Chronic lower back pain(LBP)is the leading cause of disability worldwide.Due to its close relationship with intervertebral disc(IVD)degeneration(IVDD),research has historically focused more on understanding the mechan...Chronic lower back pain(LBP)is the leading cause of disability worldwide.Due to its close relationship with intervertebral disc(IVD)degeneration(IVDD),research has historically focused more on understanding the mechanism behind IVDD while clinical efforts prioritize pain management.More recently,there has been a shift toward understanding LBP as a distinct pathological entity.This review synthesizes current knowledge on discogenic LBP,combining known pathophysiology,molecular mechanisms,risk factors,diagnostic challenges,and available experimental models.IVDD is a complex,multifactorial process involving biochemical,mechanical,and inflammatory changes within the disc,leading to structural breakdown and potential discogenic pain.Key mechanisms include extracellular matrix degradation,upregulation of inflammatory mediators,immune cell infiltration,and aberrant nerve and vascular ingrowth.However,not all cases of IVDD result in LBP,highlighting the need for further investigation into the cellular,molecular,and biomechanical factors contributing to symptom development.Current diagnostic tools and experimental models for studying discogenic LBP remain limited,impeding the development of targeted treatments.Existing therapies primarily focus on symptom management rather than addressing underlying disease mechanisms.展开更多
Spinal subarachnoid hemorrhage(SSAH)is a relatively uncommon but significant cause of acute and progressive neurological impairment.It represents less than 1.5%of all instances of bleeding within the subarachnoid spac...Spinal subarachnoid hemorrhage(SSAH)is a relatively uncommon but significant cause of acute and progressive neurological impairment.It represents less than 1.5%of all instances of bleeding within the subarachnoid space.[1]The early stages of SSAH often present atypical clinical symptoms,making diagnosis challenging and potentially leading to treatment delays,which further result in irreversible neurological damage.Lower back pain is a common complaint in the emergency department(ED).[2]Common causes include overuse resulting in back strain.展开更多
Introduction: Common low-back pain is a frequent reason for consultation and a genuine public health problem. Preserving quality of life remains one of the main challenges. Objective: To evaluate the quality of life o...Introduction: Common low-back pain is a frequent reason for consultation and a genuine public health problem. Preserving quality of life remains one of the main challenges. Objective: To evaluate the quality of life of patients with low back pain seen in rheumatology consultations at Brazzaville University Hospital. Patients and Method: Cross-sectional, analytical study with control group, conducted at the Brazzaville University Hospital, from January 2 to September 30, 2023. Patients over 30 years of age, seen for documented common low-back pain, were included. Study variables were epidemiological, clinical and functional. The EIFEL and SF-36 scores were used to assess functional impact and quality of life, respectively. Results: We included 96 people divided into two groups: 48 patients with low back pain and 48 controls. The frequency of common low-back pain was 12.8%. The mean age of patients with low back pain was 59.14 ± 11.86 years. Women predominated (sex ratio 0.3). Degenerative disc disease was the main etiology. Common low-back pain had a moderate impact on functional abilities, with a mean EIFEL score of 11 +/− 5.51. Quality of life was impaired in patients with low back pain (overall SF-36 at 43.95%) compared with the control group, with a statistically significant difference (P Conclusion: Common low back pain affects patients’ overall quality of life, particularly in terms of physical pain and limitations due to physical condition.展开更多
Background: Chronic low back pain is a leading cause of morbidity and disability globally. Low and Middle-Income Countries (LMICs) tend to be more affected, with chronic low back pain (CLBP) being among the leading pr...Background: Chronic low back pain is a leading cause of morbidity and disability globally. Low and Middle-Income Countries (LMICs) tend to be more affected, with chronic low back pain (CLBP) being among the leading presenting complaints at specialist consultation. The exact burden of this disease is sparingly known in our setting. Objective: To evaluate the burden of chronic low back pain at the Yaounde Central Hospital. Methods: This was a descriptive cross-sectional study for a period of 3 months, from March 2022 to May 2022. After obtaining ethical clearance and research authorisations, data was collected using structured questionnaires from patients with chronic low back pain presenting at the Yaounde Central Hospital during the aforementioned time frame. This data was then tabulated with the Statistical Package for Social Sciences (SPSS 23.0), and disability was assessed using the modified Roland Morris Disability Questionnaire and the Oswestry Disability Index. Data analysis was done using the International Business Machines Statistical Package for Social Sciences (IBM-SPSS) VERSION 23.0. Results: 115 cases of CLBP were included. The mean age was 52.62 years, and the sex ratio was 0.3. The average monthly income was less than 50,000 frs CFA, in 37.4% of cases. In 57.9%, patients had a job that involved physical labour. The patients had a secondary level of education in 40.9%, and alcohol consumption was observed in 36%. The average number of days of a work stoppage due to LBP was 12.75 days (±12SD), and the median duration of CLBP was 7.15 (7.5SD) years. The median pain intensity was 7 (±2SD), with leg pain and sensory neuropathy observed in 67.8% and 63.5% respectively. Lumbar X-ray was done in 45.2% and revealed lumbar osteoarthrosis in 62.4%. Hypertension as a comorbidity was observed in 26.1%. Medical treatment was used at least once in 98.3% of cases. The average cost of management per month was assessed, and the median was 52,000 FCFA (±20,876 SD). Using the Oswestry Disability Questionnaire, 46 patients, that is 40% of the study population, were classified as severely disabled with a median ODI score of 40%. The factors which were independently associated with disability were level of education, alcohol consumption, treatment modality, pain intensity, body mass index (BMI), psychological wellbeing and number of sick leave days. Conclusion: Chronic low back pain is common in our setting. There is a female predominance with the mean age of the study population situated in the 5th decade. Low-income earners and patients with a job involving physical labour were the most affected. Medical treatment was the main therapeutic modality, with the average cost of management per month being above the average monthly income of the greater majority of the patients. Several factors influenced disability, some of which were independently associated with it, such as level of education, alcohol consumption and treatment modality.展开更多
Purpose: The purpose of this umbrella review was to synthesize the evidence from systematic reviews on the benefits and harms of exercise therapy and physical activity(PA) for the secondary prevention and management o...Purpose: The purpose of this umbrella review was to synthesize the evidence from systematic reviews on the benefits and harms of exercise therapy and physical activity(PA) for the secondary prevention and management of low back pain(LBP).Methods: An umbrella review was conducted to evaluate the effectiveness of exercise therapy and PA in the management and secondary prevention of LBP. A systematic search was performed in MEDLINE, CINAHL, Scopus, Web of Science, Cochrane Database of Systematic Reviews,and Physiotherapy Evidence Database(PEDro), including reference lists of relevant reviews, covering studies published between January 1,2010 and May 20, 2024. Eligible studies were systematic reviews of randomized controlled trials and observational studies, with or without meta-analyses. The primary outcome for secondary prevention was LBP recurrence, while for management, primary outcomes included pain intensity and disability, with adverse events as secondary outcomes. Data were extracted across immediate, short-term, intermediate, and longterm follow-up periods. The Grading of Recommendations Assessment, Development, and Evaluation(GRADE) framework was used to assess the certainty of evidence, and the Assessment of Multiple Systematic Reviews tool(AMSTAR) tool was applied by 2 independent reviewers(JC, QL, and/or DXMW) to evaluate the quality of the included reviews. The study was prospectively registered on the Open Science Framework(OSF).Results: A total of 70 systematic reviews were included, 43 with meta-analyses, 7 with network meta-analyses, and 20 without meta-analyses.Six(out of 10) reviews with meta-analyses for secondary prevention indicated a small benefit from general exercises and leisure-time PA(low-to-moderate certainty). For LBP management, 35(out of 36) reviews reported that exercise therapies such as Pilates, motor control,mixed exercise, Tai Chi, water-based exercises, and yoga showed small beneficial effects on pain and disability compared to minimal intervention mainly in the short-term(low-to-moderate certainty). Seven network meta-analyses favored motor control and Pilates over other forms of exercise to reduce pain(low certainty). Adverse events were reported in less than 31% of the reviews, predominantly involving postexercise soreness and temporary increases in pain, mainly in yoga-related studies. Adverse events were considered minor, and no serious adverse events were reported.Conclusion: There is low-to-moderate certainty that exercise therapy and leisure-time PA are beneficial for improving pain and preventing the recurrence of LBP. However, evidence on the potential harms of these interventions is limited, and adverse events related to exercise and PA remain under-investigated.展开更多
Purpose:The aim of this study was to summarize the evidence regarding whether pain reduction in individuals with chronic non-specific low back pain(CNSLBP)following conservative interventions is related to correspondi...Purpose:The aim of this study was to summarize the evidence regarding whether pain reduction in individuals with chronic non-specific low back pain(CNSLBP)following conservative interventions is related to corresponding improvements in balance control.Methods:Randomized controlled trials were identified from 5 databases(MEDLINE,Cochrane Library,Embase,Web of Science,and PsycINFO).Two reviewers independently screened and identified relevant studies that investigated the effects of non-surgical or non-pharmacological CNSLBP treatments on both pain intensity and balance control.Meta-regression analyses were performed to establish the associations between post-treatment changes in these 2 variables.Results:Thirty one studies involving 1280 participants with CNSLBP were included.Moderate-quality evidence suggested that pain reduction was associated with and explained 34%-45%of decreases in body sway,as measured by center-of-pressure(CoP)area and CoP velocity with eyes open.However,no significant association was observed between pain reduction and CoP area or velocity in anteroposterior/mediolateral directions.Similarly,there was no significant association between pain reduction and CoP distance or radius.Low-quality evidence indicated that pain relief explained a 15%improvement in one-leg stance with eyes open but not in the eyes-closed condition.Additionally,very low-quality evidence suggested that pain relief explained a 44%decrease in the static anteroposterior stability index with eyes closed but not in the eyes-open,mediolateral,or overall conditions.Furthermore,low-quality evidence indicated that reduced pain was associated with and accounted for 25%-43%of the improved composite and posteromedial scores of the star-excursion balance test,rather than the anterior and posterolateral scores.Conclusion:Depending on the type of balance assessment,pain relief following conservative interventions may slightly to moderately enhance balance control in individuals with CNSLBP.Clinicians should pay close attention to the balance control in patients with CNSLBP,particularly among older adults.展开更多
Background: Osteopathic manual treatment (OMT) has been reported to have positive initial results for subjects with chronic non-specific back pain in a rural safety-net hospital. However, the effects of OMT following ...Background: Osteopathic manual treatment (OMT) has been reported to have positive initial results for subjects with chronic non-specific back pain in a rural safety-net hospital. However, the effects of OMT following initial treatment have not been reported. Objective: To determine the effects of OMT for patients with chronic non-specific back pain in a rural safety-net hospital setting for an initial post-clinical and follow-up visit. Methods: A longitudinal, rolling admission, eleven-year study of cohort study with a primary complaint of chronic, non-specific back pain that had plateaued in improvement for a minimum of six months. One hundred and fifty-one subjects completed the first two study visits necessary for data collection, and fifty-nine subjects completed the follow-up visit after six months. Results: A two-way, mixed model, repeated measures ANOVA with pre- post1 and post2 (follow-up) treatment as the within variable and sex as the between subject variable showed a significant main effect from pre- to follow-up, (F (1, 57) = 21.171, P ηP2= 0.426), but not a significant interaction between time and sex (F (1, 57) = 0.279, P ηP2= 0.002). Conclusions: The results of this study support the hypothesis that OMT has a continued benefit in pain reduction and functional improvement beyond the initial treatment period. The rural, safety-net hospital setting made this study unique relative to the sample population.展开更多
Low back pain(LPB)is a common and impactful health concern globally,affecting individuals across various demographics and imposing a significant burden on the health care system.Nonspecific chronic LBP(NCLBP),charac-t...Low back pain(LPB)is a common and impactful health concern globally,affecting individuals across various demographics and imposing a significant burden on the health care system.Nonspecific chronic LBP(NCLBP),charac-terized as pain lasting over 12 weeks without an identifiable cause,leads to notable functional limitations and reduced quality of life.Traditional rehabil-itation programs,often focusing on dynamic exercises for lumbar strengthening,typically do not target the deep stabilizing muscles crucial for lumbar support and effective recovery.Multi-angular isometric lumbar exercise(MAILE)offers a low-impact method for strengthening lumbar stabilizers through multi-angular isometric contractions,reducing risks from dynamic movements.This article examines MAILE’s potential in addressing motor control dysfunctions in NCLBP,highlighting studies on lumbar muscle activation,core stability,and isometric exercises.The article explores the prevalence and socioeconomic impact of NCLBP in the Middle East,highlighting the need for affordable treatment options in areas like Qatar and Saudi Arabia.This article aims to validate the efficacy of MAILE in reducing pain,enhancing mobility,and improving lumbar stability,offering a valuable option for NCLBP management.Future research should focus on large-scale clinical trials to substantiate these findings and guide clinical practice.展开更多
BACKGROUND Back pain and sciatica are common complaints that often require imaging for accurate diagnosis and management.Conventional lumbar magnetic resonance imaging(MRI)protocols typically include sagittal and axia...BACKGROUND Back pain and sciatica are common complaints that often require imaging for accurate diagnosis and management.Conventional lumbar magnetic resonance imaging(MRI)protocols typically include sagittal and axial T1 and T2 sequences;however,these may miss certain pathologies.The addition of coronal short tau inversion recovery(STIR)sequences offers the potential to enhance the detection of both spinal and extra-spinal abnormalities,thereby improving clinical decisionmaking and patient outcomes.AIM To evaluate the impact of adding coronal STIR sequences to routine lumbar MRI in diagnosing back pain and sciatica.METHODS We prospectively analyzed data from patients aged 6 and older presenting with back pain or sciatica who underwent lumbar spine MRI at our institution.The standardized MRI protocol utilized included sagittal and axial T1 and T2 sequences,complemented by a coronal STIR sequence.Data on structural abnormalities were collected,reviewed,and analyzed using counts,percentages,and Fisher's exact test for categorical variables.RESULTS Our cohort comprised 274 patients(115 males,159 females;mean age 44.91 years).Notably,39 patients exhibited abnormalities across all sequences,while 72.63%showed normal findings on the coronal STIR sequence.Importantly,30.29%of cases were diagnosed as normal without the coronal STIR,and 36 patients with normal T1 and T2 sequences presented abnormalities on the coronal STIR.The coronal STIR sequence successfully identified 26 spinal and 10 non-spinal pathologies,including 17 cases of sacroiliitis,with a significant association(P<0.0001)between sacroiliitis diagnosis and abnormalities visible solely on this sequence.CONCLUSION Integrating coronal STIR into routine lumbar MRI enhances detection of hidden spinal and extra-spinal pathologies,improves patient management,and offers a cost-effective,practical upgrade with significant diagnostic and clinical value.展开更多
Objective This study aims to analyze the current state and emerging trends in research articles related to acupuncture treatment for low back pain(LBP).Methods The Web of Science core database was utilized to retrieve...Objective This study aims to analyze the current state and emerging trends in research articles related to acupuncture treatment for low back pain(LBP).Methods The Web of Science core database was utilized to retrieve relevant literature on acupuncture therapy for LBP from January 1,1997,to August 29,2023.Literature metrics analysis was conducted using Microsoft Excel,VOSviewer,SCImago Graphica,and Pajek.The analysis focused on annual publication volume,countries(regions),institutions,authors,journals,keywords,and references.Results A total of 1,434 papers on acupuncture treatment for LBP were identified,demonstrating a fluctuating growth trend over the past 25 years.Research in this field has been conducted in 57 countries,with the United States leading in terms of research output.Italy emerged as the country with the highest-quality publications,with an average citation frequency of 205.16 times.A total of 1,781 institutions contributed to research on acupuncture treatment for LBP,with Harvard University having the highest publication volume(cited 77 times).The number of authors contributing to this field reached 5,696,with In-Hyuk Ha having the highest publication count(31 papers)and Claudia-M.Witt is the most influential author(cited 2,699 times).Relevant research was published in 378 journals,with the Journal of Alternative and Complementary Medicine having the highest publication volume(77 papers),and Spine being the most influential journal(cited 3,420 times).A total of 3,854 keywords were identified,forming six main thematic clusters:care management,nerve stimulation,complementary medicine,pregnancy pain,rehabilitation research,and musculoskeletal pain.Twelve highly cited papers with citation frequencies≥85 times were recognized,predominantly consisting of randomized controlled trials.Conclusion Over the past 25 years,the number of articles published on acupuncture for LPB has shown a fluctuating trend of growth;the distribution of countries(regions)and institutions that publish articles is scattered,mainly based on inter-regional cooperation,and international cooperation is still insufficient;Journals in alternative and integrative medicine category provide references for scholars to submit manuscripts and learn about the frontiers;Acupuncture is effective and economical in the treatment of pain,and it has been widely used in the treatment of low back pain.However,the difference in efficacy between acupuncture and sham acupuncture or placebo acupuncture remains controversial.Therefore,in the future,it is necessary to consider the selection of appropriate efficacy evaluation methods in clinical trials that reflect the therapeutic advantages of acupuncture.展开更多
Objective:The objective of this study is to explore the current situation of nurses’participant activation for self-management of low back pain,analyze its influencing factors,and provide a reference for improving th...Objective:The objective of this study is to explore the current situation of nurses’participant activation for self-management of low back pain,analyze its influencing factors,and provide a reference for improving the participant activation for self-management of low back pain.Materials and Methods:A cross-sectional study was conducted with 5,120 nurses recruited through convenience sampling from hospitals across 25 provinces and municipalities in China.Participants completed two standardized instruments:General Information Questionnaire which collected demographic characteristics and work-related factors,and the Participant Activation for Self-Management of Back Pain Questionnaire which measured activation levels across three dimensions(including self-management beliefs,self-management awareness,and knowledge related to low back pain).Results:The score of nurses’participant activation for low back pain self-management was 38.00(33.00,44.00).The results of multiple linear regression showed that nurses of different gender,age,and professional titles,whether they had administrative positions,and whether they had back pain in the past year were influencing factors of nurses’participant activation for low back pain management.Conclusion:The overall participant activation for self-management of low back pain is at a medium level.Their self-management awareness is strong,but their beliefs about management of low back pain are insufficient.Targeted intervention measures can be taken to improve their activation for management of back pain and reduce the incidence of occupational low back pain.展开更多
Aging is a pivotal risk factor for intervertebral disc degeneration(IVDD)and chronic low back pain(LBP).The restoration of aging nucleus pulposus cells(NPCs)to a youthful epigenetic state is crucial for IVDD treatment...Aging is a pivotal risk factor for intervertebral disc degeneration(IVDD)and chronic low back pain(LBP).The restoration of aging nucleus pulposus cells(NPCs)to a youthful epigenetic state is crucial for IVDD treatment,but remains a formidable challenge.Here,we proposed a strategy to partially reprogram and reinstate youthful epigenetics of senescent NPCs by delivering a plasmid carrier that expressed pluripotency-associated genes(Oct4,Klf4 and Sox2)in Cavin2-modified exosomes(OKS@M-Exo)for treatment of IVDD and alleviating LBP.The functional OKS@M-Exo efficaciously alleviated senescence markers(p16^(INK4a),p21^(CIP1)and p53),reduced DNA damage and H4K20me3 expression,as well as restored proliferation ability and metabolic balance in senescent NPCs,as validated through in vitro experiments.In a rat model of IVDD,OKS@M-Exo maintained intervertebral disc height,nucleus pulposus hydration and tissue structure,effectively ameliorated IVDD via decreasing the senescence markers.Additionally,OKS@MExo reduced nociceptive behavior and downregulated nociception markers,indicating its efficiency in alleviating LBP.The transcriptome sequencing analysis also demonstrated that OKS@M-Exo could decrease the expression of age-related pathways and restore cell proliferation.Collectively,reprogramming by the OKS@M-Exo to restore youthful epigenetics of senescent NPCs may hold promise as a therapeutic platform to treat IVDD.展开更多
Objective:To observe the specific effects of acupuncture in middle-aged and older patients with chronic nonspecific low back pain(CNSLBP).Methods:Sixty-six patients with CNSLBP were randomized into the acupuncture or ...Objective:To observe the specific effects of acupuncture in middle-aged and older patients with chronic nonspecific low back pain(CNSLBP).Methods:Sixty-six patients with CNSLBP were randomized into the acupuncture or sham acupuncture groups(n=33).In the acupuncture group,penetrating acupuncture with a long needle was delivered at Ashi points(painful/sensitive points),and the needles were manipulated by rotating technique after deqi till patients felt distending pain.The needles were retained in place for 30 min.Acupuncture was given three times per week for 4 weeks.In the sham acupuncture group,shallow needling was performed at non-meridian,non-acupoint,non-painful,and non-sensitive points.The needle retention and duration of treatment were the same as those of the acupuncture group before treatment,after the first intervention,after the whole treatment,and in follow-up visit(4 weeks after the whole treatment).The scores of the visual analog scale(VAS)for pain,range of movement(ROM)of the spine,and simplified Oswestry Dysfunction Index(ODI)were observed separately.Results:Compared to the outcomes before treatment,the VAS score,spinal ROM,and simplified ODI score were lower after the first intervention,after treatment,and in follow-up visits in the acupuncture group,indicating the statistical significance(P<0.05).When compared with the sham acupuncture group,the VAS score,spinal ROM,and simplified ODI score were significantly lower in the acupuncture group after the first intervention,after treatment,and in follow-up visit(P<0.05).The total effective rate was 90.9%in the acupuncture group,which was significantly higher than that(75.76%)in the sham acupuncturegroup(P<0.05).Conclusion:Acupuncture has a specific effect on CNSLBP in middle-aged and older patients and a superior effect on immediate analgesia.展开更多
BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gather...BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS) from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period.RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3% from 2007(244,000 visits) to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8% to 57.6%),female patients(from 54.5% to 62.0%),black patients(from 22.5% to 30.4%),and Hispanic/Latino patients(from 9.4% to 19.6%).Oxycodone/acetaminophen was most prescribed and accounted for 90.2% of all oxycodone-containing analgesics in 2007,with a decrease to 68.5% in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1% in 2007 and 31.5% in 2018.CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.展开更多
Objective:To compare the efficacy of using“distal acupoints only”vs.“local acupoints mainly combined with distal acupoints”in cases of acute low back pain(ALBP).Methods: A total of 102 eligible patients aged 18–6...Objective:To compare the efficacy of using“distal acupoints only”vs.“local acupoints mainly combined with distal acupoints”in cases of acute low back pain(ALBP).Methods: A total of 102 eligible patients aged 18–65 years with ALBP lasting less than 6 weeks will be randomized in a 1:1 ratio to the distal acupoints only group(DPOG)and the local acupoints mainly combined with the distal acupoints group(LPMG).During a 4-week treatment period,patients in the DPOG will receive acupuncture at distal acupoints only(Houxi[SI 3]and Yaotongxue[EX-UE 7])twice a week,while those in the LPMG group will receive acupuncture at local acupoints(mainly Shenshu[BL 23]and Dachangshu[BL 25])combined with distal points(Weizhong[BL 40]).The patients in both groups will be evaluated at every session of treatment,and the follow-up will be performed for 3 months.The primary outcome measure will be the change in ALBP intensity,assessed using visual analogue scale scores before and after treatment.The secondary outcome measure will be the evaluation of functional disability using the Oswestry Disability Index.Discussion: This study compares the DPOG and LPMG to explore the feasibility of the DPOG in the treatment of ALBP.展开更多
In this editorial we comment on the article published in a recent issue of the World Journal of Clinical Cases.This article described a novel ultrasound-guided lateral recess block approach in treating a patient with ...In this editorial we comment on the article published in a recent issue of the World Journal of Clinical Cases.This article described a novel ultrasound-guided lateral recess block approach in treating a patient with lateral recess stenosis.The impact of spinal pain-related disability extends significantly,causing substantial human suffering and medical costs.Each county has its preferred treatment strategies for spinal pain.Here,we explore the lower back pain(LBP)treatment algorithm recommended in France.The treatment algorithm for LBP recommended by the French National Authority for Health emphasizes early patient activity and minimal medication use.It encourages the continuation of daily activities,limits excessive medication and spinal injections,and incorporates psychological assessments and non-pharmacological therapies for chronic cases.However,the algorithm may not aggressively address acute pain in the early stages,potentially delaying relief and increasing the risk of chronicity.Additionally,the recommended infiltrations primarily involve caudal epidural steroid injections,with limited consideration for other injection procedures,such as transforaminal or interlaminar epidural steroid injections.The fixed follow-up timeline may not accommodate patients who do not respond to initial treatment or experience intense pain,potentially delaying the exploration of alternative therapies.Despite these limitations,understanding the strengths and weaknesses of the French approach could inform adaptations in LBP treatment strategies globally,potentially enhancing patient outcomes and satisfaction across diverse healthcare systems.展开更多
BACKGROUND Low back pain has become a global problem.Since many traditional Chinese therapies are helpful for low back pain,the current status of low back pain in China may provide some insights to this issue.AIM To d...BACKGROUND Low back pain has become a global problem.Since many traditional Chinese therapies are helpful for low back pain,the current status of low back pain in China may provide some insights to this issue.AIM To demonstrate the disease burden of low back pain in China and the response of Chinese scholars to this issue.METHODS The burden of low back pain in China was estimated using the Global Burden of Disease Study 2021 released by the American Institute for Health Metrics and Evaluation.The incidence,prevalence and disability-adjusted life years were analyzed.We also performed a bibliometric analysis to analyzed the publication trend,changes of cooperation models and research topics on low back pain.RESULTS Prevalence of low back pain increased from 69.61 million in 1990 to 102.96 million in 2021.New cases increased by a stunning 44.50 million in 2021.Low back pain led to an increase of 4.16 per 1000000 population in terms of disability-adjusted life years from 1990 to 2021.But the increase in China was slower than that of world average.As a response,publications of low back pain published by Chinese scholars were stably raised.From 1990 to 2023,domestic cooperation significantly increased,while international cooperation and no cooperation decreased.However,domestic cooperation decreased between 2021 and 2023.The number of studies on prevention and treatment of low back pain reduced from 1990 to 2023,while the mechanism,etiology and other aspects of low back pain augmented.CONCLUSION The burden of low back pain in China is heavy.Together with the government,Chinese institutions of medical science should do more in declining the impacts of low back pain.展开更多
Introduction: Low back pain is nowadays a real public health problem in companies. The objective of the study was to determine the prevalence and factors associated with chronic low back pain among workers of a mining...Introduction: Low back pain is nowadays a real public health problem in companies. The objective of the study was to determine the prevalence and factors associated with chronic low back pain among workers of a mining company in Burkina Faso. Material and Methods: This was a descriptive and analytical cross-sectional study with a retrospective collection that took place from August 1, 2021 to March 16, 2022 in a gold mine in Burkina Faso. It focused on mine workers who participated in the 2019 annual medical visit. Results: Out of a total workforce of 880 workers who took part in the annual medical visit in 2019, 165 had chronic common low back pain, i.e. a prevalence of 18.75%. The average age of low back pain workers was 37.21 ± 7.5 years. Among the workers suffering from low back pain, 62 (37.58%) held the position of machine operator. Clinically, mechanical pain was found in 113 low back pain workers (76%) and twenty-nine (17.58%) had radicular pain. Standard radiography of the lumbar spine was abnormal in 129 workers (78.18%. In the univariate analysis, the factors associated with the pathology were sex, level of study, work station and seniority in the position. After a logistic regression, the factors associated with its occurrence were whole-body vibration (Fisher’s test = 12.7541;P = 0.000), male sex (Fisher’s test = 8.363;P = 0.004), and seniority for 4 to 5 years (Chi2 = 4.0234;p = 0.046). Conclusion: The study reveals the existence of chronic low back pain cases among the workers of the mining company. There is a predominance of the pathology in men, workers exposed to vibrations and those with a seniority of 4 to 5 years. It is necessary to establish a policy of prevention of low back pain for the benefit of workers, in particular those exposed to vibrations.展开更多
Background: Low back pain (LBP) is a very common health problem amongst the general population and a major cause of disability that affects work performance and well-being. Healthcare workers (HCWs) are especially at ...Background: Low back pain (LBP) is a very common health problem amongst the general population and a major cause of disability that affects work performance and well-being. Healthcare workers (HCWs) are especially at risk of developing LBP because of physical and emotional factors. Little is known about the burden of LBP in Cameroon. Objective: To determine the prevalence of low back pain and identify its associated factors among healthcare workers. Methods: A cross-sectional study using a self-administered questionnaire was conducted among healthcare workers in the Yaound Central Hospital and the Yaound University Teaching Hospital. The questionnaire collected data regarding recent, past year and lifetime occurrences of LBP, socio-demographics and work conditions. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: A total number of 268 HCWs participated in the study, including 197 (73.5%) females and 71 (26.5%) males. The mean age of the study participants was 40.60 8.38 years (extremes of 20 and 65 years). The lifetime, annual, and point prevalences of LBP among the participants were 67.5% (CI: 61.6 - 73.1), 61.5% (CI: 55.6 - 67.1) and 35.7% (CI: 29.7 - 41.5) respectively. Multivariate analysis confirmed a moderate stress level, a sedentary lifestyle, working in the medicine and specialities department, lifting heavy objects and bending to work as associated factors to LBP. Most sufferers had a minimal functional disability (65.7%) while 34.3% had a moderate to severe disability. Conclusions: Healthcare providers have a considerably high prevalence of low back pain. Factors associated with LBP found in this study were similar to those widely recognized in the literature. A substantial proportion of healthcare providers are suffering from functional disability associated with low back pain, affecting their social and work lives. There is a need for multilevel interventions to prevent and control low back pain in this highly vulnerable occupational group.展开更多
Background: low back pain affects many individuals, with 80% classified as non-specific low back pain (NSLBP) due to mechanical rather than structural issues. The link between pelvic alignment and lumbopelvic-hip rota...Background: low back pain affects many individuals, with 80% classified as non-specific low back pain (NSLBP) due to mechanical rather than structural issues. The link between pelvic alignment and lumbopelvic-hip rotation movement for NSLBP is controversial. Methods: twenty males with NSLBP and 20 healthy males participated. Data collected included static pelvic asymmetry and active lumbopelvic-hip rotation with motion capture system for kinematic analysis. Results: Unpaired T test was used to compare the difference of kinematic parameters between two groups. NSLBP group showed significantly larger angles between the ASIS-PSIS line and the z-axis (p Conclusion: Evaluations focusing on bone structure alone may be inadequate. A more comprehensive approach including functional assessments like muscle strength and range of motion could be beneficial. Integrating lumbopelvic-hip movement patterns and pelvic symmetry into clinical assessments should be considered, as they may be influenced by physical activity.展开更多
基金supported by the California Institute for Regenerative Medicine under EDUC4-12751(Giselle Kaneda)DISC2-14049(Dmitriy Sheyn)+1 种基金Additional support was provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award numbers R01AR066517(Debiao Li)R01AR082041(Dmitriy Sheyn).
文摘Chronic lower back pain(LBP)is the leading cause of disability worldwide.Due to its close relationship with intervertebral disc(IVD)degeneration(IVDD),research has historically focused more on understanding the mechanism behind IVDD while clinical efforts prioritize pain management.More recently,there has been a shift toward understanding LBP as a distinct pathological entity.This review synthesizes current knowledge on discogenic LBP,combining known pathophysiology,molecular mechanisms,risk factors,diagnostic challenges,and available experimental models.IVDD is a complex,multifactorial process involving biochemical,mechanical,and inflammatory changes within the disc,leading to structural breakdown and potential discogenic pain.Key mechanisms include extracellular matrix degradation,upregulation of inflammatory mediators,immune cell infiltration,and aberrant nerve and vascular ingrowth.However,not all cases of IVDD result in LBP,highlighting the need for further investigation into the cellular,molecular,and biomechanical factors contributing to symptom development.Current diagnostic tools and experimental models for studying discogenic LBP remain limited,impeding the development of targeted treatments.Existing therapies primarily focus on symptom management rather than addressing underlying disease mechanisms.
基金National Natural Science Foundation of China(82472218)National Key Clinical Specialist Construction Project(Z155080000004)+4 种基金National Key Research and Development Program of China(2024YFC3044400)Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0506502)the Science and Technology of Shanghai Committee(23Y31900100)Shen Kang Hospital Development Center Project for Technical Standardization Management and Promotion(SHDC22023239)Key Supporting Discipline of Shanghai Healthcare System(2023ZDFC0102).
文摘Spinal subarachnoid hemorrhage(SSAH)is a relatively uncommon but significant cause of acute and progressive neurological impairment.It represents less than 1.5%of all instances of bleeding within the subarachnoid space.[1]The early stages of SSAH often present atypical clinical symptoms,making diagnosis challenging and potentially leading to treatment delays,which further result in irreversible neurological damage.Lower back pain is a common complaint in the emergency department(ED).[2]Common causes include overuse resulting in back strain.
文摘Introduction: Common low-back pain is a frequent reason for consultation and a genuine public health problem. Preserving quality of life remains one of the main challenges. Objective: To evaluate the quality of life of patients with low back pain seen in rheumatology consultations at Brazzaville University Hospital. Patients and Method: Cross-sectional, analytical study with control group, conducted at the Brazzaville University Hospital, from January 2 to September 30, 2023. Patients over 30 years of age, seen for documented common low-back pain, were included. Study variables were epidemiological, clinical and functional. The EIFEL and SF-36 scores were used to assess functional impact and quality of life, respectively. Results: We included 96 people divided into two groups: 48 patients with low back pain and 48 controls. The frequency of common low-back pain was 12.8%. The mean age of patients with low back pain was 59.14 ± 11.86 years. Women predominated (sex ratio 0.3). Degenerative disc disease was the main etiology. Common low-back pain had a moderate impact on functional abilities, with a mean EIFEL score of 11 +/− 5.51. Quality of life was impaired in patients with low back pain (overall SF-36 at 43.95%) compared with the control group, with a statistically significant difference (P Conclusion: Common low back pain affects patients’ overall quality of life, particularly in terms of physical pain and limitations due to physical condition.
文摘Background: Chronic low back pain is a leading cause of morbidity and disability globally. Low and Middle-Income Countries (LMICs) tend to be more affected, with chronic low back pain (CLBP) being among the leading presenting complaints at specialist consultation. The exact burden of this disease is sparingly known in our setting. Objective: To evaluate the burden of chronic low back pain at the Yaounde Central Hospital. Methods: This was a descriptive cross-sectional study for a period of 3 months, from March 2022 to May 2022. After obtaining ethical clearance and research authorisations, data was collected using structured questionnaires from patients with chronic low back pain presenting at the Yaounde Central Hospital during the aforementioned time frame. This data was then tabulated with the Statistical Package for Social Sciences (SPSS 23.0), and disability was assessed using the modified Roland Morris Disability Questionnaire and the Oswestry Disability Index. Data analysis was done using the International Business Machines Statistical Package for Social Sciences (IBM-SPSS) VERSION 23.0. Results: 115 cases of CLBP were included. The mean age was 52.62 years, and the sex ratio was 0.3. The average monthly income was less than 50,000 frs CFA, in 37.4% of cases. In 57.9%, patients had a job that involved physical labour. The patients had a secondary level of education in 40.9%, and alcohol consumption was observed in 36%. The average number of days of a work stoppage due to LBP was 12.75 days (±12SD), and the median duration of CLBP was 7.15 (7.5SD) years. The median pain intensity was 7 (±2SD), with leg pain and sensory neuropathy observed in 67.8% and 63.5% respectively. Lumbar X-ray was done in 45.2% and revealed lumbar osteoarthrosis in 62.4%. Hypertension as a comorbidity was observed in 26.1%. Medical treatment was used at least once in 98.3% of cases. The average cost of management per month was assessed, and the median was 52,000 FCFA (±20,876 SD). Using the Oswestry Disability Questionnaire, 46 patients, that is 40% of the study population, were classified as severely disabled with a median ODI score of 40%. The factors which were independently associated with disability were level of education, alcohol consumption, treatment modality, pain intensity, body mass index (BMI), psychological wellbeing and number of sick leave days. Conclusion: Chronic low back pain is common in our setting. There is a female predominance with the mean age of the study population situated in the 5th decade. Low-income earners and patients with a job involving physical labour were the most affected. Medical treatment was the main therapeutic modality, with the average cost of management per month being above the average monthly income of the greater majority of the patients. Several factors influenced disability, some of which were independently associated with it, such as level of education, alcohol consumption and treatment modality.
基金funded by the Medical Research Future Fund-MRFF 2019 (Rapid Applied Research TranslationRART award)funded by an Australian Government Research Training Program Scholarship-RTP+1 种基金funded by National Health and Medical Research Council of Australia Research Fellowshipsfunded by the National Health and Medical Research Council (NHMRC) Leadership Fellow level 2
文摘Purpose: The purpose of this umbrella review was to synthesize the evidence from systematic reviews on the benefits and harms of exercise therapy and physical activity(PA) for the secondary prevention and management of low back pain(LBP).Methods: An umbrella review was conducted to evaluate the effectiveness of exercise therapy and PA in the management and secondary prevention of LBP. A systematic search was performed in MEDLINE, CINAHL, Scopus, Web of Science, Cochrane Database of Systematic Reviews,and Physiotherapy Evidence Database(PEDro), including reference lists of relevant reviews, covering studies published between January 1,2010 and May 20, 2024. Eligible studies were systematic reviews of randomized controlled trials and observational studies, with or without meta-analyses. The primary outcome for secondary prevention was LBP recurrence, while for management, primary outcomes included pain intensity and disability, with adverse events as secondary outcomes. Data were extracted across immediate, short-term, intermediate, and longterm follow-up periods. The Grading of Recommendations Assessment, Development, and Evaluation(GRADE) framework was used to assess the certainty of evidence, and the Assessment of Multiple Systematic Reviews tool(AMSTAR) tool was applied by 2 independent reviewers(JC, QL, and/or DXMW) to evaluate the quality of the included reviews. The study was prospectively registered on the Open Science Framework(OSF).Results: A total of 70 systematic reviews were included, 43 with meta-analyses, 7 with network meta-analyses, and 20 without meta-analyses.Six(out of 10) reviews with meta-analyses for secondary prevention indicated a small benefit from general exercises and leisure-time PA(low-to-moderate certainty). For LBP management, 35(out of 36) reviews reported that exercise therapies such as Pilates, motor control,mixed exercise, Tai Chi, water-based exercises, and yoga showed small beneficial effects on pain and disability compared to minimal intervention mainly in the short-term(low-to-moderate certainty). Seven network meta-analyses favored motor control and Pilates over other forms of exercise to reduce pain(low certainty). Adverse events were reported in less than 31% of the reviews, predominantly involving postexercise soreness and temporary increases in pain, mainly in yoga-related studies. Adverse events were considered minor, and no serious adverse events were reported.Conclusion: There is low-to-moderate certainty that exercise therapy and leisure-time PA are beneficial for improving pain and preventing the recurrence of LBP. However, evidence on the potential harms of these interventions is limited, and adverse events related to exercise and PA remain under-investigated.
基金supported by GP Batteries Industrial Safety Trust Fund(Funding number:R-ZDDR).
文摘Purpose:The aim of this study was to summarize the evidence regarding whether pain reduction in individuals with chronic non-specific low back pain(CNSLBP)following conservative interventions is related to corresponding improvements in balance control.Methods:Randomized controlled trials were identified from 5 databases(MEDLINE,Cochrane Library,Embase,Web of Science,and PsycINFO).Two reviewers independently screened and identified relevant studies that investigated the effects of non-surgical or non-pharmacological CNSLBP treatments on both pain intensity and balance control.Meta-regression analyses were performed to establish the associations between post-treatment changes in these 2 variables.Results:Thirty one studies involving 1280 participants with CNSLBP were included.Moderate-quality evidence suggested that pain reduction was associated with and explained 34%-45%of decreases in body sway,as measured by center-of-pressure(CoP)area and CoP velocity with eyes open.However,no significant association was observed between pain reduction and CoP area or velocity in anteroposterior/mediolateral directions.Similarly,there was no significant association between pain reduction and CoP distance or radius.Low-quality evidence indicated that pain relief explained a 15%improvement in one-leg stance with eyes open but not in the eyes-closed condition.Additionally,very low-quality evidence suggested that pain relief explained a 44%decrease in the static anteroposterior stability index with eyes closed but not in the eyes-open,mediolateral,or overall conditions.Furthermore,low-quality evidence indicated that reduced pain was associated with and accounted for 25%-43%of the improved composite and posteromedial scores of the star-excursion balance test,rather than the anterior and posterolateral scores.Conclusion:Depending on the type of balance assessment,pain relief following conservative interventions may slightly to moderately enhance balance control in individuals with CNSLBP.Clinicians should pay close attention to the balance control in patients with CNSLBP,particularly among older adults.
文摘Background: Osteopathic manual treatment (OMT) has been reported to have positive initial results for subjects with chronic non-specific back pain in a rural safety-net hospital. However, the effects of OMT following initial treatment have not been reported. Objective: To determine the effects of OMT for patients with chronic non-specific back pain in a rural safety-net hospital setting for an initial post-clinical and follow-up visit. Methods: A longitudinal, rolling admission, eleven-year study of cohort study with a primary complaint of chronic, non-specific back pain that had plateaued in improvement for a minimum of six months. One hundred and fifty-one subjects completed the first two study visits necessary for data collection, and fifty-nine subjects completed the follow-up visit after six months. Results: A two-way, mixed model, repeated measures ANOVA with pre- post1 and post2 (follow-up) treatment as the within variable and sex as the between subject variable showed a significant main effect from pre- to follow-up, (F (1, 57) = 21.171, P ηP2= 0.426), but not a significant interaction between time and sex (F (1, 57) = 0.279, P ηP2= 0.002). Conclusions: The results of this study support the hypothesis that OMT has a continued benefit in pain reduction and functional improvement beyond the initial treatment period. The rural, safety-net hospital setting made this study unique relative to the sample population.
文摘Low back pain(LPB)is a common and impactful health concern globally,affecting individuals across various demographics and imposing a significant burden on the health care system.Nonspecific chronic LBP(NCLBP),charac-terized as pain lasting over 12 weeks without an identifiable cause,leads to notable functional limitations and reduced quality of life.Traditional rehabil-itation programs,often focusing on dynamic exercises for lumbar strengthening,typically do not target the deep stabilizing muscles crucial for lumbar support and effective recovery.Multi-angular isometric lumbar exercise(MAILE)offers a low-impact method for strengthening lumbar stabilizers through multi-angular isometric contractions,reducing risks from dynamic movements.This article examines MAILE’s potential in addressing motor control dysfunctions in NCLBP,highlighting studies on lumbar muscle activation,core stability,and isometric exercises.The article explores the prevalence and socioeconomic impact of NCLBP in the Middle East,highlighting the need for affordable treatment options in areas like Qatar and Saudi Arabia.This article aims to validate the efficacy of MAILE in reducing pain,enhancing mobility,and improving lumbar stability,offering a valuable option for NCLBP management.Future research should focus on large-scale clinical trials to substantiate these findings and guide clinical practice.
文摘BACKGROUND Back pain and sciatica are common complaints that often require imaging for accurate diagnosis and management.Conventional lumbar magnetic resonance imaging(MRI)protocols typically include sagittal and axial T1 and T2 sequences;however,these may miss certain pathologies.The addition of coronal short tau inversion recovery(STIR)sequences offers the potential to enhance the detection of both spinal and extra-spinal abnormalities,thereby improving clinical decisionmaking and patient outcomes.AIM To evaluate the impact of adding coronal STIR sequences to routine lumbar MRI in diagnosing back pain and sciatica.METHODS We prospectively analyzed data from patients aged 6 and older presenting with back pain or sciatica who underwent lumbar spine MRI at our institution.The standardized MRI protocol utilized included sagittal and axial T1 and T2 sequences,complemented by a coronal STIR sequence.Data on structural abnormalities were collected,reviewed,and analyzed using counts,percentages,and Fisher's exact test for categorical variables.RESULTS Our cohort comprised 274 patients(115 males,159 females;mean age 44.91 years).Notably,39 patients exhibited abnormalities across all sequences,while 72.63%showed normal findings on the coronal STIR sequence.Importantly,30.29%of cases were diagnosed as normal without the coronal STIR,and 36 patients with normal T1 and T2 sequences presented abnormalities on the coronal STIR.The coronal STIR sequence successfully identified 26 spinal and 10 non-spinal pathologies,including 17 cases of sacroiliitis,with a significant association(P<0.0001)between sacroiliitis diagnosis and abnormalities visible solely on this sequence.CONCLUSION Integrating coronal STIR into routine lumbar MRI enhances detection of hidden spinal and extra-spinal pathologies,improves patient management,and offers a cost-effective,practical upgrade with significant diagnostic and clinical value.
基金Supported by the Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences:CI2021B002.
文摘Objective This study aims to analyze the current state and emerging trends in research articles related to acupuncture treatment for low back pain(LBP).Methods The Web of Science core database was utilized to retrieve relevant literature on acupuncture therapy for LBP from January 1,1997,to August 29,2023.Literature metrics analysis was conducted using Microsoft Excel,VOSviewer,SCImago Graphica,and Pajek.The analysis focused on annual publication volume,countries(regions),institutions,authors,journals,keywords,and references.Results A total of 1,434 papers on acupuncture treatment for LBP were identified,demonstrating a fluctuating growth trend over the past 25 years.Research in this field has been conducted in 57 countries,with the United States leading in terms of research output.Italy emerged as the country with the highest-quality publications,with an average citation frequency of 205.16 times.A total of 1,781 institutions contributed to research on acupuncture treatment for LBP,with Harvard University having the highest publication volume(cited 77 times).The number of authors contributing to this field reached 5,696,with In-Hyuk Ha having the highest publication count(31 papers)and Claudia-M.Witt is the most influential author(cited 2,699 times).Relevant research was published in 378 journals,with the Journal of Alternative and Complementary Medicine having the highest publication volume(77 papers),and Spine being the most influential journal(cited 3,420 times).A total of 3,854 keywords were identified,forming six main thematic clusters:care management,nerve stimulation,complementary medicine,pregnancy pain,rehabilitation research,and musculoskeletal pain.Twelve highly cited papers with citation frequencies≥85 times were recognized,predominantly consisting of randomized controlled trials.Conclusion Over the past 25 years,the number of articles published on acupuncture for LPB has shown a fluctuating trend of growth;the distribution of countries(regions)and institutions that publish articles is scattered,mainly based on inter-regional cooperation,and international cooperation is still insufficient;Journals in alternative and integrative medicine category provide references for scholars to submit manuscripts and learn about the frontiers;Acupuncture is effective and economical in the treatment of pain,and it has been widely used in the treatment of low back pain.However,the difference in efficacy between acupuncture and sham acupuncture or placebo acupuncture remains controversial.Therefore,in the future,it is necessary to consider the selection of appropriate efficacy evaluation methods in clinical trials that reflect the therapeutic advantages of acupuncture.
文摘Objective:The objective of this study is to explore the current situation of nurses’participant activation for self-management of low back pain,analyze its influencing factors,and provide a reference for improving the participant activation for self-management of low back pain.Materials and Methods:A cross-sectional study was conducted with 5,120 nurses recruited through convenience sampling from hospitals across 25 provinces and municipalities in China.Participants completed two standardized instruments:General Information Questionnaire which collected demographic characteristics and work-related factors,and the Participant Activation for Self-Management of Back Pain Questionnaire which measured activation levels across three dimensions(including self-management beliefs,self-management awareness,and knowledge related to low back pain).Results:The score of nurses’participant activation for low back pain self-management was 38.00(33.00,44.00).The results of multiple linear regression showed that nurses of different gender,age,and professional titles,whether they had administrative positions,and whether they had back pain in the past year were influencing factors of nurses’participant activation for low back pain management.Conclusion:The overall participant activation for self-management of low back pain is at a medium level.Their self-management awareness is strong,but their beliefs about management of low back pain are insufficient.Targeted intervention measures can be taken to improve their activation for management of back pain and reduce the incidence of occupational low back pain.
基金supported by the Ministry of Science and Technology of China(2020YFA0908900)National Natural Science Foundation of China(21935011 and 82072490)+1 种基金Shenzhen Science and Technology Innovation Commission(KQTD20200820113012029 and KJZD20230923114612025)Guangdong Provincial Key Laboratory of Advanced Biomaterials(2022B1212010003).
文摘Aging is a pivotal risk factor for intervertebral disc degeneration(IVDD)and chronic low back pain(LBP).The restoration of aging nucleus pulposus cells(NPCs)to a youthful epigenetic state is crucial for IVDD treatment,but remains a formidable challenge.Here,we proposed a strategy to partially reprogram and reinstate youthful epigenetics of senescent NPCs by delivering a plasmid carrier that expressed pluripotency-associated genes(Oct4,Klf4 and Sox2)in Cavin2-modified exosomes(OKS@M-Exo)for treatment of IVDD and alleviating LBP.The functional OKS@M-Exo efficaciously alleviated senescence markers(p16^(INK4a),p21^(CIP1)and p53),reduced DNA damage and H4K20me3 expression,as well as restored proliferation ability and metabolic balance in senescent NPCs,as validated through in vitro experiments.In a rat model of IVDD,OKS@M-Exo maintained intervertebral disc height,nucleus pulposus hydration and tissue structure,effectively ameliorated IVDD via decreasing the senescence markers.Additionally,OKS@MExo reduced nociceptive behavior and downregulated nociception markers,indicating its efficiency in alleviating LBP.The transcriptome sequencing analysis also demonstrated that OKS@M-Exo could decrease the expression of age-related pathways and restore cell proliferation.Collectively,reprogramming by the OKS@M-Exo to restore youthful epigenetics of senescent NPCs may hold promise as a therapeutic platform to treat IVDD.
基金Supported by the Bejing Municipal Administration of Hospitals Incubation Program:PZ2022012National Famous Traditional Chinese Medicine Expert Inheritance Studio Construction Project:Guozhongyao Renjiaohan[2022]No.75Construction Project for the Inheritance of National Famous Traditional Chinese Medicine Experts in the Seventh Batch:Guozhongyao Renjiao Han[2022]No.76.
文摘Objective:To observe the specific effects of acupuncture in middle-aged and older patients with chronic nonspecific low back pain(CNSLBP).Methods:Sixty-six patients with CNSLBP were randomized into the acupuncture or sham acupuncture groups(n=33).In the acupuncture group,penetrating acupuncture with a long needle was delivered at Ashi points(painful/sensitive points),and the needles were manipulated by rotating technique after deqi till patients felt distending pain.The needles were retained in place for 30 min.Acupuncture was given three times per week for 4 weeks.In the sham acupuncture group,shallow needling was performed at non-meridian,non-acupoint,non-painful,and non-sensitive points.The needle retention and duration of treatment were the same as those of the acupuncture group before treatment,after the first intervention,after the whole treatment,and in follow-up visit(4 weeks after the whole treatment).The scores of the visual analog scale(VAS)for pain,range of movement(ROM)of the spine,and simplified Oswestry Dysfunction Index(ODI)were observed separately.Results:Compared to the outcomes before treatment,the VAS score,spinal ROM,and simplified ODI score were lower after the first intervention,after treatment,and in follow-up visits in the acupuncture group,indicating the statistical significance(P<0.05).When compared with the sham acupuncture group,the VAS score,spinal ROM,and simplified ODI score were significantly lower in the acupuncture group after the first intervention,after treatment,and in follow-up visit(P<0.05).The total effective rate was 90.9%in the acupuncture group,which was significantly higher than that(75.76%)in the sham acupuncturegroup(P<0.05).Conclusion:Acupuncture has a specific effect on CNSLBP in middle-aged and older patients and a superior effect on immediate analgesia.
文摘BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS) from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period.RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3% from 2007(244,000 visits) to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8% to 57.6%),female patients(from 54.5% to 62.0%),black patients(from 22.5% to 30.4%),and Hispanic/Latino patients(from 9.4% to 19.6%).Oxycodone/acetaminophen was most prescribed and accounted for 90.2% of all oxycodone-containing analgesics in 2007,with a decrease to 68.5% in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1% in 2007 and 31.5% in 2018.CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.
基金funded by Chinese Medicine Research Practical Training Program of Hong Kong Hospital Authority Chinese Medicine Department(Hong Kong,China),fourth batch.
文摘Objective:To compare the efficacy of using“distal acupoints only”vs.“local acupoints mainly combined with distal acupoints”in cases of acute low back pain(ALBP).Methods: A total of 102 eligible patients aged 18–65 years with ALBP lasting less than 6 weeks will be randomized in a 1:1 ratio to the distal acupoints only group(DPOG)and the local acupoints mainly combined with the distal acupoints group(LPMG).During a 4-week treatment period,patients in the DPOG will receive acupuncture at distal acupoints only(Houxi[SI 3]and Yaotongxue[EX-UE 7])twice a week,while those in the LPMG group will receive acupuncture at local acupoints(mainly Shenshu[BL 23]and Dachangshu[BL 25])combined with distal points(Weizhong[BL 40]).The patients in both groups will be evaluated at every session of treatment,and the follow-up will be performed for 3 months.The primary outcome measure will be the change in ALBP intensity,assessed using visual analogue scale scores before and after treatment.The secondary outcome measure will be the evaluation of functional disability using the Oswestry Disability Index.Discussion: This study compares the DPOG and LPMG to explore the feasibility of the DPOG in the treatment of ALBP.
基金Supported by The National Research Foundation of Korea Grant funded by the Korea Government,No.00219725.
文摘In this editorial we comment on the article published in a recent issue of the World Journal of Clinical Cases.This article described a novel ultrasound-guided lateral recess block approach in treating a patient with lateral recess stenosis.The impact of spinal pain-related disability extends significantly,causing substantial human suffering and medical costs.Each county has its preferred treatment strategies for spinal pain.Here,we explore the lower back pain(LBP)treatment algorithm recommended in France.The treatment algorithm for LBP recommended by the French National Authority for Health emphasizes early patient activity and minimal medication use.It encourages the continuation of daily activities,limits excessive medication and spinal injections,and incorporates psychological assessments and non-pharmacological therapies for chronic cases.However,the algorithm may not aggressively address acute pain in the early stages,potentially delaying relief and increasing the risk of chronicity.Additionally,the recommended infiltrations primarily involve caudal epidural steroid injections,with limited consideration for other injection procedures,such as transforaminal or interlaminar epidural steroid injections.The fixed follow-up timeline may not accommodate patients who do not respond to initial treatment or experience intense pain,potentially delaying the exploration of alternative therapies.Despite these limitations,understanding the strengths and weaknesses of the French approach could inform adaptations in LBP treatment strategies globally,potentially enhancing patient outcomes and satisfaction across diverse healthcare systems.
文摘BACKGROUND Low back pain has become a global problem.Since many traditional Chinese therapies are helpful for low back pain,the current status of low back pain in China may provide some insights to this issue.AIM To demonstrate the disease burden of low back pain in China and the response of Chinese scholars to this issue.METHODS The burden of low back pain in China was estimated using the Global Burden of Disease Study 2021 released by the American Institute for Health Metrics and Evaluation.The incidence,prevalence and disability-adjusted life years were analyzed.We also performed a bibliometric analysis to analyzed the publication trend,changes of cooperation models and research topics on low back pain.RESULTS Prevalence of low back pain increased from 69.61 million in 1990 to 102.96 million in 2021.New cases increased by a stunning 44.50 million in 2021.Low back pain led to an increase of 4.16 per 1000000 population in terms of disability-adjusted life years from 1990 to 2021.But the increase in China was slower than that of world average.As a response,publications of low back pain published by Chinese scholars were stably raised.From 1990 to 2023,domestic cooperation significantly increased,while international cooperation and no cooperation decreased.However,domestic cooperation decreased between 2021 and 2023.The number of studies on prevention and treatment of low back pain reduced from 1990 to 2023,while the mechanism,etiology and other aspects of low back pain augmented.CONCLUSION The burden of low back pain in China is heavy.Together with the government,Chinese institutions of medical science should do more in declining the impacts of low back pain.
文摘Introduction: Low back pain is nowadays a real public health problem in companies. The objective of the study was to determine the prevalence and factors associated with chronic low back pain among workers of a mining company in Burkina Faso. Material and Methods: This was a descriptive and analytical cross-sectional study with a retrospective collection that took place from August 1, 2021 to March 16, 2022 in a gold mine in Burkina Faso. It focused on mine workers who participated in the 2019 annual medical visit. Results: Out of a total workforce of 880 workers who took part in the annual medical visit in 2019, 165 had chronic common low back pain, i.e. a prevalence of 18.75%. The average age of low back pain workers was 37.21 ± 7.5 years. Among the workers suffering from low back pain, 62 (37.58%) held the position of machine operator. Clinically, mechanical pain was found in 113 low back pain workers (76%) and twenty-nine (17.58%) had radicular pain. Standard radiography of the lumbar spine was abnormal in 129 workers (78.18%. In the univariate analysis, the factors associated with the pathology were sex, level of study, work station and seniority in the position. After a logistic regression, the factors associated with its occurrence were whole-body vibration (Fisher’s test = 12.7541;P = 0.000), male sex (Fisher’s test = 8.363;P = 0.004), and seniority for 4 to 5 years (Chi2 = 4.0234;p = 0.046). Conclusion: The study reveals the existence of chronic low back pain cases among the workers of the mining company. There is a predominance of the pathology in men, workers exposed to vibrations and those with a seniority of 4 to 5 years. It is necessary to establish a policy of prevention of low back pain for the benefit of workers, in particular those exposed to vibrations.
文摘Background: Low back pain (LBP) is a very common health problem amongst the general population and a major cause of disability that affects work performance and well-being. Healthcare workers (HCWs) are especially at risk of developing LBP because of physical and emotional factors. Little is known about the burden of LBP in Cameroon. Objective: To determine the prevalence of low back pain and identify its associated factors among healthcare workers. Methods: A cross-sectional study using a self-administered questionnaire was conducted among healthcare workers in the Yaound Central Hospital and the Yaound University Teaching Hospital. The questionnaire collected data regarding recent, past year and lifetime occurrences of LBP, socio-demographics and work conditions. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: A total number of 268 HCWs participated in the study, including 197 (73.5%) females and 71 (26.5%) males. The mean age of the study participants was 40.60 8.38 years (extremes of 20 and 65 years). The lifetime, annual, and point prevalences of LBP among the participants were 67.5% (CI: 61.6 - 73.1), 61.5% (CI: 55.6 - 67.1) and 35.7% (CI: 29.7 - 41.5) respectively. Multivariate analysis confirmed a moderate stress level, a sedentary lifestyle, working in the medicine and specialities department, lifting heavy objects and bending to work as associated factors to LBP. Most sufferers had a minimal functional disability (65.7%) while 34.3% had a moderate to severe disability. Conclusions: Healthcare providers have a considerably high prevalence of low back pain. Factors associated with LBP found in this study were similar to those widely recognized in the literature. A substantial proportion of healthcare providers are suffering from functional disability associated with low back pain, affecting their social and work lives. There is a need for multilevel interventions to prevent and control low back pain in this highly vulnerable occupational group.
文摘Background: low back pain affects many individuals, with 80% classified as non-specific low back pain (NSLBP) due to mechanical rather than structural issues. The link between pelvic alignment and lumbopelvic-hip rotation movement for NSLBP is controversial. Methods: twenty males with NSLBP and 20 healthy males participated. Data collected included static pelvic asymmetry and active lumbopelvic-hip rotation with motion capture system for kinematic analysis. Results: Unpaired T test was used to compare the difference of kinematic parameters between two groups. NSLBP group showed significantly larger angles between the ASIS-PSIS line and the z-axis (p Conclusion: Evaluations focusing on bone structure alone may be inadequate. A more comprehensive approach including functional assessments like muscle strength and range of motion could be beneficial. Integrating lumbopelvic-hip movement patterns and pelvic symmetry into clinical assessments should be considered, as they may be influenced by physical activity.
