BACKGROUND Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients’health-related quality of life(HRQoL).Although empirical evidence has demonstrated that novel Ther...BACKGROUND Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients’health-related quality of life(HRQoL).Although empirical evidence has demonstrated that novel Thermobalancing therapy and Dr Allen’s Device can relieve chronic low back pain,there have been no randomised controlled trials for these indications.AIM To evaluate the efficacy of Dr Allen’s Device in lumbar disc herniation(LDH)and non-specific low back pain(NSLBP).METHODS A randomised clinical trial was conducted investigating 55 patients with chronic low back pain due to LDH(n=28)or NSLBP(n=27),out of which 15 were randomly assigned to the control group and 40 were assigned to the treatment group.The intervention was treatment with Dr Allen’s Device for 3 mo.Changes in HRQoL were assessed using the Numerical Pain Rating Scale and the Japanese Orthopedic Association Back Pain Questionnaire.RESULTS Thermobalancing therapy with Dr Allen’s Device showed a significant reduction in pain in the treatment group(P<0.001),with no recorded adverse effects.Both pain assessment scales showed a significant improvement in patients’perception of pain indicating improvement in HRQoL.CONCLUSION The out-of-hospital use of Thermobalancing therapy with Dr Allen’s Device for Low Back Treatment relieves chronic low back pain significantly and without adverse effects,improves the level of activity and HRQoL among patients with LDH and NSLBP.This study demonstrates the importance of this safe first-line therapy that can be used for effective at-home management of chronic low back pain.展开更多
Purpose: The multifidus muscle is an important extensor muscle of the lumbar spine. It plays a major role in the stability and realization of axial rotation movements of the thoraco-lumbar spine. Its atrophy by fatty ...Purpose: The multifidus muscle is an important extensor muscle of the lumbar spine. It plays a major role in the stability and realization of axial rotation movements of the thoraco-lumbar spine. Its atrophy by fatty degeneration would be at the origin of the occurrence of chronic low back pain which constitutes a public health problem in Senegal. Taking into account its anatomy is essential for the etiopathogenic analysis and the treatment of low back pain. The purpose of our work was to investigate the impact of multifidus muscle morphometry on the anatomy-clinical evolution of low back pain. Material and method: this was a prospective study over a period of 30 months from November 2019 to May 2022. It involved 100 patients seen in the neurology department of Fann Hospital for chronic low back pain and who had already had a scanner falling within the criteria for low back pain. We used 3D Slicer, SPSS 20, Excel 2016 software to model and analyze the morphometric data of the multifidus muscle after physiotherapy and control lumbar scans. Results: The sex ratio was 2.23. The average age of the patients was 45 ± 7 years. On the initial CT scan, according to the Hadar classification, we noted a predominance of grade 2 with 56% in L5/S1, followed by grade 1 with 32% and grade 3 with 14%. In L4/L5, the majority of patients, 67%, had grade 1. A conflicting circumferential disc bulge with the roots predominating in L5/S1 was present in 94% of men (p-value = 0.02). Before physiotherapy, the average volume of the multifidus was 193 mm<sup>3</sup> ± 39, after physiotherapy it was 203 mm<sup>3</sup> ± 42 with a progression rate of 5.2%. Clinically, severe type pain had regressed from 86% before physiotherapy to 0% after physiotherapy (p-value = 0.03). Conclusion: Taking into account the morphometry of the multifidus is an essential element in the management of chronic low back pain.展开更多
Objective:To systematically evaluate the efficacy and safety of Tenghuang Jiangu Tablet(藤黄健骨片)in the treatment of discogenic low back pain.Methods:CNKI,WanFang,CBM,VIP,PubMed,EMbase,Cochrane Library and Web of Sc...Objective:To systematically evaluate the efficacy and safety of Tenghuang Jiangu Tablet(藤黄健骨片)in the treatment of discogenic low back pain.Methods:CNKI,WanFang,CBM,VIP,PubMed,EMbase,Cochrane Library and Web of Science were systematically searched to collect the randomized controlled trials(RCTs)of Tenghuang Jiangu Tablet in the treatment of discogenic low back pain.Literature screening and data extraction according to the set criteria were conducted.Cochrane Risk Bias assessment tool was used to evaluate the quality of included RCTs,and Meta-analysis was performed using RevMan 5.4.1 software.Results:A total of 4 studies were included,with a total sample size of 404 cases.The results of Meta-analysis suggested that Tenghuang Jiangu Tablet combined with conventional treatment in the treatment of discogenic low back pain was superior to conventional treatment alone in terms of total clinical response rate(RR=1.21,95%CI[1.09,1.35],P=0.0004),excellent rate of curative effect(RR=1.24,95%CI[1.10,1.41],P=0.0007),lower VAS score(MD=-0.62,95%CI[-0.79,-0.44],P<0.00001)and JOA score(MD=1.84,95%CI[1.35,2.33],P<0.00001).There was no statistical significance in the incidence of adverse reactions between Tenghuang Jiangu Tablet combined with conventional treatment and conventional treatment alone(RR=0.76,95%CI[0.04,15.42],P=0.86).Conclusion:Based on existing research and methods,Tenghuang Jiangu Tablet combined with conventional therapy is effective on discogenic low back pain.Conventional therapy combined with Tenghuang Jiangu Tablet for the treatment of discogenic low back pain may be better than conventional therapy alone.All the adverse reactions occurred during the treatment were mild.There is no evidence that Tenghuang Jiangu Tablet can cause serious adverse reactions.However,the number of existing clinical studies is small and the quality is generally not high.It is suggested to carry out more large-sample and high-quality RCTs,and pay more attention to the long-term efficacy of drugs and the occurrence of adverse reactions,so as to further verify the above conclusions.展开更多
Low back pain(LBP)is the world's leading cause of disability and is increasing in prevalence more rapidly than any other pain condition.Intervertebral disc(IVD)degeneration and facet joint osteoarthritis(FJOA)are ...Low back pain(LBP)is the world's leading cause of disability and is increasing in prevalence more rapidly than any other pain condition.Intervertebral disc(IVD)degeneration and facet joint osteoarthritis(FJOA)are two common causes of LBP,and both occur more frequently in elderly women than in other populations.Moreover,osteoarthritis(OA)and OA pain,regardless of the joint,are experienced by up to twice as many women as men,and this difference is amplified during menopause.Changes in estrogen may be an important contributor to these pain states.Receptors for estrogen have been found within IVD tissue and nearby joints,highlighting the potential roles of estrogen within and surrounding the IVDs and joints.In addition,estrogen supplementation has been shown to be effective at ameliorating IVD degeneration and OA progression,indicating its potential use as a therapeutic agent for people with LBP and OA pain.This review comprehensively examines the relationship between estrogen and these pain conditions by summarizing recent preclinical and clinical findings.The potential molecular mechanisms by which estrogen may relieve LBP associated with IVD degeneration and FJOA and OA pain are discussed.展开更多
[Objectives]To explore the clinical effect of Erxian decoction on relieving low back pain after percutaneous vertebroplasty(PVP)of vertebral compression fracture caused by postmenopausal osteoporosis(PMOP).[Methods]Ni...[Objectives]To explore the clinical effect of Erxian decoction on relieving low back pain after percutaneous vertebroplasty(PVP)of vertebral compression fracture caused by postmenopausal osteoporosis(PMOP).[Methods]Ninety patients who were treated in Suzhou TCM Hospital from September 2021 to January 2023 were randomly divided into three groups:traditional Chinese medicine group(n=30),western medicine group(n=30)and blank group(n=30).The patients in all the three groups were treated with basic anti-osteoporosis drugs.The patients in the traditional Chinese medicine group were treated with Erxian decoction after PVP,and those in the western medicine group were treated with celecoxib to relieve pain after operation.The visual analogue(VAS)score,Oswestry dysfunction index(ODI)score,TCM syndrome score and serum indexes such as interleukin-6(IL-6)and estrogen E2 were recorded before treatment and 2 weeks,1 month and 3 months after treatment.[Results](i)In terms of pain relief,the VAS score of the western medicine group was lower than that of the traditional Chinese medicine group after 2 weeks of treatment,but there was no significant difference in VAS score between the two groups after 1 month and 3 months,and the pain improvement of the two groups was better than that of the blank group.(ii)After 3 months of treatment,the ODI score in the traditional Chinese medicine group was lower than that in the western medicine group,and the improvement of TCM syndrome in the traditional Chinese medicine group was better than that in the other two groups 1 and 3 months after treatment(P<0.05).(iii)The level of IL-6 in the western medicine group was lower than that in the other groups after 2 weeks,and there was no significant difference between the two groups after 3 months of treatment.After 3 months of treatment,the level of E2 in the traditional Chinese medicine group was higher than that before treatment and higher than that in the western medicine group and the blank group,but there was no significant difference between the two groups(P>0.05).[Conclusions]Both Erxian decoction and non-steroidal anti-inflammatory drugs can relieve residual low back pain after PVP,and their long-term effects are similar,but Erxian decoction has more advantages in alleviating pain,muscle and joint pain and sensory abnormalities in postmenopausal women.Moreover,it is safe and reliable,and is worthy of clinical application.展开更多
Background:The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain(LBP).Despite substantial research,it is still unclear whether consiste...Background:The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain(LBP).Despite substantial research,it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP.The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls.Methods:A search was conducted in PubMed,CINAHL,SPORTDiscus,and PsycINFO in June 2019 and was repeated in December 2020.Studies were included if they reported biomechanical characteristics of individuals with and without LBP during steady-state or perturbed walking and running.Biomechanical data included spatiotemporal,kinematic,kinetic,and electromyography variables.The reporting quality and potential for bias of each study was assessed.Data were pooled where possible to compare the standardized mean differences(SMD)between back pain and back-healthy control groups.Results:Ninety-seven studies were included and reviewed.Two studies investigated acute pain and the rest investigated persistent pain.Nine studies investigated running gait.Of the studies,20%had high reporting quality/low risk of bias.In comparison with back-healthy controls,individuals with persistent LBP walked slower(SMD=-0.59,95%confidence interval(95%CI):-0.77 to-0.42)and with shorter stride length(SMD=-0.38,95%CI:-0.60 to-0.16).There were no differences in the amplitude of motion in the thoracic or lumbar spine,pelvis,or hips in individuals with LBP.During walking,coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the persistent LBP groups(SMD=-0.60,95%CI:-0.90 to-0.30),and individuals with persistent LBP exhibited greater amplitude of activation in the paraspinal muscles(SMD=0.52,95%CI:0.23-0.80).There were no consistent differences in running biomechanics between groups.Conclusion:There is moderate-to-strong evidence that individuals with persistent LBP demonstrate differences in walking gait compared to back-healthy controls.展开更多
Background:Most papers examining the lateral abdominal muscles(LAMs)and low back pain(LBP)are cross-sectional,with groups of participants being divided into a control and an LBP group.We hypothesized that morphologica...Background:Most papers examining the lateral abdominal muscles(LAMs)and low back pain(LBP)are cross-sectional,with groups of participants being divided into a control and an LBP group.We hypothesized that morphological measurements of the LAMs in adolescent soccer players may predict future LBP incidence.The aim of this study was to examine the associations between the morphology of LAMs and LBP incidence rate among adolescent soccer players.Methods:Ninety-seven adolescent male soccer players with no LBP at baseline were recruited into the prospective cohort study.The thickness of the LAMs was measured at baseline by ultrasound imaging in a supine rest position.Nine cases of LBP occurred during the follow-up 6-month observation.Results:An obliquus internus(OI)asymmetry was related to increasing LBP risk(odds ratio=19.99;95%CI:2.4-167.9).Spearman correlation also showed a linear relationship between OI asymmetry value and duration of LBP(R=0.75,p=0.02).An OI side-to-side difference greater than 1.25 mm suggests possible LBP incidence in the 6-month observation among adolescent soccer players.Conclusion:The morphological changes of the OI may be related to LBP’s incidence in adolescent soccer players.The presence of OI asymmetry increases the odds of LBP by at least 2.4 times.Hypertrophy of the OI on one side of the body may contribute to trunk muscle imbalance.展开更多
Intervertebral disc degeneration is the main cause of low back pain.In the past 20 years,the injection of mesenchymal stromal cells(MSCs)into the nucleus pulposus of the degenerative disc has become the main approach ...Intervertebral disc degeneration is the main cause of low back pain.In the past 20 years,the injection of mesenchymal stromal cells(MSCs)into the nucleus pulposus of the degenerative disc has become the main approach for the treatment of low back pain.Despite the progress made in this field,there are still many barriers to overcome.First,intervertebral disc is a highly complex loadbearing composite tissue composed of annulus fibrosus,nucleus pulposus and cartilaginous endplates.Any structural damage will change its overall biomechanical function,thereby causing progressive degeneration of the entire intervertebral disc.Therefore,MSC-based treatment strategies should not only target the degenerated nucleus pulposus but also include degenerated annulus fibrosus or cartilaginous endplates.Second,to date,there has been relatively little research on the basic biology of annulus fibrosus and cartilaginous endplates,although their pathological changes such as annular tears or fissures,Modic changes,or Schmorl's nodes are more commonly associated with low back pain.Given the high complexity of the structure and composition of the annulus fibrosus and cartilaginous endplates,it remains an open question whether any regeneration techniques are available to achieve their restorative regeneration.Finally,due to the harsh microenvironment of the degenerated intervertebral disc,the delivered MSCs die quickly.Taken together,current MSC-based regenerative medicine therapies to regenerate the entire disc complex by targeting the degenerated nucleus pulposus alone are unlikely to be successful.展开更多
Background:Low back pain(LBP)is one of the most common occupational injuries that nurses experience in their daily work,which ultimately causes disability or difficulty in performing heavy physical activity.There is s...Background:Low back pain(LBP)is one of the most common occupational injuries that nurses experience in their daily work,which ultimately causes disability or difficulty in performing heavy physical activity.There is scarce information that presents a direct figure about the prevalence of LBP in Chinese nurses.Objective:To systematically review and analyze the prevalence and influencing factors of LBP among nurses in China.Methods:Related literature extracted from PubMed,Web of Science,Scopus,China National Knowledge Infrastructure databases were selected and reviewed based on the PRISMA guideline.Random effects models were used for data analysis,where heterogeneity was tested through I2.Egger’s test was used to analyze the literature publication bias.Results:The combined data indicated that the prevalence of LBP among nurses in China was 78%[95%confidence interval(CI)=0.72–0.83].The prevalence of LBP among nurses in China has declined in the past decade.Nurses presented a high risk of LBP in terms of female(OR=2.38,95%CI=1.23–3.44,P<0.0001),married(OR=2.79,95%CI=1.57–3.86,P<0.0001),24≤BMI<28(OR=2.03,95%CI=1.18–3.08,P<0.0001),and working for more than ten>10 years(OR=2.54,95%CI=2.03–3.32,P<0.0001).Conclusions:There is a high prevalence of LBP among nurses in China.Interventions that include healthy dietary habits and physical activity mainly focusing on female married nurses who are working for at least 10 years should be implemented.Furthermore,nurses ought to apply ergonomic principles for personal protection at the workplace.展开更多
Low back pain(LBP)represents the most prevalent,problematic and painful of musculoskeletal conditions that affects both the individual and society with health and economic concerns.LBP is a heterogeneous condition wit...Low back pain(LBP)represents the most prevalent,problematic and painful of musculoskeletal conditions that affects both the individual and society with health and economic concerns.LBP is a heterogeneous condition with multiple diagnoses and causes.In the absence of consensus definitions,partly because of terminology inconsistency,it is further referred to as non-specific LBP(NSLBP).In NSLBP patients,the lumbar multifidus(MF),a key stabilizing muscle,has a depleted role due to recognized myocellular lipid infiltration and wasting,with the potential primary cause hypothesized as arthrogenic muscle inhibition(AMI).This link between AMI and NSLBP continues to gain increasing recognition.To date there is no‘gold standard’or consensus treatment to alleviate symptoms and disability due to NSLBP,though the advocated interventions are numerous,with marked variations in costs and levels of supportive evidence.However,there is consensus that NSLBP management be cost-effective,self-administered,educational,exercise-based,and use multi-modal and multi-disciplinary approaches.An adjuvant therapy fulfilling these consensus criteria is‘slacklining’,within an overall rehabilitation program.Slacklining,the neuromechanical action of balance retention on a tightened band,induces strategic indirect-involuntary therapeutic muscle activation exercise incorporating spinal motor control.Though several models have been proposed,understanding slacklining’s neuro-motor mechanism of action remains incomplete.Slacklining has demonstrated clinical effects to overcome AMI in peripheral joints,particularly the knee,and is reported in clinical case-studies as showing promising results in reducing NSLBP related to MF deficiency induced through AMI(MF-AMI).Therefore,this paper aims to:rationalize why and how adjuvant,slacklining therapeutic exercise may positively affect patients with NSLBP,due to MF-AMI induced depletion of spinal stabilization;considers current understandings and interventions for NSLBP,including the contributing role of MF-AMI;and details the reasons why slacklining could be considered as a potential adjuvant intervention for NSLBP through its indirect-involuntary action.This action is hypothesized to occur through an over-ride or inhibition of central down-regulatory induced muscle insufficiency,present due to AMI.This subsequently allows neuroplasticity,normal neuro-motor sequencing and muscle re-activation,which facilitates innate advantageous spinal stabilization.This in-turn addresses and reduces NSLBP,its concurrent symptoms and functional disability.This process is hypothesized to occur through four neuro-physiological processing pathways:finite neural delay;movement-control phenotypes;inhibition of action and the innate primordial imperative;and accentuated corticospinal drive.Further research is recommended to investigate these hypotheses and the effect of slacklining as an adjuvant therapy in cohort and control studies of NSLBP populations.展开更多
[Objectives]This paper aimed to investigate the effect of Tuina combined with sling exercise therapy(SET)and psoas&abdominal training on serum 5-hydroxytryptamine(5-HT)andβ-endorphin(β-EP)levels in patients with...[Objectives]This paper aimed to investigate the effect of Tuina combined with sling exercise therapy(SET)and psoas&abdominal training on serum 5-hydroxytryptamine(5-HT)andβ-endorphin(β-EP)levels in patients with nonspecific low back pain(NLBP).[Methods]Total 46 patients with NLBP who visited the Tuina Department of the First Affiliated Hospital of Hainan Medical University from August 2019 to May 2020 were randomly and evenly divided into control group and treatment group.On the basis of Tuina therapy,the patients in the control group and treatment group were treated with psoas&abdominal training and SET,respectively.After the treatment,the serum 5-HT andβ-EP levels of the patients were detected.[Results]The serum 5-HT andβ-EP levels in the treatment group were significantly improved compared with the control group(P<0.05).[Conclusions]The nerve&muscle reconstruction techniques of Tuina combined with SET or psoas&abdominal training can improve serum 5-HT andβ-EP levels in patients with NLBP.展开更多
Low back pain(LBP)is a morbid condition that has afflicted several citizens in Europe.It has negatively impacted the European economy due to several man-days lost,with bed rest and forced inactivity being the usual LB...Low back pain(LBP)is a morbid condition that has afflicted several citizens in Europe.It has negatively impacted the European economy due to several man-days lost,with bed rest and forced inactivity being the usual LBP care and management steps.Direct models,which incorporate various regression analyses,have been executed for the investigation of this premise due to the simplicity of translation.However,such straight models fail to completely consider the impact of association brought about by a mix of nonlinear connections and autonomous factors.In this paper,we discuss a system that aids decision-making regarding the best-suited support system for LBP,allowing the individual to avail of reinforcement and improvement in its self-management.These activities are monitored with the help of a wearable sensor that helps in their detection and their classification as those that soothe or aggravate LBP and hence,should or should not be performed.This system helps the patients set their own boundaries and milestones with respect to suitable activities.This system also does windowing and feature extraction.The present study is an empirical and comparative analysis of the most suitable activities that patients suffering from low back pain can select.The evaluation shows that the system can distinguish between nine common daily activities effectively and helps self-monitor these activities for the efficient management of LBP.展开更多
Objective:To assess the efficacy of gabapentin in the treatment of low back pain patients.Methods:This prospective observational study was conducted over 6 months to assess the efficacy of gabapentin in patients suffe...Objective:To assess the efficacy of gabapentin in the treatment of low back pain patients.Methods:This prospective observational study was conducted over 6 months to assess the efficacy of gabapentin in patients suffering from low back pain.Past medical history,pain severity by Visual Analogue scale(VAS)and sleep quality by Pittsburgh Sleep Quality Index(PQSI)were collected.VAS scores and PQSI scores before and after gabapentin treatment were compared,and gabapentin satisfaction post treatment were recorded.Results:This study included 100 low back pain patients with 65 males and 35 females,and the mean age was(39.0±10.5)years.The commonest presentation was non-radiating low back pain(40%).The mean VAS score and the mean PQSI score in the study before treatment were 7.70±1.91 and 10.95±5.02,respectively.After treatment with gabapentin,the mean VAS score and the mean PQSI score decreased to 2.75±1.79 and 4.90±2.20,respectively,and the differences before and after the treatment were significantly different(both P=0.001).Overall,62%of the patients were extremely satisfied with gabapentin because they reported no adverse drug reaction.Besides,31%of the patients were satisfied and 7%were strongly dissatisfied with the therapy.Conclusion:Gabapentin can improve sleep quality and reduce lower back pain as measured by the VAS and PQSI.The efficacy of this drug is relatively good,but further improvement is required.展开更多
Objective:To analyze the level changes of the degree of back pain by visual analogue scale(VAS),lumbar function(Japanese Orthopaedic Association Scores,JOA),muscle temperature,serum serotonin 5-hydroxytryptamine(5-HT)...Objective:To analyze the level changes of the degree of back pain by visual analogue scale(VAS),lumbar function(Japanese Orthopaedic Association Scores,JOA),muscle temperature,serum serotonin 5-hydroxytryptamine(5-HT)andβ-endorphin(β-EP)in patients of low back pain(LBP).Methods:64 LBP patients treated in the tuina department of first affiliated hospital of Hainan Medical University were randomly divided into observation group(32 cases)and control group(32 cases).The control group was treated with traditional filiform acupuncture needling,the observation group was treated with Chinese tuina.VAS,JOA,muscle temperature,5-HT,β-EP,these indexes were tested before and after treatment.Results:The VAS and JOA score in the observation group were significantly lower than those in the control group(P<0.01),the muscle temperature in the observation group and the control group increased significantly(P<0.01),and the observation group was higher than that in the control group(P<0.05);5-HT、β-EP was significant difference before and after treatment(P<0.01),and the level in observation group was significantly higher than that in the control group,the difference was statistically significant(P<0.05).Conclusion:Chinese tuina has significant clinical efficacy in the treatment of LBP.The medical infrared thermal imaging technology and serum pain detection technology is conducive to objectively helpful to analyze the exact efficacy of tuina in the treatment of LBP and its impact on relevant indexes.展开更多
Degenerative disc disease is the most common cause of low back pain. Intervertebral disc abnormalities are commonly evaluated by magnetic resonance imaging (MRI), and Pfirrmann’s system involves the use of T2-weighte...Degenerative disc disease is the most common cause of low back pain. Intervertebral disc abnormalities are commonly evaluated by magnetic resonance imaging (MRI), and Pfirrmann’s system involves the use of T2-weighted images (T2WI) to classify disc degeneration. However, as this classification is based on visual evaluation, it is not possible to quantify degeneration using this method. The present study was performed to establish an MRI-based intervertebral disc classification system using diffusional kurtosis imaging (DKI), to quantify intervertebral disc water content according to the Pfirrmann classification. Sagittal mean diffusional kurtosis (MK) mapping was performed for the L3/4, L4/5, and L5/S1 intervertebral discs in 32 patients (15 female, 17 male;age range, 24 - 82 years;mean age, 57.7 years). The degree of disc degeneration was assessed in the midsagittal section on T2WI according to the Pfirrmann classification (grade I - V). The relationships between MK values, which are correlated with intervertebral disc composition changes, and grade of degeneration determined using the Pfirrmann classification were analyzed. The MK values tended to decrease with increasing grade of degeneration, and differed significantly between grades I and IV, but not between grade IV and V (P < 0.05, Mann-Whitney U test). DKI is an effective means of detecting the early stages of disc degeneration. Therefore, DKI may be a useful diagnostic tool for quantitative assessment of intervertebral disc degeneration.展开更多
We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or w...We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or walk, a condition known as astasia-abasia. Initial concern had been that this neurological phenomenon was as a result of complications of his chronic pain intervention. Despite an essentially normal neurological examination and dedicated battery of neurological imaging and special testing, no cause was identified. Over a 7-day period of in-patient admission and physical rehabilitation symptoms resolved entirely. In the course of the workup for this episode, it was suggested that the phenomenon was the result of a side effect of dexamfetamine, an agent that had been prescribed for the patient by his neurologist for treatment of his narcolepsy. On the back of this episode, this treatment was discontinued by his neurologist following an outpatient consultation. Subsequent repeated SIJ injections were entirely uneventful and the patient experienced no further occurrences of this phenomenon.展开更多
<strong><span style="font-family:Verdana;">Background:</span></strong><span style="font-family:Verdana;"> Low back pain is one of the important patients’ presenting&l...<strong><span style="font-family:Verdana;">Background:</span></strong><span style="font-family:Verdana;"> Low back pain is one of the important patients’ presenting</span><span style="font-family:Verdana;"> complain that requires expert management from the physiotherapists. Yet no work was available for reference on the use of outcome measures for its e</span><span style="font-family:;" "=""><span style="font-family:Verdana;">valuation by Nigeria physiotherapists. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> This study, therefore, investigated the outcome measures used by Nigerian physiotherapists</span></span><span style="font-family:Verdana;"> to </span><span style="font-family:;" "=""><span style="font-family:Verdana;">e</span><span style="font-family:Verdana;">valuate patients with Low Back Pain and the fac</span><span style="font-family:Verdana;">tors that influenced their use. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A survey questionnaire was posted to 306 randomly selected mem</span></span><span style="font-family:Verdana;">- </span><span style="font-family:;" "=""><span style="font-family:Verdana;">bers</span><span> </span><span style="font-family:Verdana;">of the Nigeria Society of Physiotherapy (NSP). Data were analyzed using f</span><span style="font-family:Verdana;">requency, percentages, mean, ANOVA, and Pearson’s Chi</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">square. P</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">val</span><span style="font-family:;" "=""><span style="font-family:Verdana;">ue was placed at 0.05. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> 52.9% of the respondents (221) used a pain visual analog scale. Only 36.1% used LBP</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">specific clinical outcome measures. The factors that influenced their use were belief, attitude, knowledge, and choice. There was no significant difference between the majority of the factors and the use of clinical outcome measures. The </span><span style="font-family:Verdana;">P-</span><span style="font-family:;" "=""><span style="font-family:Verdana;">values were 0.960, 0.648, 0.760 </span><span style="font-family:Verdana;">for belief, attitude and knowledge respectively. The only factor that had a </span><span style="font-family:Verdana;">significant difference (</span></span><span style="font-family:Verdana;">P </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.029) with the use of clinical outcome measures </span><span style="font-family:Verdana;">w</span><span style="font-family:Verdana;">as choice. Gender and postgraduate qualification had no significant influ</span></span><span style="font-family:Verdana;">- </span><span style="font-family:;" "=""><span style="font-family:Verdana;">e</span><span style="font-family:Verdana;">nce on the use of clinical outcome measures at the </span></span><span style="font-family:Verdana;">P-</span><span style="font-family:Verdana;">value </span><span style="font-family:;" "=""><span style="font-family:Verdana;">of 0.117 and 0.510 respe</span><span><span style="font-family:Verdana;">ctively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Pain visual analog scale is the outcome measure frequently used by Nigeria Physiotherapists to evaluate patien</span></span><span style="font-family:Verdana;">ts with Low Back Pain. Belief, attitude, knowledge, and choice are the factors that influ</span></span><span style="font-family:Verdana;">- </span><span style="font-family:Verdana;">enced the use. There is a need to incorporate the use of LBP</span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""><span style="font-family:Verdana;">specific outcome measures by Nigerian physiotherapists while treating patients with LBP.</span></span>展开更多
Objective: To analyze the Patient Functionality Questionnaire (PFQ) scores of the patients treated with either Diclofenac + B vitamins (Group DB) or Diclofenac monotherapy (Group D) in order to better understand the i...Objective: To analyze the Patient Functionality Questionnaire (PFQ) scores of the patients treated with either Diclofenac + B vitamins (Group DB) or Diclofenac monotherapy (Group D) in order to better understand the impact of the combination of diclofenac with vitamins B<sub>1</sub>, B<sub>6</sub>, and B<sub>12</sub> on quality of life. Research Design/Methods: We performed a post-hoc analysis of tabulated data generated during the DOLOR study (Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: the DOLOR study), using the software GraphPad Prism 5 for Windows, v5.04. The absolute number or percentage of “True”/“False” respondents for each questionnaire item at each study visit, together with the absolute number and percentage of subjects with no change, improvement, or worsening of each PFQ item at each study visit, within and between treatment groups were arranged on contingency tables and analyzed with the Chi-squared or Fisher’s Exact test. Results: At pretreatment there were no statistically significant differences between treatment groups (p > 0.05 for all items). At Visit 2 in both treatment groups, there were statistically significant improvements in individual question responses in each of the 12 items of the questionnaire (p < 0.05 for all items). At Visit 2, comparing the distribution of patients in each treatment group with “improvement”, “no change”, or “worsening”, there was a statistically significant superiority among subjects of group DB in response to items 1, 6, 8, and 10. At Visit 3, both groups had statistically significant (p < 0.001) improvements in each individual item of the PFQ in relation to pretreatment values. The distribution of subjects in each treatment group presenting with “improvement”, “no change”, or “worsening” at Visit 3 varied significantly in favor of group DB in the responses to item 4. At Visit 4, the subjects remaining in treatment in both groups showed statistically significant improvement in PFQ responses in relation to pretreatment values (p < 0.05). The distribution of subjects in each treatment group presenting with “improvement” or “no change” at Visit 4 varied significantly in favor of group D in the responses to items 5, 8, and 12. Conclusion: Improvement in overall PFQ scores was observed in both treatment groups, though the specific items of the questionnaire of the subjects in group DB at Visit 2 showed greater improvement in areas related to sleep quality, mobility, ability to wash and dry, ability to walk distances, and posture comfort. These results serve to corroborate the previously published data, which indicates a benefit of combining the B vitamins with diclofenac in the treatment of patients with low back pain, yielding shorter treatment time to resolution of the lumbago in the treated patients.展开更多
<b><span style="font-family:Verdana;">Purpose:</span></b></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span st...<b><span style="font-family:Verdana;">Purpose:</span></b></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Persistent Postoperative Low Back Pain (PLBP) is inordinately </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">com</span><span style="font-family:Verdana;">mon, and has been attributed to various pre-operative and post-operative</span><span style="font-family:Verdana;"> anatomical and mechanical factors in the spine. It may or may not be associated with sensory symptoms in the lower extremities—frequently termed “radiculopathy”—with or without Electromyographic (EMG) or imaging abnormalities. The present study aimed to look at these various symptoms in the lower extremities from a different angle and perspective and to clarify the distinc</span><span style="font-family:Verdana;">tion between true radiculopathy and pseudoradiculopathy;and determine</span><span style="font-family:Verdana;"> their possible relationship with the outcome of surgery. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Medical records of twenty-four patients with PLBP who were referred to the author for clinical and electrodiagnostic examinations several months after surgery were re</span><span style="font-family:Verdana;">viewed. Clinical symptomatology, with special reference to the presence or</span><span style="font-family:Verdana;"> ab</span><span style="font-family:Verdana;">sence of sensory and motor deficits together with EMG findings, were reviewed and categorized into 4 groups: non</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">radicular, true radiculopathy, </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">pseudoradiculopathy, and peripheral neuropathy. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Lower Back Pain (LBP) in all patients persisted following successful and uncomplicated surgery. LBP in patients with true radiculopathy persisted but was less disabling when the neurologic deficits resolved partially or significantly. As expected</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> the neurologic deficits related to peripheral neuropathy, together with LBP, remained per</span><span><span style="font-family:Verdana;">sistent. </span><b><span style="font-family:Verdana;">Conclusion:</span></b> <span style="font-family:Verdana;">LBP and various sensory and</span></span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">motor symptoms in the</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> lower </span><span style="font-family:Verdana;">extremities are 2 distinct entities, both clinically</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and pathophysiologically.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> These sensory and motor symptoms, together with </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">the </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">heightened activity of various</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pro</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">inflammatory cytokines and neurotrophins—setting aside the various</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">anatomical and mechanical factors in the spine—can influence the outcome of surgery, favorably or unfavorably.展开更多
文摘BACKGROUND Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients’health-related quality of life(HRQoL).Although empirical evidence has demonstrated that novel Thermobalancing therapy and Dr Allen’s Device can relieve chronic low back pain,there have been no randomised controlled trials for these indications.AIM To evaluate the efficacy of Dr Allen’s Device in lumbar disc herniation(LDH)and non-specific low back pain(NSLBP).METHODS A randomised clinical trial was conducted investigating 55 patients with chronic low back pain due to LDH(n=28)or NSLBP(n=27),out of which 15 were randomly assigned to the control group and 40 were assigned to the treatment group.The intervention was treatment with Dr Allen’s Device for 3 mo.Changes in HRQoL were assessed using the Numerical Pain Rating Scale and the Japanese Orthopedic Association Back Pain Questionnaire.RESULTS Thermobalancing therapy with Dr Allen’s Device showed a significant reduction in pain in the treatment group(P<0.001),with no recorded adverse effects.Both pain assessment scales showed a significant improvement in patients’perception of pain indicating improvement in HRQoL.CONCLUSION The out-of-hospital use of Thermobalancing therapy with Dr Allen’s Device for Low Back Treatment relieves chronic low back pain significantly and without adverse effects,improves the level of activity and HRQoL among patients with LDH and NSLBP.This study demonstrates the importance of this safe first-line therapy that can be used for effective at-home management of chronic low back pain.
文摘Purpose: The multifidus muscle is an important extensor muscle of the lumbar spine. It plays a major role in the stability and realization of axial rotation movements of the thoraco-lumbar spine. Its atrophy by fatty degeneration would be at the origin of the occurrence of chronic low back pain which constitutes a public health problem in Senegal. Taking into account its anatomy is essential for the etiopathogenic analysis and the treatment of low back pain. The purpose of our work was to investigate the impact of multifidus muscle morphometry on the anatomy-clinical evolution of low back pain. Material and method: this was a prospective study over a period of 30 months from November 2019 to May 2022. It involved 100 patients seen in the neurology department of Fann Hospital for chronic low back pain and who had already had a scanner falling within the criteria for low back pain. We used 3D Slicer, SPSS 20, Excel 2016 software to model and analyze the morphometric data of the multifidus muscle after physiotherapy and control lumbar scans. Results: The sex ratio was 2.23. The average age of the patients was 45 ± 7 years. On the initial CT scan, according to the Hadar classification, we noted a predominance of grade 2 with 56% in L5/S1, followed by grade 1 with 32% and grade 3 with 14%. In L4/L5, the majority of patients, 67%, had grade 1. A conflicting circumferential disc bulge with the roots predominating in L5/S1 was present in 94% of men (p-value = 0.02). Before physiotherapy, the average volume of the multifidus was 193 mm<sup>3</sup> ± 39, after physiotherapy it was 203 mm<sup>3</sup> ± 42 with a progression rate of 5.2%. Clinically, severe type pain had regressed from 86% before physiotherapy to 0% after physiotherapy (p-value = 0.03). Conclusion: Taking into account the morphometry of the multifidus is an essential element in the management of chronic low back pain.
基金2021 Qihuang Scholars Support Project of State Administration of Traditional Chinese Medicine(National Letter of TCM Education[2022]No.6)National Key Research and Development Program"Modernization of Traditional Chinese Medicine"Project(2018YFC1707400)。
文摘Objective:To systematically evaluate the efficacy and safety of Tenghuang Jiangu Tablet(藤黄健骨片)in the treatment of discogenic low back pain.Methods:CNKI,WanFang,CBM,VIP,PubMed,EMbase,Cochrane Library and Web of Science were systematically searched to collect the randomized controlled trials(RCTs)of Tenghuang Jiangu Tablet in the treatment of discogenic low back pain.Literature screening and data extraction according to the set criteria were conducted.Cochrane Risk Bias assessment tool was used to evaluate the quality of included RCTs,and Meta-analysis was performed using RevMan 5.4.1 software.Results:A total of 4 studies were included,with a total sample size of 404 cases.The results of Meta-analysis suggested that Tenghuang Jiangu Tablet combined with conventional treatment in the treatment of discogenic low back pain was superior to conventional treatment alone in terms of total clinical response rate(RR=1.21,95%CI[1.09,1.35],P=0.0004),excellent rate of curative effect(RR=1.24,95%CI[1.10,1.41],P=0.0007),lower VAS score(MD=-0.62,95%CI[-0.79,-0.44],P<0.00001)and JOA score(MD=1.84,95%CI[1.35,2.33],P<0.00001).There was no statistical significance in the incidence of adverse reactions between Tenghuang Jiangu Tablet combined with conventional treatment and conventional treatment alone(RR=0.76,95%CI[0.04,15.42],P=0.86).Conclusion:Based on existing research and methods,Tenghuang Jiangu Tablet combined with conventional therapy is effective on discogenic low back pain.Conventional therapy combined with Tenghuang Jiangu Tablet for the treatment of discogenic low back pain may be better than conventional therapy alone.All the adverse reactions occurred during the treatment were mild.There is no evidence that Tenghuang Jiangu Tablet can cause serious adverse reactions.However,the number of existing clinical studies is small and the quality is generally not high.It is suggested to carry out more large-sample and high-quality RCTs,and pay more attention to the long-term efficacy of drugs and the occurrence of adverse reactions,so as to further verify the above conclusions.
基金supported by the Natural Science Foundation of China (No.81871800 and 82072496)granted to W.D.the Natural Science Foundation of Hebei Province (No.H2020206203)granted to S.Y.+1 种基金a National Health and Medical Research Council (NHMRC)Australia Ideas Grant (No.2011398) granted to D.H.supported by the Assistant Secretary of Defense for Health Affairs endorsed by the US Department of Defense through the FY19 Chronic Pain Management Research Program (D.M.K:award no.W81XWH2010909)。
文摘Low back pain(LBP)is the world's leading cause of disability and is increasing in prevalence more rapidly than any other pain condition.Intervertebral disc(IVD)degeneration and facet joint osteoarthritis(FJOA)are two common causes of LBP,and both occur more frequently in elderly women than in other populations.Moreover,osteoarthritis(OA)and OA pain,regardless of the joint,are experienced by up to twice as many women as men,and this difference is amplified during menopause.Changes in estrogen may be an important contributor to these pain states.Receptors for estrogen have been found within IVD tissue and nearby joints,highlighting the potential roles of estrogen within and surrounding the IVDs and joints.In addition,estrogen supplementation has been shown to be effective at ameliorating IVD degeneration and OA progression,indicating its potential use as a therapeutic agent for people with LBP and OA pain.This review comprehensively examines the relationship between estrogen and these pain conditions by summarizing recent preclinical and clinical findings.The potential molecular mechanisms by which estrogen may relieve LBP associated with IVD degeneration and FJOA and OA pain are discussed.
基金Supported by National Natural Science Foundation of China(82074456)Suzhou Health Commission,Gusu Health Talent Project(GSWS2020090).
文摘[Objectives]To explore the clinical effect of Erxian decoction on relieving low back pain after percutaneous vertebroplasty(PVP)of vertebral compression fracture caused by postmenopausal osteoporosis(PMOP).[Methods]Ninety patients who were treated in Suzhou TCM Hospital from September 2021 to January 2023 were randomly divided into three groups:traditional Chinese medicine group(n=30),western medicine group(n=30)and blank group(n=30).The patients in all the three groups were treated with basic anti-osteoporosis drugs.The patients in the traditional Chinese medicine group were treated with Erxian decoction after PVP,and those in the western medicine group were treated with celecoxib to relieve pain after operation.The visual analogue(VAS)score,Oswestry dysfunction index(ODI)score,TCM syndrome score and serum indexes such as interleukin-6(IL-6)and estrogen E2 were recorded before treatment and 2 weeks,1 month and 3 months after treatment.[Results](i)In terms of pain relief,the VAS score of the western medicine group was lower than that of the traditional Chinese medicine group after 2 weeks of treatment,but there was no significant difference in VAS score between the two groups after 1 month and 3 months,and the pain improvement of the two groups was better than that of the blank group.(ii)After 3 months of treatment,the ODI score in the traditional Chinese medicine group was lower than that in the western medicine group,and the improvement of TCM syndrome in the traditional Chinese medicine group was better than that in the other two groups 1 and 3 months after treatment(P<0.05).(iii)The level of IL-6 in the western medicine group was lower than that in the other groups after 2 weeks,and there was no significant difference between the two groups after 3 months of treatment.After 3 months of treatment,the level of E2 in the traditional Chinese medicine group was higher than that before treatment and higher than that in the western medicine group and the blank group,but there was no significant difference between the two groups(P>0.05).[Conclusions]Both Erxian decoction and non-steroidal anti-inflammatory drugs can relieve residual low back pain after PVP,and their long-term effects are similar,but Erxian decoction has more advantages in alleviating pain,muscle and joint pain and sensory abnormalities in postmenopausal women.Moreover,it is safe and reliable,and is worthy of clinical application.
文摘Background:The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain(LBP).Despite substantial research,it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP.The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls.Methods:A search was conducted in PubMed,CINAHL,SPORTDiscus,and PsycINFO in June 2019 and was repeated in December 2020.Studies were included if they reported biomechanical characteristics of individuals with and without LBP during steady-state or perturbed walking and running.Biomechanical data included spatiotemporal,kinematic,kinetic,and electromyography variables.The reporting quality and potential for bias of each study was assessed.Data were pooled where possible to compare the standardized mean differences(SMD)between back pain and back-healthy control groups.Results:Ninety-seven studies were included and reviewed.Two studies investigated acute pain and the rest investigated persistent pain.Nine studies investigated running gait.Of the studies,20%had high reporting quality/low risk of bias.In comparison with back-healthy controls,individuals with persistent LBP walked slower(SMD=-0.59,95%confidence interval(95%CI):-0.77 to-0.42)and with shorter stride length(SMD=-0.38,95%CI:-0.60 to-0.16).There were no differences in the amplitude of motion in the thoracic or lumbar spine,pelvis,or hips in individuals with LBP.During walking,coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the persistent LBP groups(SMD=-0.60,95%CI:-0.90 to-0.30),and individuals with persistent LBP exhibited greater amplitude of activation in the paraspinal muscles(SMD=0.52,95%CI:0.23-0.80).There were no consistent differences in running biomechanics between groups.Conclusion:There is moderate-to-strong evidence that individuals with persistent LBP demonstrate differences in walking gait compared to back-healthy controls.
文摘Background:Most papers examining the lateral abdominal muscles(LAMs)and low back pain(LBP)are cross-sectional,with groups of participants being divided into a control and an LBP group.We hypothesized that morphological measurements of the LAMs in adolescent soccer players may predict future LBP incidence.The aim of this study was to examine the associations between the morphology of LAMs and LBP incidence rate among adolescent soccer players.Methods:Ninety-seven adolescent male soccer players with no LBP at baseline were recruited into the prospective cohort study.The thickness of the LAMs was measured at baseline by ultrasound imaging in a supine rest position.Nine cases of LBP occurred during the follow-up 6-month observation.Results:An obliquus internus(OI)asymmetry was related to increasing LBP risk(odds ratio=19.99;95%CI:2.4-167.9).Spearman correlation also showed a linear relationship between OI asymmetry value and duration of LBP(R=0.75,p=0.02).An OI side-to-side difference greater than 1.25 mm suggests possible LBP incidence in the 6-month observation among adolescent soccer players.Conclusion:The morphological changes of the OI may be related to LBP’s incidence in adolescent soccer players.The presence of OI asymmetry increases the odds of LBP by at least 2.4 times.Hypertrophy of the OI on one side of the body may contribute to trunk muscle imbalance.
文摘Intervertebral disc degeneration is the main cause of low back pain.In the past 20 years,the injection of mesenchymal stromal cells(MSCs)into the nucleus pulposus of the degenerative disc has become the main approach for the treatment of low back pain.Despite the progress made in this field,there are still many barriers to overcome.First,intervertebral disc is a highly complex loadbearing composite tissue composed of annulus fibrosus,nucleus pulposus and cartilaginous endplates.Any structural damage will change its overall biomechanical function,thereby causing progressive degeneration of the entire intervertebral disc.Therefore,MSC-based treatment strategies should not only target the degenerated nucleus pulposus but also include degenerated annulus fibrosus or cartilaginous endplates.Second,to date,there has been relatively little research on the basic biology of annulus fibrosus and cartilaginous endplates,although their pathological changes such as annular tears or fissures,Modic changes,or Schmorl's nodes are more commonly associated with low back pain.Given the high complexity of the structure and composition of the annulus fibrosus and cartilaginous endplates,it remains an open question whether any regeneration techniques are available to achieve their restorative regeneration.Finally,due to the harsh microenvironment of the degenerated intervertebral disc,the delivered MSCs die quickly.Taken together,current MSC-based regenerative medicine therapies to regenerate the entire disc complex by targeting the degenerated nucleus pulposus alone are unlikely to be successful.
文摘Background:Low back pain(LBP)is one of the most common occupational injuries that nurses experience in their daily work,which ultimately causes disability or difficulty in performing heavy physical activity.There is scarce information that presents a direct figure about the prevalence of LBP in Chinese nurses.Objective:To systematically review and analyze the prevalence and influencing factors of LBP among nurses in China.Methods:Related literature extracted from PubMed,Web of Science,Scopus,China National Knowledge Infrastructure databases were selected and reviewed based on the PRISMA guideline.Random effects models were used for data analysis,where heterogeneity was tested through I2.Egger’s test was used to analyze the literature publication bias.Results:The combined data indicated that the prevalence of LBP among nurses in China was 78%[95%confidence interval(CI)=0.72–0.83].The prevalence of LBP among nurses in China has declined in the past decade.Nurses presented a high risk of LBP in terms of female(OR=2.38,95%CI=1.23–3.44,P<0.0001),married(OR=2.79,95%CI=1.57–3.86,P<0.0001),24≤BMI<28(OR=2.03,95%CI=1.18–3.08,P<0.0001),and working for more than ten>10 years(OR=2.54,95%CI=2.03–3.32,P<0.0001).Conclusions:There is a high prevalence of LBP among nurses in China.Interventions that include healthy dietary habits and physical activity mainly focusing on female married nurses who are working for at least 10 years should be implemented.Furthermore,nurses ought to apply ergonomic principles for personal protection at the workplace.
文摘Low back pain(LBP)represents the most prevalent,problematic and painful of musculoskeletal conditions that affects both the individual and society with health and economic concerns.LBP is a heterogeneous condition with multiple diagnoses and causes.In the absence of consensus definitions,partly because of terminology inconsistency,it is further referred to as non-specific LBP(NSLBP).In NSLBP patients,the lumbar multifidus(MF),a key stabilizing muscle,has a depleted role due to recognized myocellular lipid infiltration and wasting,with the potential primary cause hypothesized as arthrogenic muscle inhibition(AMI).This link between AMI and NSLBP continues to gain increasing recognition.To date there is no‘gold standard’or consensus treatment to alleviate symptoms and disability due to NSLBP,though the advocated interventions are numerous,with marked variations in costs and levels of supportive evidence.However,there is consensus that NSLBP management be cost-effective,self-administered,educational,exercise-based,and use multi-modal and multi-disciplinary approaches.An adjuvant therapy fulfilling these consensus criteria is‘slacklining’,within an overall rehabilitation program.Slacklining,the neuromechanical action of balance retention on a tightened band,induces strategic indirect-involuntary therapeutic muscle activation exercise incorporating spinal motor control.Though several models have been proposed,understanding slacklining’s neuro-motor mechanism of action remains incomplete.Slacklining has demonstrated clinical effects to overcome AMI in peripheral joints,particularly the knee,and is reported in clinical case-studies as showing promising results in reducing NSLBP related to MF deficiency induced through AMI(MF-AMI).Therefore,this paper aims to:rationalize why and how adjuvant,slacklining therapeutic exercise may positively affect patients with NSLBP,due to MF-AMI induced depletion of spinal stabilization;considers current understandings and interventions for NSLBP,including the contributing role of MF-AMI;and details the reasons why slacklining could be considered as a potential adjuvant intervention for NSLBP through its indirect-involuntary action.This action is hypothesized to occur through an over-ride or inhibition of central down-regulatory induced muscle insufficiency,present due to AMI.This subsequently allows neuroplasticity,normal neuro-motor sequencing and muscle re-activation,which facilitates innate advantageous spinal stabilization.This in-turn addresses and reduces NSLBP,its concurrent symptoms and functional disability.This process is hypothesized to occur through four neuro-physiological processing pathways:finite neural delay;movement-control phenotypes;inhibition of action and the innate primordial imperative;and accentuated corticospinal drive.Further research is recommended to investigate these hypotheses and the effect of slacklining as an adjuvant therapy in cohort and control studies of NSLBP populations.
基金Natural Science Foundation of Hainan Province(No.818QN248,No.818MS061)。
文摘[Objectives]This paper aimed to investigate the effect of Tuina combined with sling exercise therapy(SET)and psoas&abdominal training on serum 5-hydroxytryptamine(5-HT)andβ-endorphin(β-EP)levels in patients with nonspecific low back pain(NLBP).[Methods]Total 46 patients with NLBP who visited the Tuina Department of the First Affiliated Hospital of Hainan Medical University from August 2019 to May 2020 were randomly and evenly divided into control group and treatment group.On the basis of Tuina therapy,the patients in the control group and treatment group were treated with psoas&abdominal training and SET,respectively.After the treatment,the serum 5-HT andβ-EP levels of the patients were detected.[Results]The serum 5-HT andβ-EP levels in the treatment group were significantly improved compared with the control group(P<0.05).[Conclusions]The nerve&muscle reconstruction techniques of Tuina combined with SET or psoas&abdominal training can improve serum 5-HT andβ-EP levels in patients with NLBP.
基金the Deanship of Scientific research atMajmaah University for funding this work under project No.RGP-2019-26.
文摘Low back pain(LBP)is a morbid condition that has afflicted several citizens in Europe.It has negatively impacted the European economy due to several man-days lost,with bed rest and forced inactivity being the usual LBP care and management steps.Direct models,which incorporate various regression analyses,have been executed for the investigation of this premise due to the simplicity of translation.However,such straight models fail to completely consider the impact of association brought about by a mix of nonlinear connections and autonomous factors.In this paper,we discuss a system that aids decision-making regarding the best-suited support system for LBP,allowing the individual to avail of reinforcement and improvement in its self-management.These activities are monitored with the help of a wearable sensor that helps in their detection and their classification as those that soothe or aggravate LBP and hence,should or should not be performed.This system helps the patients set their own boundaries and milestones with respect to suitable activities.This system also does windowing and feature extraction.The present study is an empirical and comparative analysis of the most suitable activities that patients suffering from low back pain can select.The evaluation shows that the system can distinguish between nine common daily activities effectively and helps self-monitor these activities for the efficient management of LBP.
文摘Objective:To assess the efficacy of gabapentin in the treatment of low back pain patients.Methods:This prospective observational study was conducted over 6 months to assess the efficacy of gabapentin in patients suffering from low back pain.Past medical history,pain severity by Visual Analogue scale(VAS)and sleep quality by Pittsburgh Sleep Quality Index(PQSI)were collected.VAS scores and PQSI scores before and after gabapentin treatment were compared,and gabapentin satisfaction post treatment were recorded.Results:This study included 100 low back pain patients with 65 males and 35 females,and the mean age was(39.0±10.5)years.The commonest presentation was non-radiating low back pain(40%).The mean VAS score and the mean PQSI score in the study before treatment were 7.70±1.91 and 10.95±5.02,respectively.After treatment with gabapentin,the mean VAS score and the mean PQSI score decreased to 2.75±1.79 and 4.90±2.20,respectively,and the differences before and after the treatment were significantly different(both P=0.001).Overall,62%of the patients were extremely satisfied with gabapentin because they reported no adverse drug reaction.Besides,31%of the patients were satisfied and 7%were strongly dissatisfied with the therapy.Conclusion:Gabapentin can improve sleep quality and reduce lower back pain as measured by the VAS and PQSI.The efficacy of this drug is relatively good,but further improvement is required.
文摘Objective:To analyze the level changes of the degree of back pain by visual analogue scale(VAS),lumbar function(Japanese Orthopaedic Association Scores,JOA),muscle temperature,serum serotonin 5-hydroxytryptamine(5-HT)andβ-endorphin(β-EP)in patients of low back pain(LBP).Methods:64 LBP patients treated in the tuina department of first affiliated hospital of Hainan Medical University were randomly divided into observation group(32 cases)and control group(32 cases).The control group was treated with traditional filiform acupuncture needling,the observation group was treated with Chinese tuina.VAS,JOA,muscle temperature,5-HT,β-EP,these indexes were tested before and after treatment.Results:The VAS and JOA score in the observation group were significantly lower than those in the control group(P<0.01),the muscle temperature in the observation group and the control group increased significantly(P<0.01),and the observation group was higher than that in the control group(P<0.05);5-HT、β-EP was significant difference before and after treatment(P<0.01),and the level in observation group was significantly higher than that in the control group,the difference was statistically significant(P<0.05).Conclusion:Chinese tuina has significant clinical efficacy in the treatment of LBP.The medical infrared thermal imaging technology and serum pain detection technology is conducive to objectively helpful to analyze the exact efficacy of tuina in the treatment of LBP and its impact on relevant indexes.
文摘Degenerative disc disease is the most common cause of low back pain. Intervertebral disc abnormalities are commonly evaluated by magnetic resonance imaging (MRI), and Pfirrmann’s system involves the use of T2-weighted images (T2WI) to classify disc degeneration. However, as this classification is based on visual evaluation, it is not possible to quantify degeneration using this method. The present study was performed to establish an MRI-based intervertebral disc classification system using diffusional kurtosis imaging (DKI), to quantify intervertebral disc water content according to the Pfirrmann classification. Sagittal mean diffusional kurtosis (MK) mapping was performed for the L3/4, L4/5, and L5/S1 intervertebral discs in 32 patients (15 female, 17 male;age range, 24 - 82 years;mean age, 57.7 years). The degree of disc degeneration was assessed in the midsagittal section on T2WI according to the Pfirrmann classification (grade I - V). The relationships between MK values, which are correlated with intervertebral disc composition changes, and grade of degeneration determined using the Pfirrmann classification were analyzed. The MK values tended to decrease with increasing grade of degeneration, and differed significantly between grades I and IV, but not between grade IV and V (P < 0.05, Mann-Whitney U test). DKI is an effective means of detecting the early stages of disc degeneration. Therefore, DKI may be a useful diagnostic tool for quantitative assessment of intervertebral disc degeneration.
文摘We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or walk, a condition known as astasia-abasia. Initial concern had been that this neurological phenomenon was as a result of complications of his chronic pain intervention. Despite an essentially normal neurological examination and dedicated battery of neurological imaging and special testing, no cause was identified. Over a 7-day period of in-patient admission and physical rehabilitation symptoms resolved entirely. In the course of the workup for this episode, it was suggested that the phenomenon was the result of a side effect of dexamfetamine, an agent that had been prescribed for the patient by his neurologist for treatment of his narcolepsy. On the back of this episode, this treatment was discontinued by his neurologist following an outpatient consultation. Subsequent repeated SIJ injections were entirely uneventful and the patient experienced no further occurrences of this phenomenon.
文摘<strong><span style="font-family:Verdana;">Background:</span></strong><span style="font-family:Verdana;"> Low back pain is one of the important patients’ presenting</span><span style="font-family:Verdana;"> complain that requires expert management from the physiotherapists. Yet no work was available for reference on the use of outcome measures for its e</span><span style="font-family:;" "=""><span style="font-family:Verdana;">valuation by Nigeria physiotherapists. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> This study, therefore, investigated the outcome measures used by Nigerian physiotherapists</span></span><span style="font-family:Verdana;"> to </span><span style="font-family:;" "=""><span style="font-family:Verdana;">e</span><span style="font-family:Verdana;">valuate patients with Low Back Pain and the fac</span><span style="font-family:Verdana;">tors that influenced their use. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A survey questionnaire was posted to 306 randomly selected mem</span></span><span style="font-family:Verdana;">- </span><span style="font-family:;" "=""><span style="font-family:Verdana;">bers</span><span> </span><span style="font-family:Verdana;">of the Nigeria Society of Physiotherapy (NSP). Data were analyzed using f</span><span style="font-family:Verdana;">requency, percentages, mean, ANOVA, and Pearson’s Chi</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">square. P</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">val</span><span style="font-family:;" "=""><span style="font-family:Verdana;">ue was placed at 0.05. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> 52.9% of the respondents (221) used a pain visual analog scale. Only 36.1% used LBP</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">specific clinical outcome measures. The factors that influenced their use were belief, attitude, knowledge, and choice. There was no significant difference between the majority of the factors and the use of clinical outcome measures. The </span><span style="font-family:Verdana;">P-</span><span style="font-family:;" "=""><span style="font-family:Verdana;">values were 0.960, 0.648, 0.760 </span><span style="font-family:Verdana;">for belief, attitude and knowledge respectively. The only factor that had a </span><span style="font-family:Verdana;">significant difference (</span></span><span style="font-family:Verdana;">P </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.029) with the use of clinical outcome measures </span><span style="font-family:Verdana;">w</span><span style="font-family:Verdana;">as choice. Gender and postgraduate qualification had no significant influ</span></span><span style="font-family:Verdana;">- </span><span style="font-family:;" "=""><span style="font-family:Verdana;">e</span><span style="font-family:Verdana;">nce on the use of clinical outcome measures at the </span></span><span style="font-family:Verdana;">P-</span><span style="font-family:Verdana;">value </span><span style="font-family:;" "=""><span style="font-family:Verdana;">of 0.117 and 0.510 respe</span><span><span style="font-family:Verdana;">ctively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Pain visual analog scale is the outcome measure frequently used by Nigeria Physiotherapists to evaluate patien</span></span><span style="font-family:Verdana;">ts with Low Back Pain. Belief, attitude, knowledge, and choice are the factors that influ</span></span><span style="font-family:Verdana;">- </span><span style="font-family:Verdana;">enced the use. There is a need to incorporate the use of LBP</span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""><span style="font-family:Verdana;">specific outcome measures by Nigerian physiotherapists while treating patients with LBP.</span></span>
文摘Objective: To analyze the Patient Functionality Questionnaire (PFQ) scores of the patients treated with either Diclofenac + B vitamins (Group DB) or Diclofenac monotherapy (Group D) in order to better understand the impact of the combination of diclofenac with vitamins B<sub>1</sub>, B<sub>6</sub>, and B<sub>12</sub> on quality of life. Research Design/Methods: We performed a post-hoc analysis of tabulated data generated during the DOLOR study (Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: the DOLOR study), using the software GraphPad Prism 5 for Windows, v5.04. The absolute number or percentage of “True”/“False” respondents for each questionnaire item at each study visit, together with the absolute number and percentage of subjects with no change, improvement, or worsening of each PFQ item at each study visit, within and between treatment groups were arranged on contingency tables and analyzed with the Chi-squared or Fisher’s Exact test. Results: At pretreatment there were no statistically significant differences between treatment groups (p > 0.05 for all items). At Visit 2 in both treatment groups, there were statistically significant improvements in individual question responses in each of the 12 items of the questionnaire (p < 0.05 for all items). At Visit 2, comparing the distribution of patients in each treatment group with “improvement”, “no change”, or “worsening”, there was a statistically significant superiority among subjects of group DB in response to items 1, 6, 8, and 10. At Visit 3, both groups had statistically significant (p < 0.001) improvements in each individual item of the PFQ in relation to pretreatment values. The distribution of subjects in each treatment group presenting with “improvement”, “no change”, or “worsening” at Visit 3 varied significantly in favor of group DB in the responses to item 4. At Visit 4, the subjects remaining in treatment in both groups showed statistically significant improvement in PFQ responses in relation to pretreatment values (p < 0.05). The distribution of subjects in each treatment group presenting with “improvement” or “no change” at Visit 4 varied significantly in favor of group D in the responses to items 5, 8, and 12. Conclusion: Improvement in overall PFQ scores was observed in both treatment groups, though the specific items of the questionnaire of the subjects in group DB at Visit 2 showed greater improvement in areas related to sleep quality, mobility, ability to wash and dry, ability to walk distances, and posture comfort. These results serve to corroborate the previously published data, which indicates a benefit of combining the B vitamins with diclofenac in the treatment of patients with low back pain, yielding shorter treatment time to resolution of the lumbago in the treated patients.
文摘<b><span style="font-family:Verdana;">Purpose:</span></b></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Persistent Postoperative Low Back Pain (PLBP) is inordinately </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">com</span><span style="font-family:Verdana;">mon, and has been attributed to various pre-operative and post-operative</span><span style="font-family:Verdana;"> anatomical and mechanical factors in the spine. It may or may not be associated with sensory symptoms in the lower extremities—frequently termed “radiculopathy”—with or without Electromyographic (EMG) or imaging abnormalities. The present study aimed to look at these various symptoms in the lower extremities from a different angle and perspective and to clarify the distinc</span><span style="font-family:Verdana;">tion between true radiculopathy and pseudoradiculopathy;and determine</span><span style="font-family:Verdana;"> their possible relationship with the outcome of surgery. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Medical records of twenty-four patients with PLBP who were referred to the author for clinical and electrodiagnostic examinations several months after surgery were re</span><span style="font-family:Verdana;">viewed. Clinical symptomatology, with special reference to the presence or</span><span style="font-family:Verdana;"> ab</span><span style="font-family:Verdana;">sence of sensory and motor deficits together with EMG findings, were reviewed and categorized into 4 groups: non</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">radicular, true radiculopathy, </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">pseudoradiculopathy, and peripheral neuropathy. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Lower Back Pain (LBP) in all patients persisted following successful and uncomplicated surgery. LBP in patients with true radiculopathy persisted but was less disabling when the neurologic deficits resolved partially or significantly. As expected</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> the neurologic deficits related to peripheral neuropathy, together with LBP, remained per</span><span><span style="font-family:Verdana;">sistent. </span><b><span style="font-family:Verdana;">Conclusion:</span></b> <span style="font-family:Verdana;">LBP and various sensory and</span></span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">motor symptoms in the</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> lower </span><span style="font-family:Verdana;">extremities are 2 distinct entities, both clinically</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and pathophysiologically.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> These sensory and motor symptoms, together with </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">the </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">heightened activity of various</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pro</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">inflammatory cytokines and neurotrophins—setting aside the various</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">anatomical and mechanical factors in the spine—can influence the outcome of surgery, favorably or unfavorably.
