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Low Back Pain Management: Clinical Advances and Perspectives

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (20 July 2024) | Viewed by 33644

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Dr. Maryse Fortin

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Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
Interests: low back pain; musculoskeletal health; multifidus; paraspinal muscle; spine imaging; rehabilitation; cervical spondylotic myelopathy; sports injury
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Special Issue Information

Dear Colleagues,

Low back pain (LBP) is a worldwide public health concern, carrying the greatest disability burden globally, both in terms of disability-adjusted life years and years lived with disability. This economically and socially burdensome musculoskeletal condition prevails, despite nearly 30 years of data from clinical trials. While exercise therapy is widely endorsed by clinical guidelines and systematic reviews, effect sizes between exercise approaches remain small. This is likely due to the heterogeneity in clinical presentations, lack of tailored treatment approaches and inapproriate exercise dose prescription. Indeed, the mutifactorial biopsychosocial environement aetiology of LBP is now widely recognized, and there is palpable interest from clinicians and researchers for the development of evidence-based stratified care models. Selecting the most appropriate treatment options, based on frameworks that integrate pain mechanisms, physical deficits along with a complete consideration of personal and environemental factors is a plausible approach to improve outcomes. To date, however, while promising multi-dimensional risk stratification tools and biopsychosocial models exist, they have been poorly integrated or tested in clinical trials. Furthermore, while altered paraspinal muscle composition is a key finding in chronic LBP, the effect of exercise therapy on paraspinal muscle morphology and function remains poorly understood. Recent literature on this topic emphasized the need for high-quality trials, with consensus-driven methodologies, larger sample sizes and longer exercise treatment durations with higher intensity/dose prescription.

With these points in mind, the Journal of Clinical Medicine is launching this Special Issue to update many clinical advances and perspectives for the treatment of LBP. A number of topics will be considered: epidemiological data, prevention, exercise and therapeutic treatment approaches and paraspinal muscle health. We warmly invite you to submit articles reporting on the evidence and expectations from targeted therapeutic interventions, with a special focus on individualized approaches. Manuscripts may differ from literature reviews to original research (e.g., clinical trials, cohort studies, case control studies). We particularly welcome multidisciplinary projects with high translational potential for clinical practice.

Dr. Maryse Fortin
Guest Editor

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Keywords

low back pain
exercise therapy
paraspinal muscle
precision medicine
conservative treatment

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Published Papers (10 papers)

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Research

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14 pages, 737 KiB

Open AccessArticle

Novel Insight into the Association between Balneotherapy and Functional State and Health Perception in Chronic Low Back Pain: A Cross-Sectional Study

by Dragana Terzic Markovic, Sanja Kocic, Jovana Bradic, Aleksandra Jurisic-Skevin, Biljana Jakovljevic, Biljana Majstorovic, Zvonko Dimoski, Goran Stojanovic, Vesna Maksimovic, Katarina Pavlovic Jugovic, Marijana Dabic, Danijela Jezdimirovic and Sandra Zivanovic

J. Clin. Med. 2024, 13(17), 5248; https://doi.org/10.3390/jcm13175248 - 5 Sep 2024

Cited by 1 | Viewed by 1724

Abstract

Background: Epidemiological data indicate that low back pain (LBP) affected 619 million people globally in 2020, representing a significant health and economic burden. Additionally, chronic LBP (cLBP) strongly impairs quality of life and leads to disability and premature retirement, thus emphasizing the need for providing deeper insight into the factors that affect treatment outcomes and for offering thorough guidance for the assessment and management of this condition. Taking into consideration the rising prevalence of cLBP and the knowledge gap referring to the overall health benefits of balneotherapy (BT), the aim of this study was to assess the effects of BT on functional status, quality of life, and psychological symptoms in patients with cLBP. Methods: Among 220 patients from the database, two groups were retrospectively identified: patients receiving conventional pharmacological therapy (CT) and patients receiving BT. The effectiveness of the treatment was assessed through a visual analog scale for pain intensity, EuroQol (EQ-5D), and the Work Ability Index Questionnaire. In order to provide deeper insight into the quality of life and also factors associated with functional status and mental health affected by BT, we also used the Short Form Health Survey Questionnaire and the Center of Epidemiologic Studies Depression Scale. Results: Both age and treatment protocol were found to have a significant impact on all observed parameters, i.e., older patients and those receiving CT tended to report lower overall health and physical functioning. On the other hand, BT was associated with better functionality and disability perception status. Conclusions: Understanding the association between individual perceptions of functionality and its emotional and social elements provides a basis for providing comprehensive guidelines and recommendations for cLBP management. Full article

(This article belongs to the Special Issue Low Back Pain Management: Clinical Advances and Perspectives)

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13 pages, 3295 KiB

Open AccessArticle

A Retrospective Observational Study to Evaluate Adjacent Segmental Degenerative Change with the Dynesys-Transition-Optima Instrumentation System

by Chi-Ruei Li, Shih-Hao Chen, Wen-Hsien Chen, Hsi-Kai Tsou, Chung-Yuh Tzeng, Tse-Yu Chen and Mao-Shih Lin

J. Clin. Med. 2024, 13(2), 582; https://doi.org/10.3390/jcm13020582 - 19 Jan 2024

Viewed by 1188

Abstract

Background: This study evaluates the impact of hybrid dynamic stabilization using the Dynesys-Transition-Optima (DTO) system on adjacent segment disease (ASD) in lumbar spinal stenosis patients with spondylolisthesis. Methods: From 2012 to 2020, 115 patients underwent DTO stabilization at a single center by a single neurosurgeon. After exclusions for lack of specific stabilization and incomplete data, 31 patients were analyzed. Follow-up was conducted at 6, 12, and 24 months postoperatively, assessing disc height, listhesis distance, and angular motion changes at L2–L3, L3–L4, and L5–S1. Results: L3–L4 segment (the index level), demonstrated a delayed increase in listhesis distance, contrasting with earlier changes in other segments. At two years, L3–L4 exhibited less increase in listhesis distance and less disc height reduction compared to L2–L3 and L5–S1. Notably, the L3–L4 segment showed a significant reduction in angular motion change over two years. Conclusions: In conclusion, while ASD was not significantly prevented, the study indicates minor and delayed degeneration at the index level. The L3–L4 segment experienced reduced angular change in motion, suggesting a potential benefit of DTO in stabilizing this specific segment. Full article

(This article belongs to the Special Issue Low Back Pain Management: Clinical Advances and Perspectives)

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18 pages, 1502 KiB

Open AccessArticle

Effects of Multidisciplinary Biopsychosocial Rehabilitation on Short-Term Pain and Disability in Chronic Low Back Pain: A Systematic Review with Network Meta-Analysis

by Ivan Jurak, Kristina Delaš, Lana Erjavec, Janez Stare and Igor Locatelli

J. Clin. Med. 2023, 12(23), 7489; https://doi.org/10.3390/jcm12237489 - 4 Dec 2023

Cited by 4 | Viewed by 5043

Abstract

Chronic low back pain (CLBP) is a significant public health issue, with prevalence intensifying due to an ageing global population, amassing approximately 619 million cases in 2020 and projected to escalate to 843 million by 2050. In this study, we analyzed the effects of multidisciplinary biopsychosocial rehabilitation (MBR) on pain and disability. To address this question, we conducted a PRISMA-guided systematic review and random-effect network meta-analysis on studies collected from six electronic databases. The network comprised diverse MBR modalities (behavioral, educational, and work conditioning) alongside exercise therapy (ET), minimal intervention, and usual care, with pain and disability as outcomes. Ninety-three studies were included, encompassing a total of 8059 participants. The NMA substantiated that both ET and MBR modalities were effective in alleviating CLBP, with education-oriented MBR emerging as the most efficacious for pain mitigation (MD = 18.29; 95% CI = 13.70; 22.89) and behavior-focused MBR being the most efficacious for disability reduction (SMD = 0.88; 95% CI = 0.46; 1.30). Nevertheless, the discerned differences amongst the treatments were minimal and uncertain, highlighting that no modality was definitively superior to the others. Given the intricate nature of CLBP, embodying various facets, our findings advocate for a combined therapeutic approach to optimize treatment efficacy. Full article

(This article belongs to the Special Issue Low Back Pain Management: Clinical Advances and Perspectives)

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14 pages, 1019 KiB

Open AccessArticle

Effects of a Therapeutic Exercise Protocol for Patients with Chronic Non-Specific Back Pain in Primary Health Care: A Single-Group Retrospective Cohort Study

by Juan Nicolás Cuenca-Zaldívar, Josué Fernández-Carnero, Eleuterio A. Sánchez-Romero, Verónica Álvarez-Gonzalo, Rocío Conde-Rodríguez, David Rodríguez-Sanz and César Calvo-Lobo

J. Clin. Med. 2023, 12(20), 6478; https://doi.org/10.3390/jcm12206478 - 12 Oct 2023

Cited by 20 | Viewed by 3369

Abstract

Background: Back pain is highly prevalent; in Spain, it produces a very high economic cost and the scientific evidence supporting treatments shows low to moderate evidence for exercise. Therefore, the aim of this study was to assess the effectiveness of a therapeutic group exercise protocol in reducing pain intensity and disability in patients with back pain in primary health care setting. Methods: A total sample of 149 patients who suffered from chronic non-specific back pain was selected. Patients received a therapeutic exercise protocol, including auto-mobilization exercises for the neck and lumbar regions, as well as core stabilization exercises. Pain intensity and disability were evaluated before and after the therapeutic exercise protocol. Results: Statistically significant differences (p < 0.05) were shown in pain intensity and disability for patients with non-specific neck and low-back pain, with an effect size from moderate to large. Conclusions: A therapeutic exercise protocol may provide beneficial effects upon disability and pain intensity in patients with chronic non-specific back pain, including neck and low-back pain conditions In addition, It could be considered for inclusion as a back-pain-approach program in primary healthcare. Full article

(This article belongs to the Special Issue Low Back Pain Management: Clinical Advances and Perspectives)

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11 pages, 1880 KiB

Open AccessArticle

Magnetic Resonance Imaging Evaluation of Multifidus Muscle in Patients with Low Back Pain after Microlumbar Discectomy Surgery

by Halil Cihan Kose and Serdar Onur Aydin

J. Clin. Med. 2023, 12(19), 6122; https://doi.org/10.3390/jcm12196122 - 22 Sep 2023

Cited by 1 | Viewed by 2265

Abstract

Cross-sectional area (CSA) and signal intensity ratio (SIR) of the multifidus muscle (MFM) on magnetic resonance imaging (MRI) was used to evaluate the extent of injury and atrophy of the MFM in patients with negative treatment outcomes following microlumbar discectomy (MLD). Negative treatment outcome was determined by pain score improvement of <50% compared to baseline. Patients in groups 1, 2, and 3 were evaluated at <4 weeks, 4–24 weeks, and >24 weeks postoperatively, respectively. The associations between the follow-up, surgery time and the changes in the MFM were evaluated. A total of 79 patients were included, with 22, 27, and 30 subjects in groups 1, 2, and 3, respectively. The MFM SIR of the ipsilateral side had significantly decreased in groups 2 (p = 0.001) and 3 (p < 0.001). The ipsilateral MFM CSA significantly decreased postoperatively in groups 2 (p = 0.04) and 3 (p = 0.006). The postoperative MRI scans found significant MFM changes on the ipsilateral side in patients with negative treatment outcomes regarding pain intensity following MLD. As the interval to the postoperative MRI scan increased, the changes in CSA of the MFM and change in T2 SIR of the MFM showed a tendency to increase. Full article

(This article belongs to the Special Issue Low Back Pain Management: Clinical Advances and Perspectives)

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22 pages, 2334 KiB

Open AccessArticle

The Effects of Combined Motor Control and Isolated Extensor Strengthening versus General Exercise on Paraspinal Muscle Morphology, Composition, and Function in Patients with Chronic Low Back Pain: A Randomized Controlled Trial

by Maryse Fortin, Meaghan Rye, Alexa Roussac, Chanelle Montpetit, Jessica Burdick, Neda Naghdi, Brent Rosenstein, Cleo Bertrand, Luciana G. Macedo, James M. Elliott, Geoffrey Dover, Richard DeMont, Michael H. Weber and Véronique Pepin

J. Clin. Med. 2023, 12(18), 5920; https://doi.org/10.3390/jcm12185920 - 12 Sep 2023

Cited by 9 | Viewed by 3455

Abstract

Low back pain (LBP), a globally widespread and persistent musculoskeletal disorder, benefits from exercise therapy. However, it remains unclear which type leads to greater changes in paraspinal muscle health. This study aimed to (1) compare the effects of a combined motor control and isolated lumbar extension exercise (MC+ILEX) versus a general exercise (GE) intervention on paraspinal muscle morphology, composition, and function, and (2) examine whether alterations in paraspinal muscle health were correlated with improvements in pain, function, and quality of life. Fifty participants with chronic LBP were randomly assigned to each group and underwent a 12-week supervised intervention program. Magnetic resonance imaging and ultrasound assessments were acquired at baseline, 6 and 12 weeks to examine the impact of each intervention on erector spinae (ES) and multifidus (MF) muscle size (cross-sectional area, CSA), composition, and function at L4-L5 and L5-S1. Self-reported questionnaires were also acquired to assess participant-oriented outcomes. Our findings indicated that the MC+ILEX group demonstrated greater improvements in MF and ES CSA, along with MF thickness at both levels (all p < 0.01). Both groups significantly improved in pain, function, and quality of life. This study provided preliminary results suggesting that an MC+ILEX intervention may improve paraspinal morphology while decreasing pain and disability. Full article

(This article belongs to the Special Issue Low Back Pain Management: Clinical Advances and Perspectives)

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10 pages, 837 KiB

Open AccessArticle

Is There an Association between Post-Traumatic Stress Disorder and the Incidence of Chronic Low Back Pain?

by Karel Kostev, Lee Smith, Josep Maria Haro, Marcel Konrad, Ai Koyanagi and Louis Jacob

J. Clin. Med. 2023, 12(17), 5753; https://doi.org/10.3390/jcm12175753 - 4 Sep 2023

Cited by 1 | Viewed by 1799

Abstract

Background: Preliminary research suggests post-traumatic stress disorder (PTSD) is a risk factor for chronic low back pain (CLBP). However, this literature displays some limitations. Therefore, this study aimed to investigate the association between PTSD and the 10-year cumulative incidence of CLBP in adults from Germany. Methods: The present retrospective cohort study included adults diagnosed with PTSD in 1 of 1284 general practices in Germany in 2005–2020 (index date). Individuals without PTSD were matched to those with PTSD (1:1) using a propensity score based on age, sex, index year, duration of follow-up, and the mean number of consultations during follow-up. In patients without PTSD, the index date was a randomly selected visit date. Results: There were 60,664 patients included in the study. After adjusting for frequent comorbidities, there was a positive but non-significant association between PTSD and incident CLBP in the overall population (HR = 1.07, 95% CI = 0.99–1.15). Nonetheless, the relationship between PTSD and CLBP was statistically significant in the age group >60 years (HR = 1.24, 95% CI = 1.05–1.46). Conclusions: Conversely to previous research, PTSD was not associated with incident CLBP in this large German sample. Further longitudinal studies are warranted to corroborate these findings before drawing any firm conclusions. Full article

(This article belongs to the Special Issue Low Back Pain Management: Clinical Advances and Perspectives)

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Review

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28 pages, 1281 KiB

Open AccessReview

Diagnosis Value of Patient Evaluation Components Applicable in Primary Care Settings for the Diagnosis of Low Back Pain: A Scoping Review of Systematic Reviews

by Janny Mathieu, Mégane Pasquier, Martin Descarreaux and Andrée-Anne Marchand

J. Clin. Med. 2023, 12(10), 3581; https://doi.org/10.3390/jcm12103581 - 21 May 2023

Cited by 4 | Viewed by 3885

Abstract

Low back pain ranks as the leading cause of years lived with disability worldwide. Although best practice guidelines share a consistent diagnostic approach for the evaluation of patients with low back pain, confusion remains as to what extent patient history and physical examination findings can inform management strategies. The aim of this study was to summarize evidence investigating the diagnostic value of patient evaluation components applicable in primary care settings for the diagnosis of low back pain. To this end, peer-reviewed systematic reviews were searched in MEDLINE, CINAHL, PsycINFO and Cochrane databases from 1 January 2000 to 10 April 2023. Paired reviewers independently reviewed all citations and articles using a two-phase screening process and independently extracted the data. Of the 2077 articles identified, 27 met the inclusion criteria, focusing on the diagnosis of lumbar spinal stenosis, radicular syndrome, non- specific low back pain and specific low back pain. Most patient evaluation components lack diagnostic accuracy for the diagnosis of low back pain when considered in isolation. Further research is needed to develop evidence-based and standardized evaluation procedures, especially for primary care settings where evidence is still scarce. Full article

(This article belongs to the Special Issue Low Back Pain Management: Clinical Advances and Perspectives)

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Other

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14 pages, 3887 KiB

Open AccessProtocol

The Effect of an Active Break Intervention on Nonspecific Low Back Pain and Musculoskeletal Discomfort during Prolonged Sitting among Young People—Protocol for a Randomized Controlled Trial

by Magdalena Plandowska, Marta Kinga Labecka, Aleksandra Truszczyńska-Baszak, Maciej Płaszewski, Reza Rajabi, Beata Makaruk and Dorota Różańska

J. Clin. Med. 2024, 13(2), 612; https://doi.org/10.3390/jcm13020612 - 22 Jan 2024

Cited by 2 | Viewed by 3241

Abstract

Background: The most recent evidence has shown that the pandemic of COVID-19 caused an increasing problem with spinal pain in the population of teenagers and young adults. This may be explained by prolonged sitting times in flexed positions with electronic devices. Positions maintained for a prolonged time cause overloading of soft tissue and discogenic symptoms. This study aims to evaluate the effectiveness of the active break program in reducing musculoskeletal discomfort and LBP (low back pain) among young people. Methods: This will be a randomized controlled study. The participants will be recruited from Bachelor’s course students of the Physical Education Department aged 18–25 years. The participants will be assigned to an experimental group (with an active break) and a control group. The group with an active break with lumbar and hip extension exercises will be recommended to take a break for every 30 min of sitting. The control group will receive self-care recommendations. The primary outcomes will be pain intensity (Visual Analogue Scale), disability index (Oswestry Disability Index), and perceived musculoskeletal discomfort during prolonged sitting (Borg scale), assessed at baseline and after the intervention, and the Global Perceived Effect, only assessed after the 12-week intervention. The secondary outcome will be a Post-Intervention Questionnaire (a 5-item self-completed questionnaire), only assessed after the 12-week intervention. Results: Our main research outcome—exercise protocols and interventions—will lead to the development of recommendations and protocols for the LBP population. It is important to determine the effect of interventions that are feasible and effective in addressing LBP and perceived musculoskeletal discomfort in young people. Conclusions: This is the first study examining the effect of active breaks with proposed lumbar and hip extension exercises on reducing or decreasing LBP in students based on a search of the literature. Exercises and recommendations will be the basis for developing proprietary preventative and therapeutic programs, which will be implemented in selected educational institutions. Full article

(This article belongs to the Special Issue Low Back Pain Management: Clinical Advances and Perspectives)

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16 pages, 2593 KiB

Open AccessSystematic Review

The Effect of Transcutaneous Electrotherapy on Lumbar Range of Motion and Paraspinal Muscle Characteristics in Chronic Low Back Pain Patients: A Systematic Review and Meta-Analysis

by Daniel Wolfe, Brent Rosenstein and Maryse Fortin

J. Clin. Med. 2023, 12(14), 4680; https://doi.org/10.3390/jcm12144680 - 14 Jul 2023

Cited by 6 | Viewed by 4136

Abstract

Chronic low back pain (CLBP) affects paraspinal muscle size, quality (e.g., fatty infiltration), range of motion (ROM), and strength. Although transcutaneous electrotherapies are used to treat CLBP, their effects on paraspinal-related outcomes are not fully known. The aim of this systematic review and meta-analysis was to assess the overall effect of transcutaneous electrotherapies on trunk/lumbar ROM, paraspinal muscle morphology, and trunk muscle function (including strength and endurance) in CLBP patients. A systematic search of four databases and two study registers was conducted between 1 February 2022 and 15 September 2022. Two reviewers were responsible for screening and data extraction. Of the 3939 independent records screened, 10 were included in the systematic review and 2 in the meta-analysis. The results suggest there is limited evidence that both EMS and EMS plus exercise are superior to passive and active controls, respectively, for improving trunk muscle endurance. There is limited evidence that neither TENS nor mixed TENS are superior to controls for improving trunk muscle endurance. There is limited evidence that NMES is superior to passive controls for improving trunk muscle strength. The effect of transcutaneous electrotherapy on the other investigated outcomes was inconclusive. Future transcutaneous electrotherapy studies should focus on paraspinal-based outcomes that are under-studied. Full article

(This article belongs to the Special Issue Low Back Pain Management: Clinical Advances and Perspectives)

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