Tag: low back pain

Categories : Pain ManagementTags :

Sitting Less may Prevent Back Pain – Even Without Exercise

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A new study from the University of Turku showed that reducing daily sitting prevented back pain from worsening over six months. The results, published in BMJ Open, strengthen the current understanding of the link between activity and back pain as well as the mechanisms related to back pain.

Intuitively, it is easy to think that reducing sitting would help with back pain, but previous research data is surprisingly scarce. The study from the Turku PET Centre and UKK Institute in Finland investigated whether reducing daily sitting could prevent or relieve back pain among overweight or obese adults who spend the majority of their days sitting. The participants were able to reduce their sitting by 40 min/day, on average, during the six-month study.

“Our participants were quite normal middle-aged adults, who sat a great deal, exercised little, and had gained some extra weight. These factors not only increase the risk for cardiovascular disease but also for back pain,” says Doctoral Researcher and Physiotherapist Jooa Norha from the University of Turku in Finland.

Previous results from the same and other research groups have suggested that sitting may be detrimental for back health but the data has been preliminary.

The figure presents the change in back pain intensity on a scale from 0 to 10. The blue bars represent individuals in the intervention group that reduced sitting and the red bars represent the control participants who did not change their sitting habits. Most of the participants in the intervention group decreased their back pain whereas the back pain in the control participants tended to increase.

Robust methods for studying the mechanisms behind back pain

The researchers also examined potential mechanisms behind the prevention of back pain.

”However, we did not observe that the changes in back pain were related to changes in the fattiness or glucose metabolism of the back muscles,” Norha says.

Individuals with back pain have excessive fat deposits within the back muscles, and impaired glucose metabolism, or insulin sensitivity, can predispose to pain. Nevertheless, back pain can be prevented or relieved even if no improvements in the muscle composition or metabolism take place. The researchers  used magnetic resonance imaging (MRI) and PET imaging that is based on a radioactive tracer to measure the back muscles.

“If you have a tendency for back pain or excessive sitting and are concerned for your back health, you can try to figure out ways for reducing sitting at work or during leisure time. However, it is important to note that physical activity, such as walking or more brisk exercise, is better than simply standing up,” Norha points out.

The researchers wish to remind that switching between postures is more important than only looking for the perfect posture.

Source: University of Turku

Categories : Exercise Pain ManagementTags :

Walking is Highly Effective for Stopping Low Back Pain from Returning

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New research from Macquarie University’s Spinal Pain Research Group shows that walking has the potential to change the way low back pain is managed, making effective interventions accessible to more people than ever before. The results of the trial, which combined walking with education, are published in The Lancet.

About 800 million people worldwide have low back pain, which is a leading cause of disability and reduced quality of life. Recurrences of low back pain are very common, with seven in 10 people who recover from an episode going on to have a recurrence within a year.

Professor of Physiotherapy Mark Hancock and his research team have been investigating ways to shift the emphasis from treatment to prevention to improve the management of back pain, an approach that empowers individuals to manage their own health and reduces the cost to society and the healthcare system.

Far from the bed rest recommended for back pain in the past, current best practice includes the combination of exercise and education, both to treat current pain and to prevent future episodes.

While beneficial, some forms of exercise are not accessible or affordable to many people due to their high cost, complexity and need for supervision.

A simpler, more accessible method

The world-first WalkBack trial examined whether a programme of walking combined with education could be effective in preventing recurrences of low back pain.

The trial followed 701 adults who had recently recovered from an episode of low back pain, randomly allocating participants to either an individualised walking program facilitated by a physiotherapist and six education sessions across six months, or to a no-intervention control group.

The participants’ progress was then followed for between one and three years to collect information about any new recurrences of low back pain they experienced.

The researchers’ primary aim was to compare the two groups for the number of days before participants experienced a recurrence of back pain that impacted daily activities or required care from a healthcare provider.

They also evaluated the cost effectiveness of the intervention, including costs related to work absenteeism and healthcare services.

Longer pain-free periods

The paper’s senior author, Professor Hancock, says what they discovered could have a profound impact on how low back pain is managed.

“The intervention group had fewer occurrences of activity-limiting pain compared to the control group, and a longer average period before they had a recurrence, with a median of 208 days compared to 112 days,” Professor Hancock says. “The risk of having a recurrence that required seeking care was nearly halved in those in the intervention group.

“Walking is a low-cost, widely accessible and simple exercise that almost anyone can engage in, regardless of age, geographic location or socio-economic status.

“We don’t know exactly why walking is so good for preventing back pain, but it is likely to include the combination of gentle oscillatory movements, loading and strengthening the spinal structures and muscles, relaxation and stress relief, and the release of ‘feel-good’ endorphins.

“And of course, we also know that walking comes with many other health benefits, including cardiovascular health, improved bone density, maintenance of a healthy weight and improved mental health.”

Professor Hancock said the amount of walking each person completed was individualised based on a range of factors including their age, physical capacity, preferences and available time. Participants were given a rough guide to build up to 30 minutes, five times a week over a six-month period.

After three months, Professor Hancock said most of the people who took part were walking three to five days a week for an average of 130 minutes.

“You don’t need to be walking five or 10 kilometres every day to get these benefits,” Professor Hancock says.

A cost-effective option

The paper’s lead author, Postdoctoral Fellow Dr Natasha Pocovi, says in addition to providing participants with longer pain-free periods, they found the program was also cost effective.

“It not only improved people’s quality of life, but it reduced their need both to seek healthcare support and the amount of time taken off work by approximately half,” Dr Pocovi says.

“The exercise-based interventions to prevent back pain that have been explored previously are typically group-based and need close clinical supervision and expensive equipment, so they are much less accessible to the majority of patients.

“Our study has shown that this effective and accessible means of exercise has the potential to be successfully implemented on a much larger scale than other forms of exercise.”

To build on these findings, the team now hopes to explore how they can integrate the preventive approach into the routine care of patients who experience recurrent low back pain.

Source: MacQuarie University

Categories : Neurology Surgeries & ProceduresTags :

Spinal Surgeons can Now Monitor their Procedure’s Effects Mid-surgery

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With technology developed at UC Riverside, scientists can, for the first time, make high resolution images of the human spinal cord during surgery. The advancement could help bring real relief to millions suffering chronic back pain.

The technology, known as fUSI or functional ultrasound imaging, not only enables clinicians to see the spinal cord, but also enables them to map the cord’s response to various treatments in real time. A paper published today in the journal Neuron details how fUSI worked for six people undergoing electrical stimulation for chronic back pain treatment.

“The fUSI scanner is freely mobile across various settings and eliminates the requirement for the extensive infrastructure associated with classical neuroimaging techniques, such as functional magnetic resonance imaging (fMRI),” said Vasileios Christopoulos, assistant professor of bioengineering at UCR who helped develop the technology. “Additionally, it offers ten times the sensitivity for detecting neuroactivation compared to fMRI.”

Until now, it has been difficult to evaluate whether a back pain treatment is working since patients are under general anaesthesia, unable provide verbal feedback on their pain levels during treatment. “With ultrasound, we can monitor blood flow changes in the spinal cord induced by the electrical stimulation. This can be an indication that the treatment is working,” Christopoulos said.

The spinal cord is an “unfriendly area” for traditional imaging techniques due to significant motion artifacts, such as heart pulsation and breathing. “These movements introduce unwanted noise into the signal, making the spinal cord an unfavorable target for traditional neuroimaging techniques,” Christopoulos said.

By contrast, fUSI is less sensitive to motion artifacts, using echoes from red blood cells in the area of interest to generate a clear image. “It’s like submarine sonar, which uses sound to navigate and detect objects underwater,” Christopoulos said. “Based on the strength and speed of the echo, they can learn a lot about the objects nearby.”

Christopoulos partnered with the USC Neurorestoration Center at Keck Hospital to test the technology on six patients with chronic low back pain. These patients were already scheduled for the last-ditch pain surgery, as no other treatments, including drugs, had helped to ease their suffering. For this surgery, clinicians stimulated the spinal cord with electrodes, in the hopes that the voltage would alleviate the patient’s discomfort and improve their quality of life.

“If you bump your hand, instinctively, you rub it. Rubbing increases blood flow, stimulates sensory nerves, and sends a signal to your brain that masks the pain,” Christopoulos said. “We believe spinal cord stimulation may work the same way, but we needed a way to view the activation of the spinal cord induced by the stimulation.”

The Neuron paper details how fUSI can detect blood flow changes at unprecedented levels of less than 1mm/s. For comparison, fMRI is only able to detect changes of 2cm/s.

“We have big arteries and smaller branches, the capillaries. They are extremely thin, penetrating your brain and spinal cord, and bringing oxygen places so they can survive,” Christopoulos said. “With fUSI, we can measure these tiny but critical changes in blood flow.”

Generally, this type of surgery has a 50% success rate, which Christopoulos hopes will be dramatically increased with improved monitoring of the blood flow changes. “We needed to know how fast the blood is flowing, how strong, and how long it takes for blood flow to get back to baseline after spinal stimulation. Now, we will have these answers,” Christopoulos said.

Moving forward, the researchers are also hoping to show that fUSI can help optimise treatments for patients who have lost bladder control due to spinal cord injury or age. “We may be able to modulate the spinal cord neurons to improve bladder control,” Christopoulos said.

“With less risk of damage than older methods, fUSI will enable more effective pain treatments that are optimised for individual patients,” Christopoulos said. “It is a very exciting development.”

Source: University of California Riverside

Categories : Metabolic Disorders Skeletal SystemTags :

Type 2 Diabetes Alters the Behaviour of Discs in the Vertebral Column

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Type 2 diabetes alters the behaviour of discs in the vertebral column, making them stiffer, and also causes the discs to change shape earlier than normal. As a result, the disc’s ability to withstand pressure is compromised. This is one of the findings of a new rodent-based study published in PNAS Nexus.

Low back pain is a major cause of disability, often associated with intervertebral disc degeneration. People with type 2 diabetes face a higher risk of low back pain and disc-related issues. Yet the precise mechanisms of disc degeneration remain unclear.

Investigating the biomechanical properties of the intervertebral disc is crucial for understanding the disease and developing effective strategies for managing low back pain.

“These findings provide novel insight into the potential mechanisms underlying diabetes-related disc tissue damage and may inform the development of preventative and therapeutic strategies for this debilitating condition,” the research team wrote. The team consisted of engineers and physicians from the University of California San Diego, UC Davis, UCSF and the University of Utah.

The study emphasises that nanoscale deformation mechanisms of collagen fibrils accommodate compressive loading of the intervertebral disc.

In the context of type 2 diabetes, these mechanisms are compromised, resulting in collagen embrittlement.

These findings provide novel insight into the potential mechanisms underlying diabetes-related disc tissue damage and may inform the development of preventative and therapeutic strategies for this debilitating condition.

Researchers employed synchrotron small-angle x-ray scattering (SAXS), an experimental technique that looks at collagen fibril deformation and orientation at the nanoscale.

They wanted to explore how alterations in collagen behaviour contribute to changes in the disc’s ability to withstand compression.

They compared discs from healthy rats to those from rats with type 2 diabetes (UC Davis rat model). The healthy rats showed that collagen fibrils rotate and stretch when discs are compressed, allowing the disc to dissipate energy effectively.

“In diabetic rats, the way vertebral discs dissipate energy under compression is significantly impaired: diabetes reduces the rotation and stretching of collagen fibrils, indicating a compromised ability to handle pressure,” the researchers write.

Further analysis showed that the discs from diabetic rats exhibited a stiffening of collagen fibrils, with a higher concentration of non-enzymatic cross-links.

This increase in collagen cross-linking, induced by hyperglycaemia, limited plastic deformations via fibrillar sliding.

These findings highlight that fibril reorientation, straightening, stretching, and sliding are crucial mechanisms facilitating whole-disc compression.

Type 2 diabetes disrupts these efficient deformation mechanisms, leading to altered whole-disc biomechanics and a more brittle (low-energy) behaviour.

Source: University of California – San Diego

Categories : Pain ManagementTags :

Can Yoga Effectively Treat Chronic Back Pain?

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New research published in the Journal of Orthopaedic Research suggests that the physical postures, breathing exercises, and mindfulness practices of yoga may benefit individuals with back pain.

In the study, 10 women with and 11 without chronic low back pain underwent an 8‐session yoga program over 4 weeks, with the first session conducted in a clinic and the rest delivered with a tele‐approach. Women with chronic low back pain experienced a significant decrease in pain intensity, as assessed through a 10-point visual analogue scale (an average pain of 6.80 at the start, dropped to 3.30 after the sessions) and through a spine-related measure called the flexion–relaxation phenomenon, which is often absent or disrupted in people with low back pain  (5.12 at the start versus 9.49 after the sessions).

The findings suggest yoga can positively impact the neuromuscular response during trunk flexion and pain perception in individuals with chronic low back pain.

“It was interesting to show the role that yoga might play in the management of chronic back pain,” said corresponding author Prof Alessandro de Sire, MD, of the University of Catanzaro “Magna Graecia” and University Hospital “Renato Dulbecco,” in Italy.

The authors noted that further research is warranted to assess yoga’s long‐term effects.

Source: Wiley

Categories : Injury & Trauma Pain ManagementTags :

Acute Back Pain is Easily Treated but When Recovery Slows, can Become Persistent

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A systematic review published in the Canadian Medical Association Journal revealed that while people had good odds of recovering from short term back pain, but if it becomes persistent, then the chances of recovery are greatly reduced. This has important implications for the treatment of chronic back pain, as it points to the pain from the original injury being replaced by pain hypersensitivity.

“The good news is that most episodes of back pain recover, and this is the case even if you have already had back pain for a couple of months,” University of South Australia Professor Lorimer Moseley says.

“The bad news is that once you have had back pain for more than a few months, the chance of recovery is much lower. This reminds us that although nearly everyone experiences back pain, some people do better than others, but we don’t completely understand why.”

The systematic review and meta-analysis, conducted by an international team of researchers, included 95 studies with the goal of understanding the clinical course of acute (< 6 weeks), subacute (six to less than 12 weeks) and persistent (12 to less than 52 weeks) low back pain.

For people with new back pain, pain and mobility problems lessened significantly in the first six weeks, but then recovery slowed.

This study filled a gap in a 2012 paper from the same research team, with new findings showing that many people with persistent low back pain (more than 12 weeks) continue to have moderate-to-high levels of pain and disability.

“These findings make it clear that back pain can persist even when the initial injury has healed,” Prof Moseley says.

“In these situations, back pain is associated with pain system hypersensitivity, not ongoing back injury. This means that if you have chronic back pain – back pain on most days for more than a few months – then it’s time to take a new approach to getting better.”

He notes that there are new treatments based on training both the brain and body that “focus on first understanding that chronic back pain is not a simple problem, which is why it does not have a simple solution, and then on slowly reducing pain system sensitivity while increasing your function and participation in meaningful activities.”

The authors state that identifying slowed recovery in people with subacute low back pain is important so that care can be escalated and the likelihood of persistent pain reduced.

Further research into treatments is needed to help address this common and debilitating condition, and to better understand it in people younger than 18 and older than 60 years.

Source: University of South Australia

Categories : Pain ManagementTags :

Chronic Back Pain may be Easier to Treat if it’s ‘in the Brain’

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One therapy for chronic back pain is to teach patients how to ‘reprocess’ it in the brain. Now, this therapy may become even more effective thanks a study published in JAMA Network Open. The study examined the critical connection between the brain and pain for treating chronic pain. Specifically, they looked at the importance of pain attributions, which are people’s beliefs about the underlying causes of their pain, to reduce chronic back pain severity. Understanding the source of the pain may help some to avoid surgery which may be ineffective or even worsen the pain.

“Millions of people are experiencing chronic pain and many haven’t found ways to help with the pain, making it clear that something is missing in the way we’re diagnosing and treating people,” said the study’s first author Yoni Ashar, PhD, assistant professor of internal medicine at the University of Colorado Anschutz Medical Campus.

Pain is often in the brain

Ashar and his team tested whether the reattribution of pain to mind or brain processes was associated with pain relief in pain reprocessing therapy (PRT), which teaches people to perceive pain signals sent to the brain as less threatening. Their goal was to better understand how people recovered from chronic back pain. The study revealed after PRT, patients reported reduced back pain intensity.

“Our study shows that discussing pain attributions with patients and helping them understand that pain is often ‘in the brain’ can help reduce it,” Ashar said.

To study the effects of pain attributions, they enrolled over 150 adults experiencing moderately severe chronic back pain in a randomised trial to receive PRT. They found that two-thirds of people treated with PRT reported being pain-free or nearly so after treatment, compared to only 20% of placebo controls.

“This study is critically important because patients’ pain attributions are often inaccurate. We found that very few people believed their brains had anything to do with their pain. This can be unhelpful and hurtful when it comes to planning for recovery since pain attributions guide major treatment decisions, such as whether to get surgery or psychological treatment,” said Ashar.

Before PRT treatment, only 10% of participants’ attributions of PRT treatment were mind- or brain-related. However, after PRT, this increased to 51%. The study revealed that the more participants shifted to viewing their pain as due to mind or brain processes, the greater the reduction in chronic back pain intensity they reported.

The role of discussing brain drivers of chronic pain 

“These results show that shifting perspectives about the brain’s role in chronic pain can allow patients to experience better results and outcomes,” Ashar adds.

Ashar says that one reason for this may be that when patients understand their pain as due to brain processes, they learn that there is nothing wrong with their body and that the pain is a ‘false alarm’ being generated by the brain that they don’t need to be afraid of.

The researchers hope this study will encourage providers to talk to their patients about the reasons behind their pain and discuss causes outside of biomedical ones.

“Often, discussions with patients focus on biomedical causes of pain. The role of the brain is rarely discussed,” said Ashar. “With this research, we want to provide patients as much relief as possible by exploring different treatments, including ones that address the brain drivers of chronic pain.”

Source: University of Colorado Anschutz Medical Campus

Categories : Pain ManagementTags :

Spinal Degeneration Pain may Result from Damaged, Stiffened Ligaments

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From back pain to achy joints, musculoskeletal pain, while common, can be life-changing and debilitating. A recent study published by the Journal of Biomechanical Engineering reveals that, in spinal degeneration, stiffening ligaments can alter mechanical loading on joints resulting in facet joint pain. This research may help to develop new treatments for musculoskeletal pain.

“Our goal is to understand the degeneration process of musculoskeletal tissues, including cartilage, ligaments, and intervertebral discs, using advanced mechanics techniques,” says Jill Middendorf, an assistant professor of mechanical engineering at Johns Hopkins University. “If we understand why this process is happening, we hope to translate our findings into new methods to repair damaged tissues and prevent more pain,”

Middendorf and collaborators sought to understand how the soft tissues of the spine change as spinal discs break down, or degenerate, over time.

Specifically, they looked at the facet capsular ligament, a soft tissue that holds the two sides of the facet joint together and is thought to be a common cause of lower back pain. Previous studies suggest this could be related to mechanical changes that occur in this ligament during spinal degeneration, though it’s not clear exactly why, Middendorf says.

To find out, the team extracted facet capsular ligaments from cadaver spines and ran experiments to measure the ligament’s mechanical properties, like stress and strain, under different loading conditions. By comparing MRI images of the spine and their experimental results, the team discovered that the tissues in the ligament became stiffer as the spine degenerated.

The researchers think this increased stiffness causes altered loading in surrounding tissues, and may explain why some people experience facet joint pain.

“Here we show that there is a correlation between the mechanics of the ligament and spine degeneration, which brings us even closer to being able determine if this ligament is causing pain or if it’s some other part of the spine,” Middendorf says.

With insights gathered from their tissue experiments, researchers in Middendorf’s lab plan to work next on furthering our understanding of spinal degeneration and creating engineered musculoskeletal tissue that can be implanted to replace damaged or diseased tissue.

However, when it comes to pain, answers aren’t always easy to find.

“‘One of the challenges associated with diagnosing and treating spine pain is determining the source of the pain,” Middendorf says. “But we can understand more about the causes and mechanisms of tissue damage, and that means we will someday be able to reverse engineer a solution.”

Source: Johns Hopkins

Categories : Pain ManagementTags :

Paracetamol and NSAIDs Best Non-opioid Drugs for Low Back Pain

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Acute low back pain is a common cause of disability, and while opioid drugs are effective at controlling pain, excessive use creates a great potential for substance abuse. An analysis in the Journal of Orthopaedic Research examined which non-opioid drugs are best for relieving this pain.

The analysis, which included all randomised controlled trials published to date (18 studies with 3478 patients), showed that muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs) could effectively and rapidly reduce symptoms.

The combination of NSAIDs and paracetamol was associated with a greater improvement than NSAIDs alone.

“This is a first step towards the optimisation of the management of acute low back pain. However, specific patient characteristics such as having allergies and comorbidities must always be taken into consideration,” said lead author Alice Baroncini, MD, PhD, of RWTH University Hospital in Germany. “Further research will need to focus on the identification of the type of drugs that not only offer the best and quickest pain relief, but also show the lowest rate of symptom recurrence.”

Source: Wiley

Categories : Pain ManagementTags :

Muscle Relaxants Largely Ineffective for Low Back Pain, Study Finds

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Though muscle relaxant drugs are largely widely prescribed to treat low back pain, they are largely ineffective, suggests an analysis of the latest evidence published by The BMJ.

While the evidence shows that muscle relaxants might reduce pain in the short term, the effect is too small to be considered clinically meaningful, and there is an increased risk of side effects.

However, the researchers stressed that the certainty of evidence is low, necessitating large trials to resolve uncertainties around the use of these drugs for back pain.

Low back pain is a global public health problem and muscle relaxants (a broad class of drugs that include non-benzodiazepine antispasmodics and antispastics) are a commonly prescribed treatment. Prescriptions in England last year exceeded 1.3 million, and in the US more than 30 million. Yet clinical practice guidelines around the world provide conflicting recommendations for their use.

To cast light on the matter, researchers in Australia investigated the effectiveness, acceptability, and safety of muscle relaxants compared with placebo, usual care, or no treatment in adults with non-specific low back pain.

The team analysed 31 randomised controlled trials involving over 6500 participants. Though the trials were of varying quality, the researchers were able to assess the certainty of evidence using the recognised GRADE system.

They set a difference of at least 10 points on a 0 to 100 point scale for pain and disability to be the smallest clinically important effect, which is a threshold used in other low back pain studies.

Very low certainty evidence showed that, compared with controls, non-benzodiazepine antispasmodic drugs might reduce pain intensity at two weeks or less for patients with acute low back pain. However, the effect is less than 8 points on a 0-100 point scale, therefore not meeting common thresholds to be clinically meaningful.

Little to no effect of non-benzodiazepine antispasmodics on pain intensity was seen at 3-13 weeks or on disability. Additionally, low and very low certainty evidence also showed that non-benzodiazepine antispasmodics might increase the risk of adverse events (typically, dizziness, drowsiness, headache and nausea) and might have little to no effect on treatment discontinuation compared with controls. The effect of muscle relaxants on long term outcomes was not evaluated in any of the trials.

The researchers acknowledged some limitations of the analysis, despite its using the best available evidence, and noted that some, but not all, individuals could gain a worthwhile benefit due to the modest overall effect. The low to very low certainty of evidence does not allow any firm recommendations, they cautioned.

Source: News-Medical.Net

Journal information: Cashin, A.G., et al. (2021) Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ. doi.org/10.1136/bmj.n1446.