Implementing Yoga Into the Management of Patients With Refractory Low Back Pain in an Outpatient Clinic Setting

2018 ◽  
Vol 37 (3) ◽  
pp. 238-247
Author(s):  
Karen Lewis ◽  
Sharon Metcalfe ◽  
Tamera Pearson ◽  
Ramona Whichello
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Small Sample Size ◽  
Small Sample ◽  
Low Back ◽  
Qualitative Feedback ◽  
Feedback Method ◽  
Individual Scores ◽  
Back Pain Management

Purpose: To evaluate the effectiveness of implementing yoga into the treatment of patients with chronic low back pain. Design: Quantitative analysis with opportunity for qualitative feedback. Method: Effectiveness of this complementary treatment was assessed using a pretest/posttest design of patients who volunteered to participate in yoga classes as part of their back pain management. Measurements included low back pain rating, perception of back pain interference with daily activities, and self-efficacy in dealing with chronic low back pain. Findings: Although no statistically significant findings were found due to the small sample size, most participants demonstrated improved individual scores on all measurement surveys including qualitative comments. Conclusion: Based on the findings of this pilot study, further studies on implementing yoga into the treatment of chronic low back pain are encouraged.

Chronic Low Back Pain Management in Primary Care

2003 ◽  
Vol 28 (8) ◽  
pp. 26-31 ◽  
Author(s):  
Kelly Phillips ◽  
Anne P.Y. Ch’ien ◽  
Barbara R. Norwood ◽  
Chris Smith
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Pain Management ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Back Pain Management

scholarly journals Chronic Low Back Pain: The Therapeutic Benefits of Diagnostic Medial Branch Nerve Blocks

2021 ◽  
pp. E521-E528
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Nerve Block ◽  
Chronic Low Back Pain ◽  
Facet Joint ◽  
Small Sample ◽  
Therapeutic Effects ◽  
Medial Branch ◽  
Low Back ◽  
Therapeutic Benefits

BACKGROUND: Chronic low back pain (CLBP) is an extremely prevalent disease, whose etiology is often multifactorial. Facet joint arthropathy is one of the most common causes of CLBP. Facet joints are innervated by the medial branches of the primary and adjacent level dorsal rami and are, therefore, key potential targets for the symptomatic management of CLBP. A lumbar medial branch nerve block (MBB) procedure is often used to assist in the diagnosis of facet mediated CLBP. For unclear reasons, some patients experience protracted relief of CLBP after diagnostic MBBs alone. OBJECTIVE: To describe the phenomenon of protracted relief of CLBP after diagnostic MBBs and search for predictors of this response. STUDY DESIGN: A retrospective chart review of patients who underwent MBB procedures by a single practitioner, over a 2 year period, was conducted. SETTING: All patients were seen at the Montefiore Multidisciplinary Pain Program, Bronx, NY. METHODS: Data from follow up visits was used to categorize patient’s response to MBBs as having no relief (NR), transient relief (TR) or protracted relief (PR). Patient demographics and characteristics were collected, and a multivariate analysis investigating associations with PR was conducted. RESULTS: 146 patients met inclusion criteria. 41 patients (28%) had NR, 54 (37%) had TR, and 51 (35%) had PR. CLBP symptom duration of < 6 months (P = 0.013) and unilateral back pain symptoms (P = 0.0253) were significantly associated with PR after MBB. LIMITATION: This is a retrospective study with a relatively small sample size conducted on patients belonging to a single practitioner. Outcomes were based largely on subjective patient satisfaction scores. CONCLUSIONS: In select patients, MBB may produce protracted relief of CLBP symptoms. The authors present distinct hypotheses which may help explain the therapeutic effects of diagnostic MBB procedures. KEY WORDS: Chronic low back pain, facet joint, medial branch nerve block

scholarly journals Osteopathic Manual Treatment vs Kaltenborn-Evjenth Orthopedic Manual Therapy for Chronic Low Back Pain: A Proposal for a Protocol for Randomized Trials

2020 ◽  
Vol 1 (8) ◽  
pp. 383-388
Author(s):  
Pawel Lizis ◽  
Wojciech Kobza ◽  
Grzegorz Manko ◽  
Jaroslaw Jaszczur-Nowicki ◽  
Joanna Bukowska ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Manual Therapy ◽  
Randomized Trials ◽  
Rating Scale ◽  
Small Sample Size ◽  
Randomized Study ◽  
Small Sample ◽  
Random Allocation ◽  
Low Back

Introduction: Numerous modalities of conservative therapeutic interventions are available to achieve the best health benefits in people with Low Back Pain (LBP), e.g., kinesiotherapy, physical therapy, behavior therapy. People with LBP continue to experience pain and disability despite receiving the best evidence based therapy. Osteopathic Manual Therapy (OMT) and Kaltenborn-Evjenth Ortopedic Manual Therapy (KEOMT) are the other options, although their effectiveness remains controversial. The aim of this study is a proposal for a protocol for randomized trials to compare the effectiveness of OMT vs. KEOMT on pain and disability in people suffering from LBP. Methods and analysis: It's a randomized study with two-arms parallel, designed with concealed allocation, the assessor's blinding with intention to-treat analysis. It will include 34 people a group with severe disability ranged from 41 to 60% in Oswestry Disability Index (ODI). There will be two groups: a treatment group (OMT) and a comparison group (KEOMT). All the patients in both groups will receive 2 treatments a week for 5 weeks. Each session in both groups will not exceed 30 minutes. During each session OMT and KEOMT techniques will be repeated 3 times. A baseline assessment will be performed pre and post intervention, two days later. The following parameters will be assessed during the evaluations: Numeric Pain Rating Scale – NPRS, ODI. Ethics and dissemination: The trial was approved by the Scientific Research Ethics Committee of University of Warmia and Mazury, Olsztyn, Poland. Registration approval number: 9/2018. Trial registration: The study protocol was prospectively registered in the Chinese Clinical Trial Registry on December 28, 2019 (registration ID: ChiCTR1900028580). Strengths and Limitations of this Study The participants' random allocation to the experimental and the control groups. The same experienced physiotherapist, blind to the outcome measures, provides the interventions. The same assistant, blind to the group allocation, administrates the outcomes. The same number of the interventions, the compared contact time with the physiotherapist providing the interventions. A short follow-up period and/or a rather small sample size.

scholarly journals What is the incidence of cauda equina syndrome? A systematic review

2020 ◽  
Vol 32 (6) ◽  
pp. 832-841 ◽  
Author(s):  
Ingrid Hoeritzauer ◽  
Matthew Wood ◽  
Phillip C. Copley ◽  
Andreas K. Demetriades ◽  
Julie Woodfield
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Adult Population ◽  
Cauda Equina ◽  
Small Sample ◽  
Low Back ◽  
Patient Pathways

OBJECTIVECauda equina syndrome (CES) is a surgical emergency requiring timely operative intervention to prevent symptom progression. Accurately establishing the incidence of CES is required to inform healthcare service design and delivery, including out-of-hours imaging arrangements.METHODSA systematic literature search of MEDLINE, EMBASE, and Scopus was undertaken to identify original studies stating the incidence of CES, and the estimates were combined in a meta-analysis as described in the protocol registered with PROSPERO (registration no. CRD42017065865) and reported using the PRISMA guidelines.RESULTSA total of 1281 studies were identified, and 26 studies were included in the review. Data about CES incidence were available from 3 different populations: asymptomatic community populations, patients with nontraumatic low-back pain, and patients presenting as an emergency with suspected CES. The incidence of CES was 0.3–0.5 per 100,000 per year in 2 asymptomatic community populations, 0.6 per 100,000 per year in an asymptomatic adult population, and 7 per 100,000 per year in an asymptomatic working-age population. CES occurred in 0.08% of those with low-back pain presenting to primary care in 1 study, and a combined estimate of 0.27% was calculated for 4 studies of those with low-back pain presenting to secondary care. Across 18 studies of adults with suspected CES, 19% had radiological and clinical CES. Difficulties in comparison between studies resulted from the heterogeneous definitions of CES and lack of separation of more advanced CES with retention, which is unlikely to be reversible. In the studies of patients with suspected CES, the small sample size, the high number of single-center studies (18/18), the high number of studies from the United Kingdom (17/18), the retrospective nature of the studies, and the high number of abstracts rather than full texts (9/18) reduced the quality of the data.CONCLUSIONSFrom current studies, it appears that CES occurs infrequently in asymptomatic community populations and in only 19% of those presenting with symptoms. Determining accurate incidence figures and designing a bespoke service for investigation of patients with suspected CES would require a consensus clinical and radiological definition of CES and international multisite studies of patient pathways of investigation and management.

Opioids for chronic low back pain management: a Bayesian network meta-analysis

2021 ◽  
pp. 1-7
Author(s):  
Filippo Migliorini ◽  
Nicola Maffulli ◽  
Alice Baroncini ◽  
Jörg Eschweiler ◽  
Markus Tingart ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Management ◽  
Bayesian Network ◽  
Chronic Low Back Pain ◽  
Meta Analysis ◽  
Low Back ◽  
Back Pain Management

scholarly journals Test-retest Reliability of EMG β-Band Intermuscular Coherence of Non-specific Chronic Low Back Pain During Flexion-extension Task

2021 ◽  
Author(s):  
Salah Ghazi ◽  
Mohammad Reza Hadian ◽  
Azadeh Shadmehr ◽  
Saeed Talebian ◽  
Gholamreza Olyaei ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Healthy Subjects ◽  
Small Sample ◽  
Low Back ◽  
Beta Band ◽  
Flexion Extension ◽  
Intermuscular Coherence ◽  
High Level

Introduction: This study aimed to investigate the reliability and agreement of the Beta-band Intermuscular Coherence (Bb-IMC) as a clinical assessment tool for Non-Specific Chronic Low Back Pain (NS-CLBP) patients and healthy subjects by studying four phases of the Flexion-Extension Task (F-ET): standing, flexion, relaxation, and extension phases. Materials and Methods: Twenty-four men with NS-CLBP and 20 healthy subjects voluntarily participated in this study. All subjects performed three trials of F-ET while the surface electromyography was recorded from the lumbar erector spinal, gluteus maximus,  and hamstring muscles of both sides. Beta-band intermuscular coherence analysis was used to calculate the pool coherence and the pairwise coherence for all mentioned muscles. Afterward, the Intra-class Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC) for four phases of F-ET were used to analyze the intra- rater reliability and agreement of the measurements. Results: The investigation of ICC, SEM, and MDC showed that the reliability was moderate to a high level for pool and pairwise coherence of Bb-IMC in all mentioned muscles for   four phases of the flexion-extension task in NS-CLBP patients and healthy subjects. Yet, the agreement was low because the measurement error was relatively large. Conclusion: So far, no studies have used the Bb-IMC method to study low back pain, which is carried out in our research to check the reliability of this new method. Our findings revealed that pool and pairwise coherence obtained during F-ET have moderate to a high level of reliability for using Bb-IMC and could be considered a tool for the NS-CLBP patients’ assessment. Despite the small sample size investigated, in clinical practice the using Bb-IMC measure  can help to study the interaction of corticospinal in NS-CLBP and also in healthy subjects. This measure requires larger sample sizes in addition to studying other circumstances and functional movements such as lifting weight. Further, more research appears to be warranted by the observed effectiveness of a particular intervention in modulation mechanisms of corticospinal tract function by Bb-IMC in NS-CLBP.

scholarly journals VP191 Peripheral Nerve Field Stimulation For Chronic Low Back Pain

2017 ◽  
Vol 33 (S1) ◽  
pp. 238-238
Author(s):  
Marc Rhainds ◽  
Brigitte Larocque ◽  
Sylvain Bussières ◽  
Alice Nourrisat ◽  
Martin Coulombe ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Peripheral Nerve ◽  
Chronic Low Back Pain ◽  
Spinal Cord Stimulation ◽  
Small Sample ◽  
Field Stimulation ◽  
Low Back ◽  
Peripheral Nerve Field Stimulation

INTRODUCTION:Despite numerous medical, pharmacological and surgical approaches for chronic low back pain (LBP), many patients continue to complain of severe disabling pain. Peripheral nerve field stimulation (PNfS), alone or combined with spinal cord stimulation, is a neuromodulation procedure that have been recently developed and implemented in our hospital. We conducted a Health Technology Assessment (HTA) to determine if PNfS may be considered as a standard of practice in the management of intractable LBP and failed back surgery syndrome (FBSS).METHODS:An interdisciplinary group of experts was involved in the project. A systematic review (SR) was performed in several databases and grey literature to identify clinical practice guidelines, SR and observational studies published through September 2016. A survey was conducted among other chronic pain centers in Canada to document PNfS use in LBP and FBSS treatment.RESULTS:Data on effectiveness and safety of PNfS in chronic LBP treatment were scarce. Short-term results (3-12 months) from small sample and low quality studies suggest that PNfS, alone or combined with spinal cord stimulation, is associated with pain intensity and opioid use reductions. Effects on functional status and quality of life remain undetermined. Most frequent adverse events reported with PNfS devices are lead migrations, discomfort or pain and surgical site infections. No other Canadian pain centers were found to use PNfS in chronic LBP or FBSS.CONCLUSIONS:PNfS is potentially a beneficial treatment option for patients with chronic low back pain or FBSS. However, the value of this innovative treatment remains unknown. Among factors to be clarified are target population (any chronic low back pain or FBSS), use of PNfS alone or combined with spinal cord stimulation, long-term effects, and comparison with conventional medical management. PNfS use in chronic LBP has to be assessed through a rigorous framework before its introduction as a standard medical practice.

scholarly journals THERAPEUTIC EFFECT OF CUPPING ON NON-SPECIFIC NECK AND LOW BACK PAIN - A SYSTEMATIC REVIEW

2020 ◽  
Vol 9 (1) ◽  
pp. 4-10
Author(s):  
Danish Rasool
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Sample Size ◽  
Small Sample Size ◽  
Research Work ◽  
Cupping Therapy ◽  
Small Sample ◽  
Low Back ◽  
Eligibility Criteria

ABSTRACT BACKGROUND & AIMS Neck and low back pain are the major musculoskeletal problems effecting people around the globe. Increasing number of researches underpin the effects of cupping in neck and low back pain. However, empirical studies are required to confirm the efficiency of cupping therapy. Therefore, the aim of this review was to examine the efficacy of cupping treatment in non-specific neck and low back pain. STUDY SELECTION & ELIGIBILITY CRITERIA This systematic review included Randomized Controlled Trials focused on cupping therapy and its effects on neck and low back pain. Extensive search was performed on Google Scholar, PubMed, MEDLINE and Pedro databases. Studies published from 2009 to 2017 were included. RESULTS Eight RCT’s with a 659 sample size were selected for review. Compared to other cupping methods ‘wet cupping’, ‘fire cupping’ and ‘cupping massage’ were superior in reducing pain in neck and low back pain P<0.001. However, a few cupping techniques showed relatively less significant P<0.133, P<0.05, and P<0.037 in comparison to previously mentioned methods. CONCLUSION Cupping therapy can be beneficial in alleviation of non-specific cervicalgia and lumbago in short-term. However, due to weak evidence and a small sample size, the study was restricted from drawing a definite conclusion. Future high-level evidence and research work is required for confirmative and conclusive recommendation of cupping in clinical settings for musculoskeletal pain.

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