease is also discussed.

Characterization of the biology leading to disc degeneration has allowed for the development of intradiscal biologics. They may soon be capable of preventing and reversing disc degeneration. Clinical trials have shown promise, but further research into efficacy and safety is needed before these therapies are widely employed.

Low back pain derived from intervertebral disc (IVD) degeneration is a debilitating spinal condition that, despite its prevalence, does not have any intermediary guidelines for pharmacological treatment between palliative care and invasive surgery. The development of treatments for the IVD is complicated by the variety of resident cell types needed to maintain the regionally distinct structural properties of the IVD that permit the safe, complex motions of the spine. Osteoporosis of the spine increases the risk of vertebral bone fracture that can increase the incidence of back pain. Fortunately, there are a variety of pharmacological treatments for osteoporosis that target osteoblasts, osteoclasts and/or osteocytes to build bone and prevent vertebral fracture. Of particular note, clinical and preclinical studies suggest that commonly prescribed osteoporosis drugs like bisphosphonates, intermittent parathyroid hormone, anti-sclerostin antibody, selective estrogen receptor modulators and anti-receptor activator of nuclear factor-kappa B ligand inhibitor denosumab may also relieve back pain. Here, we cite clinical and preclinical studies and include unpublished data to support the argument that a subset of these therapeutics for osteoporosis may alleviate low back pain by also targeting the IVD.

The research carried out is a large research project that examined two different massage methods on many variables so that they can determine their effect on variables on a wider scale, namely pain, range of movement (ROM), and low back function. Pain and ROM variables have been published in different journals, and their acute effects are only known after treatment and the results are effective. This study examined the low back function variable 24, 48, and 72 hours after treatment.

This study aimed to determine the effectiveness of Tepurak and deep tissue massaging with stretching (DTMS) on low back function in nonspecific low back pain (NSLBP) and conduct a comparison of the effectiveness of Tepurak versus DTMS for low back function in NSLBP.

This research is a quasi-experiment using a pre-test/post-test design to determine the difference in scores before and after treatment. The variable measured involved the low back function using the Oswestry Disability Index. Measurements were carried out four times at pre-test, 24, 48, and 72 hours after the treatments. This study used two different sample groups. The research sample consisted of 42 NSLBP sufferers who were randomly divided into two groups, A and B. Group A received Tepurak treatment, while Group B received DTMS treatment. These treatments were carried out in one treatment session.

The results of the different treatments for the low back function variables in the Tepurak treatment have a p-value of 0.000. The results of the low back function variables in the DTMS treatment have a p-value of 0.000. The results of the comparison test of Tepurak versus DTMS therapy for the low back function variable had a p-value of 0.771.

Both Tepurak and DTMS are effective in improving low back function in NSLBP cases. In comparison between Tepurak and DTMS, there was no significant difference in the effectiveness in improving low back function in NSLBP cases.

Low back pain (LBP) is the number one cause of disability worldwide; however, it is not clear how social determinants of health (SDOH) impact care management and outcomes related to physical therapy (PT) services for patients with LBP.

The purposes of this scoping review are to examine and assimilate the literature on how SDOH and PT care relate to non-specific LBP outcomes and identify gaps in the literature to target for future research.

Data were extracted from eight electronic databases from January 2011 to February 2022. Reviewers independently screened all studies using the PRISMA extension for scoping review guidelines. Data related to study design, type of PT, type of non-specific LBP, patient demographics, PT intervention, SDOH, and PT outcomes were extracted from the articles.

A total of 30,523 studies were screened, with 1961 articles undergoing full text review. Ultimately, 76 articles were identified for inclusion. Sex and age were the most frequent SDOH examined (88% and 78% respectively) followed by education level (18%). Approximately half of the studies that examined age, sex, and education level identified no effect on outcomes. The number of studies examining other factors was small and the types of outcomes evaluated were variable, which limited the ability to pool results.

Sex and age were the most frequent SDOH examined followed by education level. Other factors were evaluated less frequently, making it difficult to draw conclusions. Study design and heterogeneity of determinants and outcomes were barriers to examining the potential impact on patients with LBP.