Personalized assessment and management of non-specific low back pain

Examination of Non-Specific Low Back Pain, Pain Perceptions and Disability Between Brazilian Jiu Jitsu, Muay Thai and Boxing Athletes

Background: Non-specific low back pain is the leading cause of years lived with disability worldwide. The present study investigates non-specific low back pain, pain perceptions and disability due to pain among Brazilian Jiu Jitsu, Muay Thai and Boxing athletes. Methods: The study included 90 amateur athletes (aged 18-45 years; M = 28.97, SD = 5.88). The athletes completed the valid and reliable Pain Beliefs Perceptions Inventory (PBPI), the Quebec Pain Disability Scale (QPDS) and the Short-Form McGill Pain Questionnaire (SF-MPQ) which includes the Visual Analogue Scale (10 cm VAS 0-10 rating system) and the Present Pain Intensity index (PPI). Results: The results revealed that the majority of athletes rated their pain as low (SF-MPQ: M = 12.34, SD = 8.91; VAS: M = 1.65, SD = 1.82; PPI: M = 2.10, SD = 1.08) with low disability due to pain (QPDS: M = 18.98, SD = 22.71). Also, the majority of athletes disagreed that their pain was mysterious or persistent with high duration (PBPI: M = 1.43, SD = 2.23). Between the three martial arts, Brazilian Jiu Jitsu athletes showed statistically significantly (a) higher emotional and sensational pain intensity (x2(2) = 15.73; p < 0.001; x2(2) = 19.34; p < 0.001), (b) higher disability due to pain (x2(2)= 25.30; p < 0.001) and (c) more mysterious, more persistent pain with more duration (x2(2)= 9.32; p < 0.05) than Muay Thai and Boxing athletes. Also, a few correlations were found between age and pain perception only in Brazilian Jiu Jitsu and Boxing martial arts athletes. Conclusions: Further research is required to elucidate the biomechanical and psychological factors contributing to these differences between martial arts athletes.

A cost-effectiveness analysis of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain

BACKGROUND CONTEXT

Randomized trials have demonstrated the superiority of intraosseous basivertebral nerve ablation (BVNA) compared with sham and standard care in terms of improvements in pain, disability, and health-related quality of life in patients with vertebrogenic chronic low back pain (cLBP).

PURPOSE

To assess the cost effectiveness of BVNA in patients with vertebrogenic cLBP compared to standard care alone.

STUDY DESIGN/SETTING

A model-based economic analysis.

PATIENT SAMPLE

Base case analysis used INTRACEPT, a randomized trial comparing BVNA with standard care in 140 patients with vertebrogenic cLBP, recruited from 23 sites across the United States, with a follow-up, up to 5 years. Scenario analyses compared data from the Surgical Multicenter Assessment of Radiofrequency Ablation for the Treatment of Vertebrogenic Back Pain (SMART) randomized trial against a sham control, and a single-arm study.

OUTCOME MEASURES

Costs and quality-adjusted life years (QALYs) were calculated to determine the incremental cost-effectiveness ratio (ICER).

METHODS

A cost-effectiveness model was built in Microsoft Excel to evaluate the costs and health outcomes of patients undergoing BVNA using the Intracept Procedure (Relievant Medsystems) to treat vertebrogenic cLBP from a US payor perspective. Alternative scenario sensitivity analyses and probabilistic sensitivity analyses were conducted to assess the robustness of the model results. QALYs were discounted at 3.0% per year.

RESULTS

Base case analysis showed that BVNA relative to standard care alone was a cost-effective strategy for the management of patients with vertebrogenic cLBP, with an ICER of US$11,376 per QALY at a 5-year time horizon from introduction of the procedure. Modeling demonstrated a >99% probability that this was cost effective in the US, based on a willingness-to-pay threshold of US$100,000 to US$150,000. Various sensitivity and scenario analyses produced ICERs that all remained below this threshold.

CONCLUSIONS

BVNA with the Intracept Procedure offers patients with vertebrogenic cLBP, clinicians, and healthcare systems a cost-effective treatment compared to standard care alone.

Retrospective cohort study of fluctuations in emergency department visits for nonspecific back and neck pain during the COVID-19 pandemic

OBJECTIVE

We examined fluctuations in emergency department (ED) visits for nonspecific back and neck pain during the COVID-19 pandemic and explored potential contributing factors.

METHODS

This retrospective cohort study included patients who presented to the ED with nonspecific back and neck pain between January 2019 and December 2021. Demographic data, visit frequencies, and clinical outcomes were analyzed to assess the impact of the pandemic on visit patterns.

RESULTS

A total of 1245 ED visits were recorded. Visits decreased by 30% during the peak of the pandemic, with a gradual return to baseline by mid-2021. No significant changes in patient demographics or clinical outcomes were noted during the pandemic. However, a proportional increase in neck pain visits was observed.

CONCLUSIONS

The observed decline in visits may be linked to pandemic-related concerns, such as fear of exposure in the hospital and reduced activities. The increased neck pain visits highlights the potential influence of pandemic-related stress and lifestyle changes. Visit patterns rebounded as the pandemic eased, indicating a temporary decrease unrelated to condition severity. The COVID-19 pandemic temporarily affected ED visits for nonspecific back and neck pain. Further research is needed to explore the long-term effects of the pandemic on health care utilization.

A Systematic Review on the Neuropsychological Assessment of Patients with LBP: The Impact of Chronic Pain on Quality of Life

Background and objective: Low back pain (LBP) is most common pain syndrome in Europe, affecting approximately 50% of European citizens. LBP is a complex condition that negatively affects many aspects of an individual's life such as work productivity, mobility, and mental health. The aim of this study is to assess the impact of pain associated with chronic LBP on patients' quality of life. Methods: Clinical studies reviewed in our search with no time restrictions were identified from PubMed, Web of Science, Scopus, and Cochrane Library databases. Of the initial 1929 studies, only 15 met inclusion criteria. Results: Results of our study indicate that chronic pain has a negative impact on numerous functions and areas in which the individual is involved and that this condition leads to reduced performance. Conclusions: LBP is a debilitating condition for patients, negatively affecting quality of life. Future studies should focus on validating a standardized assessment that examines all aspects affected by LBP through a customized questionnaire.

Barriers to using physical exercise as an intervention within inpatient mental health settings: A systematic review

Service providers find it difficult to implement Physical Exercise (PE) strategies in routine care within inpatient mental health settings even though they perceive it to be an effective therapy, with a robust evidence base. Identifying barriers that exist can assist with the development of future interventions and support PE services being introduced into mental health inpatient settings. The aim of this systematic review was to synthesise the evidence on the barriers or perceived barriers that exist amongst service users and providers when incorporating PE as an intervention within inpatient mental health settings. Using a narrative synthesis approach, four main themes were identified: (i) Barriers relating to service users' mental and physical health, (ii) Factors relating to service providers, (iii) Environmental factors and (iv) Cultural factors. Both service users and providers need more knowledge on implementing PE in inpatient mental health settings. Tailored programmes for service users are warranted, with specialist roles for staff developed.

Influence and Relationship of Pain on Lumbar Biomechanics in a Young Adult Population with Non-Specific Low Back Pain

The therapeutic actions indicated for low back pain, in addition to physiotherapy, include mobilization of the affected segment, as it is assumed that a loss of mobility may contribute to a patient's pain. The aim of this study was to investigate the influence of back pain on the degrees of spinal mobility in young adults. Eighty-six volunteers participated in the study. Fingertip-to-floor distance, Schöber's test, the fingertip-to-floor lateral flexion test, GHQ-12, the Fear-Avoidance Beliefs Questionnaire and the STarT Back Screening Tool were used. There were statistically significant differences between the two groups (pain and no pain) in degrees of spinal flexion (Schöber's test and side flexion) showing greater mobility in the group with pain. However, the group with low back pain showed less rotational mobility. The presence or absence of back pain had an impact on the individual's sporting practice and perception of pain, and they were able to carry out their sporting activities normally. Young adults with idiopathic low back pain showed some statistically significant differences in relation to the mobility of the spine in the different planes of movement (flexion and side flexion), conditioning their quality of life and sports practice.

Tactile acuity and active joint repositioning sense in individuals with and without chronic low back pain: a cross-sectional study

BACKGROUND

Sensorimotor dysfunction, as measured by tactile acuity and active joint repositioning, has been identified as a contributing factor of chronic low back pain (CLBP). Existing research suggests that further research is necessary to improve the characterization of sensorimotor perception in patients with CLBP.

OBJECTIVES

The main aim is to investigate whether tactile acuity and repositioning errors differ between individuals with CLBP and controls without CLBP. A secondary aim was to investigate the association between age, body mass index (BMI) and physical activity, and tactile acuity and repositioning sense.

METHODS

Cross-sectional study. Sixty-eight participants (36 with, 32 without CLBP) were examined. Two-Point Discrimination (TPD) test (four measures: horizontal and vertical run, left and right side) and Active Joint Reposition Sense (AJRS) test (2 directions: to flexion and to extension) were used.

RESULTS

No differences were found for TPD (right horizontal run: p = .069; left horizontal run: p = .066; right vertical run: p = .933; left vertical run: p = .285) or AJRS (flexion: p = .792; extension: p = .956) between participants with and without CLBP. Older subjects had significantly worse tactile acuity (3 sites, p = .018, p = .004, p = .041) and worse repositioning sense (2 directions, p = .026, p = .040,) than younger subjects. Individuals with BMI ≥ 25 had significantly worse TPD compared to individuals with normal weight (2 sites, p = .028, p = .020).

CONCLUSIONS

Individuals with CLBP did not have impaired tactile and repositioning accuracy when compared to controls without CLBP. Future studies comparing sensorimotor performance should consider age and BMI as potential confounding factors.

On-Site Physiotherapy in Emergency Department Patients Presenting with Nonspecific Low Back Pain: A Randomized Controlled Trial

Background: There is a high incidence of nonspecific Low Back Pain (LBP) in patients visiting Emergency Departments (EDs), but there is a lack of knowledge regarding emergency physiotherapy for LBP. The effect of on-site physiotherapy in these patients was therefore never demonstrated. We assessed short-term outcomes, feasibility and patient satisfaction with physiotherapy in ED patients presenting with nonspecific LBP. Methods: A block-randomized, controlled, open-label trial with a follow-up of 42 days. Patients aged 18 years or older presenting to an ED with nonspecific LBP were prospectively enrolled. Both groups received the same booklet with written information on LBP management and exercises. Patients in the intervention group were given additional instructions by a certified physiotherapist. Results: We included 86 patients in the primary analysis. The median age was 40, and 40.7% were female. At day 7, the median Oswestry Disability Index (ODI) was 2 points lower in the intervention group compared to the control group, which was not statistically significant. There was no between-group difference in pain at day 7. Patients who received physiotherapy felt significantly more confident with the exercises they were taught (p = 0.004, effect size = 0.3 [95% CI 0.1 to 0.5]). Conclusions: On-site physiotherapy in ED patients presenting with nonspecific low back pain is associated with higher patient satisfaction, compared to standard of care. The effect of physiotherapy was small, with only minimal improvement in disability, but without a reduction in pain. Despite the very small effect size, physiotherapeutic interventions should be investigated in larger cohorts with an extended intervention including patient education, exercises, and other physiotherapeutic modalities.