Prevalence of chronic low back pain: systematic review

Objective and subjective assessment of back shape and function in persons with and without low back pain

Individuals with chronic low back pain (cLBP) may self-report about impairment of their back shape and function. As classical clinical diagnostic modalities seem to provide limited information on the pathogenesis of cLBP, interest has shifted to a more comprehensive approach of diagnosing cLBP. Self-reported outcome measurements in the form of either questionnaires or as part of clinical interview have gained interest. In theory, these self-reported assessments on one's LBP provide the clinician with substantial information regarding the dominance of specific factors in a rather complex bio-psycho-social interplay of factors leading to cLBP. In order to analyze how well self-reported impairment (SRI) corresponds with objective measures, we evaluated the association between SRI and objectively measured back shape and function. In a cross-sectional study, we included 914 participants (207 asymptomatic, 480 non-chronic LBP (ncLBP), 227 cLBP). Participants were categorized into three groups: asymptomatic participants did not report back pain. Participants with back pain lasting for 12 weeks or more were categorized as cLBP patients, while participants with back pain for less than 12 weeks were classified as non-chronic LBP patients (ncLBP). Back function was quantified using finger-to-floor distance (FFD), Ott and Schober test, and 30 s sit-to-stand test (STS). Back shape and function were measured in standing position using a computer-assisted medical device. SRI was quantified during a clinical interview using a numerical 10-score-scale (1: unrestricted, 10: severely restricted). Higher SRI was associated with worse performance in every clinical test. Effect estimates ranged from small (Ott test: β = -0.05, CI -0.09-0.00, η2 = 0.01; p = 0.05; Schober test: β = 0.08, CI -0.13 -0.04, η2 = 0.01, p < 0.01) to moderate (FFD: β = 1.66, CI 1.27-2.19, η2 = 0.05, p = 0.05; STS: β = -0.08, CI -0.82, CI -1.06--0.59, η2 = p < 0.01) in participants with ncLBP and cLBP. Higher SRI was associated with pathological back shape (hyperkyphosis, β = -0.03, CI = -0.29-0.51, η2 = 0.01; p = 0.58 and hyperlordosis, β = 0.35, CI 0.04-0.65, η2 = 0.02, p = 0.03) as well as attenuation of range of motion in the frontal and sagittal planes in every direction except for the thoracic range of extension. Effect sizes were small (η2 = 0.01-0.04). This study demonstrated an association of SRI with objective back shape and function. Participants with ncLBP seem to have the highest correspondence between objective evaluation and SRI of back shape an function. In the future, these associations can be used to further personalize both diagnostic and therapeutic modalities for individuals suffering from LBP rather than generalizing treatment options.

Treatment for the central sensitization component of lower back pain using systemic manual therapy

OBJECTIVE

The purpose of this study was to analyze treatments for central sensitization (CS) and other contributors to chronic lower back pain (CLBP), using systemic manual therapy (SMT) protocols based on the temporal model for CS (TMCS).

DESIGN

Cohort retrospective multivariate analysis.

METHODS

This study analyzed episode of care and rate of improvement data in 1053 patients, evaluating 715 protocol combinations of SMT.

RESULTS

While 682 (68%) patients reported improvement in overall symptoms, only 583 (53%) reported improvement in the lower back pain complaint. Comorbidities with statistically significant (p < 0.05) association with worse lower back pain outcomes were statin use, anxiety, depression, digestive and urinary issues, smoking and prior surgery. A significantly higher rate of improvement resulted from the use of 43 protocol combinations, which were composed of 19 protocols, a group that includes five protocols including urinary-drainage (UD), Diaphragm-cranial-sinus (DCS), Barral-abdominal-motility (Barral), lower-abdominal-urogenital (LAUG), and Cardiac-cervical-cranial-vascular (CCCV), which were all predicted to treat CS by the TMCS.

DISCUSSION AND CONCLUSIONS

The results of this study support the use of SMT to treat CLBP and reinforce the TMCS hypothesis defining CS as a functional, multifaceted neurophysiological state rather than a purely structural adaptation of the CNS. The lower rate of improvement in CLBP compared to overall improvement and the correlations of worse outcome with certain comorbidities suggests that, in addition to SMT, a multimodal approach for CLBP should favor lifestyle improvements such as smoking cessation, lifelong exercise habits, and a balanced diet over medications and surgery.

Understanding the role of positive body image in chronic low back pain: A path-analytic model

Chronic low back pain (CLBP) is a prevalent and disabling condition that significantly affects individuals' quality of life. Recently, the cognitivebehavioral model of body image and chronic pain has emphasized the influence of body image on the course of this condition. Nevertheless, the role of positive body image constructs, such as body appreciation and appreciation of body functionality, in CLBP remains underexplored. This study examined associations between body appreciation and functionality appreciation with pain intensity and interference in individuals with CLBP, with pain catastrophizing and kinesiophobia as potential mediators. A sample of 99 Spanish adults suffering from CLBP completed self-report measures. The path-analytic model showed an acceptable fit. While body appreciation showed no significant associations, functionality appreciation was negatively associated with pain catastrophizing, which in turn was positively associated with both pain intensity and interference. Indirect associations revealed that pain catastrophizing mediated the relationships between functionality appreciation and both pain outcomes. These results suggest the potential role of functionality appreciation in relation to pain outcomes in CLBP, with pain catastrophizing mediating these associations, highlighting the need for research examining whether targeting positive body image constructs, especially functionality appreciation, in pain management interventions could influence CLBP outcomes.

Health-related measures and subjective prognosis of gainful employment among patients with non-specific chronic low back pain in multidisciplinary orthopedic rehabilitation

Non-specific chronic low back pain (CLBP) restricts participation in society and employment also due to the high psychosocial burden of this condition. Thus, there is an urgent need for rehabilitation of patients with CLBP, which must be determined by a valid diagnosis of psychosocial risk factors. The subjective prognosis of gainful employment (SPE) is considered to indicate the need for medical rehabilitation for back pain. The present study investigated the association between SPE and psychosocial risk factors among individuals with non-specific CLBP undergoing inpatient multidisciplinary orthopedic rehabilitation (MOR).This cross-sectional observational study included 925 individuals aged 20 to 65 with non-specific CLBP at admission to inpatient MOR (M=52.2 years, SD=7.2; 77.5% female; ICD-10: M51/53/54). Associations of the SPE total score with psychological, pain-related, and work-related measures were examined by using correlation and regression analyses. Moreover, moderated associations of the SPE categorical score were tested using one-way analyses of variance with the independent factor self-reported prognosis of employment (favorable vs. unfavorable). Additionally, the frequency distributions of scores within the clinical range for depressive symptoms, chronic stress, and subjectively assessed work ability stratified by self-reported prognosis of employment were investigated.A less favorable self-reported prognosis of employment was predicted by higher job strain and chronic stress as well as lower pain self-efficacy and subjective physical work ability. In particular, individuals with an unfavorable self-reported prognosis of employment showed a risk pattern and were frequently in the clinical range for depressive symptoms, chronic stress, and subjective work ability.The results supported a high need for rehabilitation for this target group, especially for patients with non-specific CLBP and unfavorable self-reported prognosis of employment. Early assessment of sociomedical criteria, in addition to pain and psychodiagnosis as well as targeted referral to needs-based interdisciplinary multimodal treatment approaches could reduce the risk of further chronification of pain and the development of mental disorders.

Impact of exercise therapy with/without cognitive functional therapy on pain, Function, and biopsychosocial factors in chronic nonspecific low back pain

BACKGROUND

Exercise therapy (ET) is a well-established treatment for chronic low back pain. However, the combined effect of ET with cognitive functional therapy (CFT) on chronic nonspecific low back pain (CNLBP) remains under-investigated. This study investigated how these interventions, used together or separately, affected individuals with CNLBP.

METHODS

Sixty females (40-60 years) were allocated to ET, ET + CFT, and control groups. Both intervention groups received 24 sessions (3x/week) over 8 weeks. Functional disability, pain, lumbar pelvic motor control, and anxiety/depression were assessed before and after the intervention.

RESULTS

Fifty-one participants completed the study. The ET + CFT group showed greater improvements compared to both ET and control in all measured areas (functional disability, pain, motor control, anxiety/depression) (P < 0.05). However, both ET and ET + CFT groups improved significantly compared to control for all variables (P < 0.05).

CONCLUSIONS

Following eight weeks of intervention, both ET and ET + CFT improved functional disability, pain, lumbar pelvic motor control, and biopsychosocial indicators in individuals with CNLBP. Notably, while the combined intervention group (ET + CFT) showed greater improvements across most outcomes, it was significantly different from the exercise-only group only on the Kinesiophobia scale. These findings suggest that cognitive functional therapy may enhance the effectiveness of exercise therapy by addressing psychological factors, such as fear of movement, that contribute to pain and disability in CNLBP.

Memory deficits in chronic low back pain patients: A scoping review

BACKGROUND

Chronic pain often results in cognitive dysfunction, with memory complaints being the most prevalent cognitive deficits. Our aim was to review the existing literature on memory deficits in the most prevalent chronic pain condition, Chronic Low Back Pain (CLBP).

METHOD

We conducted a scoping review from inception to April 2023, employing a narrow literature research without study design restrictions. We searched on five databases: MEDLINE, Cochrane Library, CINAHL, Scopus and Web of Science. We included studies that compared memory performances between Chronic Low Back Pain patients and healthy controls.

RESULTS

22,368 results were retrieved, and 15,589 were screened. 9 cross-sectional studies met our inclusion criteria. These studies had differences in definitions and measurements of memory functions. CLBP groups showed lower performances in memory tests.

CONCLUSION

This scoping review provides an overview of the literature on memory deficits in CLBP patients. We found discrepancies in definitions and measurements of memory functions, as well as a lack of quantitative data due to limited studies. In each study, CLBP patients exhibited lower performance in memory tests compared to healthy population. It would be interesting to gather more data and to standardize definitions and measurements.

Evaluating an early Interdisciplinary Multimodal Assessment for Patients at Risk of Developing Chronic Pain: Results of a Multicentre RCT in Germany

INTRODUCTION

Patients at risk of developing chronic pain are often significantly impaired in their daily, social and work activities. An early interdisciplinary multimodal assessment (IMA) includes a systematically integrated view of medical, psychosocial and functional factors to direct patients to need-based treatment services. This multicentre, randomised, controlled trial examined the effects of an IMA on preventing chronic pain and improving care for adult patients.

METHODS

The intervention group (IG) received an IMA in accordance with standardised guidelines. The control group (CG) was offered a unimodal medical pain assessment (MPA). Data from the Characteristic Pain Intensity (PI) and Disability Score (DS), as primary outcomes, were collected at assessment and 3 and 6 months later together with secondary outcomes (e.g. depression, anxiety, stress, catastrophizing, health-related quality of life).

RESULTS

A total of 620 (68.4%) valid questionnaires were available at the 6-month follow-up. The mean reduction (numerical rating scale, 0-10) in terms of improvement within both groups (IG/CG) was 1.6/1.7 points for PI and 1.9/1.8 points for DS. Most secondary outcomes improved as well. However, the differences between the two groups did not reach statistical significance, although there was a tendency for the IG to have a greater effect on some psychological outcomes. Regarding the recommended treatment approaches, the focus in the IG was more on physical activity and psychological and psychosomatic interventions, whereas in the CG there was also a preference for adjusting the medication.

CONCLUSIONS

Both early MPA and IMA seem to have a positive effect on outcomes such as pain intensity, functional limitations and psychological factors for patients at risk of developing chronic pain. We critically reflect on the results of the primary research question by discussing the limitations in detail and conclude that further research should ensure that the control conditions reflect standard care and that the follow-up period is long enough.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS-ID: DRKS00015443).

Effects of a land and aquatic exercise-based program on pain, mobility and quality of life in patients with chronic low back pain: a study protocol for a randomized controlled trial

BACKGROUND

Chronic low back pain (CLBP) is a disease with significant functional, emotional and social impact. Several interventions are proposed for its management and exercise is one of main, land-based or water-based. This study describes a randomized controlled trial that will analyze the effect of a combined aquatic and land-based exercise program compared to an aquatic-based program on pain, functional incapacity and quality of life in adults with CLBP. Additionally, it will analyze the effects of exercise cessation in the same outcomes.

METHODS AND DESIGN

A blind randomized controlled trial will be developed with a 1:1 allocation ratio. Around 30 adults with mechanical CLBP will be randomly allocated in two groups. The experimental group (ALG) will complete an aquatic and land-based exercise program and control group (AG) will carry out only an aquatic program, both for 8 weeks. Participants will be assessed with Visual Analogue Scale, Oswestry Disability Index, Short-Form 36, Tampa Scale of Kinesiophobia-13 and Modified-Modified Schober Test, collected at baseline (M0), after 8 weeks (M1) and 4 weeks after the end of the intervention (M2).

DISCUSSION

This study may provide a relevant contribution to understand the potential effect of a combined land and aquatic exercise program on pain, functional disability, fear of movement, quality of life and lumbar mobility. The results may provide important information for CLBP management.

TRIAL REGISTRATION

This trial is registered with ClinicalTrials.gov (registration number: NCT06641570; date of registration: October 14, 2024).

The periaqueductal gray in chronic low back pain: dysregulated neurotransmitters and function

ABSTRACT

Mechanisms underlying chronic pain are insufficiently understood, hampering effective treatment approaches. Preclinical evidence suggests a potential contribution of decreased excitatory (glutamatergic) and increased inhibitory (γ-aminobutyric acid [GABA]ergic) neurotransmission in the periaqueductal gray (PAG), a key descending pain modulatory brainstem area. This magnetic resonance spectroscopy (MRS) study investigated (1) whether a lower excitatory/inhibitory balance is also observed in the PAG of patients with nonspecific chronic low back pain (CLBP) and (2) whether the excitatory/inhibitory balance relates to psychophysical measures of descending pain modulation and pain sensitivity. Magnetic resonance spectroscopy was acquired on a 3T MR system in 41 patients with CLBP and 29 age- and sex-matched controls. Descending pain modulation and pain sensitivity were evaluated using conditioned pain modulation and pressure pain stimuli, respectively, which were both assessed at the lower back as the most painful area and the nondominant hand as a pain-free, remote area. Patients with CLBP presented with a lower glutamate + glutamine (Glx)/GABA ratio compared with controls (P = 0.002), driven by both decreased Glx (P = 0.012) and increased GABA (P = 0.038). Controls with lower Glx/GABA were more sensitive to pressure pain in both areas, but this association was missing in the patients (lower back: P = 0.004; hand: P = 0.002). Patients with more severe clinical pain showed impaired descending pain modulation at the hand (P = 0.003). In line with preclinical evidence, these findings support a dysregulated PAG in patients with CLBP that might be associated with dysfunctional descending pain inhibition.

Bridging the Gap Between Rehabilitation and Return to Work: A Qualitative Evaluation of a Workplace Intervention for Low Back Pain

BACKGROUND

Low back pain (LBP) can lead to disability and sick leave, impacting work participation and overall health. Given the complex and multifactorial nature of LBP, Belgium's Federal Agency for Occupational Risks (FEDRIS) promotes a secondary prevention strategy for LBP among workers engaged in ergonomically demanding tasks. This strategy includes multidisciplinary-based rehabilitation and an optional workplace intervention (WPI), initiated upon employer request. The WPI component consists of a half-day ergonomic risk analysis at the workplace conducted by an external occupational health service. This paper is one of two parallel qualitative studies that explored the experiences and perspectives of employees and healthcare professionals (HCPs) on the secondary prevention program. The current study focuses on the optional WPI, aiming to identify its strengths, challenges, and potential solutions.

METHODS

Between April 2022 and April 2023, six multicenter semistructured focus groups were held with 15 employees (2015-2019 program participants) and 24 HCPs (including external ergonomists) recruited from 11 Belgian rehabilitation centers and hospitals. Sessions were organized as employee-only, HCP-only, or mixed groups. All the interviews were anonymized, transcribed verbatim, and analyzed inductively via thematic analysis, with validation through data triangulation, intercoder checks, and participant feedback.

RESULTS

The analysis reveals strengths, challenges, and solutions associated with the WPI before, during, and after implementation. Before the intervention, some HCPs recognized the WPIs' benefits, but limited awareness, employer hesitancy, practicality concerns, and job security fears presumably contributed to low application rates. The proposed solutions include proactive communication, streamlined processes, and enhanced employer engagement. During implementation, strengths included improved employee engagement and interdisciplinary collaboration, but challenges related to limited integration and timing affected effectiveness. Early ergonomic assessments and better communication are suggested. After the intervention, inconsistent feedback hindered sustainability, highlighting the need for systematic follow-up and stronger organizational commitment.

CONCLUSIONS

The WPI provides some tangible benefits for sustainable return to work in Belgium's secondary prevention strategy for LBP, yet a few gaps remain. Low employer awareness, application hesitancy, and inconsistent follow-up hinder effective implementation. Equally, interdisciplinary collaboration and proactive ergonomic assessments are considered strengths of the WPI. Involving all key stakeholders emerges as critical for addressing practical concerns and ensuring ongoing support. Future refinements should prioritize streamlined processes, early-stage interventions, and consistent feedback.

Individual Education for Patients With Chronic Low Back Pain: Likely a Clinically Relevant Effect for Long-term Disability Compared to Noneducational Interventions. A Systematic Review With Meta-Analysis

OBJECTIVE: To assess the effectiveness of individual education for patients with chronic low back pain (CLBP), compared to no intervention, placebo, noneducational interventions, or other type of education. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: PubMed, CINAHL, PEDro, Embase, and Scopus (up to January 14, 2024); citation tracking in Web of Science, grey literature and reference lists of previous systematic reviews. STUDY SELECTION CRITERIA: We included RCTs that evaluated individual patient education interventions for adults with CLBP. DATA SYNTHESIS: Random-effects meta-analysis for clinically homogeneous RCTs. We assessed risk of bias using the Cochrane Risk of Bias 2.0, and applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the certainty of evidence. RESULTS: We included 17 RCTs (n = 1893). There was moderate-certainty evidence that individual patient education had a clinically relevant effect compared to noneducational interventions on long-term disability (standardized mean difference, -0.23; 95% confidence interval [CI]: -1.13, 0.66). There was moderate-certainty evidence that individual patient education had no effect on short-term health-related quality of life compared to no intervention (mean difference, -0.003; 95% CI: -0.04, 0.04), and no effect on medium-term disability (SMD, 0.10; 95% CI: -0.37, 0.57) and long-term pain intensity (mean difference, -2.20; 95% CI: -14.43, 10.03) compared to noneducational interventions. CONCLUSION: Individual patient education provided a clinically relevant effect on long-term disability when compared to noneducational interventions. There were no other clinically relevant effects of individual patient education for CLBP. J Orthop Sports Phys Ther 2025;55(5):1-13. Epub 20 March 2025. doi:10.2519/jospt.2025.12794.

The Effects of Joint Mobilization and Myofascial Release on Muscle Thickness in Non-Specific Low Back Pain: A Randomized Clinical Trial

Background: Non-specific low back pain is a discomfort that affects individuals at any point in their lives. This study's aim was to determine the effects of myofascial release and joint mobilization on muscle thickness via ultrasonography in individuals experiencing non-specific low back pain. Methods: This double-blinded randomized clinical trial was conducted on 84 participants in three groups: joint mobilization, myofascial release, and a combination of joint mobilization and myofascial release. Data were collected during a two-week treatment regimen (days 1, 4, 8, and 12) and at a one-month follow-up. Ultrasound evaluations were used to measure the thickness of deep lumbar muscles at rest and contraction, i.e., the transverse abdominis (rTrA and cTrA) and lumbar multifidus (rLM and cLM). Repeated-measures ANOVA was utilized to analyze the follow-ups within the groups and among the groups, with post hoc tests conducted to identify specific differences. Results: Significant increases in muscle thickness were observed over time in the transverse abdominis, with improvements in both rTrA (right, p = 0.001; left, p = 0.001) and cTrA (right, p = 0.001; left, p = 0.008). The lumbar multifidus also demonstrated significant changes, with increases in the rLM (right, p = 0.001; left, p = 0.047) and cLM (right, p = 0.004; left, p = 0.037). However, the main effects showed no significant differences in muscle thickness among the groups. Conclusions: Joint mobilization demonstrated increased effectiveness in improving muscle thickness relative to myofascial release and a combination of both treatments for individuals with non-specific low back pain.

Experiences and perceptions of employees and healthcare professionals on a multidisciplinary program for the secondary prevention of low back pain

Low back pain (LBP) can lead to disability and sick leave, impacting work participation and overall health. Given the complex and multifactorial nature of LBP, Belgium's Federal Agency for Occupational Risks (FEDRIS) promotes a secondary prevention strategy for LBP among workers engaged in ergonomically demanding tasks. This strategy includes multidisciplinary-based rehabilitation (MBR) and an optional workplace intervention. This paper explored the experiences and perceptions of employees and healthcare professionals (HCPs) regarding the secondary prevention program with a focus on the MBR component, aiming to identify its strengths, challenges, and potential solutions. A multicenter qualitative design involving six semistructured focus groups was employed. The participants included 15 employees who attended the program because of LBP and 24 HCPs involved in its delivery. The data were analyzed via thematic analysis. Three major themes were identified: functional and work-related outcomes, content-related factors, and duration and continuation. Positive outcomes included improvements in pain, function, and return to work (RTW), with workplace adaptations and ergonomic guidance playing key roles. Success factors such as education, exercise therapy, motivation, and social interaction were highlighted. However, challenges were identified, including limited communication between centers and employers, insufficient psychological support, and a lack of follow-up to sustain the program's effects. This qualitative evaluation highlights that person-centered, biopsychosocial approaches-encompassing individualized education, ergonomic adaptations, and psychological support-are crucial for optimizing the FEDRIS MBR program's long-term impact on LBP and RTW outcomes. Consistency in staffing, structured follow-up, and systematic prescreening are key areas for improvement. Although limited by a small sample size and retrospective design, these findings pinpoint actionable refinements that future longitudinal studies can explore to ensure sustained, cost-effective rehabilitation benefits.

Dutch translation, cross-cultural adaptation, validation, and reliability of the Back Pain Attitudes Questionnaire (Back-PAQ)

PURPOSE

To translate and cross-culturally adapt the Back Pain Attitudes Questionnaire (Back-PAQ) to Dutch for the Belgian and Dutch populations, and to investigate its measurement properties in the general population and physiotherapists.

METHODS

The adaptation followed established guidelines. Content validity, internal consistency, test-retest reliability (intraclass correlation coefficient), floor and ceiling effects, minimal detectable change (MDC), construct validity, and structural validity were assessed in physiotherapists and the general population. The modified Fear-Avoidance Beliefs Questionnaire (mFABQ) investigated the Back-PAQ's convergent validity, and Confirmatory Factor Analysis evaluated structural validity. Discriminant validity was assessed between physiotherapists and the general population.

RESULTS

Two hundred and sixty participants (mean age: 29 ± 13.3) completed the initial survey and 147 completed the test-retest survey. All Back-PAQ versions (34-item, 20-item, and 10-item) demonstrated good internal consistency, good to excellent test-retest reliability. Moderate correlations with the mFABQ (p < 0.001) and adequate discriminant validity between physiotherapists and the general population supported robust construct validity. The Back-PAQ 10 exhibited a good model fit and enables meaningful sub-score comparisons.

CONCLUSIONS

This collaboration produced a validated Dutch Back-PAQ suitable for use in both the Netherlands and Belgium. All versions demonstrated robust measurement properties, supporting their use in clinical and research settings assessing unhelpful beliefs in back pain management.

Comparative analysis of ground reaction forces and spatiotemporal gait parameters in older adults with sway-back posture and chronic low back pain: a cross-sectional study

BACKGROUND

Gait alterations associated with postural deviations are a significant factor contributing to functional limitations in older adults. Among these, sway-back posture has been linked to chronic low back pain (CLBP), defined as pain persisting for more than three months. This study aimed to analyze ground reaction forces (GRFs), loading and unloading rates, spatiotemporal gait parameters, and the asymmetry index (ASI) in older adults with sway-back posture and CLBP (SBCLBP) without adjusting for walking speed.

METHODS

A total of 36 older adults were included and categorized into three groups: 12 with SBCLBP, 12 with CLBP without sway-back posture, and 12 without CLBP. GRFs and spatiotemporal gait parameters-including stride time, cadence, stride length, gait speed, and stance phase duration-were recorded for all participants. GRFs were analyzed at the anteroposterior peaks during heel contact (Fx1) and push-off (Fx2) phases, as well as at the vertical force peaks at heel contact (Fy1), mid-stance (Fy2), and push-off (Fy3) phases. Additionally, mediolateral force peaks (Fz) during heel contact were assessed. The ASI was calculated for all participants. Between-group differences were examined using one-way ANOVA and ANCOVA.

RESULTS

Cadence, stride length, gait speed, and Fy2 values were significantly lower in the SBCLBP and CLBP groups compared to the control group. Additionally, these parameters were significantly lower in the SBCLBP group than in the CLBP group. However, the loading rate demonstrated greater variability across participants. No significant differences in ASI were observed among the groups.

CONCLUSIONS

Older adults with SBCLBP exhibit distinct gait characteristics compared to those with CLBP alone and those without CLBP. These differences may be attributed to structural postural alterations, distinguishing this subgroup from individuals with isolated CLBP. These findings underscore the need for targeted rehabilitation strategies tailored to the specific biomechanical alterations observed in this population. Future research should focus on optimizing intervention protocols to enhance stability and mitigate pain-related gait impairments associated with aging.

TRIAL REGISTRATION

Current Controlled Trials using the UMIN Clinical Trials Registry website with ID number of, UMIN000055653 "Retrospectively registered" at 27/09/2024.

Risk factors of chronic low back pain among Syrian patients: across- sectional study

BACKGROUND

Chronic low back pain is a global health issue that leads to disability and significant economic costs. However, it has received limited attention in low- and middle-income countries. This study aimed to determine the prevalence of chronic low back pain and identify its associated risk factors among the Syrian population.

METHOD

This cross-sectional study included adults aged 18 years and above who visited neurology outpatient clinics in seven centers across four provinces (Damascus, Aleppo, Homs, and Latakia) between November 2021 and January 2022. A self-administered questionnaire was utilized to collect data on socio-demographic factors, work-related characteristics, and information about chronic low back pain. Descriptive statistics were employed to summarize the demographic characteristics of the participants. Multivariate logistic regression analysis was conducted to assess the risk factors for chronic low back pain.

RESULTS

A total of 830 adults participated in the study. The overall prevalence of chronic low back pain was estimated to be 16.7% (95% CI: 13.6-25.5), with females having a higher prevalence 17.8%, (95% CI: 14.8-27.5) compared to males 15.4%, (95% CI: 14.8-23.1). Multivariate regression analysis revealed several risk factors associated with chronic low back pain. These included being overweight (aOR: 5.2, 95% CI: 1.9-8.4, p = 0.041), having no formal education (aOR: 4.6, 95% CI: 1.6-8.4, p = 0.001), lack of regular physical exercise (aOR: 3.7, 95% CI: 1.8-6.3, p = 0.003), smoking more than 11 cigarettes per day (aOR: 4.8, 95% CI: 2.4-12.6, p = 0.003), leading a sedentary lifestyle (aOR: 8.3, 95% CI: 3.5-18.9, p = 0.002), manual work (aOR: 7.9, 95% CI: 5.9-16.7, p = 0.003), and adopting a stooped sitting posture (aOR: 3.5, 95% CI: 0.9-8.2, p = 0.039).

CONCLUSION

This study demonstrates that the prevalence of chronic low back pain in Syria is higher compared to other regions, and it is associated with several risk factors. These risk factors include a lack of formal education, being overweight, insufficient regular physical exercise, smoking, leading a sedentary lifestyle, manual work, and adopting a stooped sitting posture. These findings underscore the importance of addressing these modifiable risk factors to prevent and manage chronic low back pain in the Syrian population.

Pathomechanics of Early-Stage Lumbar Intervertebral Disc Degradation Leading to Discogenic Pain-A Narrative Review

Although the existence of highly prevalent pain, disability, and work time lost associated with discogenic low back pain is well known, the recognition of the culpability of universally present disc degradation and mechanical insufficiency in the first three decades of life is often overlooked. There is a corresponding "treatment gap" and no current interventions with demonstrated capabilities to address the pain and resist the usual progression of increasing structural failure of spinal tissues with increasing levels of pain and disability. This narrative review summarizes more than forty years of the literature describing the pathomechanics of progressive degradation of lumbar discs, with a focus on studies that implicate an increasing mechanical insufficiency in the etiology of early-stage chronic and recurrent discogenic low back pain. Topics highlighted in this review include the deleterious biological changes that begin soon after birth, stress intensification due to the loss of fluid phase load support, fatigue weakening and damage accumulation in non-regenerative tissue, disc tears, segmental instability, and the timeline for first incidence of chronic low back pain. The review concludes with preferred treatment characteristics and a brief summary of emerging treatment approaches.

[Specific back pain - effective diagnosis and treatment from the radiologist's point of view]

The diagnosis and treatment of specific back pain is important in radiology. Due to the high number of patients suffering from back pain, it is important to provide excellent diagnostic and therapeutic support.Based on a recent literature search and considering the relevant guidelines as well as expert opinions, the aspects of specific back pain important for radiologists in terms of pathogenesis, diagnosis, and treatment are presented.Clinical examination in combination with the medical history provides a valid suspected diagnosis. This should subsequently be verified radiologically. MRI is the most effective cross-sectional diagnostic method for investigating specific back pain. A conventional X-ray on two planes in a standing position can be a useful addition if postural causes are suspected. If the clinical symptoms match the morphological findings, radiological treatment can be carried out for nerve root involvement as well as for inflammatory changes of the facet joints. The improvement in symptoms after radiological therapy is considered good overall; at least a short-term improvement in symptoms can generally be achieved, but no reliable data is available regarding the long-term outcome. Using preparations containing triamcinolone, low dosages should be selected in accordance with the guidelines. Embedding in a multimodal pain therapy treatment concept should be considered.Radiology provides essential diagnostic findings regarding specific back pain. Interventional pain therapy is an effective and safe method of treating proven specific back pain. · First examine clinically, then confirm the suspected diagnosis radiologically.. · MRI is usually the method of choice.. · Interventional pain therapy should show success after a maximum of 2 interventions.. · The anti-inflammatory drug dose should be kept as low as possible.. · The individual course determines the number of interventions.. · Stueckle CA, Haage P. Specific back pain - effective diagnosis and treatment from the radiologist's point of view. Fortschr Röntgenstr 2024; DOI 10.1055/a-2371-1752.

Impact of lumbar support on pain reduction in low back pain patients: A systematic review and meta-analysis of randomized control trials

Low back pain (LBP) is a global health concern, affecting millions and contributing significantly to disability and economic burden. Various non-pharmacological interventions, including lumbar support, have been explored for LBP management. However, its efficacy remains debated due to inconsistent findings. The aim of this study was to evaluate the impact of lumbar support on pain reduction in individuals with LBP and compare its effectiveness to alternative interventions. A systematic search was conducted across multiple databases (PubMed, ScienceDirect, Scopus, SpringerLink, Google Scholar, and ProQuest) for studies published up to 2023. Data from six search engines were searched using inclusion criteria based on the PICO framework. Search terms included low back pain, lumbar support, lumbar orthose and randomized controlled trial, combined using Boolean operators. Sixteen randomized controlled trials (RCTs) were included in the systematic review, with eight studies analyzed in the meta-analysis. Eligible studies focused on adults with non-specific LBP, assessing pain levels using the Visual Analog Scale (VAS). The meta-analysis was assessed using the standardized mean difference (SMD) in the Visual Analog Scale (VAS). The meta-analysis revealed a statistically significant pain reduction with lumbar support compared to other interventions (SMD: 1.33; 95%CI: -2.09-(-0.57)); p = 0.0006), though with high heterogeneity (I 2 = 97%). The findings indicated that lumbar support effectively reduces pain and improves health-related quality of life, particularly in physically demanding occupations or among individuals with severe pain. While efficacy may depend on specific conditions, lumbar support represents a viable non-pharmacological option for LBP management.

Effects of Fear Avoidance Beliefs Questionnaire thresholds and gender on spatiotemporal parameters during walking in patients with chronic low back pain

ObjectiveThe purpose of this study was to evaluate the effects of the threshold value of Fear-Avoidance Beliefs Subscales on quantified movement as a function of gender.Design studyRetrospective cohort study.SettingsSingle center study.ParticipantsOne hundred forty patients (aged 38.4) with chronic low back pain and referred to functional restauration program.InterventionPatients participated in a five-week multidisciplinary Functional Restoration Program between 1 April 2013 and 1 April 2019, evaluated with clinical scales, psychosocial care and objective gait analysis. This study was a noninterventional retrospective study.Main measuresObjective gait analysis with the Vicon Motion Systems (Ltd, Oxford, UK), Fear-Avoidance Belief Scale, Visual Analog Scale, the DALLAS Pain Questionnaire, and the Hospital Anxiety and Depression Scale.ResultsData from 131 patients were studied. Patients with significant Fear-Avoidance Beliefs scores walked with significantly higher cadence. Patients with higher work subscale values presented significantly lower cadence, without effects on step length and self-selected speed. Women with significant fear-avoidance belief score walked with higher step length (0.58 m (0.05)) than men with significant fear-avoidance belief score (0.61 m (0.05). Correlations between Fear Avoidance Beliefs Questionnaire and spatiotemporal parameters were gender-dependent but nonsignificant or low.ConclusionsThe threshold values depicted in the literature on psychometric analysis reveal low but quantitative effect of fear-avoidance on spatiotemporal parameters. These threshold values can be used by clinicians to evaluate the significance of the clinical scale. Considering gait, cadence should help the clinician to assess the fear-avoidance, particularly for patients are not able to complete all clinical scale items.

Infectious pyogenic sacroiliitis following acupuncture: a series of three cases and review of the literature

BACKGROUND

Acupuncture is an unusual cause of infectious sacroiliitis. Herein, we report three new cases of pyogenic sacroiliitis deemed to be attributable to acupuncture.Case 1:A 45-year-old male underwent 8 acupuncture sessions. He developed inflammatory pain in the left buttock, fever and tachycardia 11 days after the last session. Examination revealed involvement of the left sacroiliac joint. Magnetic resonance imaging (MRI) of the pelvis was consistent with sacroiliitis and blood cultures were positive for Staphylococcus aureus. The final diagnosis was left sacroiliitis caused by S. aureus. He was treated with lincomycin.Case 2:A 55-year-old female who had undergone 10 acupuncture sessions presented with inflammatory gluteal pain 10 days after the last session. Physical examination revealed signs of sacroiliac involvement, confirmed by MRI of the pelvis. The diagnosis was right sacroiliitis complicated by myositis of the gluteal muscles caused by S. aureus. Treatment consisted of antibiotic therapy with amoxicillin and ofloxacin.Case 3:A 72-year-old female who had undergone 10 acupuncture sessions presented 5 days after the last session for inflammatory gluteal pain. On examination, left unipodal weight-bearing was impossible and the tripod sign was present. MRI and clinical findings were in favor of left sacroiliitis associated with infectious pyogenic spondylodiscitis at L4-L5 and paravertebral abscesses. She received empiric antibiotic treatment with amoxicillin and gentamycin, followed by ofloxacin. On the 14th day, the patient unexpectedly died of pulmonary embolism after developing respiratory distress.

CONCLUSION

This case series highlights the continued need for vigilance in the clinical practice of acupuncture.

Fear-avoidance beliefs are associated with changes of back shape and function

Introduction

Psychosocial function in people with chronic low back pain (cLBP) is often impaired, indicating poor well-being. Fear-avoidance beliefs (FAB) are common concomitants of cLBP. Fear-avoidance beliefs are gaining attention as a potential prognostic factor for chronification and resulting disability in cLBP. This article aims to examine the associations of back function with FAB.

Methods

This study presents data from a cohort study (DRKS00027907). In the present cross-sectional analyses, we included 914 participants (480 nonchronic LBP [ncLBP], 227 cLBP, 207 asymptomatic). Fear-avoidance beliefs were assessed using the fear-avoidance belief questionnaire (FABQ). The association between the FAB and clinical measures (Ott and Schober test, the sit-to-stand test [STS], and the finger-floor distance [FFD]) were analyzed. Back shape and function were also measured using a noninvasive device. The association between FABQ scores and clinical measures was assessed using age, body mass index, sex, and pain intensity-adjusted multiple linear regression models.

Results

Associations between FAB and both clinical (Ott, Schober, STS, FFD) and noninvasive device measures were small. All relevant clinical measures were attenuated in individuals with elevated FAB.

Discussion

We were able to demonstrate the association of both back shape and function in both clinical tests and noninvasive device measurements with self-reported fear-avoidance beliefs. However, the effect sizes were small. This may be attributed to the different assessment methods (objective vs self-report), resulting in reduced common method variance. In addition to the FAB, there may be other factors (eg, altered neuronal pathways; actual avoidance behavior such as reduced physical activity) that contribute to functional impairment.

Trends in chronic neck and low back pain prevalence in Spain (2006-2020): differences by sex, age, and social class

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Differences in anxiety, depression and pain experience among adults with chronic low back pain as a function of nicotine product use

The landscape of nicotine use in the United States (US) has continued to evolve, with electronic cigarette use (hereafter e-cigarette) becoming more evident in recent years. Patterns of dual nicotine use, or using combustible nicotine in conjunction with e-cigarettes, may increase dependence on nicotine, continued exposure to toxins, and corresponding health risks. One of the most prevalent health problems related to nicotine use is the experience of chronic pain. Past work has established a bidirectional relationship between nicotine use and pain, such that pain motivates nicotine use and nicotine use contributes to pain. However, no work has explored differences in negative mood and pain experience as a product of nicotine use type among adults with chronic low back pain. The current cross-sectional study examined whether dual cigarette/e-cigarette use was associated with greater anxiety, depression, and pain experience among a sample of adult nicotine users (cigarettes and/or e-cigarettes) with self-reported mild to severe chronic low back pain (N = 1034, 66.0% female, Mage= 44.47 years, SD = 11.63). Results indicated that, compared to exclusive combustible nicotine users, dual cigarette/e-cigarette users had statistically significantly higher anxiety, depression, and pain disability scores, beyond the effects of age, sex, education, and use of opioid medications for pain. No significant group differences emerged as a function of exclusive e-cigarette use. The current findings highlight that dual cigarette/e-cigarette use may serve to mark a subpopulation of persons with chronic low back pain who present more complicated clinical features that require comprehensive care.

Turkish adaptation, validity and reliability study of the cognitive behavior questionnaire in non-specific chronic low back pain:: CBQNSCLBP Turkish Version Validity and Reliability

BackgroundChronic low back pain (CLBP) is a complex condition with significant physical, psychological, and social impacts. The Cognitive Behavior Questionnaire for Nonspecific Chronic Low Back Pain (CBQ-NSCLBP) was developed to assess cognitive-behavioral factors.ObjectiveThe aim of this study was to translate the CBQ-NSCLBP into Turkish (CBQ-NSCLBP-Tr), evaluate its psychometric properties, and also to assess the clinicometric properties of the instrument, including its validity, reliability, and effectiveness in assessing cognitive-behavioral factors in Turkish-speaking individuals with chronic low back pain.MethodsA total of 120 participants with CLBP aged 18-65 years were recruited. Construct validity was evaluated by correlating CBQ-NSCLBP-Tr scores with established measures, including the Oswestry Disability Index(ODI), Fear Avoidance Beliefs Questionnaire(FABQ), Tampa Kinesiophobia Scale(TKS), Back Pain Attitudes Questionnaire(Back-PAQ), Beck Anxiety Inventory(BAI), and Beck Depression Inventory(BDI). Test-retest reliability was assessed using the intraclass correlation coefficient(ICC), and internal consistency was determined using Cronbach's alpha.ResultsThe CBQ-NSCLBP-Tr demonstrated excellent reliability (ICC = 0.89) and strong internal consistency significant correlations with established measures, such as the Oswestry Disability Index (ODI, r = 0.44) and Fear Avoidance Beliefs Questionnaire (FABQ, r = 0.48). According to these results, the CBQ-NSCLBP-Tr is a reliable instrument for evaluating cognitive-behavioral variables affecting chronic low back pain in Turkish-speaking individuals.ConclusionsThe CBQ-NSCLBP-Tr is a reliable and valid instrument for assessing cognitive-behavioral factors in Turkish-speaking CLBP populations. It captures critical psychological dimensions influencing pain perception and disability, complementing existing measures.

Integrating multidimensional data analytics for precision diagnosis of chronic low back pain

Low back pain (LBP) is a leading cause of disability worldwide, with up to 25% of cases become chronic (cLBP). Whilst multi-factorial, the relative importance of contributors to cLBP remains unclear. We leveraged a comprehensive multi-dimensional data-set and machine learning-based variable importance selection to identify the most effective modalities for differentiating whether a person has cLBP. The dataset included questionnaire data, clinical and functional assessments, and spino-pelvic magnetic resonance imaging (MRI), encompassing a total of 144 parameters from 1,161 adults with (n = 512) and without cLBP (n = 649). Boruta and random forest were utilised for variable importance selection and cLBP classification respectively. A multimodal model including questionnaire, clinical, and MRI data was the most effective in differentiating people with and without cLBP. From this, the most robust variables (n = 9) were psychosocial factors, neck and hip mobility, as well as lower lumbar disc herniation and degeneration. This finding persisted in an unseen holdout dataset. Beyond demonstrating the importance of a multi-dimensional approach to cLBP, our findings will guide the development of targeted diagnostics and personalized treatment strategies for cLBP patients.

Efficacy and Safety of the Combination of Diclofenac and Thiocolchicoside in the Treatment of Low Back Pain and Other Conditions: Systematic Review of the Literature

Background/Objectives: Low back pain (LBP) is a leading cause of disability worldwide. Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), and thiocolchicoside, a muscle relaxant, are commonly combined to target inflammation and muscle spasm. However, the efficacy and safety of their combination remain under discussion. This systematic review evaluates the efficacy and safety of diclofenac-thiocolchicoside therapy for LBP and other musculoskeletal conditions. Methods: A systematic review was conducted following PRISMA guidelines. Eligible studies included randomized controlled trials (RCTs) and observational studies comparing diclofenac-thiocolchicoside combination with placebo, monotherapy, or alternative treatments. A search was performed in PubMed, Scopus, and relevant websites, identifying articles published up to 30 September 2024. Studies from trial registries were excluded. Risk of bias was assessed using Revised Cochrane Risk of Bias for randomized trials (RoB 2) for RCTs and the Newcastle-Ottawa Scale (NOS) for observational studies. Evidence certainty was evaluated with the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Results were visualized using Robvis, tables, and graphs. Results: Of 393 identified records, 9 studies (1097 patients) met the inclusion criteria. Seven RCTs reported significant pain reduction and functional improvement with combination therapy compared to placebo or active controls. However, study heterogeneity, dosage variations, and risk of bias limited comparability. Adverse events (AEs) included gastrointestinal (GI) discomfort and drowsiness, though no severe complications were consistently reported. Conclusions: Despite methodological limitations, the diclofenac-thiocolchicoside combination demonstrates promising efficacy for acute LBP and musculoskeletal pain management. However, there is no clear evidence of its clinical superiority over other available treatments, due to study heterogeneity and potential biases. Rigorous, standardized research with larger sample sizes and consistent methodologies is essential to definitively establish the efficacy and safety of diclofenac-thiocolchicoside, providing clearer guidance for clinical decision-making.

Measurement properties of self-reported outcome measures for older adults with nonspecific low back pain: a systematic review

OBJECTIVE

To summarise the measurement properties of patient-reported outcome measures (PROMs) for older adults with nonspecific low back pain.

METHODS

Eight databases were searched from inception to January 2024. Two independent reviewers conducted article screening, data extraction, risk of bias assessments, evaluations of measurement properties of PROMs, syntheses of quality of evidence and forming recommendation levels using relevant checklists and assessment tools.

RESULTS

Ten PROMs were identified from 12 included studies. The Functional Rating Index, Oswestry Disability Index, Roland Morris Disability Questionnaire and Quebec Back Pain Disability Scale demonstrated the highest recommendation (category A: PROM most suitable) for evaluating pain-related functional limitation or pain intensity in older adults with acute, subacute or chronic nonspecific low back pain. The Pain Response to Activity and Positioning questionnaire obtained a category A recommendation for making a differential diagnosis of chronic nonspecific low back pain in older adults. The 36-Item World Health Organization Disability Assessment Schedule 2.0 was considered promising (category B: PROM recommended) for assessing physical functioning, while the Back Believe Questionnaire, Catastrophizing Avoidance Scale D-65+, Pain Catastrophizing Scale and Psychological Inflexibility in Pain Scale obtained category B recommendation for evaluating negative thoughts in this population, although further validation is warranted.

CONCLUSIONS

This systematic review identified suitable PROMs for assessing physical function in older adults with nonspecific low back pain, but more studies are needed to evaluate the measurement properties of questionnaires on other outcome domains in this population.

Response to functional restoration in non-specific chronic low back pain with Modic type 1 changes

PURPOSE

Little information exists on the potential differential response to functional restoration between non-specific chronic low back pain (NSCLBP) individuals with and those without Modic type 1 changes. Therefore, this case-control study investigated the response profile of NSCLBP patients with and without Modic type 1 changes undergoing functional restoration.

METHODS

The present study included patients participating in a functional restoration program (day-hospital program lasting five weeks) at a French tertiary care center from 2009 to 2019. Each case with Modic type 1 changes was matched to one to two controls without Modic type 1 changes by sex, working incapacity, and lumbar spine surgery history. The primary effectiveness outcome was the Quebec Back Pain Disability Scale (QBPDS) score (0-100, with higher scores indicating higher disability). There were multiple secondary outcomes, such as subjective improvement and return to work.

RESULTS

The study included 83 patients (cases: median [IQR] age 47.8 [11.6] years, 77.4% women; controls: median [IQR] age 46.0 [16.2] years, 75.0% women). At three months, there were no statistically significant differences between cases and controls in the QBPDS score (34.0 versus 31.5), subjective improvement (67.7% versus 69.2%), return to work in those who were not working at the inclusion (72.7% versus 52.6%), and the consumption of different analgesics.

CONCLUSION

The response profile of NSCLBP adults undergoing functional restoration did not statistically differ between the groups with and without Modic type 1 changes. These findings suggest that patients may benefit from such a program irrespective of their Modic type 1 status.

Sex-specific role of RNA-binding protein, pAUF1, on prolonged hypersensitivity after repetitive ischemia with reperfusion injury

ABSTRACT

Repetitive ischemia with reperfusion (I/R) injury is a common cause of myalgia. Ischemia with reperfusion injuries occur in many conditions that differentially affect males and females including complex regional pain syndrome and fibromyalgia. Our preclinical studies have indicated that primary afferent sensitization and behavioral hypersensitivity caused by I/R injury may be due to sex-specific gene expression in the dorsal root ganglia (DRG) and distinct upregulation of growth factors and cytokines in the affected muscles. To determine how these unique gene expression programs may be established in a sex-dependent manner in a model that more closely mimics clinical scenarios, we used a developed prolonged ischemic myalgia model in mice whereby animals experience repeated I/R injuries and compared behavioral results with unbiased and targeted screening strategies in male and female DRG. Several distinct proteins were found to be differentially expressed in male and female DRG, including phosphorylated AU-rich element RNA-binding protein (pAUF1), which is known to regulate gene expression. Nerve-specific siRNA-mediated knockdown of AUF1 inhibited prolonged hypersensitivity in females only, whereas overexpression of AUF1 in male DRG neurons increased pain-like responses. AUF1 knockdown was able to specifically inhibit repeated I/R-induced gene expression in females potentially downstream of prolactin receptor signaling. Data suggest RNA-binding proteins such as pAUF1 may underlie the sex-specific effects on DRG gene expression that modulates behavioral hypersensitivity after repeated I/R injury through prolactin signaling. This study may aid in finding distinct receptor differences related to the evolution of acute to chronic ischemic muscle pain development between sexes.

The intersectionality of chronic pain stigma and racial discrimination in Black and White adults with chronic low back pain

OBJECTIVE

We examined the intersection between chronic pain stigma and racial discrimination, separately among Black and White US adults with chronic low back pain.

METHODS

Participants completed measures of chronic pain stigma, lifetime experiences of racial discrimination, pain severity and interference. A composite variable representing the intersectionality of stigma and discrimination was created, and Black and White participants were separately categorized into 4 groups. Black participants were categorized as: (1) high discrimination/high stigma, (2) high discrimination/low stigma, (3) low discrimination/high stigma, and (4) low discrimination/low stigma. White participants were categorized as: (1) any discrimination/high stigma, (2) any discrimination/low stigma, (3) no discrimination/high stigma, and (4) no discrimination/low stigma.

RESULTS

Black participants reported more frequent experiences of racial discrimination than White participants (P < .05), but there was not a racial difference in chronic pain stigma (P > .05). Among Black participants, those in the high discrimination/high stigma and low discrimination/high stigma groups reported greater pain severity and interference than those in the high discrimination/low stigma and low discrimination/low stigma groups (P < .05). Among White participants, those in the any discrimination/high stigma group reported greater pain severity and interference than those in the no discrimination/low stigma group (P < .05), but there were no differences in pain severity or interference between the any discrimination/no stigma and no discrimination/high stigma groups (P > .05).

CONCLUSION

Our findings suggest that the relationship of intersectional chronic pain stigma and racial discrimination with pain is nuanced and differs across racial groups.

Conflict at work and incident chronic low back pain: a retrospective cohort of more than 101,000 adults from Germany

PURPOSE

Little is known about the relationship between conflict at work and incident chronic low back pain (CLBP). Thus, this retrospective cohort study analyzed the association between conflict at work and the five-year incidence of CLBP in adults living in Germany.

METHODS

This study included individuals aged 18-65 years reporting conflict at work for the first time in one of 1,293 general practices in Germany between 2005 and 2022 (index date). Patients not reporting conflict at work were matched (5:1) to those reporting conflict at work using a propensity score based on multiple demographic and clinical variables. In people not reporting conflict at work, the index date was a randomly selected consultation in 2005-2022. CLBP corresponded to two diagnoses of LBP at least three months apart. The relationship between conflict at work and incident CLBP was studied using Cox regression models.

RESULTS

There were 16,925 patients reporting (mean [SD] age 39.5 [13.0] years; 63% women) and 84,625 patients not reporting conflict at work (mean [SD] age 39.6 [12.9] years; 64% women). Conflict at work was not associated with incident CLBP in the overall population (HR = 1.07, 95% CI = 0.99-1.14). However, there was a positive and significant association for CLBP without sciatica, individuals aged 18-30 years, and those with no history of low back pain before the index date.

CONCLUSION

Conflict at work may be a predisposing factor for CLBP without sciatica, highlighting the need to prevent conflict in the workplace. Further research is warranted to corroborate these results in other countries.

Multimodal abnormalities of brain function in chronic low back pain: a systematic review and meta-analysis of neuroimaging studies

Objectives

Neuroimaging investigations into chronic low back pain (CLBP) have detected functional abnormalities across a spectrum of brain regions, yet the findings have often been inconsistent. In this meta-analysis, we integrated the existing data, delineating a pattern of coherent results from the encompassed studies.

Methods

A systematic search of neuroimaging studies investigating the brain activity differences between CLBP and Healthy controls (HCs) was conducted in seven databases up to December 22, 2024. An anisotropic effect-size signed differential mapping (AES-SDM)-based meta-analysis was carried out to report the results and perform a multimodal analysis.

Results

A total of 20 publications reporting on 24 experiments in this meta-analysis. The ReHo meta-analysis showed abnormal spontaneous activity of left inferior temporal gyrus (ITG), left superior frontal gyrus (SFG), right middle frontal gyrus (MFG), right precuneus, right fusiform gyrus and bilateral postcentral gyrus (PoCG) in CLBP patients. The ALFF meta-analysis demonstrated functional alterations in the right rolandic operculum (extending to the right insula and right IFG), left ITG, left middle occipital gyrus (MOG), left paracentral lobule, left PoCG and bilateral cuneus cortex in CLBP patients. The results of the functional group meta-analysis revealed that patients with CLBP displayed new decreased functional activity in the right thalamus, right precentral gyrus (PreCG) and right lingual gyrus.

Conclusion

Patients with CLBP exhibit extensive multimodal functional neuroimaging abnormalities, involving brain regions related to pain perception, emotional processing, cognitive functions, and both the visual and motor cortices. These meta-analysis findings might provide a valuable reference for the identification of potential therapeutic targets for CLBP in the brain.

Short-term effects of exergaming on patients with chronic low back pain: A single-blind randomized controlled trial

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

The impact of biofeedback in enhancing chronic pain rehabilitation: A systematic review of mechanisms and outcomes

Background and objectives

Chronic pain (CP), affecting approximately 20 % of adults globally, imposes a profound burden on individuals and healthcare systems. This condition, characterized by persistent pain, muscle stiffness, and emotional distress, often results in a complex interplay of physical and psychological factors that exacerbate symptoms and hinder recovery. Biofeedback (BFB), a non-invasive intervention, offers a promising rehabilitation strategy by enabling individuals to monitor and self-regulate physiological responses, such as muscle tension, heart rate, and skin temperature. Through this process, BFB disrupts the vicious cycle of pain and stress, fostering relaxation, reducing muscle strain, and alleviating emotional distress. This systematic review aimed to examine the mechanisms underlying BFB's therapeutic effects in CP rehabilitation, specifically its ability to enhance self-regulation and promote relaxation to improve pain control. Furthermore, it aimed to evaluate the impact of BFB on key outcomes, including pain severity, functional capabilities, and quality of life, with the goal of guiding its integration into contemporary rehabilitation practices.

Materials and Methods

Following PRISMA guidelines, a systematic search was conducted in PubMed, Web of Science, and Embase (2014-2024) to identify studies on BFB for CP. Inclusion criteria included original research involving BFB as a primary or secondary intervention for CP, with outcomes related to pain management and rehabilitation. This review is registered on Open OSF (X5HPB).

Results

BFB has shown consistent efficacy as a complementary therapy in CP management, offering significant reductions in pain intensity and enhancements in quality of life across diverse CP conditions. Mechanistically, BFB facilitates improved self-regulation by training patients to modulate physiological responses, such as muscle tension and heart rate variability, leading to better pain control and stress reduction.

Conclusions

BFB shows significant promise as a supplementary treatment for different CP disorders. The evidence that was examined shows that it is effective in improving how pain is perceived, increasing functional results, and boosting overall quality of life among a variety of patient groups.

Effect of a Healing Program Using Marine Resources on Reducing Pain and Improving Physical Function in Patients with Non-Specific Chronic Low Back Pain: A Randomized Controlled Trial Study

Background and Objectives: Chronic low back pain is a widespread condition, particularly in older populations, contributing to physical, mental, and social burdens. Traditional treatments, such as medications and surgery, carry long-term risks, including dependency, side-effects, and complications from invasive procedures. Additionally, healthcare accessibility is limited due to high costs, long waiting times, and geographic disparities in healthcare services, particularly in rural areas. For these reasons, non-pharmacological approaches that address both physical and psychological aspects are increasingly recognized as effective. This study aimed to evaluate the effectiveness of a marine resource-based healing program in Taean, South Korea, in improving pain, physical function, and mental health in patients with non-specific chronic low back pain. Materials and Methods: This randomized controlled trial involved 46 participants with non-specific chronic low back pain (mean age, 68.7 ± 5.1 years), randomly allocated to either an experimental group (marine healing program) or a control group (core exercises). The experimental group participated in a 4-night, 5-day intervention comprising heated peat pack therapy, mindfulness meditation, core exercises, and local tourism. The control group performed core exercises without additional interventions. Key outcomes included pain, muscle properties, functional disability, lower extremity function, balance, gait, and depression. Results: The experimental group demonstrated significant reductions in resting pain (p < 0.001), improved pressure pain threshold at L3 (p < 0.001), decreased L3 muscle tone (p = 0.015), and improved functional disability scores (p < 0.001). Functional gains were observed in lower extremity function scores (p < 0.001), balance (sway area: p = 0.046), gait velocity (p < 0.001), and depression levels (p < 0.001). Conclusions: The marine healing program significantly improved pain, functional abilities, and mental well-being in patients with non-specific chronic low back pain, highlighting its potential as an integrative approach to chronic low back pain management. Further studies are recommended to explore long-term and generalized effects.

Is the Central Sensitization in Chronic Nonspecific Low Back Pain Structural Phenomenon or Psychological Reaction? A Narrative Review

Lower back pain (LBP) is a common condition affecting primarily populations in developed countries, placing a significant burden on public health systems around the world. A high rate of pain recurrence increases the risk of developing a chronic syndrome and the occurrence of complex psychosocial and professional problems. Symptoms lasting longer than 12 weeks are associated with the risk of sleep problems, depression, and anxiety. In the 21st century, the development of knowledge about central sensitization (CS) to pain allowed for a better understanding of the pathomechanism of pain and the transformation of LBP into a chronic form. Patients with chronic severe pain often experience accompanying symptoms such as fatigue, depression, anxiety, sleep disorders, appetite disorders, flatulence, dyspepsia, and dizziness-these are part of the picture of CS. The article presents a narrative, chronological review of reports covering the current state of knowledge on the possibility of assessing central sensitization and its impact on low back pain. The authors also attempt to answer the question posed in the title. CS can be seen as an excessive reactivity of nociceptive neurons in the central nervous system to normal or subthreshold afferent chronic stimuli in people with certain mental predispositions.

Maximal inspiratory pressure and exercise-induced inspiratory muscle fatigue in chronic nonspecific low back pain

BACKGROUND

Patients with chronic nonspecific low back pain (CNSLBP) show reduced inspiratory muscle function. However, studies comparing maximal inspiratory pressure (MIP) and exercise-induced inspiratory muscle fatigue (IMF) between CNSLBP and healthy controls (HC) are lacking.

OBJECTIVE

To compare MIP and exercise-induced IMF between CNSLBP and HC.

DESIGN

Cross-sectional study.

METHODS

MIP was recorded in 25 persons with CNSLBP and 15 HC before and immediately, 15 and 30 minutes after a maximal cardiopulmonary exercise test. Inspiratory muscle weakness was defined as a predicted MIP value lower than 80%, and exercise-induced IMF as a ≥10% reduction in MIP following the exercise test.

RESULTS

Baseline MIP was similar between CNSLBP (109±32 cmH2O) and HC (116±32 cmH2O) (p= 0.525). Inspiratory muscle weakness was present in 36% of the CNSLBP group and in 20% of the HC group, with no significant difference between groups (p= 0.777). None of the groups showed significant exercise-induced IMF immediately (CNSLBP: -2.1%, HC: 3.7%), 15 minutes (CNSLBP: -5.4%, HC: -5.2%), and 30 minutes (CNSLBP: -4.7%, HC: -6.6%) after the maximal exercise test (p> 0.05), with no between group differences with regard to magnitude and proportion (CNSLBP: 24%, HC: 33%) (p> 0.05).

CONCLUSIONS

This study shows that there is no difference in MIP and the proportion of inspiratory muscle weakness between persons with CNSLBP and HC. Additionally, within both groups, there was no exercise-induced IMF immediately, 15 and 30 minutes after a maximal exercise test. Furthermore, there was no difference in the magnitude and proportion of exercise-induced IMF between both groups.

Low back pain prevalence, capacity, and performance according to sociodemographic variables, population-based study in Chile

BACKGROUND

Low back pain (LBP) is one of the main causes of disability and need for rehabilitation services. It is necessary to have a better understanding about the association of sociodemographic factors with the disability related to individuals with LBP.

OBJECTIVE

Assess the prevalence of LBP and its association with capacity, performance, and sociodemographic variables in Chilean population.

METHODS

Cross-sectional study was performed with data from the population survey from Chile, 2015. People over 17 years old were selected for the analysis (n = 12,265 people). The variables chosen were: presence of LBP, place of living in Chile, sex, age, marital status, education, income, work status, and type of home. Capacity and performance levels were assessed by the Model Disability Survey. The population characteristics, performance, and capacity values were presented through means or frequencies. A generalized linear model with logarithmic linkage and gamma distribution was employed to assess the associations between the explanatory variables and the outcomes, considering the distribution of the variables, while adjusting for all study variables.

RESULTS

22 % of the population reported having LBP. People with LBP had worse levels of capacity and performance. Being female, older age, having worse education level, and worse health classification, were factors associated with worse capacity and performance in those with LBP. Conversely, being employed in the last week was correlated with improved capacity in this group.

CONCLUSION

Individuals with LBP demonstrated poorer capacity and performance outcomes, with sociodemographic variables influencing their functioning.

Comparisons of the effects of psychologically-informed and usual physiotherapy on pain sensitivity in chronic low back pain: an exploratory randomized controlled trial

Introduction

The presence of altered central pain processing and modulation, as well as negative psychological factors, have been suggested to impede recovery in chronic low back pain (CLBP). Psychologically-informed physiotherapy (PiP) aims to specifically address the latter factors-in addition to physical factors-to improve treatment effects. This study aims to determine if the effect of PiP is superior to usual physiotherapy (UP) on pain sensitivity and modulation in participants with CLBP and if changes in these variables were associated with changes in clinical outcomes.

Methods

Forty participants with CLBP were randomly allocated to PiP or UP. Seven physiotherapy sessions over 6 weeks plus a booster session at an 11-week follow-up were delivered. Pressure pain threshold (PPT), temporal summation of pain (TSP), and exercise-induced hypoalgesia were assessed on lumbar, upper, and lower limb sites at baseline and after 6 weeks. Linear mixed models tested if PiP was superior to UP on pain sensitivity/modulation. Linear regressions tested if pain sensitivity/modulation changes were associated with changes in clinical outcomes (pain intensity, physical functioning, symptoms of central sensitization).

Results

PiP was not superior to UP to modulate pain sensitivity/modulation variables. All PPTs increased after 6 weeks regardless of the approach. Lumbar PPT and lumbar and lower limb TSP changes were associated with physical functioning changes.

Conclusion

Although our study suggests that neither approach has a superiority to impact on pain sensitivity, both approaches elicited widespread hypoalgesia. Future powered trials should verify if pain sensitivity can be a mediator of physical functioning improvement, as suggested by our results.

Role of Magnetic Resonance Spectroscopy and T2 Relaxometry as Imaging Biomarker of Early Lumbar Intervertebral Disc Degeneration

STUDY DESIGN

Observational comparative study.

OBJECTIVE

To study the role of magnetic resonance spectroscopy (MRS) and T2 relaxometry (T2r) as imaging biomarkers for identifying early lumbar disc degeneration.

METHODS

We evaluated 236 discs in normal volunteers and 215 discs in low back pain (LBP) patients by MRS and T2r to document the molecular spectra of various metabolites as well as disc hydration and collagen content, respectively. All volunteer discs were Pfirrmann grade 1 (PF1), whereas patients with LBP had PF 1 (n = 156) and PF 2 (n = 59). The study population was compared in three age groups: A (20-30 years), B (30-40 years), and C (40-50 years).

RESULTS

T2r, an indicator of collagen and hydration, was higher in volunteers (121.8 ± 31.1), compared to PF 1 patients (110.68 ± 23.96) and PF 2 patients (90.15 ± 25.81) (P = 0.001). Proteoglycan assessed by MRS was more stable for volunteers (3.39 ± 1.69) and PF 1 patients (3.6 ± 1.69) but reduced in PF 2 patients (2.86 ± 1.47), showing that structural molecules did not alter within the PF 1. However, lactate and other metabolites showed a difference even within PF1 between volunteers and LBP patients. We were able to identify a unique subset of PF 1 that had a normal value of proteoglycan and T2r but altered metabolite distribution, which may represent early disc degeneration (DD).

CONCLUSION

MRS and T2r can be used as imaging biomarkers for early DD by identifying altered metabolic activity with an intact matrix.

Assessment of a manual therapy and acupressure method as a treatment of nonspecific low back pain: A prospective, observational and non-interventional cohort study

The first-line treatment for nonspecific low back pain (LBP) relief is physical exercise; however, there is no uniformity in recommendations regarding the type of exercise, and physicians predominantly prescribe pharmacological treatments. This creates a treatment gap in non-pharmacological management of LBP. Preliminary data suggest that manual therapy and acupressure could be relevant therapeutic options. The primary objective of this study was to describe the evolution of pain in patients with nonspecific LBP persisting for at least 4 weeks who received 2 treatment sessions combining manual therapy with acupressure (Biokinergie® method) as part of their routine management. In this prospective, observational, and non-interventional study, participants were monitored on the days of manual therapy session delivery (initial visit on Day 0 and follow-up visit on Day 21). Follow-up assessments occurred 3 days and 3 weeks post-therapy sessions. A total of 114 participants suffering from LBP for a median duration of 11.9 weeks were enrolled from May 2021 to May 2023. The intensity of average pain experienced over a 24-hour period was significantly reduced on Day 24 (-36.0 ± 27.2 mm on a visual analog scale of 100 mm, P < .001), with 82 (75.2%) participants reporting a decrease of at least 20 mm. Participants reported significant reductions in pain (-25.9 ± 23.9 mm on Day 3, -29.7 ± 26.7 mm on Day 21, and -40.9 ± 28.3 mm on Day 42, P < .001) and functional disability (Roland-Morris Disability Questionnaire score: -5.4 ± 0.4 points on Day 21 and -7.4 ± 0.4 points on Day 42, P < .001). This was associated with an improved Dallas Pain Questionnaire score, indicating a reduced impact of LBP on daily activities (-27.2 ± 2.0% on Day 21 and -35.8 ± 2.0% on Day 42, P < .001). Posttreatment, most participants (86.3%) reported reduced analgesic intake compared to baseline, and 83.3% were very satisfied with the therapy. A significant and clinically relevant reduction in lumbar pain was observed after 2 sessions of manual therapy combined with acupressure, paving the way for future clinical research.

Relationship Between Psychological Factors and Health-Related Quality of Life in Patients with Chronic Low Back Pain

BACKGROUND

Low back pain has frequently been mentioned as the most common sort of chronic pain, and numerous studies have confirmed its influence on the health-related quality of life (HRQoL). Despite a great deal of research demonstrating the important part that psychological factors play in explaining HRQoL, a therapeutic setting that prioritizes the physical domain still predominates. For this reason, the aim of this study is to assess the relationship between age, pain intensity, pain catastrophizing, depression, anxiety, pain-related anxiety, chronic pain acceptance and the psychological and physical dimensions of HRQoL in patients with chronic low back pain (CLBP).

METHODS

Data were collected from 201 patients with CLBP using sociodemographic data, the SF-36 Health Status Questionnaire (SF-36), the Hospital Anxiety and Depression Scale (HADS), the Pain Anxiety Symptoms Scale Short Form 20 (PASS-20), the Pain Catastrophizing Scale (PCS), the Chronic Pain Acceptance Questionnaire (CPAQ-8) and the Numeric Pain Rating Scale (NRS). The linear regression model for the dependent variable of Physical Health (SF-36 PhyH) was statistically significant (F (7, 201) = 38.951, p < 0.05), explaining 57.6% of the variance regarding the Physical Health dimension of HRQL in patients with CLBP.

RESULTS

The linear regression model for the dependent variable of Psychological Health (SF-36 PsyH) was statistically significant (F (7, 200) = 39.049, p < 0.05), explaining 57.7% of the variance regarding the Psychological Health dimension of HRQL in patients with CLBP.

CONCLUSIONS

The findings of this study confirm that age, pain intensity, depression, pain-related anxiety and chronic pain acceptance are significant predictors of the physical dimension of HRQoL, while pain intensity, anxiety and depression proved to be significant predictors of the psychological dimension of HRQoL in patients with CLBP.

FAPs orchestrate homeostasis of muscle physiology and pathophysiology

As a common clinical manifestation, muscle weakness is prevalent in people with mobility disorders. Further studies of muscle weakness have found that patients with muscle weakness present with persistent muscle inflammation, loss of muscle fibers, fat infiltration, and interstitial fibrosis. Therefore, we propose the concept of muscle microenvironment homeostasis, which explains the abnormal pathological changes in muscles through the imbalance of muscle microenvironment homeostasis. And we identified an interstitial progenitor cell FAP during the transition from normal muscle microenvironment homeostasis to muscle microenvironment imbalance caused by muscle damage diseases. As a kind of pluripotent stem cell, FAPs do not participate in myogenic differentiation, but can differentiate into fibroblasts, adipocytes, osteoblasts, and chondrocytes. As a kind of mesenchymal progenitor cell, it is involved in the generation of extracellular matrix, regulate muscle regeneration, and maintain neuromuscular junction. However, the muscle microenvironment is disrupted by the causative factors, and the abnormal activities of FAPs eventually contribute to the complex pathological changes in muscles. Targeting the mechanisms of these muscle pathological changes, we have identified appropriate signaling targets for FAPs to improve and even treat muscle damage diseases. In this review, we propose the construction of muscle microenvironmental homeostasis and find the key cells that cause pathological changes in muscle after homeostasis is broken. By studying the mechanism of abnormal differentiation and apoptosis of FAPs, we found a strategy to inhibit the abnormal pathological changes in muscle damage diseases and improve muscle regeneration.

Minimally Invasive Transforaminal Versus Lateral Lumbar Interbody Fusion for Degenerative Spinal Pathology: Clinical Outcome Comparison in Patients With Predominant Back Pain

STUDY DESIGN

Retrospective review.

OBJECTIVE

To compare perioperative and postoperative clinical outcomes between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and lateral lumbar interbody fusion (LLIF) in patients presenting with predominant back pain.

BACKGROUND

Two popular techniques utilized for lumbar arthrodesis are MIS-TLIF and LLIF. Both techniques have reported high fusion rates and suitable postoperative clinical outcomes. Scarce literature exists, however, comparing these 2 common fusion techniques in a subset population of patients presenting with predominant back pain preoperatively.

METHODS

A retrospective review of lumbar procedures performed between November 2005 and December 2021 was conducted using a prospectively maintained single-surgeon database. Inclusion criteria were set as primary, elective, single, or multilevel MIS-TLIF or LLIF procedures for degenerative spinal pathology in patients with predominant preoperative back pain [visual analog scale (VAS) back pain preoperative score > VAS leg preoperative score]. Patients undergoing a revision procedure, single-level procedure at L5-S1, or surgery indicated for infectious, malignant, or traumatic etiologies were excluded. In addition, patients with VAS leg preoperative scores ≥ to VAS back preoperative scores were excluded. Patient demographics, perioperative characteristics, postoperative complications, and patient-reported outcome measures (PROMs) were collected. PROMs included VAS for back and leg pain, Oswestry Disability Index (ODI), and Short Form-12 (SF-12) Item Survey Mental (MCS) and Physical (PCS) Composite Scores with all values collected at the preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year follow-up time point. Patients were grouped into 2 cohorts, depending on whether a patient underwent a MIS-TLIF or LLIF. Demographic and perioperative characteristics were compared between groups using χ 2 and Student t test for categorical and continuous variables, respectively. Mean PROM scores were compared between cohorts at each time point utilizing an unpaired Student t test. Postoperative improvement from preoperative baseline within each cohort was assessed with paired samples t test. Achievement of minimum clinical important difference (MCID) was determined by comparing ΔPROM scores to previously established threshold values. MCID achievement rates were compared between groups with χ 2 analysis. Statistical significance was noted as a P value <0.05.

RESULTS

Eligible study cohort included 153 patients, split into 106 patients in the MIS-TLIF cohort and 47 patients in the LLIF cohort. The mean age was 55.9 years, the majority (57.5%) of patients were males, the mean body mass index was 30.8 kg/m 2 , and the majority of the included cohort were nondiabetic and nonhypertensive. No significant demographic differences were noted between cohorts. The MIS-TLIF cohort had a significantly greater proportion of patients with preoperative spinal pathology of recurrent herniated nucleus pulposus, whereas a significantly greater proportion of patients in the LLIF cohort demonstrated isthmic spondylolisthesis ( P < 0.046, all). No significant differences were noted between cohorts for operative duration, estimated blood loss, 1-year rate of arthrodesis, postoperative length of stay, postoperative VAS pain scores on postoperative day 0 or 1, and postoperative narcotic consumption on postoperative day 0 or 1. Patients in the LLIF cohort showed greater rates of postoperative ileus (4.3% vs 0.0%). No other significant differences were noted between cohorts for postoperative complications. Between cohorts, preoperative PROM scores did not significantly differ. The following significant postoperative mean PROM scores were demonstrated: VAS back at 12 weeks and ODI at 12 weeks with both mean scores favoring the LLIF cohort. The MIS-TLIF cohort reported significant improvement from preoperative baseline to the 2-year time point for all PROMs collected at all individual postoperative time points except SF-12 MCS at 6 weeks ( P < 0.0, all). LLIF cohort reported significant improvement from preoperative baseline to the 1-year time point for all PROMs collected at all individual postoperative time points except for ODI at 6 weeks, 1 year, and 2 years, SF-12 MCS at 6 weeks and 2 years, and SF-12 PCS at 2 years( P < 0.042, all). The majority of patients in both cohorts achieved overall MCID for VAS back, VAS leg, ODI, and SF-12 PCS. A significantly greater proportion of patients in the LLIF cohort achieved MCID for SF-12 PCS at 12 weeks (94.4% vs 61.1%; P < 0.008).

CONCLUSION

Patients with predominant back pain undergoing MIS-TLIF or LLIF for degenerative spinal pathology demonstrated similar 2-year mean clinical outcomes for physical function, disability, leg pain, and back pain. At the 12-week time point, mean outcome scores for back pain and disability favored the lateral approach with concurrent higher rates of MCID achievement for physical function at that time point.

Back on track - digital health applications to treat back pain of rheumatic patients? Results of a qualitative interview study

Non-specific low back pain (NLBP) is prevalent among patients with rheumatic conditions. Digital health applications (DiGAs) provide reimbursed, personalized home treatment for patients, promising to overcome limitations of traditional healthcare systems. However, the adoption and effectiveness of back pain-specific DiGAs in rheumatology are not well understood. This study aims to explore the experiences and perspectives of a diverse group of rheumatology stakeholders regarding the use of DiGAs for back pain management. Qualitative interviews and a focus group discussion were conducted with a wide range of stakeholders including rheumatic patients, rheumatologists, nurses and DiGA producers. The data were analysed using qualitative content analysis. The study included 15 interviews (10 rheumatic patients, 4 rheumatologists, 1 DiGA producer) and 1 focus group with mixed participants (n = 12). Most stakeholders valued the instant access to personalized and effective back pain treatment provided by DiGAs. Patients appreciated the flexibility and ease of use of DiGAs which can be used anywhere and anytime. Concerns were raised about insufficient guidance regarding correct execution of exercises, which was seen as potentially dangerous and unsettling for patients. Healthcare professionals (HCPs) highlighted barriers, such as the lack of reimbursement, time constraints, and inadequate DiGA-specific education as barriers to prescribing DiGAs. Additionally, poor patient onboarding often led to delays, increased skepticism, and premature discontinuation of therapy. Stakeholders emphasized the challenges of current care driven by a shortage of HCPs and generally supported usage of back pain DiGAs. Various barriers and solution approaches were identified to enhance the performance, usability, and implementation of DiGAs in rheumatology.

Temporal Trends in the Epidemiology of Lower Back Pain in the United States

STUDY DESIGN

This was an observational study.

OBJECTIVE

This study aims to explore sociodemographic and regional geographic variations in lower back pain (LBP) incidence, prevalence, and burden in the United States (US from 2000 to 2019).

SUMMARY OF BACKGROUND DATA

LBP is a major contributor to lost wages and disability in the United States. As LBP is associated with increasing age and sedentary lifestyle, the incidence of LBP is expected to rise. Due to LBP's multifactorial causes, US epidemiological trends lack sufficient data.

MATERIALS AND METHODS

Descriptive epidemiological data including disability-adjusted life years (DALYs), incidence, and prevalence per 100,000 population from 2000 to 2019 were collected from the Global Burden of Disease database. State-level data regarding poverty, insurance and employment status were obtained from the US Government Census Bureau and US Department of Labor. Statistical significance was indicated by P <0.05.

RESULTS

From 2000 to 2019, the US demonstrated reductions in LBP incidence, prevalence, and DALYs. Regional analysis demonstrated the Midwest to have the greatest mean incidence, prevalence, and DALYs; with Midwestern females significantly more affected than females in other regions. Those aged 25 to 49 in the Midwest were impacted significantly more across all measures compared with age-matched populations in other regions. Nationally, there were no significant associations between unemployment and LBP. Poverty was inversely correlated with LBP incidence. Uninsured status was positively correlated with prevalence and DALYs.

CONCLUSION

Although there has been progress in reducing the impact of LBP in the United States, the Midwest region has greater rates for all measures compared with other US regions. Further, females and those aged 25 to 49 in the Midwest were more likely to be affected by LBP compared with counterparts in other regions. Future studies should identify specific factors contributing to elevated LBP rates in the Midwest in order to guide targeted interventions to reduce the incidence and burden of LBP there.

The effect of height of lifting on dynamic postural control in low back pain patients and healthy subjects

Objectives

The study investigated the influence of starting load position during lifting on postural control in nonspecific chronic low back pain (LBP) and healthy volunteers.

Patients and methods

The cross-sectional study included 20 healthy males (mean age: 31.8±7.4 years; range, 18 to 55 years) and 52 male patients (mean age: 33.4±9.2 years; range, 18 to 55 years) with chronic LBP between February 2016 and April 2018. Postural control characteristics were assessed by a force plate system. Center of pressure signals were obtained at a frequency of 100 Hz, and the mean of three trials was calculated. The participants were told to place their feet hip-width apart on the force plate while standing barefoot. They were then asked to lift a box weighing 10% of their body weight from the ground to waist height and then from waist height to overhead with straight elbows. They moved the box at their selected speed. The examinations began upon the examiner's command.

Results

Results indicated a significant difference (p<0.001) in all postural control variables in chronic LBP patients who lifted a load at different heights. In addition, there was a significant difference between all of the postural control measures of this study in healthy participants during load lifting at different heights (p<0.05), with the exception of the mediolateral standard deviation of velocity (p=0.067).

Conclusion

Different lifting heights impact LBP patients' and healthy people's postural control differently. Postural control was more challenging during waist-to-overhead lifting in the patient group. This may be due to a stiffening strategy. The central nervous system reduces postural sway at higher centers of mass.

Comparison of Isometric and Dynamic Bridging Exercises on Low Back Muscle Oxygenation

Bridging exercises are commonly performed by people with low back pain (LBP). However, the effect of the contraction mode in a bridging exercise on the hemodynamics of the low back muscle has not been investigated in people with and without LBP. The objective of this study was to assess the effect of the mode of bridging exercise on oxygenation of the low back muscle. A near-infrared spectroscopy was used to measure hemodynamic responses of the erector spinae between isometric and dynamic bridging exercises in 16 healthy participants. The results demonstrated that during exercise, the isometric bridging exercise significantly decreased oxyhemoglobin and deoxy-hemoglobin compared to the dynamic bridging exercise (oxyhemoglobin, t=- 3.109, p=0.007, Cohen's d=0.68 and deoxy-hemoglobin, t=- 2.193, P=0.046, Cohen's d=0.60). The results also demonstrated that after exercise, the dynamic bridging exercise induced a significantly higher oxygenation response (oxygenation, t=- 2.178, P=0.048, Cohen's d=0.43). This study indicates that the dynamic bridging exercise is more effective in improving oxygenation of low back muscles.

Yoga, Physical Therapy and Home Exercise Effects on Chronic Low Back Pain: Pain Perception, Function, Stress, and Quality of Life in a Randomized Trial

Low back pain is a common health problem. In this study, we investigated the effects of yoga, physical therapy (PT), and home exercise (HE) on pain perception, function, stress, and quality of life in chronic low back pain (cLBP). We randomly assigned 54 participants to three distinct treatment groups: (a) a physical therapy group (PT) who received spinal stabilization exercises (SSE) combined with local heat and transcutaneous electrical stimulation; (b) a home exercise group (HE) who received SSE as part of the home program; and (c) a yoga group who received yoga exercises. The primary outcome measures were a Visual Analog Scale (VAS) for measuring pain, and the Oswestry Disability Index (ODI) to measure function. Secondary outcome measures were the Tampa Kinesiophobia Scale (TKS), Central Sensitization Inventory (CSI), pain sensitivity (L3 and deltoid R/L PPTs), Spielberger State-Trait Anxiety Inventory (STAI), plasma cortisol and DHEA-S levels, Transversus Abdominis (TrA) muscle activation, and the Nottingham Health Profile (NHP). Assessments were conducted before and after a six-week intervention period. All three groups demonstrated improvements in pain on the VAS, function on the ODI, pain sensitivity on the L3 and deltoid R/L PPTs, CSI, anxiety on the STAI, TrA muscle activation, and quality of life on the NHP (p < .05). The PT group exhibited a more pronounced improvement on the ODI score (p < .05) than the other groups. Cortisol levels only decreased in the PT group (p < .05). The exercises did not impact DHEA-S and NHP-S parameters. Thus, all interventions resulted in decreased stress, pain intensity, pain sensitivity, central sensitization, and improved function and quality of life; there was no singularly superior approach between interventions. These findings will aid in tailoring treatment programs for managing cLBP according to individual needs.