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BACKGROUND: In recent studies, receipt of chiropractic care has been associated with lower odds of receiving prescription opioids and, among those already prescribed, reduced doses of opioids among patients with non-cancer spine pain. These findings suggest that access to chiropractic services may reduce reliance on opioids for musculoskeletal pain. OBJECTIVE: To assess the impact of chiropractic care on initiation, or continued use, of prescription opioids among patients with non-cancer spine pain. METHODS: We will search for eligible randomized controlled trials (RCTs) and observational studies indexed in MEDLINE, Embase, AMED, CINAHL, Web of Science, and the Index to Chiropractic Literature from database inception to June 2024. Article screening, data extraction, and risk-of-bias assessment will be conducted independently by pairs of reviewers. We will conduct separate analyses for RCTs and observational studies and pool binary outcomes (e.g. prescribed opioid receipt, long-term opioid use, and higher versus lower opioid dose) as odds ratios (ORs) with associated 95% confidence intervals (CIs). When studies provide hazard ratios (HRs) or relative risks (RRs) for time-to-event data (e.g. time-to-first opioid prescription) or incidence rates (number of opioid prescriptions over time), we will first convert them to an OR before pooling. Continuous outcomes such as pain intensity, sleep quality, or morphine equivalent dose will be pooled as weighted mean differences with associated 95% CIs. We will conduct meta-analyses using random-effects models and explore sources of heterogeneity using subgroup analyses and meta-regression. We will evaluate the certainty of evidence of all outcomes using the GRADE approach and the credibility of all subgroup effects with ICEMAN criteria. Our systematic review will follow the PRISMA statement and MOOSE guidelines. DISCUSSION: Our review will establish the current evidence informing the impact of chiropractic care on new or continued prescription opioid use for non-cancer spine pain. We will disseminate our results through peer-reviewed publication and conference presentations. The findings of our review will be of interest to patients, health care providers, and policy-makers. TRIAL REGISTRATION: Systematic review registration: PROSPERO CRD42023432277.
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Analgésicos Opioides , Manipulación Quiropráctica , Humanos , Analgésicos Opioides/uso terapéutico , Dolor de Espalda/tratamiento farmacológico , Dolor de Espalda/terapia , Metaanálisis como Asunto , Dolor Musculoesquelético/tratamiento farmacológico , Dolor Musculoesquelético/terapia , Revisiones Sistemáticas como AsuntoRESUMEN
Importance: Chronic back pain (CBP) is a leading cause of disability. Placebo treatments often provide as much pain relief as bona fide treatments, such as steroid injections. Open-label (honestly prescribed) placebos (OLPs) may relieve CBP without deception, but OLP mechanisms remain poorly understood. Objective: To investigate the long-term efficacy and neurobiological mechanisms of OLP for CBP. Design, Setting, and Participants: A randomized clinical trial of CBP with longitudinal functional magnetic resonance imaging (MRI) comparing OLP with usual care, with 1-year follow-up, was conducted in a university research setting and a community orthopedic clinic. Participants were individuals aged 21 to 70 years with CBP. The trial was conducted from November 2017 to August 2018, with 1-year follow-up completed by November 2019. Data analysis was performed from April 2020 to May 2024. The primary analysis was conducted on an intention-to-treat sample. Interventions: Participants randomized to OLP received a 1-time subcutaneous lumbar saline injection presented as placebo accompanied by information about the power of placebo to relieve pain, alongside their ongoing care. Usual care participants continued their ongoing care. Main Outcomes and Measures: The primary outcome was pain intensity (0-10, with 0 indicating no pain and 10 the most intense) at 1 month posttreatment. Secondary outcomes included pain interference, depression, anxiety, anger, and sleep quality. Functional MRI was performed before and after treatment during evoked and spontaneous back pain. Results: A total of 101 adults (52 [51.4%] females; mean [SD] age, 40.4 [15.4] years) with moderate severity CBP (mean [SD], 4.10 [1.25] intensity; duration, 9.7 [8.5] years) were enrolled. Compared with usual care, OLP reduced CBP intensity posttreatment (relative reduction, 0.61; Hedges g = 0.45; 95% CI, -0.89 to 0.04; P = .02). Through 1-year follow-up, pain relief did not persist, although significant benefits were observed for depression, anger, anxiety, and sleep disruption (Hedges g = 0.3-0.5; all P < .03). Brain responses to evoked back pain for OLP vs usual care increased in rostral anterior cingulate and ventromedial prefrontal cortex and decreased in somatomotor cortices and thalamus. During spontaneous pain, functional connectivity analyses identified OLP vs usual care increases in ventromedial prefrontal cortex connectivity to the rostral ventral medulla, a pain-modulatory brainstem nucleus. No adverse effects of treatment were reported by participants. Conclusions and Relevance: In this randomized clinical trial of OLP vs usual care, a single nondeceptive placebo injection reduced CBP intensity for 1 month posttreatment and provided benefits lasting for at least 1 year posttreatment. Brain mechanisms of OLP in a clinical population overlap with those of deceptive placebos in healthy volunteers, including engagement of prefrontal-brainstem pain modulatory pathways. Trial Registration: ClinicalTrials.gov Identifier: NCT03294148.
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Dolor de Espalda , Dolor Crónico , Neuroimagen Funcional , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Dolor Crónico/tratamiento farmacológico , Dolor de Espalda/tratamiento farmacológico , Dolor de Espalda/diagnóstico por imagen , Anciano , Neuroimagen Funcional/métodos , Placebos/administración & dosificación , Imagen por Resonancia Magnética/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: Evidence regarding percutaneous vertebroplasty (PV) for chronic painful osteoporotic vertebral compression fractures (OVCFs) remains limited. To compare pain relief, quality of life, and disability between PV and active control (anesthetic infiltration) interventions for chronic OVCF. DESIGN: Randomized controlled trial. METHODS: This prospective randomized clinical trial was conducted between May 2013 and June 2019 in participants with pain due to OVCF lasting longer than 3 months with bone marrow edema present at MRI. Study participants were randomly assigned to undergo PV (n = 40) or active control intervention (n = 40). The primary outcome was pain severity, assessed with the visual analog scale (VAS) (range, 0-10) during 12 months after treatment. Secondary outcomes included Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) score (range, 0-100) and Roland Morris Disability Questionnaire (RMDQ) score (range, 0-100). Outcomes were analyzed according to a longitudinal multilevel model used to test the difference between groups in change from baseline across follow-up. RESULTS: The mean age of the 80 participants (54 women) was 69 years ± 10 (SD) in the PV group and 71 years ± 10 in the active control group. VAS score was 7.6 (95% CI: 7.0, 8.2) in the PV group and 7.3 (95% CI: 6.9, 7.8) in the active control group at baseline (P = .47) and 3.9 (95% CI: 3.1, 4.8) and 5.1 (95% CI: 4.3, 6.0), respectively, at month 12 (P = .045). At month 12, the group difference from baseline was 1.3 (95% CI: 0.1, 2.6; P = .02) for VAS, 5.2 (95% CI: 0.9, 9.4; P = .02) for QUALEFFO, and 7.1 (95% CI: -3.3, 17.5; P = .18) for RMDQ, favoring the PV group. CONCLUSION: In the treatment of pain caused by chronic OVCFs, PV is more effective for pain relief and quality of life improvement than anesthetic injection alone, with similar improvement for disability between the groups.
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Dolor de Espalda , Fracturas por Compresión , Fracturas Osteoporóticas , Calidad de Vida , Fracturas de la Columna Vertebral , Vertebroplastia , Humanos , Femenino , Anciano , Fracturas por Compresión/cirugía , Fracturas por Compresión/complicaciones , Masculino , Vertebroplastia/métodos , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/complicaciones , Fracturas Osteoporóticas/cirugía , Fracturas Osteoporóticas/complicaciones , Estudios Prospectivos , Dolor de Espalda/etiología , Dimensión del Dolor , Persona de Mediana Edad , Resultado del Tratamiento , Dolor Crónico/etiología , Anciano de 80 o más AñosRESUMEN
OBJECTIVE: Patients with back pain (BP) and radiating leg pain have poorer clinical outcomes compared to patients with BP alone. We aimed to describe the 1-year clinical course and to identify prognostic factors associated with non-recovery in older BP patients with radiating leg pain. DESIGN: Patients in the BACE cohort aged >55 years with a new episode of BP and radiating leg pain were included (n = 377). Data on clinical outcomes were collected until 1-year follow-up. Uni- and multivariable regression analyses were performed to investigate the association between potential prognostic factors and three non-recovery outcomes at the 1-year follow-up. RESULTS: More than half of the patients (65%) did not recover after 12 months. In multivariable analyses, poor self-rated health (odds ratio [OR] 2.34, 95% CI: 1.20-4.56) and BP duration at baseline (OR 1.48, 1.12-1.96) were significantly associated with non-recovery for BP as outcome; age (OR 1.04, 1.03-1.05), smoking (OR 1.14, 1.00-1.30), depressive symptomatology (OR 1.03, 1.02-1.04), kinesiophobia (OR 1.03, 1.02-1.04), poor self-rated health (OR 2.09, 1.83-2.39), baseline disability (OR 1.16, 1.14-1.17), BP duration (OR 1.49, 1.41-1.57), leg pain (OR 1.52, 1.37-1.68), pain during rotation (OR 1.71, 1.53-1.90) and other musculoskeletal complaints (OR 1.34, 1.17-1.52) were associated with disability. No factors were associated with leg pain. CONCLUSIONS: Several prognostic factors were associated with non-recovery in older patients with BP and radiating leg pain. Primary care clinicians should be aware of these factors in managing these patients.
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Dolor de Espalda , Humanos , Femenino , Masculino , Anciano , Pronóstico , Persona de Mediana Edad , Estudios de Cohortes , Pierna , Medicina General/estadística & datos numéricosRESUMEN
BACKGROUND: The prevalence of back and neck pain is common in children and adolescents, and in some series the numbers are alarming. Various risk factors have been identified, although some are controversial. OBJECTIVE: To determine the prevalence of neck and back pain in children and adolescents and to investigate the potential association with various risk factors identified in the literature. METHODS: We established a questionnaire targeting parents of children and adolescents aged between 6 and 18 years old in Tunisia. The recruitment of participants was done online using the Google Forms application. The questionnaire was divided into 2 parts: Part one collected the sociodemographics characteristics of the participants : age, gender, body mass index (BMI), exposure to passive smoking, the practice of a physical activity, puberty status and age at puberty if applicable, type and weight of the schoolbag, mean daily time spent on electronic devices, type of school the child attends (private/public), mode of transport from home to school, parental history of neck and/or back pain (mid or low back pain (LBP)), posture of the sitting position of the child, and finally whether the child reports neck/ back pain. The second part was aimed at parents whose child reported neck and/or back pain. We asked about the weekly frequency of neck/back pain, school absenteeism due to neck/back pain, whether it prevented the child from practicing physical activity and, finally, whether the child had ever seen a doctor/chiropractor/physiotherapist for their neck/back pain. RESULTS: Eighty-eight children (45 females, 43 males) were enrolled. Mean age was 11.9 ± 3.8 years [6-18]. Mean BMI was 18.8 ± 4.2 [15.8-35.5]. Thirty-four (38.6%) were pubescent. Twenty-five (28.4%) children were exposed to passive smoking. Parental history of spine pain was found in 58% of cases. A poor sitting position was noted in n = 49 (55.7%). Mean daily screen time was 88.3 ± 75.56 min [0-360]. Prevalence of spine pain was 44% (n = 39) distributed as follows: neck pain (n = 21, 23.8%), mid back pain (n = 15, 17%), LBP (n = 26, 29.5%), neck, mid back and low back pain (n = 4, 4.5%) Professional help seeking for spine pain in children was reported by 15 participants (25.3%). Among them, 20.3% visited a physician and 5% consulted a chiropractor or physiotherapist. A significant correlation was found between spine pain and age (p = 0.006) and BMI (p = 0.006). A significant association was found between LBP and exposure to passive smoking, puberty status, type of school bag and poor posture. A positive parental history of spine pain was significantly associated with the presence of spine pain in their children with p = 0.053 (neck pain), p = 0.013 (back pain) and p < 0.00 (LBP) respectively. A significant association was found between the presence of spine pain and school absenteeism, participation in sports, consultation with a doctor or physiotherapist/chiropractor (p < 0.0001 respectively). CONCLUSION: The prevalence of spinal pain was frequent in our series. A positive parental history of spinal pain, a bad posture while sitting, passive smoking, use of backpack, higher age and higher BMI were potential associated factors.
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Dolor de Espalda , Dolor de Cuello , Humanos , Niño , Masculino , Adolescente , Femenino , Túnez/epidemiología , Prevalencia , Dolor de Cuello/epidemiología , Dolor de Cuello/etiología , Factores de Riesgo , Encuestas y Cuestionarios , Dolor de Espalda/epidemiología , Dolor de Espalda/etiología , Índice de Masa Corporal , Dolor de la Región Lumbar/epidemiología , Dolor de la Región Lumbar/etiologíaRESUMEN
BACKGROUND: Musculoskeletal (MSK) spinal pain encapsulates various conditions including lumbar (low back), cervical (neck), and thoracic pain that significantly impact individual and global health. While clinical aspects of spinal pain have been well-studied, understanding patients' personal narratives and lived experiences remains essential for enhancing patient-centered care, improving treatment adherence, and informing healthcare policies. It provides deep insights into the impacts of spinal pain, guiding more effective and empathetic treatment approaches. This systematic review aims to synthesize qualitative evidence on patients' experiences with MSK spinal pain, providing insight into the challenges faced, coping strategies, daily life impacts, and healthcare interactions. The objective of this review is to synthesize the qualitative evidence regarding the lived experiences of patients with MSK spinal pain. METHODS: This systematic review will use a meta-aggregation approach to synthesize data from qualitative studies, that will be identified through a comprehensive search of electronic databases and supplemented by grey literature searches. Two independent reviewers will screen, identify, and extract data from eligible studies. In cases of disagreement, conflicts will be resolved by consulting a third reviewer. These same reviewers will then use the Joanna Briggs Institute (JBI) qualitative quality assessment tool to evaluate the methodological quality of the identified studies, with the derived scores informing the synthesis process, that will involve extracting each study's findings along with their supporting illustrations, then grouped into categories based on similarity in meaning. These categories will then be aggregated to form synthesized findings. IMPLICATIONS: Synthesized findings on patients' lived experiences with MSK spinal pain including key themes, patterns, and insights will be presented. By emphasizing patient narratives, the results of the review can contribute to the optimization of outcomes, and to enhance patient-provider relations and improve quality of care in MSK spinal health.
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Revisiones Sistemáticas como Asunto , Humanos , Investigación Cualitativa , Dolor Musculoesquelético/psicología , Dolor Musculoesquelético/terapia , Dolor de Espalda/psicología , Dolor de Espalda/terapia , Adaptación PsicológicaRESUMEN
BACKGROUND: Sometimes during breastfeeding women adopt positions that may cause problems with musculoskeletal system, resulting in back pain. The aim of this study was to determine the prevalence of lower back, upper back and neck pain in breastfeeding women and how this may be related to the act of breastfeeding. METHODS: An online survey within Poland was conducted among 395 breastfeeding women who were 1 to 48 months postpartum and were divided into two groups; "no back pain" and "back pain present". The measurement tools used included an original questionnaire, the International Physical Activity Questionnaire (IPAQ), a Numerical Pain Rating Scale (0-10), and the Roland-Morris Disability Questionnaire. Pearson's chi-squared tests, Mann-Whitney U tests, Student's t-tests, and Kruskal-Wallis ANOVA tests were used to compare the groups. RESULTS: It was found that 84% of breastfeeding mothers suffered from back pain at least once a month. Pain was experienced at least once a week in the cervical, thoracic and lumbosacral regions in 48%, 36%, and 66% of the women, respectively. A dysfunctional state was present in 27.6% of breastfeeding mothers who suffered from back pain. Mothers experiencing back pain spent significantly more time on single breastfeeding episodes (p < 0.05) and had an increased total time breastfeeding per day (p < 0.01) compared to mothers with no back pain. Neck pain was significantly less intense in mothers preferring to breastfeed in a lying position as compared to mothers preferring a sitting position in a chair or an armchair (p < 0.05). CONCLUSIONS: This survey of Polish breastfeeding mothers revealed a very high prevalence of lower back, upper back and neck pain. The amount of time spent on breastfeeding and the choice of body position for breastfeeding were important factors differentiating the prevalence and intensity of the pain. It is recommended that breastfeeding mothers do not extend the single-feeding time in the adopted position beyond the required time. It is of utmost importance to choose a breastfeeding position in which all parts of the mother's body are supported. To prevent neck pain, lying and semi-lying positions with head support are recommended.
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Dolor de Espalda , Lactancia Materna , Dolor de Cuello , Humanos , Lactancia Materna/estadística & datos numéricos , Dolor de Cuello/epidemiología , Femenino , Adulto , Prevalencia , Polonia/epidemiología , Dolor de Espalda/epidemiología , Dolor de Espalda/diagnóstico , Adulto Joven , Encuestas y Cuestionarios , Dimensión del Dolor , Madres , Postura , InternetRESUMEN
Importance: Insomnia is highly prevalent in patients with nonspecific chronic spinal pain (nCSP). Given the close interaction between insomnia and pain, targeting sleep problems during therapy could improve treatment outcomes. Objective: To evaluate the effectiveness of cognitive behavioral therapy for insomnia (CBTi) integrated in best-evidence pain management (BEPM) vs BEPM only in patients with nCSP and insomnia. Design, Setting, and Participants: A multicenter randomized clinical trial with 1-year follow-up was conducted between April 10, 2018, and April 30, 2022. Data and statistical analysis were performed between May 1, 2022, and April 24, 2023. Patients with nCSP and insomnia were evaluated using self-report and at-home polysomnography, to exclude underlying sleep pathologic factors. Participants were treated at the University Hospital Brussels or University Hospital Ghent, Belgium. Intention-to-treat analysis was performed. Interventions: Participants were randomized to either CBTi-BEPM or BEPM only. Both groups received 18 treatment sessions over 14 weeks. The CBTi-BEPM treatment included 6 CBTi sessions and 12 BEPM sessions. The BEPM treatment included pain neuroscience education (3 sessions) and exercise therapy (9 sessions in the CBTi-BEPM group, 15 sessions in the BEPM-only group). Main Outcomes and Measures: The primary outcome was change in mean pain intensity (assessed with Brief Pain Inventory [BPI]) at 12 months after the intervention. Exploratory secondary outcomes included several pain- and sleep-related outcomes. Blinded outcome assessment took place at baseline, posttreatment, and at 3-, 6-, and 12-month follow-up. Results: A total of 123 patients (mean [SD] age, 40.2 [11.18] years; 84 women [68.3%]) were included in the trial. In 99 participants (80.5%) with 12-month BPI data, the mean pain intensity at 12 months decreased by 1.976 points (reduction of 40%) in the CBTi-BEPM group and 1.006 points (reduction of 24%) points in the BEPM-only group. At 12 months, there was no significant difference in pain intensity change between groups (mean group difference, 0.970 points; 95% CI, -0.051 to 1.992; Cohen d, 2.665). Treatment with CBTi-BEPM resulted in a response for BPI average pain with a number needed to treat (NNT) of 4 observed during 12 months. On a preliminary basis, CBTi-BEPM was, consistently over time and analyses, more effective than BEPM only for improving insomnia severity (Cohen d, 4.319-8.961; NNT for response ranging from 2 to 4, and NNT for remission ranging from 5 to 12), sleep quality (Cohen d, 3.654-6.066), beliefs about sleep (Cohen d, 5.324-6.657), depressive symptoms (Cohen d, 2.935-3.361), and physical fatigue (Cohen d, 2.818-3.770). No serious adverse effects were reported. Conclusions and Relevance: In this randomized clinical trial, adding CBTi to BEPM did not further improve pain intensity reduction for patients with nCSP and comorbid insomnia more than BEPM alone. Yet, as CBTi-BEPM led to significant and clinically important changes in insomnia severity and sleep quality, CBTi integrated in BEPM should be considered in the treatment of patients with nCSP and comorbid insomnia. Further research can investigate the patient characteristics that moderate the response to CBTi-BEPM in terms of pain-related outcomes, as understanding of these moderators may be of utmost clinical importance. Trial Registration: Clinical Trials.gov Identifier: NCT03482856.
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Dolor Crónico , Terapia Cognitivo-Conductual , Manejo del Dolor , Trastornos del Inicio y del Mantenimiento del Sueño , Humanos , Terapia Cognitivo-Conductual/métodos , Femenino , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Masculino , Persona de Mediana Edad , Dolor Crónico/terapia , Manejo del Dolor/métodos , Adulto , Resultado del Tratamiento , Dolor de Espalda/terapiaRESUMEN
BACKGROUND: Mendelian randomization (MR) studies have an advantage over conventional observational studies when studying the causal effect of lifestyle-related risk factors on back pain. However, given the heterogeneous design of existing MR studies on back pain, the reported causal estimates of these effects remain equivocal, thus obscuring the true extent of the biological effects of back pain lifestyle-risk factors. PURPOSE: The purpose of this study was to conduct a systematic review with multiple meta-analyses on the associations between various lifestyle factors and low back pain. METHODS: We conducted a PRISMA systematic review and specifically included MR studies to investigate the associations between lifestyle factors-specifically, BMI, insomnia, smoking, alcohol consumption, and leisure sedentary behavior-and various back pain outcomes. Each meta-analysis synthesized data from three or more studies to assess the causal impact of these exposures on distinct back pain outcomes, including chronic pain, disability, and pain severity. Quality of studies was assessed according to STROBE-MR guidelines. RESULTS: A total of 1576 studies were evaluated and 20 were included. Overall, the studies included were of high quality and had a low risk of bias. Our meta-analysis demonstrates the positive causal effect of BMI (OR IVW-random effects models: 1.18 [1.08-1.30]), insomnia(OR IVW-random effects models: 1.38 [1.10-1.74]), smoking(OR IVW-fixed effects models: 1.30 [1.23-1.36]), alcohol consumption(OR IVW-fixed effects models: 1.31 [1.21-1.42]) and leisure sedentary behaviors(OR IVW-random effects models: 1.52 [1.02-2.25]) on back pain. CONCLUSION: In light of the disparate designs and causal effect estimates presented in numerous MR studies, our meta-analysis establishes a compelling argument that lifestyle-related risk factors such as BMI, insomnia, smoking, alcohol consumption, and leisure sedentary behaviors genuinely contribute to the biological development of back pain.
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Consumo de Bebidas Alcohólicas , Estilo de Vida , Análisis de la Aleatorización Mendeliana , Humanos , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Dolor de Espalda/epidemiología , Dolor de Espalda/etiología , Dolor de Espalda/genética , Índice de Masa Corporal , Factores de Riesgo , Conducta Sedentaria , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Fumar/efectos adversos , Fumar/epidemiologíaRESUMEN
BACKGROUND: Chronic pain and depression share common neural mechanisms, but their impacts on empathy are different. It is unclear how comorbid depressive symptoms affect empathy-related brain function in patients with chronic pain. METHODS: A total of 29 healthy participants and 107 patients with chronic back pain (CBP) were included in this study. All subjects underwent a functional MRI scan with concurrent empathic stimulation. Multiple linear regression, moderation analysis, and mediation analysis were used to explore the impacts of chronic pain and comorbid depression on empathy. RESULTS: The interaction between the pain intensity and the depressive symptoms affected the functional connectivity (FC) of the insula-middle frontal gyrus (MFG), and the severity of the self-rating depression scale (SDS) scores moderated the effect of the pain on the left insula-left MFG FC. Within the CBP group, the emotional contagion (EC) scores served as a mediator in the association between the SDS scores and the FC of the left middle cingulate cortex (MCC)-inferior temporal gyrus (ITG), and the level of cognitive empathy (CE) moderated the effect of the SDS scores on the left MCC-ITG FC. LIMITATIONS: There is a lack of research on the effects of depressive symptoms on empathy in individuals with different types of chronic pain. CONCLUSION: Depressive symptoms were strongly associated with the emotional contagion in patients with chronic back pain. Furthermore, the emotional contagion and the cognitive empathy regulated the effect of the comorbid depressive symptoms on the MCC-ITG connectivity in patients with chronic back pain.
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Dolor de Espalda , Dolor Crónico , Depresión , Emociones , Empatía , Imagen por Resonancia Magnética , Humanos , Empatía/fisiología , Masculino , Femenino , Dolor Crónico/fisiopatología , Dolor Crónico/psicología , Adulto , Dolor de Espalda/fisiopatología , Dolor de Espalda/psicología , Depresión/fisiopatología , Depresión/psicología , Persona de Mediana Edad , Emociones/fisiología , Encéfalo/fisiopatología , Encéfalo/diagnóstico por imagen , Corteza Prefrontal/fisiopatología , Corteza Prefrontal/diagnóstico por imagen , Giro del Cíngulo/fisiopatología , Giro del Cíngulo/diagnóstico por imagen , Cognición/fisiología , Corteza Cerebral/fisiopatología , Corteza Cerebral/diagnóstico por imagen , Corteza Insular/fisiopatología , Corteza Insular/diagnóstico por imagen , Mapeo EncefálicoRESUMEN
BACKGROUND: The ultrasound-guided erector spinae plane block (ESPB), traditionally utilized for thoracic regional pain control, has been reported as an effective analgesic option for mechanical back pain, renal colic, and rib fractures in the emergency department (ED). This pilot study aims to compare the effectiveness of the ESPB to usual analgesic treatment for patients presenting to the ED with mechanical back pain. METHODS: A prospective, single-blind randomized controlled trial was conducted at a Canadian community hospital from March 2020 to December 2022. Adult patients presenting to the ED with mechanical back pain of at least 7 out of 10 on the Numeric Pain Rating Scale (NPRS) were randomized to receive either the ESPB or usual care. The primary outcome was the difference in NPRS score reduction at ED discharge. Secondary outcomes included ED length of stay, ED opiate use, follow-up NPRS and Brief Pain Inventory (BPI) scores, back pain-related return ED visits, and ongoing opiate use. RESULTS: A total of 30 patients were enrolled, with 19 randomized to the ESPB cohort and 11 to the usual care cohort. The mean NPRS reduction at ED discharge was significantly higher in the ESPB group compared to the usual care group (5.4 vs. 2.2), with a difference of 3.2 (95% confidence interval 1.4-5.1). ED opiate use was lower in the ESPB group. The ESPB also resulted in a significant reduction in ED length of stay (160 min vs. 235 min). There were no reported adverse effects related to the research interventions. CONCLUSION: This pilot study suggests that the ESPB may be an effective opioid-sparing analgesic option for patients presenting to the ED with mechanical back pain. GOV IDENTIFIER: NCT05982483.
RéSUMé: CONTEXTE: Le bloc raboteux spina érectile guidé par ultrasons (ESPB), traditionnellement utilisé pour le contrôle de la douleur régionale thoracique, a été signalé comme une option analgésique efficace pour les maux de dos mécaniques, les coliques rénales et les fractures des côtes au service des urgences (ED). Cette étude pilote vise à comparer l'efficacité de l'ESPB au traitement analgésique habituel pour les patients présentant à l'urgence des douleurs dorsales mécaniques. MéTHODES: Un essai contrôlé randomisé prospectif en aveugle a été mené dans un hôpital communautaire canadien de mars 2020 à décembre 2022. Les patients adultes se présentant à l'urgence avec une douleur dorsale mécanique d'au moins 7 sur 10 sur l'échelle numérique d'évaluation de la douleur (NPRS) ont été randomisés pour recevoir soit la ESPB ou les soins habituels. Le critère de jugement principal était la différence dans la réduction du score NPRS à la sortie de l'urgence. Les critères de jugement secondaires comprenaient la durée du séjour à l'urgence, l'utilisation d'opiacés à l'urgence, les scores de suivi à l'INRP et au Brief Pain Inventory (BPI), les visites de retour à l'urgence liées à la douleur dorsale et l'utilisation continue d'opiacés. RéSULTATS: Au total, 30 patients ont été recrutés, dont 19 randomisés dans la cohorte de la DGPSE et 11 dans la cohorte de soins habituels. La réduction moyenne du NPRS à la sortie de l'urgence était significativement plus élevée dans le groupe ESPB que dans le groupe de soins habituels (5,4 vs. 2,2), avec une différence de 3,2 (intervalle de confiance à 95 % 1,4-5,1). La consommation d'opiacés aux urgences était plus faible dans le groupe ESPB. La ESPB a également entraîné une réduction significative de la durée du séjour aux urgences (160 min contre 235 min). Aucun effet indésirable lié aux interventions de recherche n'a été signalé. CONCLUSION: Cette étude pilote suggère que l'ESPB peut être une option analgésique efficace épargnant les opioïdes pour les patients se présentant à l'urgence avec des douleurs dorsales mécaniques.
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Dolor de Espalda , Servicio de Urgencia en Hospital , Bloqueo Nervioso , Dimensión del Dolor , Humanos , Proyectos Piloto , Masculino , Femenino , Método Simple Ciego , Persona de Mediana Edad , Estudios Prospectivos , Bloqueo Nervioso/métodos , Dolor de Espalda/terapia , Dolor de Espalda/tratamiento farmacológico , Adulto , Ultrasonografía Intervencional/métodos , Músculos Paraespinales , Canadá , Manejo del Dolor/métodos , Resultado del Tratamiento , AncianoRESUMEN
OBJECTIVES: To determine the effect of elevated supine position with back support on back pain, anxiety and comfort in patients undergoing coronary angiography. METHODS: This randomized-controlled, experimental study was conducted in the Coronary Intensive Care Unit between September 2021 and January 2022, with an intervention group of 51 patients and a control group of 53 patients. Data were collected using a patient information form, a visual analog scale, the anxiety state inventory and the immobilization comfort questionnaire. Following angiography, the intervention group received pillow support to the back and the bedhead was elevated to 30 degrees. Routine nursing care was applied to the control group. In both groups, the severity of back pain was measured at 0, 2, and 4 hours, and anxiety and comfort at 0 and 4 hours. RESULTS: The pain severity at 2 and 4 hours after the procedure was determined to be significantly lower in the intervention group than in the control group (p<0.001, p<0.001). At 4 hours, the anxiety levels were similar in both groups (p<0.05), and the comfort level was higher in the intervention group (p<0.001). The mean pain value was 6.003 points lower and the comfort level was 20.499 points higher in the intervention group than in the control group. CONCLUSION: The elevated supine position with back support was seen to reduce back pain, increase comfort, and did not change anxiety levels.Clinical Trials No: NCT05546216.
Asunto(s)
Ansiedad , Dolor de Espalda , Angiografía Coronaria , Comodidad del Paciente , Humanos , Masculino , Femenino , Persona de Mediana Edad , Posición Supina , Dolor de Espalda/psicología , Dolor de Espalda/diagnóstico por imagen , Anciano , Dimensión del Dolor , Posicionamiento del Paciente/métodos , AdultoRESUMEN
Lyme neuroborreliosis is a rare zoonosis which can be difficult to diagnose, in particular in low endemic areas. We here report the case of a 35-year-old man presenting with disabling back pain preceded by facial monoplegia, which was wrongly treated as Bell's palsy (paralysis a frigore) and then as post-traumatic lumbosciatica. The onset of facial diplegia allowed for a definitive diagnosis. The patient was treated with ceftriaxone and symptoms gradually improved.
Asunto(s)
Antibacterianos , Parálisis de Bell , Ceftriaxona , Parálisis Facial , Neuroborreliosis de Lyme , Humanos , Masculino , Adulto , Parálisis Facial/etiología , Parálisis Facial/diagnóstico , Antibacterianos/administración & dosificación , Ceftriaxona/administración & dosificación , Neuroborreliosis de Lyme/diagnóstico , Neuroborreliosis de Lyme/complicaciones , Neuroborreliosis de Lyme/tratamiento farmacológico , Parálisis de Bell/diagnóstico , Parálisis de Bell/etiología , Dolor de Espalda/etiología , Errores Diagnósticos , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/complicaciones , Enfermedad de Lyme/tratamiento farmacológico , Dolor de la Región Lumbar/etiologíaRESUMEN
OBJECTIVES: To compare spinal and lower limb pain in adolescents regarding prevalence, characteristics, causes, and impact. METHODS: A descriptive cross-sectional study was conducted in 13-year-old adolescents (female n=2210; male n=2353) from the Portuguese Generation XXI birth cohort. Data were collected between 2018 and 2020 through personal interviews by applying the Luebeck Pain Questionnaire. The pain features examined in each anatomical location (back and lower limb) were recurrence, duration, frequency, intensity, perceived causes, and impact on school and leisure activities. Frequencies and the Chi-square test were used. RESULTS: Questionnaires from 4563 adolescents were analysed, 57.9% had pain in the last three months (main pain in the spine: 11.6%; main pain in the lower limb: 29.0%). Of those, 69.4% and 62.4% reported recurrent pain in the spine and lower limb, respectively. Recurrent pain was more frequent in girls than in boys (spine: 80.0%; 57.0%; lower limb: 70.4%; 58.1% respectively). Pain lasted more than three months in most adolescents (spine: about 60%; lower limb: above 50%); frequency was similarly high in both regions and both sexes (girls: 47.0%; boys: 45.7% in the spine; girls: 45.7%; boys: 40.3% in the lower limb); intensity was rated as high by girls (spine: 45.5%; lower limb: 47.3%) and moderate by boys (spine: 42.0%; lower limb: 41.0%). The leading causes of pain were daily living activities, both for the spine (girls: 65.9%; boys: 76.5%) and the lower limb (girls: 62.2%; boys: 72.1%). Psychosocial causes were the second most common cause of spinal pain (girls: 25.0%; boys: 21.0%). Other causes of lower limb pain were traumatic (girls: 25.5%; boys: 16.6%) and physical factors (girls: 20.7%; boys: 23.8%). Absences from school (girls: 11.7%; boys: 4.8%) and restrictions of leisure activities (girls: 20.7%; boys: 25.2%) were more related to pain in the lower limb. CONCLUSION: More than half of the adolescents reported spinal or lower limb recurrent pain, which presents a higher frequency, higher intensity, and longer duration in the spine. However, lower limb pain led to more concurrent limitations.
Asunto(s)
Extremidad Inferior , Recurrencia , Humanos , Masculino , Femenino , Adolescente , Estudios Transversales , Prevalencia , Extremidad Inferior/fisiopatología , Portugal/epidemiología , Encuestas y Cuestionarios , Dimensión del Dolor , Dolor de Espalda/epidemiologíaRESUMEN
The objective was to explore the mediating role of leisure-time physical activity on the correlation between back pain and disability. A mediation analysis was conducted among the cross-sectional sample of 1330 patients in outpatient clinic. The average age was 47.6â years and 64% were women. For the entire sample, the mediating effect of physical activity remained below 10% of the total effect. The mediating effect was significantly greater among women comparing to men - up to 19.0% [95% confidence interval (CI) 10.4-27.6%] versus 2.3% (95% CI 0.0-6.1%). The effect did not significantly differ based on age, BMI, or educational or professional status. Some insignificant trends, however, could be seen - the effect was possibly stronger among patients with higher educational level and those with higher BMI. The results suggested that while physical activity seems to be a weak mediator, its mediating role might vary across different groups of patients with back pain. This variation should be taken into account when planning rehabilitation measures for people with back pain.
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Dolor de Espalda , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Transversales , Dolor de Espalda/rehabilitación , Adulto , Evaluación de la Discapacidad , Índice de Masa Corporal , Actividad Motora/fisiología , Actividades Recreativas , Ejercicio Físico , Anciano , Factores Sexuales , Escolaridad , Análisis de MediaciónRESUMEN
Objective: To determine the effects of the cervicothoracic mobility programme on pain, range of motion and function in patients with chronic back pain. METHODS: The randomised controlled trial was conducted from April to November 2022 at the Physiotherapy Department of Syed Medical Complex, Sialkot, Pakistan, and comprised patients of either gender aged 18-50 years who had a minimum of 6 months of chronic back pain with moderate disability. They were randomly allocated to experimental group A and control group B. Group A subjects received cervical and thoracic mobilisation with conventional physical therapy, while group B subjects received conventional physical therapy alone. The treatment duration was 45 minutes per session, with 3 sessions per week for 3 weeks. Numeric Pain Rating Scale, Oswestry Disability Index and a goniometer was used to assess pain, disability and for the range of motion. Data was analysed using SPSS 25. RESULTS: Of the 44 patients, 22(50%) were in each of the 2 groups. Group A had 14(63.6%) females and 8(36.4%) males with overall mean age 36.45±10.80 years, while group B had 16(72.7%) females and 6(27.3%) males with overall mean age 35.77±11.05 years. There was a significant inter-group difference in terms of pain, function and flexion (p<0.05), while the difference was not significant in terms of extension, right and left lateral rotation (p>0.05). Intragroup analysis showed significant improvement in both groups (p<0.05). Conclusion: Cervicothoracic mobilisation was more effective in improving pain, functionality and range of motion in patients with chronic low back pain. ClinicalTrial gov Identifier: NCT05347251.
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Dolor Crónico , Modalidades de Fisioterapia , Rango del Movimiento Articular , Vértebras Torácicas , Humanos , Masculino , Femenino , Adulto , Dolor Crónico/terapia , Dolor Crónico/fisiopatología , Persona de Mediana Edad , Adulto Joven , Dimensión del Dolor , Vértebras Cervicales , Dolor de Espalda/terapia , Evaluación de la Discapacidad , Adolescente , Terapia por Ejercicio/métodosRESUMEN
BACKGROUND: In contrast to prior research, our study presents longitudinal comparisons of the EQ-5D-5L and Patient-Reported Outcomes Measurement Information System (PROMIS) preference (PROPr) scores. This fills a gap in the literature, providing a much-needed understanding of these preference-based measures and their applications in healthcare research. Furthermore, our study provides equations to estimate one measure from the other, a tool that can significantly facilitate comparisons across studies. METHODS: We administered a health survey to 4,098 KnowledgePanel® members living in the United States. A subset of 1,256 (82% response rate) with back pain also completed the six-month follow-up survey. We then conducted thorough cross-sectional and longitudinal analyses of the two measures, including product-moment correlations between scores, associations with demographic variables, and health conditions. To estimate one measure from the other, we used ordinary least squares (OLS) regression with the baseline data from the general population. RESULTS: The correlation between the EQ-5D-5L and PROPr scores was 0.69, but the intraclass correlation was only 0.34 because the PROPr had lower (less positive) mean scores on the 0 (dead) to 1 (perfect health) continuum than the EQ-5D-5L. The associations between the two preference measures and demographic variables were similar at baseline. The product-moment correlation between unstandardized beta coefficients for each preference measure regressed on 22 health conditions was 0.86, reflecting similar patterns of unique associations. Correlations of change from baseline to 6 months in the two measures with retrospective perceptions of change were similar. Adjusted variance explained in OLS regressions predicting one measure from the other was 48%. On average, the predicted values were within a half-standard deviation of the observed EQ-5D-5L and PROPr scores. The beta-binomial regression model slightly improved over the OLS model in predicting the EQ-5D-5L from the PROPr but was equivalent to the OLS model in predicting the PROPr. CONCLUSION: Despite substantial mean differences, the EQ-5D-5L and PROPr have similar cross-sectional and longitudinal associations with other variables. We provide the OLS regression equations for use in cost-effectiveness research and meta-analyses. Future studies are needed to compare these measures with different conditions and interventions to provide more information on their relative validity.
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Medición de Resultados Informados por el Paciente , Calidad de Vida , Humanos , Estados Unidos , Masculino , Femenino , Persona de Mediana Edad , Estudios Transversales , Adulto , Estudios Longitudinales , Anciano , Encuestas y Cuestionarios , Prioridad del Paciente/estadística & datos numéricos , Dolor de Espalda/psicología , Adulto Joven , Adolescente , Encuestas EpidemiológicasRESUMEN
Chronic spinal pain (CSP) is a prevalent condition, and prolonged sitting at work can contribute to it. Ergonomic factors like this can cause changes in motor variability. Variability analysis is a useful method to measure changes in motor performance over time. When performing the same task multiple times, different performance patterns can be observed. This variability is intrinsic to all biological systems and is noticeable in human movement. This study aims to examine whether changes in movement variability and complexity during real-time office work are influenced by CSP. The hypothesis is that individuals with and without pain will have different responses to office work tasks. Six office workers without pain and ten with CSP participated in this study. Participant's trunk movements were recorded during work for an entire week. Linear and nonlinear measures of trunk kinematic displacement were used to assess movement variability and complexity. A mixed ANOVA was utilized to compare changes in movement variability and complexity between the two groups. The effects indicate that pain-free participants showed more complex and less predictable trunk movements with a lower degree of structure and variability when compared to the participants suffering from CSP. The differences were particularly noticeable in fine movements.