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Yıldız NG, Aydin HZ, Sambo G, Aydın K, Yıldız H, Santri IN, Wardani Y, Mwamulima B, Isni K, Phiri YVA. The mediating role of depressive symptoms among Turkish population related to gender and low back pain: evidence from a national health survey. BMC Public Health 2024; 24:1136. [PMID: 38654220 DOI: 10.1186/s12889-024-18612-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Low back pain (LBP), though non-life-threatening, burdens healthcare with treatment expenses and work hours lost. Globally, 70-84% experience it, with risk factors tied to societal structure, income, and living conditions, making it a leading cause of disability. METHODS This study utilized data from the 2019 Türkiye Health Survey, which consisted of 17,084 individuals aged 15 and above. Our study focused on investigating the factors related to low back pain through a cross-sectional analysis. To analyze these factors, we employed binary multivariate logistic regression. Additionally, we conducted post-hoc analyses to assess the potential mediating effect of depressive symptoms on the relationship between low back pain and gender. RESULTS We found that 31.9% of the population experienced low back pain, with women being 58% more likely [aOR = 1.58; 95% CI (1.45-1.73)] than men to report symptoms. Individuals aged 55 + years old had a 90% [aOR = 1.90; 95% CI (1.61-2.23)] chance of experiencing low back pain, indicating an age-related increase. In the general population, having depressive symptoms was 2.49 [95% CI (2.23-2.78)] times more likely associated with low back pain. Our mediation analysis showed that gender (i.e., women vs. men), indicated by direct effects with β-estimates e = 0.78, predicted the likelihood of low back pain. Additionally, the relationship between gender and low back pain, mediated through a history of depressive symptoms, had a significant total indirect effect (i.e., β-estimate given as e = 0.49). Specifically, a history of depressive symptoms accounted for 17.86% [95% CI (9.67-20.10)] of the association between women having a higher likelihood of low back pain compared to men. CONCLUSION We observed that a higher likelihood of low back pain associated with gender and aging. Additionally, BMI served as a significant predictor, particularly in adults. Depression mediated the association between gender and low back pain. Acknowledging these associations may help identify and address contributing factors to LBP, potentially increasing awareness and alleviating the burden. Policymakers and healthcare professionals may consider these findings when developing prevention and treatment programs for low back pain.
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Affiliation(s)
- Nadire Gülçin Yıldız
- Faculty of Education, Department of Guidance and Counseling, Istanbul Medipol University, Istanbul, Turkey
| | - Halide Z Aydin
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Grace Sambo
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kemal Aydın
- Faculty of Economics and Administrative Sciences, Amasya University, Amasya, Turkey
| | - Hatice Yıldız
- Health Sciences Institute, Istanbul Medipol University, Istanbul, Turkey
| | | | - Yuniar Wardani
- Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Bwanalori Mwamulima
- Directorate of Health and Social Services, Rumphi District Council, Rumphi, Malawi
| | - Khoiriyah Isni
- Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Yohane V A Phiri
- Department of Epidemiology and Environmental Health (EEH), University at Buffalo, Buffalo, NY, USA.
- Charis Professional and Academic Research Consultants (CPARC), C/O, Mchinji, P.O. Box 132, Malawi.
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Aroke EN, Srinivasasainagendra V, Kottae P, Quinn TL, Wiggins AM, Hobson J, Kinnie K, Stoudmire T, Tiwari HK, Goodin BR. The Pace of Biological Aging Predicts Nonspecific Chronic Low Back Pain Severity. J Pain 2024; 25:974-983. [PMID: 37907115 PMCID: PMC10960701 DOI: 10.1016/j.jpain.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/15/2023] [Accepted: 10/21/2023] [Indexed: 11/02/2023]
Abstract
This study aimed to determine if and how the pace of biological aging was associated with nonspecific chronic low back pain (cLBP) and compare what measure of epigenetic age acceleration most strongly predicts cLBP outcomes. We used the Dunedin Pace of Aging from the Epigenome (DunedinPACE), Horvath's, Hannum's, and PhenoAge clocks to determine the pace of biological aging in 69 cLBP, and 49 pain-free controls (PFCs) adults, ages 18 to 85 years. On average, participants with cLBP had higher DunedinPACE (P < .001) but lower Horvath (P = .04) and Hannum (P = .02) accelerated epigenetic age than PFCs. There was no significant difference in PhenoAge acceleration between the cLBP and PFC groups (P = .97). DunedinPACE had the largest effect size (Cohen's d = .78) on group differences. In univariate regressions, a unit increase in DunedinPACE score was associated with 265.98 times higher odds of cLBP than the PFC group (P < .001). After controlling for sex, race, and body mass index (BMI), the odds ratio of cLBP to PFC group was 149.62 (P < .001). Furthermore, among participants with cLBP, DunedinPACE scores positively correlated with pain severity (rs = .385, P = .001) and interference (rs = .338, P = .005). Epigenetic age acceleration from Horvath, Hannum, and PhenoAge clocks were not significant predictors of cLBP. The odds of a faster pace of biological aging are higher among adults with cLBP, and this was associated with greater pain severity and disability. Future interventions to slow the pace of biological aging may improve cLBP outcomes. PERSPECTIVE: Accelerated epigenetic aging is common among adults with nonspecific cLBP. Higher DunedinPACE scores positively correlate with pain severity and interference, and better predict cLBP than other DNA methylation clocks. Interventions to slow the pace of biological aging may be viable targets for improving pain outcomes.
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Affiliation(s)
- Edwin N. Aroke
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vinodh Srinivasasainagendra
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pooja Kottae
- Department of Computer Science, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tammie L. Quinn
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Asia M. Wiggins
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joanna Hobson
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kiari Kinnie
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tonya Stoudmire
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hemant K. Tiwari
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R. Goodin
- Department of Anesthesiology, School of Medicine, Washington University, St Louis, USA
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de Oliveira Grigorini AE, Pereira LSM, Koes B, da Silva SLA, Chiarotto A, Felício DC, Leopoldino AAO. Does the intensity of pain and disability affect health-related quality of life of older adults with back pain? Multilevel analysis between Brazil and Netherlands: a cross-sectional study of the BACE consortium. BMC Geriatr 2024; 24:230. [PMID: 38443807 PMCID: PMC10916242 DOI: 10.1186/s12877-024-04803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The prognosis of back pain (BP) in the older adults is less favorable than in younger adults and progress to adverse outcomes and consequent worsening of health-related quality of life (HRQoL). The present study aimed to verify the association between BP intensity, disability and HRQoL in older adults residents in Brazil and Netherlands, and to evaluate whether the country of residence influences the associations. METHODS Data were collected from 602 Brazilian and 675 Dutch participants with a new episode of BP from the Back Complaints in Elders (BACE) consortium. For the present study, a cross section was used. Pain intensity and disability were assessed using the Numerical Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. HRQoL was assessed using the Short Form Health Survey (SF-36) quality of life questionnaire. Age, sex, and education were descriptive variables. Pain intensity (NPS score) and country were the independent variables and quality of life assessed by each SF domain - 36 was the dependent variable. Analysis of models at the individual level was performed to verify the association between pain and disability, also HRQoL in Netherlands and Brazil in the total sample. The multilevel model was used to verify whether the older adults person's country of residence influenced this relationship. RESULTS The average age of the participants was 67.00 (7.33) years. In the total sample, linear regression analysis adjusted for sex and age showed a significant association between BP intensity scores and HRQoL, for all domains. There was no association between disability and HRQoL. In the multilevel analysis, there was an association between BP intensity and HRQoL in all domains and an association between the country of residence and HRQoL, influencing the effect of pain, in all domains, except for the physical functioning. CONCLUSION Socioeconomic and cultural aspects of different countries can affect the perception of the elderly about their HRQoL in the presence of BP. Pain and disability in Brazilian and Dutch older adults ones are experienced differently in relation to their HRQoL.
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Affiliation(s)
- Adriana Estela de Oliveira Grigorini
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, 275 Alameda Ezequiel Dias, 30130-110, Belo Horizonte, Minas Gerais, Brazil
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, 275 Alameda Ezequiel Dias, 30130-110, Belo Horizonte, Minas Gerais, Brazil
- Department of Physical Therapy, Graduate Program in Rehabilitation Science, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bart Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Diogo Carvalho Felício
- Department of Physical Therapy, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Amanda Aparecida Oliveira Leopoldino
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, 275 Alameda Ezequiel Dias, 30130-110, Belo Horizonte, Minas Gerais, Brazil.
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Roca AM, Anwar FN, Khosla I, Medakkar SS, Loya AC, Sayari AJ, Lopez GD, Singh K. Utility of preoperative comorbidity burden on PROMIS outcomes after lumbar decompression: Cohort matched analysis. J Clin Neurosci 2024; 121:23-27. [PMID: 38335824 DOI: 10.1016/j.jocn.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
The influence of Charlson Comorbidity Index (CCI) burden on Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes following lumbar decompression (LD) is limited. The objective of this study is to evaluate CCI burden impact on PROMIS outcomes. Retrospective review of elective LD excluding revision or surgeries for infectious, malignant, or traumatic reasons. Demographics and PROMIS scores collected preoperatively and postoperatively up to 2 years included: PROMIS-Physical Function (PF)/Sleep Disturbance (SD)/Pain Interference (PI)/Anxiety (A), VR-12 Physical/Mental Health Composite scores (VR-12 PCS/MCS)/Oswestry Disability Index (ODI). Patients were divided into two groups based on their preoperative CCI score <3 (mild) or ≥4 (moderate to severe). Descriptive statistical analysis and MCID achievement rate calculations were conducted. A total of 182 patients were included: 93 CCI < 3 and 88 CCI ≥ 4. No significant differences were reported across preoperative PROMIS/legacy PROMs or final follow-up (p > 0.05, all). At 6-weeks, VR-12 PCS and ΔPROM scores indicated improved physician function in the CCI < 3 group (p = 0.020 and p = 0.040, respectively). Significant PROMIS-A ΔPROM score at final post-op was noted for CCI < 3 group (p = 0.026). MCID achievement demonstrated no significant differences for PROMIS outcomes and legacy PROMs. Results demonstrated that PROMIS outcomes were not impacted by a greater baseline comorbidity burden. At 6-weeks, the physical function scores were improved for the lower CCI group, and at final reported less anxiety. Our data suggests that comorbidity burden has a limited effect on PROMIS and legacy outcomes in patients undergoing LD.
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Affiliation(s)
- Andrea M Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Fatima N Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Ishan Khosla
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Srinath S Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Alexandra C Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Gregory D Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States.
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Justribó-Manion C, Mesa-Jiménez J, Caballero-Ruiz-de-la-Hermosa C, Zuil Escobar JC, Armijo-Olivo S. Is low back pain a risk/prognostic factor for the development and/or progression of temporomandibular disorders? A systematic review with meta-analysis. J Oral Rehabil 2024; 51:427-454. [PMID: 37743593 DOI: 10.1111/joor.13601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 06/01/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES To evaluate the association between low back pain (LBP) and painful temporomandibular disorders (TMDs). METHODS Systematic review of observational studies. Searches were conducted using OVID MEDLINE, CINHAL, Web of Science and PUBMED databases up to 21 October 2022. Qualitative and quantitative analyses were performed. Risk of bias (RoB) was assessed using the Quality in Prognosis Studies tool (QUIPS). RESULTS Eight studies were included in the present review with meta-analysis. The first onset of TMDs was more likely in patients with previous chronic LBP (hazard ratio (HR) 1.53 [95% confidence interval (CI): 1.28; 1.83, p < .00001]). In addition, patients with chronic LBP had 3.25 times the odds (OR) [95% CI: 1.94; 5.43, p < .00001] of having chronic TMDs than those who did not have chronic LBP. In addition, the higher the exposure to chronic LBP, the higher the risk of developing a first onset of TMDs. CONCLUSIONS Chronic LBP can be considered a risk/contributing factor for painful TMDs. Although there is a high certainty in the evidence linking chronic LBP with the risk of a first onset of TMDs, there are insufficient studies to draw definitive conclusions. Furthermore, while an association between chronic LBP and chronic TMDs and a dose-effect was observed between these two conditions, a limited number of studies and evidence exist to support these findings. Future studies are needed to increase the body of evidence.
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Affiliation(s)
- C Justribó-Manion
- Universidad Abat Oliba - CEU, CEU Universities, Barcelona, Spain
- Spain National Centre, Foundation COME Collaboration, Barcelona, Spain
| | - J Mesa-Jiménez
- Universidad San Pablo - CEU, CEU Universities, Madrid, Spain
| | | | | | - S Armijo-Olivo
- Faculty of Economics and Social Sciences, University of Applied Sciences Osnabrück, Osnabrück, Germany
- Faculties of Rehabilitation Medicine and Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Santos AEDN, Nunes ACL, Pereira LSM, Ferreira ML, Ferreira PH, Macedo LG, de Jesus-Moraleida FR. Physical Activity Supported by Low-Cost Mobile Technology for Back Pain (PAT-Back) to Reduce Disability in Older Adults: Results of a Feasibility Study. Phys Ther 2024; 104:pzad153. [PMID: 37941491 DOI: 10.1093/ptj/pzad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 07/26/2023] [Accepted: 09/24/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the feasibility of a randomized controlled trial investigating the effectiveness of a multimodal program (PAT-Back) compared to best practice advice on pain and disability in older adults with chronic low back pain (LBP) in primary care. METHODS This feasibility study took place in Fortaleza, Northeast Brazil. The PAT-Back intervention consisted of a program including exercises, pain education, and motivational text messages for the in-home component. The control group received an evidence-based educational booklet. Feasibility outcomes were recruitment, adherence and retention rates, level of difficulty of the education and intervention content, perception of utility of mobile technology, and adverse events. The feasibility criteria were previously defined. RESULTS A total of 248 people were screened, of which 46 older adults were eligible. The retention rate was high (100% in the PAT-Back group and 95% in the control group). The adherence rate to intervention was partially met (60%), whereas the adherence rate to unsupervised exercises was adequate (75%), and perception about safety to perform home exercise was partially acceptable (70%) in the PAT-Back group. In addition, 100% of older adults reported which text messages motivated them to perform the exercises in the PAT-Back group. Difficulty reported by participants in understanding and performing the intervention was small in both groups. Six participants reported transient adverse events in both groups. CONCLUSION Older adults accepted both interventions. Results demonstrated that the program is feasible, although minor changes targeting adherence and safety in home exercise are needed. IMPACT This feasibility study supports progression to a full trial investigating the effectiveness of a multimodal program (PAT-Back) on pain and disability in older adults with chronic LBP within a primary health care setting in low to middle income countries where such data from the older population are scarce and the burden of LBP is increasing.
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Affiliation(s)
- Ana Ellen do Nascimento Santos
- Master Program in Physiotherapy and Functioning, Department of Physiotherapy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Ana Carla Lima Nunes
- Master Program in Physiotherapy and Functioning, Department of Physiotherapy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Faculty of Medical Sciences of Minas Gerais, Graduate Program in Health Sciences, Belo Horizonte, Brazil
| | - Manuela Loureiro Ferreira
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, Sydney School of Health Sciences, The Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Paulo Henrique Ferreira
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, Sydney School of Health Sciences, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Luciana Gazzi Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Fujihara F, Kim K, Isu T, Matsumoto J, Miki K, Isobe M, Inoue T, Abe H. Paralumbar Spine Disease as a Cause of Low Back Pain in Older Adults. Cureus 2024; 16:e53983. [PMID: 38476809 PMCID: PMC10927485 DOI: 10.7759/cureus.53983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Low back pain (LBP) is a major contributor to decreases in the ability to perform activities of daily living (ADL) in older adults. Paralumbar spine disease (PLSD) is a common cause of LBP. We aimed to investigate the causes of LBP, including PLSD, among older adults. Methods Among 744 consecutive patients with LBP, 75 patients (10.1%) aged >80 years (25 males and 50 females) were included. The average patient age was 83.9 years. All patients were evaluated using lumbar magnetic resonance imaging (MRI) and radiography to diagnose the causes of LBP. PLSD was diagnosed based on clinical symptoms, palpation, and the effects of the block. Results Eleven patients (11/75, 14.7%) had acute osteoporotic vertebral fractures. Twenty-eight of the remaining 64 patients exhibited decreased LBP with oral medication, and six (6/75, 8.0%) exhibited lumbar spinal canal stenosis on MRI. PLSD was suspected in 19 of the remaining 30 cases based on clinical symptoms and palpation. Blocks were effective in 16 patients with PLSD, which involved superior cluneal nerve entrapment (SCN-E) in eight patients (10.7%), middle cluneal nerve entrapment (MCN-E) in nine patients (12.0%), sacroiliac joint (SIJ) pain in five patients (6.7%), and gluteus medius muscle (GMeM) pain in three patients (4.0%). The average numerical rating scale (NRS) scores for pain changed from 7.5 ± 1.5 before treatment to 1.3 ± 0.9 at discharge (p < 0.05). Conclusion Osteoporotic acute vertebral fracture (14.7%) was identified as the cause of LBP in older adults. Block therapy for PLSD may aid in the diagnosis and treatment of non-specific LBP.
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Affiliation(s)
| | - Kyongsong Kim
- Department of Neurological Surgery, Chiba Hokusoh Hospital, Chiba, JPN
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, JPN
| | - Juntaro Matsumoto
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Koichi Miki
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Masanori Isobe
- Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, JPN
| | - Tooru Inoue
- Department of Neurosurgery, Hakujyuji Hospital, Fukuoka, JPN
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
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Grøndahl LK, Axén I, Stensrud S, Hoekstra T, Vigdal ØN, Killingmo RM, Storheim K, Grotle M. Identifying latent subgroups in the older population seeking primary health care for a new episode of back pain - findings from the BACE-N cohort. BMC Musculoskelet Disord 2024; 25:60. [PMID: 38216905 PMCID: PMC10787445 DOI: 10.1186/s12891-024-07163-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/01/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Back pain is the number one condition contributing to years lived with disability worldwide, and one of the most common reasons for seeking primary care. Research on this condition in the ageing population is sparse. Further, the heterogeneity of patients with back pain complicates the management in clinical care. It is possible that subgrouping people with similar characteristics would improve management. This paper aimed to identify latent classes based on demographics, pain characteristics, psychosocial behavior, and beliefs and attitudes about back pain, among older patients seeking primary care with a new episode of back pain, and to examine if there were differences regarding the classes' first point-of-contact. METHODS The study was part of the international BACE (Back complaints in elders) consortium and included 435 patients aged ≥ 55 years seeking primary care (general practitioners, physiotherapists, and chiropractors) in Norway from April 2015 to March 2020. A latent class analysis was performed to identify latent classes. The classes were described in terms of baseline characteristics and first point-of-contact in primary care. RESULTS Four latent classes were identified. The mean age was similar across groups, as were high expectations towards improvement. Class 1 (n = 169, 39%), the "positive" class, had more positive attitudes and beliefs, less pain catastrophizing and shorter duration of current pain episode. Class 2 (n = 31, 7%), the "fearful" class, exhibited the most fear avoidance behavior, and had higher mean pain intensity. Class 3 (n = 33, 8%), the "distressed" class, had the highest scores on depression, disability, and catastrophizing. Finally, class 4 (n = 202, 46%), the "hopeful" class, showed the highest expectations for recovery, although having high pain intensity. The identified four classes showed high internal homogeneity, sufficient between-group heterogeneity and were considered clinically meaningful. The distribution of first point-of-contact was similar across classes, except for the positive class where significantly more patients visited chiropractors compared to general practitioners and physiotherapists. CONCLUSIONS The identified classes may contribute to targeting clinical management of these patients. Longitudinal research on these latent classes is needed to explore whether the latent classes have prognostic value. Validation studies are needed to evaluate external validity. TRIAL REGISTRATION Clinicaltrials.gov NCT04261309.
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Affiliation(s)
- Lise Kretz Grøndahl
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway.
- Et Liv i Bevegelse, the Norwegian Chiropractors' Research Foundation, Oslo, Norway.
| | - Iben Axén
- Et Liv i Bevegelse, the Norwegian Chiropractors' Research Foundation, Oslo, Norway
- Unit of Intervention and Implementation for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Silje Stensrud
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Trynke Hoekstra
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ørjan Nesse Vigdal
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Rikke Munk Killingmo
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Kjersti Storheim
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo, Norway
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo, Norway
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Huang C, Zou K, Wang Y, Tang K, Wu Y. Esculetin Alleviates IL-1β-Evoked Nucleus Pulposus Cell Death, Extracellular Matrix Remodeling, and Inflammation by Activating Nrf2/HO-1/NF-kb. ACS Omega 2024; 9:817-827. [PMID: 38222570 PMCID: PMC10785627 DOI: 10.1021/acsomega.3c06771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
Inflammation, extracellular matrix metabolic dysfunction, and oxidative stress are key pathogenic characteristics of intervertebral disk degeneration (IVDD), a major pathogenic cause of low back pain. Esculetin possesses anti-injury, anti-inflammation, and antinociceptive properties. This study aimed to explore its role in IVDD. In this research, esculetin exhibited little cytotoxicity to human nucleus pulposus cells (NPCs). Moreover, esculetin increased cell viability under IL-1β stimulation but attenuated IL-1β-induced cell apoptosis and caspase-3 activity. Furthermore, IL-1β-evoked increases in intracellular reactive oxygen species and malondialdehyde (MDA) levels, and decreases in superoxide dismutase (SOD) activity were reversed after esculetin treatment, indicating the antioxidative stress efficacy of esculetin. Esculetin alleviated the inhibitory effects of IL-1β on the transcription and protein expression of anabolic biomarkers (collagen II and aggrecan), accompanied by decreases in expression and release of catabolic biomarkers MMP-3 and MMP-13 from NPCs. Moreover, IL-1β exposure enhanced the expression levels of the inflammatory mediator nitric oxide and inflammatory cytokine IL-6 and TNF-α, which were overturned after esculetin treatment. Additionally, esculetin activated the nuclear factor-erythroid 2-related factor 2 (Nrf2)/heme oxygenase 1 (HO-1) to inhibit the activation of nuclear factor κB (NF-κB) signaling in NPCs. Importantly, suppression of Nrf2 signaling reversed the protective efficacy of esculetin against IL-1β-mediated oxidative injury, matrix metabolism disruption, and inflammatory response in NPCs. Together, esculetin may alleviate IL-1β-induced dysfunction in NPCs by regulating the Nrf2/HO-1/NF-kb signaling, indicating its potential as a promising therapeutic agent against IVDD.
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Affiliation(s)
- Chunhui Huang
- Department
of Spinal Surgery, Longyan First Affiliated
Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Xin
Luo District, Longyan 364000, P. R. China
| | - Kaiwei Zou
- Department
of Spinal Surgery, Longyan First Affiliated
Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Xin
Luo District, Longyan 364000, P. R. China
| | - Yizhang Wang
- Department
of Cardiology, Longyan First Affiliated
Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Xin
Luo District, Longyan 364000, P. R. China
| | - Kai Tang
- Department
of Spinal Surgery, Longyan First Affiliated
Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Xin
Luo District, Longyan 364000, P. R. China
| | - Yiqi Wu
- Department
of Spinal Surgery, Longyan First Affiliated
Hospital of Fujian Medical University, No. 105, Jiuyi North Road, Xin
Luo District, Longyan 364000, P. R. China
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10
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Ames H, Hestevik CH, Briggs AM. Acceptability, values, and preferences of older people for chronic low back pain management; a qualitative evidence synthesis. BMC Geriatr 2024; 24:24. [PMID: 38182977 PMCID: PMC10768085 DOI: 10.1186/s12877-023-04608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/16/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Chronic primary low back pain (CPLBP) and other musculoskeletal conditions represent a sizable attribution to the global burden of disability, with rates greatest in older age. There are multiple and varied interventions for CPLBP, delivered by a wide range of health and care workers. However, it is not known if these are acceptable to or align with the values and preferences of care recipients. The objective of this synthesis was to understand the key factors influencing the acceptability of, and values and preferences for, interventions/care for CPLBP from the perspective of people over 60 and their caregivers. METHODS We searched MEDLINE, CINAHL and OpenAlex, for eligible studies from inception until April 2022. We included studies that used qualitative methods for data collection and analysis; explored the perceptions and experiences of older people and their caregivers about interventions to treat CPLBP; from any setting globally. We conducted a best fit framework synthesis using a framework developed specifically for this review. We assessed our certainty in the findings using GRADE-CERQual. RESULTS All 22 included studies represented older people's experiences and had representation across a range of geographies and economic contexts. No studies were identified on caregivers. Older people living with CPLBP express values and preferences for their care that relate to therapeutic encounters and the importance of therapeutic alliance, irrespective of the type of treatment, choice of intervention, and intervention delivery modalities. Older people with CPLBP value therapeutic encounters that validate, legitimise, and respect their pain experience, consider their context holistically, prioritise their needs and preferences, adopt a person-centred and tailored approach to care, and are supported by interprofessional communication. Older people valued care that provided benefit to them, included interventions beyond analgesic medicines alone and was financially and geographically accessible. CONCLUSIONS These findings provide critical context to the implementation of clinical guidelines into practice, particularly related to how care providers interact with older people and how components of care are delivered, their location and their cost. Further research is needed focusing on low- and middle-income settings, vulnerable populations, and caregivers.
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Affiliation(s)
- Heather Ames
- The Norwegian Institute of Public Health, PO Box 222, 0213, Oslo, Skøyen, Norway.
| | | | - Andrew M Briggs
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
- Faculty of Health Sciences, Curtin University, PO Box U1987, Perth, 6845, Western Australia
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11
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Hicks GE, George SZ, Pugliese JM, Coyle PC, Sions JM, Piva S, Simon CB, Kakyomya J, Patterson CG. Hip-focused physical therapy versus spine-focused physical therapy for older adults with chronic low back pain at risk for mobility decline (MASH): a multicentre, single-masked, randomised controlled trial. Lancet Rheumatol 2024; 6:e10-e20. [PMID: 38258673 PMCID: PMC10806342 DOI: 10.1016/s2665-9913(23)00267-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Previously, we identified a population of older adults with chronic low back pain, hip pain, and hip muscle weakness who had worse 12-month low back pain and functional outcomes than age-matched adults with only low back pain, indicating an increased risk for future mobility decline. We sought to determine whether tailored, hip-focused physical therapy reduced pain and functional limitations in this high-risk population compared with non-tailored, spine-focused physical therapy. METHODS We did a multicentre, single-masked, randomised controlled trial at three research-based sites in the USA. We recruited older adults (aged 60-85 years) with hip pain and weakness who reported moderate low back pain intensity at least half the days in the last 6 months. Patients were randomly assigned to hip-focused physical therapy or spine-focused physical therapy using permuted blocks with random block size, stratified by site and sex (ie, male or female). The primary outcomes were self-reported disability using the Quebec Back Pain Disability Scale (QBPDS) and performance-based 10-Meter Walk Test (10MWT) at 8 weeks. All analyses were done in the intention-to-treat population. Adverse events were collected by study staff via a possible adverse event reporting form and then adjudicated by site investigators. This trial was registered with ClinicalTrials.gov, NCT04009837. FINDINGS Between Nov 1, 2019, and April 30, 2022, 184 participants were randomly assigned to receive hip-focused (n=91) or spine-focused physical therapy (n=93) interventions. The mean age was 70·7 (SD 6·2) years. 121 (66%) of 184 participants were women, 63 (34%) were men, and 149 (81%) were White. At 8 weeks, the mean between-group difference on the QBPDS was 4·0 (95% CI 0·5 to 7·5), favouring hip-focused physical therapy. Both groups had similar, clinically meaningful gait speed improvements (10MWT) at 8 weeks (mean difference 0·004 m/s [95% CI -0·044 to 0·052]). No serious adverse events were related to study participation. INTERPRETATION Tailored hip-focused physical therapy demonstrated greater improvements in low back pain-related disability at 8 weeks. However, both hip-focused physical therapy and spine-focused physical therapy produced clinically meaningful improvements in disability and function for this high-risk population at 6 months. These findings warrant further investigation before clinical implementation. FUNDING US National Institute on Aging of the National Institutes of Health.
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Affiliation(s)
- Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - Steven Z George
- Department of Orthopedic Surgery, Duke Clinical Research Institute, Duke School of Medicine, Durham, NC, USA
| | | | - Peter C Coyle
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Megan Sions
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Sara Piva
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Corey B Simon
- Department of Orthopedic Surgery, Duke Clinical Research Institute, Duke School of Medicine, Durham, NC, USA
| | - Joseph Kakyomya
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charity G Patterson
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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12
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Vigdal ØN, Storheim K, Killingmo RM, Rysstad T, Pripp AH, van der Gaag W, Chiarotto A, Koes B, Grotle M. External validation and updating of prognostic prediction models for nonrecovery among older adults seeking primary care for back pain. Pain 2023; 164:2759-2768. [PMID: 37490100 DOI: 10.1097/j.pain.0000000000002974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/23/2023] [Indexed: 07/26/2023]
Abstract
ABSTRACT Prognostic prediction models for 3 different definitions of nonrecovery were developed in the Back Complaints in the Elders study in the Netherlands. The models' performance was good (optimism-adjusted area under receiver operating characteristics [AUC] curve ≥0.77, R2 ≥0.3). This study aimed to assess the external validity of the 3 prognostic prediction models in the Norwegian Back Complaints in the Elders study. We conducted a prospective cohort study, including 452 patients aged ≥55 years, seeking primary care for a new episode of back pain. Nonrecovery was defined for 2 outcomes, combining 6- and 12-month follow-up data: Persistent back pain (≥3/10 on numeric rating scale) and persistent disability (≥4/24 on Roland-Morris Disability Questionnaire). We could not assess the third model (self-reported nonrecovery) because of substantial missing data (>50%). The models consisted of biopsychosocial prognostic factors. First, we assessed Nagelkerke R2 , discrimination (AUC) and calibration (calibration-in-the-large [CITL], slope, and calibration plot). Step 2 was to recalibrate the models based on CITL and slope. Step 3 was to reestimate the model coefficients and assess if this improved performance. The back pain model demonstrated acceptable discrimination (AUC 0.74, 95% confidence interval: 0.69-0.79), and R2 was 0.23. The disability model demonstrated excellent discrimination (AUC 0.81, 95% confidence interval: 0.76-0.85), and R2 was 0.35. Both models had poor calibration (CITL <0, slope <1). Recalibration yielded acceptable calibration for both models, according to the calibration plots. Step 3 did not improve performance substantially. The recalibrated models may need further external validation, and the models' clinical impact should be assessed.
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Affiliation(s)
- Ørjan Nesse Vigdal
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Kjersti Storheim
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Rikke Munk Killingmo
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Tarjei Rysstad
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Are Hugo Pripp
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Wendelien van der Gaag
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Center for Muscle and Health, University of Southern Denmark, Odense, Denmark
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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13
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Fonseca LS, Silva JP, Souza MB, Mascarenhas RDO, Silva HDJ, Campos MGM, Pereira LSM, Oliveira MX, Oliveira VC. Efficacy of pharmacological and non-pharmacological therapy on pain intensity and disability of older people with chronic nonspecific low back pain: a protocol for a network meta-analysis. Syst Rev 2023; 12:205. [PMID: 37936147 PMCID: PMC10629194 DOI: 10.1186/s13643-023-02369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The purpose of this network meta-analysis (NMA) is to investigate the efficacy of pharmacological and non-pharmacological therapy on pain intensity and disability of older people with chronic nonspecific low back pain, providing comprehensive evidence for an informed decision-making. METHODS We will perform a systematic search to identify randomized controlled trials of pharmacological and non-pharmacological interventions for older people with chronic nonspecific low back pain. MEDLINE, Cochrane Library, Embase, AMED, PsycINFO, and PEDro will be searched without language or date restrictions. Our primary outcomes are pain intensity and disability. Risk of bias will be assessed for all studies using the revised Cochrane risk-of-bias (RoB) tool 2.0. For each pairwise comparison between the different interventions, estimated mean differences and their 95% confidence intervals will be presented. Standard pairwise meta-analyses will be performed using random effects models in STATA version 16. The competing interventions will be ranked using the surface under the cumulative ranking curve (SUCRA) for the outcomes of interest at short and long terms. The confidence in the results from NMA will be assessed using the Confidence in Network Meta-Analysis (CINeMA) framework. DISCUSSION This NMA compares efficacy of interventions for nonspecific chronic low back pain in older people. It will provide reliable evidence for patients, clinicians, stakeholders, and researchers in this field where competing therapies, many of extraordinarily little value, are commonly used in clinical practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022312565.
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Affiliation(s)
- Letícia Soares Fonseca
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.
| | - Juliana Pereira Silva
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Mateus Bastos Souza
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | | | - Hytalo de Jesus Silva
- Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | | | - Leani Souza Máximo Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Murilo Xavier Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Vinicius Cunha Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
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14
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Papianou LN, Wilson JM, Edwards RR, Sieberg CB, Meints SM. The mediating effect of social functioning on the relationship between catastrophizing and pain among patients with chronic low back pain. Pain Med 2023; 24:1244-1250. [PMID: 37399110 DOI: 10.1093/pm/pnad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Pain catastrophizing can be characterized as an interpersonal form of coping used to elicit support or empathy from others. Despite intentions of increasing support, catastrophizing can impair social functioning. While considerable work has addressed the relationship between catastrophizing and pain, limited empirical work has examined this relationship within a social context. First, we examined the role of catastrophizing as a potential contributor to group differences (chronic low back pain [cLBP] vs pain-free controls) in social functioning. Then we conducted a follow-up, exploratory analysis to examine the relationships between catastrophizing, social functioning, and pain within the subgroup of participants with cLBP. METHODS In this observational study, participants with cLBP (N = 62) and pain-free controls (N = 79) completed validated measures of pain, social functioning, and pain catastrophizing. A mediation analysis was conducted to examine whether catastrophizing mediated group differences (cLBP vs controls) in social functioning. A follow-up, exploratory mediation analysis then tested whether social functioning mediated the association between catastrophizing and pain within the subgroup of cLBP participants. RESULTS Participants with cLBP reported higher levels of pain, impaired social functioning, and higher catastrophizing compared to pain-free controls. Catastrophizing partially mediated the group difference in impaired social functioning. Additionally, social functioning mediated the association between higher catastrophizing and greater pain within the subgroup of cLBP participants. CONCLUSIONS We showed that impaired social functioning was driving the relationship between higher pain catastrophizing and worse pain among participants with cLBP. Interventions, such as cognitive behavioral therapy, should address catastrophizing in individuals with cLBP, while simultaneously improving social functioning.
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Affiliation(s)
- Lauren N Papianou
- Department of Anesthesiology and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Jenna M Wilson
- Department of Anesthesiology and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Robert R Edwards
- Department of Anesthesiology and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Christine B Sieberg
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA 02115, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA 02115, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States
| | - Samantha M Meints
- Department of Anesthesiology and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
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15
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Fakih O, Ramon A, Chouk M, Prati C, Ornetti P, Wendling D, Verhoeven F. Comparison of sacroiliac CT findings in patients with and without ankylosing spondylitis aged over 50 years. Sci Rep 2023; 13:17901. [PMID: 37863967 PMCID: PMC10589274 DOI: 10.1038/s41598-023-45082-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
Diagnosis of axial spondyloarthritis (axSpA) is nowadays commonly made with the help of pelvic radiography or magnetic resonance imaging (MRI). However, there is an important inter-observer variability in radiography, and MRI is subject to possible false positives and is not the best modality for studying structural lesions. Conversely, pelvic computed tomography (CT) has excellent specificity and appears to be more effective than radiography for the diagnosis of ankylosing spondylitis (AS). However, its findings in patients over 50 years of age have not yet been studied. The objectives of this study were to describe the CT characteristics of sacro-iliac joints (SIJ) and the presence of intra-articular gas in patients with AS aged over 50 years and to compare them with controls of the same age and sex. This two-center, cross-sectional, observational study was performed using the medical records of the rheumatology departments of two University Hospitals. We included patients with a clinical diagnosis of axSpA, who had both definite radiographic sacroiliitis according to the modified New York criteria and met the ASAS 2009 criteria for axSpA (that is, AS), and who had undergone any CT scan including the whole SIJ. Each patient was matched for age and sex to a control randomly selected on the Picture Archiving and Communication System (PACS), symptomatic or asymptomatic, and without spondyloarthritis. For each individual, CT scans were interpreted blindly by two independent rheumatologists and scored for joint space narrowing (JSN), erosions, sclerosis, intra-articular gas, and diffuse idiopathic skeletal hyperostosis (DISH). Ninety patients and 90 controls were included in the study. The rates of positive JSN, erosion, and sclerosis scores were higher in the AS group (91% vs. 21%, p < 0.0001; 31% vs. 2%, p < 0.0001; 27% vs. 13%, p = 0.03, respectively), but the rates of intra-articular gas and DISH were higher in the control group (24% vs. 68%, p < 0.0001; 7% vs. 33%, p < 0.0001, respectively). 58% of patients had complete bilateral ankylosis. A total of 83 (92.2%) patients had a CT scan considered positive for AS, compared with only seven controls (7.8%). Sclerosis and erosions were predominantly on the anterosuperior part and iliac side of the joint in controls and were more diffuse in patients with AS. CT findings in patients with AS over 50 years of age are mostly represented by changes in the joint space; patients with AS have more erosions and sclerosis changes, but less intra-articular gas than controls.
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Affiliation(s)
- Olivier Fakih
- Service de rhumatologie, CHU de Besançon, 3 boulevard Fleming, 25030, Besançon Cedex, France.
| | - André Ramon
- Service de rhumatologie, CHU de Dijon, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France
| | - Mickaël Chouk
- Service de rhumatologie, CHU de Besançon, 3 boulevard Fleming, 25030, Besançon Cedex, France
| | - Clément Prati
- Service de rhumatologie, CHU de Besançon, 3 boulevard Fleming, 25030, Besançon Cedex, France
- EA 4267 "PEPITE", UFR Santé, Franche-Comté University, 19 rue Ambroise Paré, bâtiment S, 25030, Besançon Cedex, France
| | - Paul Ornetti
- Service de rhumatologie, CHU de Dijon, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France
| | - Daniel Wendling
- Service de rhumatologie, CHU de Besançon, 3 boulevard Fleming, 25030, Besançon Cedex, France
- EA 4266 "EPILAB", UFR Santé, Franche-Comté University, 19 rue Ambroise Paré, bâtiment S, 25030, Besançon Cedex, France
| | - Frank Verhoeven
- Service de rhumatologie, CHU de Besançon, 3 boulevard Fleming, 25030, Besançon Cedex, France
- EA 4267 "PEPITE", UFR Santé, Franche-Comté University, 19 rue Ambroise Paré, bâtiment S, 25030, Besançon Cedex, France
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16
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Sorkpor SK, Miao H, Moore C, Johnson CM, Maria DMS, Pollonini L, Ahn H. Listening to Remotely Monitored Home-based Preferred Music for Pain in Older Black Adults with Low Back Pain: A Pilot Study of Feasibility and Acceptability. Pain Manag Nurs 2023; 24:e102-e108. [PMID: 37482453 DOI: 10.1016/j.pmn.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/23/2023] [Accepted: 07/02/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Low back pain (LBP) is a complex condition that is widespread among older Black adults. Nonpharmacologic interventions are recommended as first-line therapy, but their use in practice is limited, possibly due to misunderstanding of their analgesic characteristics. AIM To determine the feasibility and acceptability of listening to preferred music at home to relieve pain in older Black adults aged 65 years or older with LBP. METHOD We recruited 20 community-dwelling older adults (≥65 years) with LBP to use noise-isolating headphones to listen to their preferred music for 20 minutes twice daily for four days via the MUSIC CARE® app. Feasibility was determined using enrollment, adherence, and attrition rates, and acceptability was determined using the Treatment Acceptance and Preference (TAP) scale. Average pain scores were self-reported using the Numeric Rating Scale (NRS) after the second intervention of the day. Pain scores were evaluated using paired sample t test and repeated-measures ANOVA. RESULTS Enrollment, adherence, and attrition rates were 95.25%, 100.00%, and 0.00%, respectively. Most participants rated the TAP scale at ≥3, indicating acceptance. Pain scores decreased significantly from baseline (M = 46.90, SD = 21.47) to post-intervention (M = 35.70, SD = 16.57), t (19) = 2.29, p = .03. Repeated measures ANOVA showed a significant decrease in mean pain scores over time [F (2.36, 44.88) = 5.61, p = .004, η2 = .23]. CONCLUSIONS Listening to preferred music for 20 minutes twice a day is a feasible and acceptable intervention that can considerably reduce pain in older Black adults with LBP.
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Affiliation(s)
- Setor K Sorkpor
- College of Nursing, Florida State University, Tallahassee, Florida.
| | - Hongyu Miao
- College of Nursing, Florida State University, Tallahassee, Florida
| | - Carolyn Moore
- School of Music, Sam Houston State University, Huntsville, Texas
| | - Constance M Johnson
- Cizik School of Nursing, University of Texas Health Science Center Houston, Houston, Texas
| | - Diane M Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center Houston, Houston, Texas
| | - Luca Pollonini
- Departments of Engineering Technology, University of Houston, Texas
| | - Hyochol Ahn
- University of Arizona College of Nursing, Tucson, Arizona
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17
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Li XY, Wang YL, Yang S, Liao CS, Li SF, Han PY, Han PF. Efficacy of oblique lumbar interbody fusion versus transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:5657-5670. [PMID: 37079105 PMCID: PMC10449690 DOI: 10.1007/s00402-023-04880-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/05/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION This meta-analysis aimed to compare the differences in postoperative efficacy between oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases. MATERIALS AND METHODS Strictly based on the search strategy, we searched the published papers on OLIF and TLIF for the treatment of lumbar degenerative diseases in PubMed, Embase, CINAHL, and Cochrane Library. A total of 607 related papers were retrieved, and 15 articles were finally included. The quality of the papers was evaluated according to the Cochrane systematic review methodology, and the data were extracted and meta-analyzed using Review manager 5.4 software. RESULTS Through comparison, it was found that in the treatment of lumbar degenerative diseases, the OLIF group had certain advantages over the TLIF group in terms of intraoperative blood loss, hospital stay, visual analog scale (VAS) for leg pain (VAS-LP), Oswestry disability index (ODI), disc height (DH), foraminal height (FH), fused segmental lordosis (FSL), and cage height, and the differences were statistically significant. The results were similar in terms of surgery time, complications, fusion rate, VAS for back pain (VAS-BP) and various sagittal imaging indicators, and there was no significant difference. CONCLUSIONS OLIF and TLIF can relieve low back pain symptoms in the treatment of lumbar degenerative diseases, but OLIF has certain advantages in terms of ODI and VAS-LP. In addition, OLIF has the advantages of minor intraoperative trauma and quick postoperative recovery.
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Affiliation(s)
- Xi-Yong Li
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, People's Republic of China
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Yun-Lu Wang
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, People's Republic of China
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Su Yang
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Chang-Sheng Liao
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Song-Feng Li
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
| | - Peng-Yong Han
- Graduate School, Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China.
| | - Peng-Fei Han
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, People's Republic of China.
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Sousa O, Dos Santos Coelho F, Pereira P. Postoperative recommendations for single-level lumbar disc herniation: a cross-section survey. Arch Orthop Trauma Surg 2023; 143:5467-5473. [PMID: 36867269 DOI: 10.1007/s00402-023-04809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 02/04/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Lumbar degenerative disc disease is one of the leading causes of low back and leg pain. Conservative treatment is the mainstay treatment, but for some patients surgical approach is required. The literature concerning postoperative recommendations on patients' return to work is sparse. The aim of this study is to assess spine surgeons' consensus regarding postoperative recommendations, including return to work, restart of daily-living activities, analgesic medication usage and rehabilitation referral. METHODS An online GoogleForms survey was sent, via electronic mail, during January 2022, to 243 surgeons described as having expertise in spine surgery, using the dissemination means of Sociedade Portuguesa de Patologia da Coluna Vertebral and Sociedade Portuguesa de Neurocirurgia. Participants (n = 59) had predominantly hybrid clinical practice in Neurosurgery field. RESULTS Only in a minority of cases (1.7%) no recommendation was given to patients. Nearly 68% of participants advised patients to return to sedentary professional work up until the 4th postoperative week. Light and heavy workload workers were advised to wait longer until initiating work activity. Low mechanical impact activities are started up to 4 weeks, and higher stress activities should be further postponed. Half of the surveyed surgeons estimates to refer to rehabilitation 10% or more patients. No differences were found when comparing recommendations given by more and less experienced surgeons-as defined by number of years in practice and number of annual surgeries-for most activities. CONCLUSION Despite not having clear guidelines in postoperative management of surgically treated patients, Portuguese practice is in line with international experience and literature.
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Affiliation(s)
- Osvaldo Sousa
- Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal
- Serviço de Neurocirurgia, Centro Hospitalar Universitário de São João, E.P.E, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Francisca Dos Santos Coelho
- Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Paulo Pereira
- Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal
- Serviço de Neurocirurgia, Centro Hospitalar Universitário de São João, E.P.E, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal
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Soares Fonseca L, Pereira Silva J, Bastos Souza M, Gabrich Moraes Campos M, de Oliveira Mascarenhas R, de Jesus Silva H, Souza Máximo Pereira L, Xavier Oliveira M, Cunha Oliveira V. Effectiveness of pharmacological and non-pharmacological therapy on pain intensity and disability in older people with chronic nonspecific low back pain: a systematic review with meta-analysis. Eur Spine J 2023; 32:3245-3271. [PMID: 37464184 DOI: 10.1007/s00586-023-07857-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND AND PURPOSE The aim of the present systematic review was to investigate the effectiveness of pharmacological and non-pharmacological therapy on pain intensity and disability in older people with chronic nonspecific low back pain. METHODS Searches were conducted in the MEDLINE, COCHRANE LIBRARY, EMBASE, AMED, PSYCINFO, and PEDRO databases up to 2022. Risk of bias was appraised using the Cochrane Risk of Bias 2.0 tool. Estimated mean differences and respective 95% confidence intervals were presented for each paired comparison and the strength of the current evidence was assessed using the GRADE approach. RESULTS AND DISCUSSION Thirty-one original trials involving 2120 participants were included. All outcomes were self-rated. Pain intensity was measured using the Visual Analogue Scale or Numerical Rating Scale. Disability was evaluated using the Roland Morris Disability Questionnaire, Oswestry Disability Index or Hannover Functional Ability Questionnaire. Short-term: Moderate quality of evidence that mindfulness reduces disability compared to patient education (mean difference [MD] = - 1.38 [95% CI - 2.02 to - 0.73]); low-quality evidence that mixed exercise (MD = - 50.33 [95% CI - 57.11 to - 43.56]) reduces pain compared to no intervention, waiting list, placebo or sham; low quality of evidence that there is no effect for opioid compared to placebo (MD = - 8.26 [95% CI - 19.29 to 2.77]) with regards to reducing pain and opioid/acetaminophen reduces disability more compared to pregabalin (MD = 2.36 [95% CI] 1.86-2.86]). CONCLUSIONS The findings showed low or very low quality of evidence for non-pharmacological interventions with a large effect in short- and long-term follow-up. The two studies that provided moderate quality of evidence had a small clinical effect. Only two studies were found that investigated pharmacological therapies-both with low quality of evidence. However, the studies were methodologically weak and had small sample sizes. Given the adverse effects of low back pain and the scarce information on the effectiveness of pharmacological and non-pharmacological treatments for older people, future randomized trials should be encouraged.
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Affiliation(s)
- Letícia Soares Fonseca
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil.
| | - Juliana Pereira Silva
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Mateus Bastos Souza
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | | | - Rodrigo de Oliveira Mascarenhas
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Hytalo de Jesus Silva
- Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Murilo Xavier Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Vinicius Cunha Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
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20
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Sahin UK, Durdu H, Korkmaz N. The role of frailty on quality of life in older adults during the COVID-19 pandemic. Aging Clin Exp Res 2023:10.1007/s40520-023-02469-w. [PMID: 37335461 DOI: 10.1007/s40520-023-02469-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
AIM The impact of frailty, a physiological state characterized by reduced reserve for stressors and related to worse outcomes, on older adults during the pandemic is unclear. Our aim was to identify the effects of frailty among older adults during the COVID-19 pandemic. METHODS A total of 197 older adults who were not exposed to COVID-19 were assessed with an online survey one year after the pandemic began in Turkey. Frailty, quality of life, and fear of COVID-19 were assessed with the Tilburg Frailty Indicator, the Nottingham Health Profile, and the Fear of COVID-19 Scale, respectively. Since March 2020, changes in pain severity and localization, fatigue, and fear of falling were assessed. Multiple linear regression analyses were conducted. RESULTS In this study, 62.5% of the participants were frail. The prevalence of pain was significantly increased during the COVID-19 pandemic, but only among the frail. The increases in pain severity, fear of falling, and fatigue were significantly higher for the frail than the non-frail. The model including physical and psychological components of frailty and pain severity explained 49% of the variation in quality of life (R = 0.696; R2 = 0.485; p < 0.001). The physical component of frailty had the highest impact on quality of life (B = 20.591; β = 0.334). CONCLUSION This study focused on negative outcomes that were experienced more by frail older adults compared to non-frail older adults when they were locked down at home for an extended period of time during the COVID-19 pandemic. It is necessary to quickly improve and maintain the health of these affected individuals.
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Affiliation(s)
- Ulku Kezban Sahin
- Department of Therapy and Rehabilitation, Vocational School of Health Services, Giresun University, Giresun, Turkey.
| | - Habibe Durdu
- Department of Therapy and Rehabilitation, Vocational School of Health Services, Giresun University, Giresun, Turkey
| | - Nurhayat Korkmaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
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21
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Migliorini F, Vaishya R, Pappalardo G, Schneider M, Bell A, Maffulli N. Between guidelines and clinical trials: evidence-based advice on the pharmacological management of non-specific chronic low back pain. BMC Musculoskelet Disord 2023; 24:432. [PMID: 37254090 DOI: 10.1186/s12891-023-06537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/16/2023] [Indexed: 06/01/2023] Open
Abstract
The pharmacological management of nonspecific chronic low back pain (NCLBP) aims to restore patients' daily activities and improve their quality of life. The management of NCLBP is not well codified and extremely heterogeneous, and residual symptoms are common. Pharmacological management should be considered as co-adjuvant to non-pharmacological therapy, and should be guided by the symptoms reported by the patients. Depending on the individual severity of NCLPB, pharmacological management may range from nonopioid to opioid analgesics. It is important to identify patients with generalized sensory hypersensitivity, who may benefit from dedicated therapy. This article provides an evidence-based overview of the principles of pharmacological management of NCLPB.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52064, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Bolzano, 39100, Italy.
| | - Raju Vaishya
- Department of Orthopedics, Indraprastha Apollo Hospitals Institutes of Orthopaedics, New Delhi, India
| | | | - Marco Schneider
- Department of Medicine and Dentistry, University of Witten/Herdecke, 58455, Witten, Germany
- Department of Arthroscopy and Joint Replacement, MVZ Praxisklinik Orthopädie Aachen, RWTH University Hospital Aachen, 52074, Aachen, Germany
| | - Andreas Bell
- Department of Orthopedics, Eifelklinik St. Brigida, Simmerath, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081, Italy
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, E1 4DG, England
- School of Pharmacy and Bioengineering, Stoke on Trent, Keele University Faculty of Medicine, Keele, England
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22
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Thonprasertvat B, Roopsawang I, Aree-Ue S. Assessing the Predictive Power of Frailty and Life-Space Mobility on Patient-Reported Outcomes of Disability in Older Adults with Low Back Pain. Healthcare (Basel) 2023; 11:healthcare11071012. [PMID: 37046939 PMCID: PMC10093851 DOI: 10.3390/healthcare11071012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/28/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Background: Frailty and decreased life-space mobility are known as risk factors to develop physical limitations leading to disability in older adults with low back pain (LBP). This cross sectional study aimed to investigate the prevalence and predictive power of frailty and life-space mobility on patient-reported outcomes of disability in older adults with LBP. Methods: The sample comprised 165 older adults with LBP who visited two tertiary care hospitals between December 2021 and February 2022. The participants responded to structured standard questionnaires. Data were analyzed using descriptive statistics and robust logistic regression. Results: More than two-thirds of participants were classified as non-frail (26.67%) or pre-frail (66.67%). Mobility restrictions and minimal to severe disability were identified. Controlling other variables, frailty (OR = 1.74, 95% CI: 1.14–2.64) and restricted life-space mobility (OR = 0.42, 95% CI: 0.26–0.67) were significantly associated with disability. Integrating frailty with life-space mobility evaluations demonstrated the highest predictive power for disability-related LBP (AUC = 0.89, 95% CI: 0.84–0.93). Conclusion: Frailty and restricted life-space mobility significantly predicted disability in older adults with LBP. Healthcare professionals should recognize the critical importance of integrating patient-reported outcomes with screening for frailty and life-space mobility limitation to optimize care or tract symptom progression.
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Affiliation(s)
- Benyapa Thonprasertvat
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Inthira Roopsawang
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Suparb Aree-Ue
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Vigdal ØN, Storheim K, Killingmo RM, Småstuen MC, Grotle M. The one-year clinical course of back-related disability and the prognostic value of comorbidity among older adults with back pain in primary care. Pain 2023; 164:e207-e216. [PMID: 36083174 DOI: 10.1097/j.pain.0000000000002779] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Back pain and comorbidity are common in older adults. Comorbidity is a promising prognostic factor for the clinical course of back-related disability, but confirmatory studies assessing its prognostic value are needed. Thus, the aims of this study were to describe the clinical course of back-related disability during 1-year follow-up in patients aged ≥55 years visiting primary care (general practitioner, physiotherapist, or chiropractor) with a new episode of back pain and assess the prognostic value of comorbidity on back-related disability during 1-year follow-up. A prospective cohort study was conducted, including 452 patients. The outcome measure was Roland-Morris Disability Questionnaire (RMDQ, range 0-24) measured at baseline and at 3-, 6-, and 12-month follow-up. The Self-Administered Comorbidity Questionnaire was used to assess comorbidity count (CC, range 0-15) and comorbidity burden (CB, range 0-45). The RMDQ scores improved from median (interquartile range) 9 (4-13) at baseline to 4 (1-9), 4 (0-9), and 3 (0-9) at 3, 6, and 12 months, respectively. Using linear mixed-effects models, we found that CC and CB were independently associated with RMDQ scores. A 1-point increase in CC was associated with an increase in RMDQ score of 0.76 points (95% confidence interval [0.48-1.04]) over the follow-up year, adjusted for known prognostic factors. A 1-point increase in CB was associated with an increased RMDQ score of 0.47 points (95% confidence interval [0.33-0.61]). In conclusion, the clinical course of back-related disability for older adults presenting in primary care was favorable, and increased comorbidity was an independent prognostic factor for increased disability levels.
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Affiliation(s)
- Ørjan Nesse Vigdal
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Kjersti Storheim
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Rikke Munk Killingmo
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Naruse M, Trappe S, Trappe TA. Human skeletal muscle-specific atrophy with aging: a comprehensive review. J Appl Physiol (1985) 2023; 134:900-914. [PMID: 36825643 PMCID: PMC10069966 DOI: 10.1152/japplphysiol.00768.2022] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Age-related skeletal muscle atrophy appears to be a muscle group-specific process, yet only a few specific muscles have been investigated and our understanding in this area is limited. This review provides a comprehensive summary of the available information on age-related skeletal muscle atrophy in a muscle-specific manner, nearly half of which comes from the quadriceps. Decline in muscle-specific size over ∼50 yr of aging was determined from 47 cross-sectional studies of 982 young (∼25 yr) and 1,003 old (∼75 yr) individuals and nine muscle groups: elbow extensors (-20%, -0.39%/yr), elbow flexors (-19%, -0.38%/yr), paraspinals (-24%, -0.47%/yr), psoas (-29%, -0.58%/yr), hip adductors (-13%, -0.27%/yr), hamstrings (-19%, -0.39%/yr), quadriceps (-27%, -0.53%/yr), dorsiflexors (-9%, -0.19%/yr), and triceps surae (-14%, -0.28%/yr). Muscle-specific atrophy rate was also determined for each of the subcomponent muscles in the hamstrings, quadriceps, and triceps surae. Of all the muscles included in this review, there was more than a fivefold difference between the least (-6%, -0.13%/yr, soleus) to the most (-33%, -0.66%/yr, rectus femoris) atrophying muscles. Muscle activity level, muscle fiber type, sex, and timeline of the aging process all appeared to have some influence on muscle-specific atrophy. Given the large range of muscle-specific atrophy and the large number of muscles that have not been investigated, more muscle-specific information could expand our understanding of functional deficits that develop with aging and help guide muscle-specific interventions to improve the quality of life of aging women and men.
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Affiliation(s)
- Masatoshi Naruse
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Scott Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Todd A Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
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Simon CB, Hicks GE, Pieper CF, Kraus VB, Keefe FJ, Colón-Emeric C. A Novel Movement-Evoked Pain Provocation Test for Older Adults With Persistent Low Back Pain: Safety, Feasibility, and Associations With Self-reported Physical Function and Usual Gait Speed. Clin J Pain 2023; 39:166-174. [PMID: 36943160 PMCID: PMC10034602 DOI: 10.1097/ajp.0000000000001101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/24/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES Low back pain (LBP) is highly prevalent and disabling for older adults. Movement-evoked pain is an emerging measure that may help to predict disability; but is not currently a part of geriatric LBP clinical care. This study tested the safety and feasibility of a new Movement-Evoked Provocation Test for Low Back Pain in Older Adults (MEPLO). We also compared associations between movement-evoked pain via 2 different scoring methods and disability-associated outcomes. MATERIALS AND METHODS Thirty-nine older adults with persistent LBP provided baseline recalled and resting pain ratings, self-reported physical function, and usual gait speed. Participants then completed MEPLO, involving 4 tasks essential for functional independence: chair rises, trunk rotation, reaching, and walking. Movement-evoked pain was then quantified using the traditional change score (delta) method of pain premovement to postmovement; and also, a new aggregate method that combines pain ratings after the 4 tasks. RESULTS No safety or feasibility issues were identified. Compared with the delta score, the aggregate score was more strongly associated with self-reported physical function (beta: -0.495 vs. -0.090) and usual gait speed (beta: -0.450 vs. -0.053). Similarly, the aggregate score was more strongly associated with self-reported physical function than recalled and resting pain (beta: -0.470, -0.283, and 0.136, respectively). DISCUSSION This study shows the safety and feasibility of testing movement-evoked pain in older adults with persistent LBP, and its potential superiority to traditional pain measures. Future studies must validate these findings and test the extent to which MEPLO is implementable to change with geriatric LBP standard of care.
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Affiliation(s)
- Corey B. Simon
- Department of Orthopaedic Surgery, Duke University, Durham, NC
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Carl F. Pieper
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Virginia Byers Kraus
- Department of Medicine, Duke University School of Medicine, Durham, NC
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | - Cathleen Colón-Emeric
- Department of Medicine, Duke University School of Medicine, Durham, NC
- Durham VA Geriatric Research Education and Clinical Center, Durham, NC
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Wong THT, Lee KSK, Lo SMC, Kan MMP, Kwan C, Opsommer E, Anwer S, Li H, Wong AYL, Schoeb V. Challenges, Concerns, and Experiences of Community-Dwelling Older Women with Chronic Low Back Pain—A Qualitative Study in Hong Kong, China. Healthcare (Basel) 2023; 11:healthcare11070945. [PMID: 37046873 PMCID: PMC10094692 DOI: 10.3390/healthcare11070945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 03/29/2023] Open
Abstract
Background and Objectives: Although chronic low back pain (CLBP) is known to negatively affect multiple aspects of the lives of older people, prior qualitative studies mainly focused on the lived experiences of older people with CLBP in Western countries. Given cultural and contextual differences and poor understanding of CLBP in older women with CLBP, it is important to better understand the concerns and lived experiences of Chinese older women with CLBP. The current study aimed to investigate the experiences, challenges, concerns, and coping strategies of older women with CLBP in Hong Kong. Research Design and Methods: A total of 15 community-dwelling older women with CLBP aged ≥60 years were recruited from a physiotherapy clinic or a community center for semi-structured interviews. The interviews were audio recorded and transcribed ‘verbatim’. The transcription was imported to NVivo 12 software. Thematic analysis was conducted using Braun and Clarke’s method. Results: Five themes were identified: (1) physical impacts of CLBP on daily life; (2) psychological influences of CLBP; (3) management of CLBP; (4) family support; and (5) social activities and support. Discussion and implications: Negative physical and psychosocial impacts of CLBP were common among older women, and they adopted diverse pain management strategies, although some of their treatment options were influenced by the Chinese culture. Misbeliefs and responses of family and friends also affected their management strategies. Elderly community centers are a significant source of social support for older women with CLBP, making it an ideal platform for establishing self-help groups to facilitate their self-management of CLBP.
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Lai A, Iliff D, Zaheer K, Wang D, Gansau J, Laudier DM, Zachariou V, Iatridis JC. Spinal Cord Sensitization and Spinal Inflammation from an In Vivo Rat Endplate Injury Associated with Painful Intervertebral Disc Degeneration. Int J Mol Sci 2023; 24:3425. [PMID: 36834838 PMCID: PMC9964286 DOI: 10.3390/ijms24043425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
Intervertebral disc (IVD) degeneration with Modic-like changes is strongly associated with pain. Lack of effective disease-modifying treatments for IVDs with endplate (EP) defects means there is a need for an animal model to improve understanding of how EP-driven IVD degeneration can lead to spinal cord sensitization. This rat in vivo study determined whether EP injury results in spinal dorsal horn sensitization (substance P, SubP), microglia (Iba1) and astrocytes (GFAP), and evaluated their relationship with pain-related behaviors, IVD degeneration, and spinal macrophages (CD68). Fifteen male Sprague Dawley rats were assigned into sham or EP injury groups. At chronic time points, 8 weeks after injury, lumbar spines and spinal cords were isolated for immunohistochemical analyses of SubP, Iba1, GFAP, and CD68. EP injury most significantly increased SubP, demonstrating spinal cord sensitization. Spinal cord SubP-, Iba1- and GFAP-immunoreactivity were positively correlated with pain-related behaviors, indicating spinal cord sensitization and neuroinflammation play roles in pain responses. EP injury increased CD68 macrophages in the EP and vertebrae, and spinal cord SubP-, Iba1- and GFAP-ir were positively correlated with IVD degeneration and CD68-ir EP and vertebrae. We conclude that EP injuries result in broad spinal inflammation with crosstalk between spinal cord, vertebrae and IVD, suggesting that therapies must address neural pathologies, IVD degeneration, and chronic spinal inflammation.
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Affiliation(s)
- Alon Lai
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Denise Iliff
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kashaf Zaheer
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Dalin Wang
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing 211166, China
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Jennifer Gansau
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Damien M. Laudier
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Venetia Zachariou
- Nash Family Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - James C. Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Kim JG, Park SM, Kim HJ, Yeom JS. Development and Validation of a Risk-Prediction Nomogram for Chronic Low Back Pain Using a National Health Examination Survey: A Cross-Sectional Study. Healthcare (Basel) 2023; 11. [PMID: 36833002 DOI: 10.3390/healthcare11040468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Several prognostic factors have been reported for chronic low back pain (CLBP). However, there are no studies on the prediction of CLBP development in the general population using a risk prediction model. This cross-sectional study aimed to develop and validate a risk prediction model for CLBP development in the general population, and to create a nomogram that can help a person at risk of developing CLBP to receive appropriate counseling on risk modification. METHODS Data on CLBP development, demographics, socioeconomic history, and comorbid health conditions of the participants were obtained through a nationally representative health examination and survey from 2007 to 2009. Prediction models for CLBP development were derived from a health survey on a random sample of 80% of the data and validated in the remaining 20%. After developing the risk prediction model for CLBP, the model was incorporated into a nomogram. RESULTS Data for 17,038 participants were analyzed, including 2693 with CLBP and 14,345 without CLBP. The selected risk factors included age, sex, occupation, education level, mid-intensity physical activity, depressive symptoms, and comorbidities. This model had good predictive performance in the validation dataset (concordance statistic = 0.7569, Hosmer-Lemeshow chi-square statistic = 12.10, p = 0.278). Based on our model, the findings indicated no significant differences between the observed and predicted probabilities. CONCLUSIONS The risk prediction model presented by a nomogram, which is a score-based prediction system, can be incorporated into the clinical setting. Thus, our prediction model can help individuals at risk of developing CLBP to receive appropriate counseling on risk modification from primary physicians.
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Puto G, Repka I, Muszalik M. Factors Correlating with Functional Capacity in Older People with Chronic Pain. Int J Environ Res Public Health 2023; 20:2748. [PMID: 36768110 PMCID: PMC9915534 DOI: 10.3390/ijerph20032748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Chronic pain in older people is a global health problem not only in terms of a negative subjective feeling, but also as a social and economic factor. Deterioration of functional capacity is one of the main symptoms of chronic pain; therefore, it should be assessed as a basic parameter in the life of older people. The aim of the study was to analyze the factors which have an impact on the functional capacity of older people with chronic pain. MATERIAL AND METHODS The study was conducted among 181 people over 65 suffering from chronic pain lasting more than 6 months. The study used a questionnaire that included questions about demographic and social characteristics and the following scales: Abbreviated Mental Score (AMTS), Personal Activities of Daily Living (PADL) by Katz, Instrumental Activities of Daily Living (IADL) by Lawton, Geriatric Pain Measure-24 (GPM-24). RESULTS In the study group, a positive correlation was found between: coexisting diseases and withdrawal due to pain, pain intensity, pain resulting from walking or from the effort from other activities, and in terms of the total GPM-24 score. A positive correlation was also found between the Geriatric Depression Scale (GDS) and withdrawal due to pain, pain intensity, pain resulting from walking or from the effort from other activities, and in terms of the total GPM-24 score. A significantly negative correlation was found between: AMTS, ADL, IADL performance and: withdrawal due to pain, pain intensity, pain resulting from walking or from the effort from other activities, and in terms of total GPM-24 score. CONCLUSIONS Chronic pain is more common in people with disabilities in basic and complex activities of daily living, with limited efficiency in cognitive functions and an increased sense of depression. The standard in everyday practice and clinical trials should be taking a history of chronic pain in every older person, monitoring the pain's intensity and accompanying characteristics by using a multidimensional scale for assessing pain in older people.
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Affiliation(s)
- Grażyna Puto
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Kopernika 25 Street, 31-501 Krakow, Poland
| | - Iwona Repka
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Kopernika 25 Street, 31-501 Krakow, Poland
| | - Marta Muszalik
- Department of Geriatrics, Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
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Park HJ, Choi JY, Lee WM, Park SM. Prevalence of chronic low back pain and its associated factors in the general population of South Korea: a cross-sectional study using the National Health and Nutrition Examination Surveys. J Orthop Surg Res 2023; 18:29. [PMID: 36631903 PMCID: PMC9832776 DOI: 10.1186/s13018-023-03509-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Many factors associated with chronic low back pain (CLBP) have been proposed, including individual, psychosocial, and physical factors. However, these associated factors are still controversial. PURPOSE (1) To determine the prevalence of CLBP and (2) to analyze factors associated with CLBP in the general population using a nationally representative sample of South Koreans. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE Data from versions IV-1, -2, and -3 of the Korea National Health and Nutrition Examination Survey (KNHANES), which were performed in 2007, 2008, and 2009, respectively (n = 24,871). OUTCOME MEASURES Multiple logistic regression analysis was performed to determine the association between several factors (age, gender, alcohol consumption, household income, education level, mid-intensity physical activity, depressive symptoms, vitamin D level, and comorbidities [stroke, ischemic heart disease, knee osteoarthritis, asthma, COPD, cancer history]) and CLBP. METHODS CLBP status was surveyed using a self-reported questionnaire. Demographic, socioeconomic status, comorbidities, and other factors were evaluated from health questionnaires, health and physical examinations, and laboratory tests. To analyze the association between these factors and CLBP, we used multiple logistic regression analysis. RESULTS Data from 17,038 participants were included in the final analysis, including 2,693 with CLBP and 14,345 without. The prevalence of CLBP was 15.8% in South Korean subjects, with a prevalence of 11.8% in men and 24.5% in women. After regression analysis, we found advanced age, female gender, mid-intensity physical activity, depressive symptoms, stroke, ischemic heart disease, knee arthritis, asthma, COPD, and cancer history were positively associated with CLBP. In contrast, alcohol consumption ≥ 1 drink per month, increased household income, higher education level, and vitamin D insufficiency were negatively associated with CLBP. CONCLUSIONS Our study showed that CLBP was most common in the elderly and women in the general South Korean population. Several individual, socioeconomic, lifestyle, and health-related factors were associated with CLBP. These results demonstrate the influence of these factors on CLBP in the general population and suggest that consideration of these factors may improve the management of CLBP.
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Affiliation(s)
- Hyun-Jin Park
- grid.464606.60000 0004 0647 432XDepartment of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jun-Young Choi
- grid.31501.360000 0004 0470 5905Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 Republic of Korea
| | - Woo Myung Lee
- grid.464606.60000 0004 0647 432XDepartment of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sang-Min Park
- grid.31501.360000 0004 0470 5905Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 Republic of Korea
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Wende O. Achieving effective long-term therapeutic results in the treatment of chronic pain of musculoskeletal origin: the place of regenerative medicine. Manuelle Medizin 2023. [DOI: 10.1007/s00337-022-00934-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Makhoul M, Bartley EJ. Exploring the relationship between gratitude and depression among older adults with chronic low back pain: a sequential mediation analysis. Front Pain Res (Lausanne) 2023; 4:1140778. [PMID: 37213708 PMCID: PMC10196463 DOI: 10.3389/fpain.2023.1140778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/14/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Gratitude has been identified as a key factor in a number of positive health-related outcomes; however, the mechanisms whereby gratitude is associated with well-being among older adults with chronic pain are poorly understood. Using the Positive Psychological Well-Being Model as a theoretical framework, the objective of the present study was to examine the serial mediating effects of social support, stress, sleep, and tumor necrosis factor-alpha (TNF-α) on the relationship between gratitude and depressive symptoms. Methods A total sample of 60 community-dwelling older adults with chronic low back pain (cLBP) provided blood samples for high-sensitivity TNF-α and completed the Gratitude Questionnaire, Perceived Stress Scale, and the PROMIS Emotional Support, Sleep Disturbance, and Depression forms. Descriptive statistics, correlation analyses, and serial mediation analyses were performed. Results Gratitude was negatively associated with perceived stress, sleep disturbance, and depression, and was positively associated with social support. No significant association was observed between gratitude and TNF-α. After controlling for age and marital status, analyses revealed that perceived stress and sleep disturbance sequentially mediated the association between gratitude and depressive symptoms. Conclusion Perceived stress and sleep disturbance may be potential mechanistic pathways by which gratitude impacts negative well-being. Targeting gratitude as a protective resource may be a potential therapeutic tool to improve psychological and behavioral outcomes in older adults with cLBP.
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Affiliation(s)
- Melissa Makhoul
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - E. J. Bartley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
- Correspondence: E. J. Bartley
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Banks JJ, Alemi MM, Allaire BT, Lynch AC, Bouxsein ML, Anderson DE. Using static postures to estimate spinal loading during dynamic lifts with participant-specific thoracolumbar musculoskeletal models. Appl Ergon 2023; 106:103869. [PMID: 36055036 DOI: 10.1016/j.apergo.2022.103869] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/06/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Static biomechanical simulations are sometimes used to estimate in vivo kinetic demands because they can be solved efficiently, but this ignores any potential inertial effects. To date, comparisons between static and dynamic analyses of spinal demands have been limited to lumbar joint differences in young males performing sagittal lifts. Here we compare static and dynamic vertebral compressive and shear force estimates during axial, lateral, and sagittal lifting tasks across all thoracic and lumbar vertebrae in older men and women. Participant-specific thoracolumbar full-body musculoskeletal models estimated vertebral forces from recorded kinematics both with and without consideration of dynamic effects, at an identified frame of peak vertebral loading. Static analyses under-predicted dynamic compressive and resultant shear forces, by an average of about 16% for all three lifts across the thoracic and lumbar spine but were highly correlated with dynamic forces (average r2 > .95). The study outcomes have the potential to enable standard clinical and occupational estimates using static analyses.
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Affiliation(s)
- Jacob J Banks
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Mohammad Mehdi Alemi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Brett T Allaire
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Andrew C Lynch
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States.
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Katal S, Clifford TG, Matcuk G, Eibschutz L, Gholamrezanezhad A. Clinical Applications of PET in Evaluating the Aging Spine. PET Clin 2023; 18:39-47. [DOI: 10.1016/j.cpet.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhou Z, Hui ES, Kranz GS, Chang JR, de Luca K, Pinto SM, Chan WW, Yau SY, Chau BK, Samartzis D, Jensen MP, Wong AYL. Potential mechanisms underlying the accelerated cognitive decline in people with chronic low back pain: A scoping review. Ageing Res Rev 2022; 82:101767. [PMID: 36280211 DOI: 10.1016/j.arr.2022.101767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/13/2022] [Accepted: 10/20/2022] [Indexed: 01/31/2023]
Abstract
A growing body of evidence has shown that people with chronic low back pain (CLBP) demonstrate significantly greater declines in multiple cognitive domains than people who do not have CLBP. Given the high prevalence of CLBP in the ever-growing aging population that may be more vulnerable to cognitive decline, it is important to understand the mechanisms underlying the accelerated cognitive decline observed in this population, so that proper preventive or treatment approaches can be developed and implemented. The current scoping review summarizes what is known regarding the potential mechanisms underlying suboptimal cognitive performance and cognitive decline in people with CLBP and discusses future research directions. Five potential mechanisms were identified based on the findings from 34 included studies: (1) altered activity in the cortex and neural networks; (2) grey matter atrophy; (3) microglial activation and neuroinflammation; (4) comorbidities associated with CLBP; and (5) gut microbiota dysbiosis. Future studies should deepen the understanding of mechanisms underlying this association so that proper prevention and treatment strategies can be developed.
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Affiliation(s)
- Zhixing Zhou
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Edward S Hui
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; The State Key Laboratory of Brain and Cognitive Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Jeremy R Chang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Katie de Luca
- School of Health, Medical and Applied Sciences, CQ University, Brisbane, Australia
| | - Sabina M Pinto
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Winnie Wy Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Suk-Yu Yau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China; Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Bolton Kh Chau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Centre, Chicago, IL, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China; Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong Special Adminstrative Region, China.
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Ge L, Pereira MJ, Yap CW, Heng BH. Chronic low back pain and its impact on physical function, mental health, and health-related quality of life: a cross-sectional study in Singapore. Sci Rep 2022; 12:20040. [PMID: 36414674 PMCID: PMC9681885 DOI: 10.1038/s41598-022-24703-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic low back pain, defined as low back pain lasting more than 3 months, is a globally prevalent health problem with significantly high medical and economic burden on individuals and the society. This study aimed to estimate the prevalence of chronic low back pain and examine its association with health outcomes including physical function, mental health, and quality of life among adult population in Singapore. Cross-sectional secondary data analysis was performed using baseline data of the 1941 adults (mean age: 52.6 years, range: 21-97 years) from a representative population health survey conducted in the Central region of Singapore. Those with self-reported chronic low back pain in past six months were identified. The Late-Life Function and Disability Instrument, Patient Health Questionnaire-9, and EQ-5D-5L were used to measure physical function and limitation, mental health, and health-related quality of life, respectively. Generalized Linear Regressions were used to examine the association of chronic low back pain with physical function, limitation, depressive symptoms, and health-related quality of life. There were 8.1% (n = 180) participants reporting having chronic low back pain in past six months, among whom 80.5% sought treatments at either primary care, specialist outpatient, or Traditional Chinese Medicine clinics. Individuals with chronic low back pain reported poorer physical function, more limitations in performing major life tasks and social activities, more depressive symptoms, and lower health-related quality of life (all p < 0.01), even after adjusting for socio-demographics, lifestyle factors, and number of morbidities. The prevalence of chronic low back pain was 8.1% among the study population. Chronic low back pain was associated with poorer physical function, more limitations and depressive symptoms, and lower health-related quality of life. The findings highlight the significant impact of chronic low back pain on physical function and limitation, mental health, and health-related quality of life in a general population. Increased awareness on prevention, early and proper management of low back pain, and rehabilitation policies are required to better tackle the burden of low back pain at the population level.
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Affiliation(s)
- Lixia Ge
- grid.466910.c0000 0004 0451 6215Health Services & Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@One-North (South Lobby), Singapore, 13854 Singapore
| | - Michelle Jessica Pereira
- grid.466910.c0000 0004 0451 6215Health Services & Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@One-North (South Lobby), Singapore, 13854 Singapore
| | - Chun Wei Yap
- grid.466910.c0000 0004 0451 6215Health Services & Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@One-North (South Lobby), Singapore, 13854 Singapore
| | - Bee Hoon Heng
- grid.466910.c0000 0004 0451 6215Health Services & Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@One-North (South Lobby), Singapore, 13854 Singapore
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Raud B, Lanhers C, Crouzet C, Eschalier B, Bougeard F, Goldstein A, Pereira B, Coudeyre E. Identification of Responders to Balneotherapy among Adults over 60 Years of Age with Chronic Low Back Pain: A Pilot Study with Trajectory Model Analysis. Int J Environ Res Public Health 2022; 19:14669. [PMID: 36429387 PMCID: PMC9690151 DOI: 10.3390/ijerph192214669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Balneotherapy may be a relevant treatment for chronic low back pain (LBP) in individuals > 60 years old. This pilot study aimed to determine the effectiveness of balneotherapy for chronic LBP in people > 60 years old and to determine profiles of responders with trajectory model analysis. This was a pilot prospective open cohort study, with repeated measurements using validated questionnaires; participants were their own controls. The primary endpoint was the proportion of participants with a change in pain intensity between the start of treatment and 3 months after treatment assessed with a numeric scale (NS) from 0 to 100 mm, with an effect size (ES) > 0.5. The assessments involved questionnaires that were self-administered on days (D) 1 and 21 and at months 3 and 6. The secondary objective was to determine the profile of responders to balneotherapy. We included 78 patients (69.2% women), mean age 68.3 ± 5.3 years. The mean pain score on the NS was 48.8 ± 19.9 at D1 and 39.1 ± 20.5 at 3 months (p < 0.001). The ES was 0.47 [95% confidence interval [CI] 0.25 to 0.69] for the whole sample; 36% (28/78) had an ES > 0.5; 23% (18/78) had a moderate ES (0 to 0.5); and 41% (32/78) had an ES of zero (14/78) or < 0 (18/78), corresponding to increased pain intensity. The pain trajectory model showed that the change in pain between D1 and D21 for trajectory A (larger reduction in pain intensity) was -50% [95% CI -60 to -27], and for trajectory B (smaller reduction in pain intensity), it was -13% [-33 to 0] (p < 0.001). Between Day 1 and month 3, the change for trajectory A was -33% [-54; 0] and for trajectory B was -13% [-40 to 0] (p = 0.14). Finally, between D1 and month 6, the change for trajectory A was -50% [-60 to 0] and for trajectory B was -6% [-33 to 17] (p = 0.007). The patients in trajectory A reported performing more physical activity than those in trajectory B (p = 0.04). They were also less disabled, with a mean Oswestry Disability Index of 40.4 versus 45.7 for those in trajectory A and B, respectively, (p = 0.03) and had a higher total Arthritis Self-Efficacy Scale score. This real-life study of the effectiveness of balneotherapy on chronic LBP identified distinct pain trajectories and predictive variables for responders. These criteria could be used in decision-making regarding the prescription of balneotherapy, to ensure personalized management of chronic LBP.
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Affiliation(s)
- Benjamin Raud
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, INRAE, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Charlotte Lanhers
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, INRAE, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Cindy Crouzet
- Département de Médecine Générale, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Bénédicte Eschalier
- Département de Médecine Générale, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - François Bougeard
- Département de Médecine Générale, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Anna Goldstein
- Unité de Biostatistique, Délégation Recherche Clinique et Innovation, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Bruno Pereira
- Unité de Biostatistique, Délégation Recherche Clinique et Innovation, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, INRAE, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
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Koszela K, Woldańska-okońska M. Age and Sex in Back Pain Intensity—Retrospective Study of Conservatory vs. Surgical Discopathy Treatment. Life (Basel) 2022; 12:1808. [DOI: 10.3390/life12111808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
(1) Background: The frequency of back pain diagnosis and treatment has markedly increased in recent years. Back pain may be caused by many factors and discopathy is one of them. The aim of the study was to assess the impact of age and sex on back pain intensity in rehabilitated patients with discopathy treated conservatively and surgically; (2) Methods: The study included 137 patients: 96 undergoing conservative therapy and 41 after back surgery due to discopathy. VAS and the Laitinen scale were used for pain assessment. All patients underwent a multidirectional rehabilitation program at the Department of Rehabilitation and Physical Medicine of the Medical University in Łódź; (3) Results: No statistically significant effect of age and sex was observed on the level of pain intensity on VAS and the Laitinen scale; (4) Conclusions: Age and sex do not seem to affect back pain intensity in rehabilitated patients treated conservatively and surgically for discopathy. The problem requires further research on a larger group of patients.
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Jenks A, Hoekstra T, van Tulder M, Ostelo RW, Rubinstein SM, Chiarotto A. Roland-Morris Disability Questionnaire, Oswestry Disability Index, and Quebec Back Pain Disability Scale: Which Has Superior Measurement Properties in Older Adults With Low Back Pain? J Orthop Sports Phys Ther 2022; 52:457-69. [PMID: 35584027 DOI: 10.2519/jospt.2022.10802] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the validity, reliability, and responsiveness of 3 commonly used questionnaires for assessing physical function (ie, Oswestry Disability Index [ODI], Quebec Back Pain Disability Scale [QBPDS], and Roland-Morris Disability Questionnaire [RMDQ]) in older patients undergoing chiropractic care for low back pain (LBP). DESIGN Head-to-head clinimetric comparison. METHODS Patients completed the ODI, QBPDS, and RMDQ at baseline and after 2 weeks of treatment. Reliability was evaluated for internal consistency (Cronbach α), test-retest reliability (interclass correlation coefficient [ICC]), and measurement error (standard error of measurement and smallest detectable change [SDC]). Structural validity was evaluated through unidimensional confirmatory factor analysis, and construct validity was investigated by a priori hypotheses with other measures. Responsiveness was evaluated by testing a priori hypotheses using data at baseline and at 2-week follow-up. RESULTS Two hundred fourteen patients (53% males and 47% females) with a mean age of 66.2 years (standard deviation = 7.8 years) were included, of which 193 patients completed the 2-week follow-up for our responsiveness analysis. The RMDQ, ODI, and QBPDS showed sufficient internal consistency (Cronbach α of .89, .86, and .94, respectively) and test-retest reliability (ICC[2,1] of 0.85, 0.89, and 0.84, respectively). The SDC for the RMDQ was 6.9, for the ODI was 19.1, and for the QBPDS was 23.6, which are values larger than the minimal important change. None of the measures met all criteria for sufficient structural validity, but the RMDQ and ODI exhibited a partial unidimensional fit. The questionnaires had sufficient construct validity and responsiveness. CONCLUSION The ODI, QBPDS, and RMDQ have similar measurement properties in older adults with LBP. J Orthop Sports Phys Ther 2022;52(7):457-469. Epub: 18 May 2022. doi:10.2519/jospt.2022.10802.
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Mortazavi H. Virtual reality: a promising non-pharmacological modality for chronic low back pain management in elderly. Korean J Pain 2022; 35:353-355. [PMID: 35768991 PMCID: PMC9251402 DOI: 10.3344/kjp.2022.35.3.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 01/09/2023] Open
Affiliation(s)
- Hamed Mortazavi
- Geriatric Care Research Center, Department of Geriatric Nursing, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Maiers M, Forte ML. Association Between Psychosocial Parameters and Response to Chiropractic Care Among Older Adults With Chronic Low Back Pain: Secondary Analysis of a Randomized Clinical Trial. J Manipulative Physiol Ther 2022:S0161-4754(22)00016-1. [PMID: 35753883 DOI: 10.1016/j.jmpt.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether baseline self-efficacy, fear of pain with movement (kinesiophobia), or change in either were associated with clinically important improvement in disability among older adults with chronic low back pain after 12 weeks of chiropractic spinal manipulation (CSM) and exercise. METHODS This secondary analysis used randomized trial data from community-dwelling adults aged 65 years or older with chronic spinal disability who received non-pharmacological treatment of CSM and exercise. Those with ≥30% reduction in the Oswestry Disability Index (ODI) after 12 weeks of treatment were considered responders to care. Psychosocial measures included the Pain Self-Efficacy Questionnaire (PSEQ) and the Tampa Scale of Kinesiophobia (TSK). Logistic regression-assessed associations were between psychosocial, demographic, and low back predictors and 30% ODI improvement. RESULTS There were 176 community-dwelling older adults included in this analysis. Mean age was 71 years, 59.7% were women; 176 (96.7%) had complete data. Baseline disability (ODI = 26.1 ± 9.3) and back pain (5.0 ± 1.9, 0-10 scale) were moderate. Baseline PSEQ reflected higher self-efficacy (47.7 ± 7.8, 0-60 scale) with minimal kinesiophobia (TSK 34.3 ± 5.2, 17-68 scale). Seventy-two (40.9%) achieved 30% reduction in ODI (mean -5.4 ± 7.9) after 12 weeks of treatment. Mean self-efficacy improvement was clinically important (2.5 ± 6.5 points); kinesiophobia (-2.7 ± 4.4 points) and LBP (-1.6 points) also improved. Baseline PSEQ and percent improvement in PSEQ and TSK were associated with response to treatment in univariate regression analyses but not in multiple regression models that included low back predictors. LBP duration >4 years negatively impacted recovery. CONCLUSIONS Among this sample of older adults who received chiropractic manipulation and exercise, baseline self-efficacy and improvements in self-efficacy and kinesiophobia were individually associated with clinically important reductions in disability post-intervention, although not in adjusted models when LBP duration was included.
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Ren C, Jin J, Li C, Xiang J, Wu Y, Zhou Y, Sun L, Zhang X, Tian N. Metformin inactivates the cGAS-STING pathway through autophagy and suppresses senescence in nucleus pulposus cells. J Cell Sci 2022; 135:276176. [PMID: 35722742 DOI: 10.1242/jcs.259738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/13/2022] [Indexed: 12/09/2022] Open
Abstract
Intervertebral disc degeneration (IVDD) is a complex process involving many factors, among which excessive senescence of nucleus pulposus cells (NPCs) is considered to be the main factor. Our previous study found that metformin may inhibit senescence in nucleus pulposus cells; however, its working mechanism is still largely unknown. In the current study, we found that metformin may inactivate cGAS-STING pathway during oxidative stress. Knock-down of STING may further suppress senescence, indicating metformin may exert its effect through cGAS-STING pathway. Damaged DNA is a major inducer of the activation of cGAS-STING pathway. Mechanistically, our study showed that DNA damage was reduced during metformin treatment; however, suppression of autophagy by 3-methyladenine (3MA) may compromise the effect of metformin on DNA damage. The in vivo study also showed that 3MA may recede the therapeutic effect of metformin on IVDD. Taken together, our results reveal that metformin may suppress senescence via inactivating the cGAS-STING pathway through autophagy, implying the new application of metformin in cGAS-STING pathway related diseases.
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Affiliation(s)
- Chenghao Ren
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang Province, China
| | - Jie Jin
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang Province, China
| | - Chenchao Li
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang Province, China
| | - Jianwei Xiang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang Province, China
| | - Yaosen Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang Province, China
| | - Yifei Zhou
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang Province, China
| | - Liaojun Sun
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang Province, China
| | - Xiaolei Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang Province, China.,Chinese Orthopaedic Regenerative Medicine Society, Hangzhou, Zhejiang Province, China
| | - Naifeng Tian
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang Province, China
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Wang R, Zhu D, Wang L, Liu J, Zou J, Sun Y, Jiang Y, Hu HY, Deng ZW, Weng LM, Zheng KY, Kiartivich S, Wang XQ. Tai Chi Quan Versus Physical Therapy on Pain and Cognitive Performance for Elderly People With Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial. Front Aging Neurosci 2022; 14:900430. [PMID: 35783144 PMCID: PMC9243751 DOI: 10.3389/fnagi.2022.900430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesChronic low back pain has become a major cause of global disability and caused a huge economic burden to society. Physical therapy is a vital strategy for rehabilitation of chronic low back pain. Although several trials have shown that Tai Chi Quan is a beneficial treatment, the comparative effectiveness of Tai Chi Quan versus physical therapy is unknown. We are conducting a randomized controlled trial to assess the effectiveness of Tai Chi Quan versus that of physical therapy in treating chronic low back pain.MethodsWe will perform a single-blind randomized controlled trial on elderly people with chronic low back pain. 138 participants will be randomly assigned to the Tai Chi Quan group (60-min classes, three times per week for 12 weeks) or physical therapy group (10 min of evaluation and warm-up, 40 min of therapist-directed exercise therapy, and 10 min of relaxation, three times per week for 12 weeks) with an allocation of 1:1. The participants will be followed up for 40 weeks for the study of long-term effects. The primary outcomes include pain intensity and back-related function at 12 weeks. Secondary outcomes include lumbar quantitative sensory testing, balance, cognitive function, psychosocial function, cost-effectiveness, compliance and adverse events. We will perform the intention-to-treat analysis for withdrawal and missing data.DiscussionThe study will be the first randomized trial with comparative-effectiveness of Tai Chi Quan and physical therapy for chronic low back pain. Standardized protocol, large sample size, and comprehensive outcomes are important features in this trial. This study aims to determine the feasibility and effectiveness of Tai Chi Quan for low back pain. The results of this study will be beneficial for elderly people with low back pain and medical rehabilitation personnel.Clinical Trial Registrationwww.chictr.org.cn, identifier ChiCTR2000029723.
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Affiliation(s)
- Rui Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Dong Zhu
- School of International Education, Shanghai University of Sport, Shanghai, China
| | - Lin Wang
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
| | - Jing Liu
- Department of Martial Arts, Shanghai University of Sport, Shanghai, China
| | - Jun Zou
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yang Sun
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yan Jiang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Hao-Yu Hu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
| | - Zhi-Wei Deng
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
| | - Lin-Man Weng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Kang-Yong Zheng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Suparata Kiartivich
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
- *Correspondence: Xue-Qiang Wang,
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Morais CA, DeMonte LC, Bartley EJ. Regulatory Emotional Self-Efficacy Buffers the Effect of Heart Rate Variability on Functional Capacity in Older Adults With Chronic Low Back Pain. Front Pain Res 2022; 3:818408. [PMID: 35669039 PMCID: PMC9163301 DOI: 10.3389/fpain.2022.818408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Chronic low back pain is one of the leading causes of disability globally among older adults. Prevailing research suggests that autonomic dysregulation places individuals at increased risk for chronic pain. This study examines the moderating role of emotional self-efficacy (ESE) on the relationship between heart rate variability (HRV) and pain related-outcomes, including movement-evoked pain (MEP) and physical functioning. Methods In a secondary analysis of the Adaptability and Resilience in Aging Adults (ARIAA) study, a total of 58 adults (aged 60 and older) with chronic low back pain (cLBP) completed the PROMIS self-efficacy for managing emotions questionnaire and the 6-minute walk test (6 MWT) to assess functional capacity and MEP. Heart rate variability, indexed by the frequency domain, was assessed for 5 min during rest. Results For pain-related outcomes, having a lower body mass index (p = 0.03) was associated with better functional capacity on the 6MWT, while higher education level (p = 0.01) and less pain duration (p = 0.00) were correlated with lower MEP. After controlling for sex, age, and body mass index, an increase in low-frequency HRV (LF-HRV) was associated with poorer physical functioning among individuals low in ESE (b = −0.12 p = 0.03). No significant moderation effects were observed for MEP. Conclusion Our results bring attention to the degree to which ESE influences the relationship between LF-HRV and physical functioning. Interventions that enhance adaptive psychological processes such as ESE may dampen ANS dysregulation and mitigate risk for adverse pain outcomes among older adults with cLBP.
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Affiliation(s)
- Calia A. Morais
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
- *Correspondence: Calia A. Morais
| | - Lucas C. DeMonte
- Department of Counseling and Higher Education, Northern Illinois University, DeKalb, IL, United States
| | - Emily J. Bartley
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
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Maggi L, Celletti C, Mazzarini M, Blow D, Camerota F. Neuromuscular taping for chronic non-specific low back pain: a randomized single-blind controlled trial. Aging Clin Exp Res 2022; 34:1171-1177. [PMID: 34988932 DOI: 10.1007/s40520-021-02029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/09/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Low-back pain is a worldwide pain syndrome causing important limitations to daily activity. Common treatment guidelines recommend drugs and exercise. AIM To evaluate the efficacy of a standardized NeuroMuscular Taping (NMT) lumbar application in reducing pain and improving function associated with back-school therapy (BST). METHODS Single-blind randomized controlled trial. The experimental group was treated with BTS followed by three applications of NMT over 8 days and the control group who underwent only BST. All patients were evaluated before and at the end of treatment, after 4 and 8 weeks from the end of BST and with a follow-up at distance of three months from the last evaluation, with pain numeric scale, Oswestry disability index and Schober test. RESULTS Significant pain reduction and functional improvement have been observed in the follow-up evaluations in the experimental group. CONCLUSION Association of a standardized NMT application to BTS was seen to significantly improve function and reduce pain with longer time efficacy.
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Abstract
OBJECTIVES Back pain and poor mental health are interrelated issues in older men. Evidence suggests that socioeconomic status moderates this relationship, but less is known about the role of subjective social status (SSS). This study examined if the association between back pain and mental health is moderated by SSS. METHOD We used a sample of community-dwelling older men (≥65 years) from the Osteoporotic Fractures in Men Study (N = 5994). Participants self-reported their back pain severity and frequency over the past 12 months. SSS was assessed with the MacArthur Scale of SSS. Mental health was assessed with the SF-12 Mental Component Summary (MCS). RESULTS Severe back pain was associated with lower SF-12 MCS scores (p = .03). Back pain frequency was not associated with SF-12 MCS scores. SSS moderated the back pain and mental health relationship. Among men with higher national or community SSS, the association between back pain severity and SF-12 MCS scores was not significant. However, among men with lower national or community SSS, more severe back pain was associated with lower SF-12 MCS scores (p's < .001). Among those with lower national or community SSS, greater back pain frequency was also associated with lower SF-12 MCS scores (p's < .05). CONCLUSION Where one ranks oneself within their nation or community matters for the back pain and mental health relationship. Higher SSS may be a psychosocial resource that buffers the negative associations of severe and frequent back pain on mental health in older men.
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Affiliation(s)
- Christina Mu
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Dylan J. Jester
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Peggy M. Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, USA;,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA;,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Soomi Lee
- School of Aging Studies, University of South Florida, Tampa, FL, USA
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Rogers CJ, Hackney ME, Zubkoff L, Echt KV. The use of patient-led goal setting in the intervention of chronic low back pain in adults: a narrative review. Pain Manag 2022; 12:653-664. [PMID: 35350847 DOI: 10.2217/pmt-2021-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chronic low back pain (cLBP) impacts millions of adults annually. Several nonsurgical interventions are recommended for treating this condition, however, limited literature exists regarding the impact patient-led goals may have on outcomes in the treatment of cLBP. The purpose of this narrative review is to identify gaps and synthesize literature examining the associations of patient-led goals combined with care for cLBP. A total of 12 studies were reviewed and findings were synthesized. Patient-led goal setting may serve as an effective intervention for adults with cLBP. Current outcome measures may not align with patient-led goals. Further investigation is required to understand patient-led goals with ancillary treatments and specific age groups, such as adults over age 65.
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Affiliation(s)
- Casey J Rogers
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Healthcare System, Birmingham, AL 35233, USA
| | - Madeleine E Hackney
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Health Care System, Decatur, GA 30033, USA.,Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Lisa Zubkoff
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Healthcare System, Birmingham, AL 35233, USA.,Department of Medicine, Division of Geriatrics & Gerontology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Katharina V Echt
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Healthcare System, Birmingham, AL 35233, USA.,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Health Care System, Decatur, GA 30033, USA.,Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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Affiliation(s)
- Adrian C Traeger
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Rowena Ivers
- Graduate Medicine, University of Wollongong, Wollongong, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
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Hickman TT, Rathan-Kumar S, Peck SH. Development, Pathogenesis, and Regeneration of the Intervertebral Disc: Current and Future Insights Spanning Traditional to Omics Methods. Front Cell Dev Biol 2022; 10:841831. [PMID: 35359439 PMCID: PMC8963184 DOI: 10.3389/fcell.2022.841831] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
The intervertebral disc (IVD) is the fibrocartilaginous joint located between each vertebral body that confers flexibility and weight bearing capabilities to the spine. The IVD plays an important role in absorbing shock and stress applied to the spine, which helps to protect not only the vertebral bones, but also the brain and the rest of the central nervous system. Degeneration of the IVD is correlated with back pain, which can be debilitating and severely affects quality of life. Indeed, back pain results in substantial socioeconomic losses and healthcare costs globally each year, with about 85% of the world population experiencing back pain at some point in their lifetimes. Currently, therapeutic strategies for treating IVD degeneration are limited, and as such, there is great interest in advancing treatments for back pain. Ideally, treatments for back pain would restore native structure and thereby function to the degenerated IVD. However, the complex developmental origin and tissue composition of the IVD along with the avascular nature of the mature disc makes regeneration of the IVD a uniquely challenging task. Investigators across the field of IVD research have been working to elucidate the mechanisms behind the formation of this multifaceted structure, which may identify new therapeutic targets and inform development of novel regenerative strategies. This review summarizes current knowledge base on IVD development, degeneration, and regenerative strategies taken from traditional genetic approaches and omics studies and discusses the future landscape of investigations in IVD research and advancement of clinical therapies.
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Affiliation(s)
- Tara T. Hickman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sudiksha Rathan-Kumar
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sun H. Peck
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
- *Correspondence: Sun H. Peck,
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Abstract
Chronic pain affects a large part of the population causing functional disability, being often associated with coexisting psychological disorders, such as depression and anxiety, besides cognitive deficits, and sleep disturbance. The world elderly population has been growing over the last decades and the negative consequences of chronic pain for these individuals represent a current clinical challenge. The main painful complaints in the elderly are related to neurodegenerative and musculoskeletal conditions, peripheral vascular diseases, arthritis, and osteoarthritis, contributing toward poorly life quality, social isolation, impaired physical activity, and dependence to carry out daily activities. Organ dysfunction and other existing diseases can significantly affect the perception and responses to chronic pain in this group. It has been proposed that elderly people have an altered pain experience, with changes in pain processing mechanisms, which might be associated with the degeneration of circuits that modulate the descending inhibitory pathways of pain. Aging has also been linked to an increase in the pain threshold, a decline of painful sensations, and a decrease in pain tolerance. Still, elderly patients with chronic pain show an increased risk for dementia and cognitive impairment. The present review article is aimed to provide the state-of-art of pre-clinical and clinical research about chronic pain in elderly, emphasizing the altered mechanisms, comorbidities, challenges, and potential therapeutic alternatives.
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Affiliation(s)
- Ana P. A. Dagnino
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Pesquisa em Toxicologia e Farmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria M. Campos
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Pesquisa em Toxicologia e Farmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Programa de Pós-graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- *Correspondence: Maria M. Campos, ,
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