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Latest & greatest articles for low back pain
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LowBackPain in the Emergency Department: Prevalence of Serious Spinal Pathologies and Diagnostic Accuracy of Red Flags - A Systematic Review Very little evidence is available on the prevalence of serious spinal pathologies and the diagnostic accuracy of red flags in patients presenting to the emergency department (ED). This systematic review aims to investigate the prevalence of serious spinal pathologies and the diagnostic accuracy of red flags in patients presenting with lowbackpain
No difference in pressure pain threshold and temporal summation after lumbar spinal manipulation compared to sham: A randomised controlled trial in adults with lowbackpain. Changes in quantitative sensory tests have been observed after spinal manipulative therapy (SMT), particularly in pressure pain thresholds (PPT) and temporal summation (TS). However, a recent systematic review comparing SMT to sham found no significant difference in PPT in patients with musculoskeletal pain. The sham (...) -controlled studies were generally low quality, and conclusions about other quantitative sensory tests could not be made.We aimed to perform a sham-controlled study with the specific objective of investigating changes in PPT and TS short-term after lumbar SMT compared to sham manipulation in people with lowback pain.This was a double-blind randomised controlled trial comparing high-velocity low-amplitude lumbar SMT against sham manipulation in participants with lowbackpain. Primary outcome measures
Clinical research on lumbar oblique-pulling manipulation in combination with sling exercise therapy for patients with chronic nonspecific lowbackpain. To investigate clinical curative effects of lumbar oblique-pulling manipulation in combination with sling-exercise-therapy training on chronic nonspecific lower back pain.A total of 60 patients with chronic nonspecific lower backpain in the Outpatient Department were included in this study. These patients were randomly divided into two groups
Comparison of intravenous NSAIDs and trigger point injection for lowbackpain in ED: A prospective randomized study Lowbackpain (LBP) is a common complaint originating from muscles Myofascial pain syndrome (MPS) is mainly associated with trigger points (TrP) in the muscle tissue. We compared the intravenously administered non-steroidal anti-inflammatory drug (NSAID) and trigger point injection (TPI) in the treatment of LBP patients admitted to the emergency department due to pain caused (...) by TrPs.After randomization, NSAID was administered intravenously in group 1 and TPIs were performed as specified by Travell and Simons in group 2. The TrPs were identified with the anamnesis and physical examination Demographic characteristics and vital signs of the patients were recorded. Pain scores were measured with the Visual Analogue Scale (VAS) at admission; and in minutes 5, 10, 15, 30, and 60.There were 32 patients in group 1 and 22 patients in group 2. The demographics, vital signs, and pain
Using Public Cost Information During LowBackPain Visits: A Qualitative Study. Patients desire information about health care costs because they are increasingly responsible for these costs. Public Web sites that offer cost information could inform provider-patient discussions of costs at the point of care.To evaluate tools to facilitate the use of publicly available cost information during clinical visits for lowbackpain (LBP).Qualitative study using individual and group interviews (...) . In contrast, patients valued cost conversations and found the tools useful, and over one half reported intending to use CompareMaine.org during future care decisions.Generalizability was limited by the small number of practices and participants. Lower-than-anticipated participation precluded examination of the effect of the tool on the frequency of cost-of-care conversations.This multicomponent intervention to introduce publicly reported cost information into LBP clinical discussions had low provider
Randomized Trial of Sacroiliac Joint Arthrodesis Compared with Conservative Management for Chronic LowBackPain Attributed to the Sacroiliac Joint Sacroiliac joint pain is increasingly recognized as a cause of lowbackpain. We compared the safety and effectiveness of minimally invasive sacroiliac joint arthrodesis using triangular titanium implants and conservative management in patients with chronic sacroiliac joint pain.This study was a prospective, multicenter randomized controlled trial (...) of adults with chronic sacroiliac joint pain assigned to either conservative management or sacroiliac joint arthrodesis with triangular titanium implants. The study end points included self-rated lowbackpain (visual analog scale [VAS]), back dysfunction (Oswestry Disability Index [ODI]), and quality of life. Ninety percent of subjects in both groups completed the study.Between June 6, 2013, and May 15, 2015, 103 subjects were randomly assigned to conservative management (n = 51) or sacroiliac joint
Are opioids effective in the treatment of chronic lowbackpain? Are Opioids Effective in the Treatment of Chronic LowBackPain? – Clinical Correlations Search Are Opioids Effective in the Treatment of Chronic LowBackPain? April 17, 2019 4 min read By Anna Hirsch Peer Reviewed The use of opioid medications for chronic lowbackpain, or for any chronic non-cancer pain complaint, is still a source of controversy in the medical community, with a large divide between the recommendations (...) for these figures comes from the National Health and Nutritional Examination Survey, in which 14.5% of . 5 Previously, the best evidence to support the use of opioids for chronic lowbackpain–and the evidence on which the three organizations based their recommendations–came from a few dozen short-term randomized controlled trials comparing the use of opioids against placebo for the treatment of backpain. A meta-analysis published in 2016 in JAMA Internal Medicine analyzed the results from 13 of these trials
Treatment Effect Sizes of Mechanical Diagnosis and Therapy for Pain and Disability in Patients With LowBackPain: A Systematic Review Mechanical Diagnosis and Therapy (MDT) is a treatment-based classification system founded on 3 core principles: classification into diagnostic syndromes, classification-based intervention, and appropriate application of force. Many randomized controlled trials have investigated the efficacy of MDT for lowbackpain; however, results have varied. The inconsistent (...) delivery of MDT across trials may explain the different findings.To compare treatment effect sizes for pain or disability between trials that delivered MDT consistent with the core principles of the approach and trials that met some or none of these principles.In this systematic review, databases were searched from inception to June 2018 for studies that delivered MDT compared to nonpharmacological, conservative control interventions in patients with lowbackpain and reported outcomes of pain
Benefits and harms of spinal manipulative therapy for the treatment of chronic lowbackpain: systematic review and meta-analysis of randomised controlled trials. To assess the benefits and harms of spinal manipulative therapy (SMT) for the treatment of chronic lowback pain.Systematic review and meta-analysis of randomised controlled trials.Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Physiotherapy Evidence Database (PEDro), Index to Chiropractic (...) Literature, and trial registries up to 4 May 2018, including reference lists of eligible trials and related reviews.Randomised controlled trials examining the effect of spinal manipulation or mobilisation in adults (≥18 years) with chronic lowbackpain with or without referred pain. Studies that exclusively examined sciatica were excluded, as was grey literature. No restrictions were applied to language or setting.Two reviewers independently selected studies, extracted data, and assessed risk of bias
Responsible, Safe, and Effective Use of Biologics in the Management of LowBackPain: American Society of Interventional Pain Physicians (ASIPP) Guidelines Regenerative medicine is a medical subspecialty that seeks to recruit and enhance the body's own inherent healing armamentarium in the treatment of patient pathology. This therapy's intention is to assist in the repair, and to potentially replace or restore damaged tissue through the use of autologous or allogenic biologics. This field (...) and the appropriate requirements for compliance with the FDA have been detailed in these guidelines.Regenerative medicine, platelet-rich plasma, medicinal signaling cells, mesenchymal stem cells, stromal vascular fraction, bone marrow concentrate, chronic lowbackpain, discogenic pain, facet joint pain, Food and Drug Administration, minimal manipulation, evidence synthesis.
A multicenter randomized controlled trial on the efficacy of intradiscal methylene blue injection for chronic discogenic lowbackpain: the IMBI study A study published in PAIN in 2010 showed remarkable effects of intradiscal methylene blue (MB) injections compared with placebo on pain intensity in patients with chronic discogenic lowbackpain (CD-LBP). Both groups received lidocaine hydrochloride injections for pain associated with the procedure. We replicated the design of the previously (...) published study and performed a multicenter, double-blind, randomized, placebo-controlled trial to assess whether the extraordinary effects of MB on pain intensity could be confirmed. The primary outcomes were treatment success defined as at least 30% reduction in pain intensity and the Patients' Global Impression of Change 6 months after the intervention. We included 84 patients with CD-LBP of which 14 (35%) in the MB plus lidocaine group showed treatment success compared with 11 (26.8%) in the control
Effectiveness of Slump Stretching on LowBackPain: A Systematic Review and Meta-analysis The slump test is a type of neurodynamic test that is believed to evaluate the mechanosensitivity of the neuromeningeal structures within the vertebral canal. The objective of this review was to investigate the effectiveness of slump stretching on backpain and disability in patients with lowbackpain (LBP).We searched eight electronic databases (PubMed/Medline, Scopus, Ovid, CINAHL, Embase, PEDro, Google (...) determined, favoring the use of slump stretching to decrease pain in patients with LBP. In addition, large effect sizes and significant results were also found for the effect of slump stretching on disability improvement (SMD = -8.03, 95% CI = -11.59 to -4.47) in the LBP population. A qualitative synthesis of results showed that slump stretching can significantly increase straight leg raise and active knee extension ROM.There is very low to moderate quality of evidence that slump stretching may have
Intra-articular Triamcinolone Versus Hyaluronate Injections for LowBackPain With Symptoms Suggestive of Lumbar Zygapophyseal Joint Arthropathy: A Pragmatic, Double-Blind Randomized Controlled Trial. The aim of the study was to compare hyaluronate with triamcinolone injections in treating chronic lowbackpain suggestive of lumbar zygopophyseal joint arthropathy.This was a prospective, double-blind, randomized controlled trial. Thirty subjects were randomly assigned to receive bilateral L3-S1 (...) = 52-99.5], P < 0.001). Medians and quartiles were used in statistical analysis when data did not pass normality.Patients with chronic lowbackpain suggestive of lumbar lumbar zygopophyseal joint arthropathy responded similarly to triamcinolone or hyaluronate injections. Synvisc-One group showed significant short- and long-term functional improvement and short-term pain improvement; KA group showed only significant short-term functional benefit and no significant short- or long-term pain
Evaluation of the Neuropathic Component of Chronic LowBackPain Assessment of neuropathic pain in chronic lowback syndromes is important. However, there is currently no gold standard for its diagnosis. The aim of this observational cross-sectional study was to assess the neuropathic component of pain in various chronic lowbackpain syndromes using a range of diagnostic tests.Included in this study were 63 patients with chronic axial lowbackpain (ALBP), 48 patients with chronic radicular (...) with sensory loss confirmed by QST was lowest in the ALBP subgroup (23.8%) compared with CDRS (47.8%), and LSS (68.0%) subgroups (P<0.001). A reduction in IENFD was disclosed in a proportion of up to 52.0% of affected roots in patients with CRS.Neuropathic pain is quite frequent in CRS, and QST reveals sensory loss as a frequent abnormality in patients with CRS. Using a cut-off value of 19, PDQ identified a neuropathic component in a relatively low proportion of patients with CRS. CRS may be associated
Combination Drug Therapy for the Management of LowBackPain and Sciatica: Systematic Review and Meta-Analysis Combining medicines may give greater pain relief and/or improved tolerability. We conducted a systematic review to investigate the effects of combination drug therapy in patients with lowbackpain and/or sciatica on pain, disability, and adverse events. Databases and trial registers were searched from inception to July 27, 2017, for randomized trials of (sub)acute or chronic backpain (...) = -27.60; 95% confidence interval = -31.70 to -23.50) terms; however, the quality of evidence was low. There was no statistically significant increased risk of serious adverse events. When the risk of adverse events was statistically significant, it favored monotherapy or placebo. There is no clear evidence to support any combination drug therapy for the management of lowbackpain and sciatica due to the limited number of studies and overall low quality of evidence. Perspective: Combining medicines
Therapeutic Ultrasound for Pain Management in Chronic LowBackPain and Chronic Neck Pain: A Systematic Review Lowbackpain (LBP) and neck pain are major causes of pain and disability that are experienced across all ages. The primary goals of treatment are to improve patient function and facilitate a return to the patient's desired level of daily activity. Therapeutic ultrasound is a noninvasive modality widely utilized in the management of musculoskeletal disorders, but there continues (...) be potentially helpful for short-term pain relief; however, it is undetermined which modality may be superior. In both pain syndromes, further trials are needed to define the true effect of low-intensity ultrasound therapy for axial backpain. No conclusive recommendations may be made for optimal settings or session duration.
Video-Game-Based Exercises for Older People With Chronic LowBackPain: A Randomized Controlledtable Trial (GAMEBACK) Video game technology increases adherence to home exercise and could support self-management for older people with chronic lowbackpain (LBP).The objective was to investigate the effects of home-based video game exercises on pain self-efficacy and care-seeking in older people with chronic LBP.The study was a randomized controlled trial.The setting was a community and waiting (...) list.Sixty participants, aged > 55 years with chronic LBP, were randomized (1:1) to Wii Fit U exercises or to continue their usual activities for 8 weeks.The intervention was home-based Wii Fit U flexibility, strengthening, and aerobic exercises for 60 minutes, 3 times per week, with fortnightly calls from a physical therapist.Measurements included pain self-efficacy and care-seeking (primary outcomes), and physical activity, pain, function, disability, fear of movement/reinjury, falls efficacy
A commonly used treatment does not improve chronic lowbackpain A commonly used treatment does not improve chronic lowbackpain Discover Portal Discover Portal A commonly used treatment does not improve chronic lowbackpain Published on 7 November 2017 doi: This trial found that destroying nerves that take pain signals to the brain using heat (radiofrequency denervation) did not improve pain, function or a sense of “recovery”. The treatment was used alongside exercise and was a variation (...) of the technique commonly used in the UK. In this large study, it was compared to exercise alone. Lowbackpain is usually short-lived, but some people develop long-term backpain which can negatively impact their lives. NICE recommends exercise, pain relief and self-management to cope with pain. If these treatments are not effective and pain is severe, then more intensive options, such as radiofrequency denervation can be considered. These findings suggest that this technique of radiofrequency denervation
Two nerve drugs are not suitable for treating long-term lowbackpain Two nerve drugs are not suitable for treating long-term lowbackpain Discover Portal Discover Portal Two nerve drugs are not suitable for treating long-term lowbackpain Published on 5 December 2017 doi: The drugs gabapentin and pregabalin (gabapentinoids) were found not to help lower backpain that had lasted more than three months. Gabapentin gave no benefit compared with placebo, while pregabalin was less effective than (...) other painkillers. Both were associated with several side effects, such as dizziness. Long-term lowbackpain without clear cause is very common. It causes considerable loss of productivity and places a high demand on the healthcare service. It is difficult to treat, and people often get limited relief from simple painkillers, causing practitioners to consider alternative options. This review gathered eight trials looking at gabapentinoids for adults with long-term lower backpain. The evidence
Discogenic lowbackpain Discogenic lowbackpain - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Discogenic lowbackpain Last reviewed: February 2019 Last updated: January 2019 Summary Magnetic resonance imaging is the imaging study of choice for degenerative disc disease due to its unique detail on the representation of the disc status. Other tests may include plain radiographs, computed tomography scanning (...) , or provocative discography. Non-surgical treatments include lifestyle measures, followed by the judicious use of medications, physiotherapy, and therapeutic needling procedures. Surgical treatment includes decompression of neural structures and, in selected patients, a fusion of the motion segment. Definition A complex, multi-factorial, clinical condition characterised by lowbackpain with or without the concurrence of radicular lower limb symptoms in the presence of radiologically-confirmed degenerative