Protocol for lower back pain management: Insights from the French healthcare system

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.

Comparative pilot study on the effects of pulsating and static cupping on non-specific neck pain and local skin blood perfusion

Objective:To compare the effects of pulsating and static cupping on non-specific neck pain and local skin microcirculation blood perfusion,which is a pilot study.Methods:Seventy participants with non-specific neck pain were randomized to the following groups:low-frequency pulsating cupping(LF,n=20);high-frequency pulsating cupping(HF,n=20);static cupping(SC,n=20),or waiting list(WL,n=10).The LF,HF,and SC received a bilateral 10-minute cupping treatment at Jianzhongshu(SI 15).Outcomes were pain intensity(visual analog scale,VAS),functional status(Neck Disability Index,NDI),and skin blood perfusion at the SI 15,Dazhui(GV 14),and Shenzhu(GV 12)acupoint areas,measured using Laser Speckle Contrast Analysis technology.Results:Both LF and HF groups showed a significant reduction in VAS scores compared with the SC group(9.00,95%Cl 1.05-16.95,P=.027;8.75,95%CI 0.80-16.70,P=.031).There was no significant difference in VAS scores between the LF and HF groups(P>.05)and between NDI scores measured 3 days after intervention among the four groups(P>.05).In the SI 15 area,blood perfusion in the three treatment groups was higher than that in WL group(P<.01),and the perfusion unit(PU)of the HF pulsating group at 5 minutes after intervention was significantly higher compared with the SC group(P<.05).In the GV 14 area,blood perfusion in the two pulsating cupping groups was higher compared with the WL and SC groups after cupping(P<.05).In the GV 12 area,the PU of the LF group was higher compared with the other three groups only at the time of cup removal(P<.05).Conclusion:This study showed that pulsating cupping may have more favorable analgesic effects on non-specific neck pain compared with static cupping,which may be related to its better effect on improving the local skin blood perfusion.

Research progress of non-specific neck pain in traditional Chinese medicine and western medicine

Non-specific neck pain is a common disease in clinic,and its pathogenesis is not clear.With the progress of the times and the change of living and working habits,the incidence of non-specific neck pain is increasing year by year,which has a great impact on people’s physical and mental health,work and life.Traditional Chinese medicine mainly treats non-specific neck pain by acupuncture and massage,while western medicine generally uses exercise and manipulation therapy,but the quality of clinical evidence of all kinds of therapy is not high,which needs to be verified.This paper summarizes the research progress of traditional Chinese medicine and western medicine in the treatment of non-specific neck pain from the aspects of pathogenesis,etiology and pathogenesis of traditional Chinese medicine,and treatment of traditional Chinese medicine and western medicine,so as to provide reference for doctors in clinical treatment of this disease.

Thermal Therapy in Patients Suffering from Non-Specific Chronic Low Back Pain—A Systematic Review

Thermal therapy is frequently used as an adjunct to treatment in patients suffering from chronic low back pain. It is also an inherent part of patients’ self-administered pain treatment. This review aims to update the evidence for thermal therapy treatments in non-specific chronic low back pain patients and to rate the methodological quality of the corresponding clinical trials. Previous studies have reported contradictory evidence for the effectiveness of thermal therapy. An electronic search on MEDLINE (PubMed), PEDro, CENTRAL and CINHAL databases was conducted between May 2016 and February 2018. Clinical trials comparing local thermal therapy to conservative or no treatment were assessed for eligibility. Pain, physical function and global health were defined as outcome parameters. A total of n = 9 studies met the inclusion criteria. All of them applied an electrophysical agent as the thermal treatment: continuous ultrasound (n = 6), short-wave diathermy (n = 2), microwave diathermy (n = 1). Out of the n = 6 studies on ultrasound treatment, n = 2 reported significant within and between-group results for pain reduction after 4 to 6 weeks of treatment. Both short-wave diathermy studies demonstrated significant between-group results for pain reduction after 3 weeks of treatment. Contradictory results for all other observed outcome parameters were reported regardless of the intervention. Moreover, significant within-group results for the control groups questioned the effectiveness of the intervention treatments. Therefore, the effect of thermal therapy, (electrophysical agents), is not superior to any control treatment except for ultrasound treatment on short-term pain reduction.

Non-specific Arm Pain

Non-specific arm pain is a special clinical condition that can occur in work-related activities that involve maintaining a static position for prolonged periods or repetitive and frequent movements of the hand or entire arm. Such activities include typing on a keyboard, maneuvering a computer mouse, playing musical instruments （such as piano and guitar） and many forms of manual labor. The pain is dull and diffuse; It is localized in the forearm or in the hand but quickly can expand to the entire extremity. Non-specific arm pain is the most frequent type of work-related pain after lower-back pain. It thus has important socio-economic significance as a major cause of absence from work. The designation of ＂non-specific＂ originates from the fact that it has no obvious signs of tissue damage, unlike the ＂specific＂ pain accompanying carpal tunnel syndrome, tenosinovitis de Quervain, or lateral epicondylitis. Suggested causes of the pain include microtrauma of soft tissue followed by an inflammatory reaction, ischemia, fatigue, hyper-sensitization of nociceptors, focal dystonia of the hand and/or psychological stress. Treatment consists of application of NSAIDs, physical modalities, stretching and aerobic exercises. Prevention focuses on ergonomic modification during manual labor or work on a computer.

Mucocele of the appendix: An unusual cause of lower abdominal pain in a patient with ulcerative colitis-. A case report and review of literature

The authors report the case of a 60-year-old male patient. In November 2001 he developed intestinal symptoms of bloody diarrhea and abdominal pain. Colononoscopy and biopsy established the diagnosis of ulcerative colitis (proctosigmoiditis). The disease activity was moderate at the beginning. No significant laboratory alterations were found (including CEA, CA19-9), and mesalazine was started orally. He was in remission until November 2003, when he was admitted to our Outpatient Clinic for upper and right lower abdominal pain and bloody diarrhea. Colonoscopy found proctosigmoiditis with a moderate activity, gastroscopy revealed chronic gastritis, laboratory data was normal. Treatment was amended with mesalazine clysma and methylprednisolone (16 mg) orally. Symptoms ameliorated; however, right lower abdominal pain persisted. US and CT examinat'on demonstrated a pericecal cystic mass (11 cm×3.5 cm). At first pericecal abscess was suspected, as the previous US examination (6 mo earlier) had revealed normal findings. Fine needie aspiration was performed. Cytology confirmed the diagnosis of mucocele. The patientunderwent partial cecum resection and extirpation of the mucocele. He recovered well and the final histology revealed a cystadenoma of the appendix. Follow up was started. The pati雗t is now free of symptoms. Although primary adenocarcinoma of the appendix is uncommon, the authors emphasize that preoperative diagnosis of an underlying malignancy in a mucocele is important for pati雗t management; however, it is difficult on imaging studies.

CLINICAL OBSERVATIONS ON THE SELECTION OF ABDOMINAL ACUPOINTS TO RELIEVE LOWER LUMBAR PAIN

This paper discusses the selection of abdominal area kidney and meridian acupoints120 patients suffering from lower lumbar pain using the fingers to press the acupoints. Althoughthe types of ailments, mildness or severity of the patients’ conditions f and duration of illness var-ied, in all cases satisfactory treatment results were achieved. The average effective rate was 97.5%. The average rate of cure (complete recovery rate) was 73.3%. Patients who had sufferedfrom symptoms for a period of less than one year and patients afflicted with mild or moderate con-ditions enjoyed the most outstanding treatment results. The advantages of this treatment method or technique are as follows: 1. This method ortechnique brings the distinctive dynamics of traditional Chinese medicine theory and meridian the-ory into full play. 2. This method of treatment uses neither acupuncture needles nor moxibus-tion. It merely utilizes the fingers to press certain acupoints. It is simple, convenient and easy toimplement.It is

Effect of ankle versus thigh tourniquets on post-operative pain in foot and ankle surgery

BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of use.There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken.Intraoperative tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h post-op.Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation coefficient.RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh.There was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 h.There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h post-operatively.CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle surgery.The choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.

An exceptional cause of left lower quadrant abdominal pain

Acute appendidtis is an exceptional cause of left lower quadrant abdominal pain. Computed tomography scan is the key to its diagnosis and helps to establish its early treatment. We present a case of a 35-year-old male patient who presented acute appendicitis with redundant and loosely attached cecum which was diagnosed based on his left lower quadrant abdominal pain.

An Exercise Rehabilitative Solution to Work-Related Musculoskeletal Lower Back Pain among Nurses

The attrition of professional nurses is a sad reality. Work-related musculoskeletal lower back pain (WRMLBP) among nurses has been cited as a factor of increased sick leave and poor health. Occupational predisposing factors of lower back pain are strenuous physical stresses of nursing, obesity and poor physical conditioning. Regular stretching and strengthening exercises dissipate lower back pain. This commentary’s objectives are to explain the association between obesity and lower back pain and the exercise mechanism that dissipates this pain, thereby concluding that nurses should consider regular exercise as a therapeutic option.

Epiploic appendagitis as an uncommon cause of lower abdominal pain

Epiploic appendagitis should be considered to be an uncommon cause of lower abdominal pain. To diagnose accurately, typical CT findings are needed, and total colonoscopy should be done later to rule out the possibility of diverticulosis.

Application of buried auricular point combined with Wenjing Sanhan prescription in arteriosclerosis obliterans patients with resting pain

BACKGROUND Research on the combined use of ear acupoint embedding beans and warming meridians with cold-dispersing formulas for alleviating resting pain in patients with arteriosclerosis obliterans(ASO)remains limited.AIM To explore the therapeutic efficacy of auricular point embedding beans combined with Wenjing Sanhan prescription in alleviating resting pain in patients with lower-limb ASO.METHODS A total of 100 patients with ASO experiencing resting pain who were treated at our hospital from January 2022 to January 2023 were enrolled.They were randomly allocated into two groups using a double-blind approach.The control group was treated using a warming meridian with a cold-dispersing formula,while the study group received additional treatment with ear acupoint embedding beans.The clinical efficacy,ankle-brachial artery pressure ratio,hemorheological indicators,and traditional Chinese medicine symptom scores were compared between the two groups.RESULTS The clinical efficacy rate in the study group was significantly higher(94.00%)than that in the control group(72.00%,P<0.05).Moreover,the ankle-brachial artery pressure ratio was significantly higher in the study group after treatment(P<0.05).Hemorheological parameters,including whole blood viscosity,plasma viscosity(1.83±0.11)mPa/s,fibrinogen levels(3.30±0.21)g/L,platelet adhesion rate(49.87%±10.51%),and erythrocyte aggregation index(1.79±0)were improved in the study group compared to the control group.In addition,the scores for decreased skin temperature(1.41±0.26),intermittent claudication(1.30±0.20),and resting pain(1.23±0.31)were significantly lower in the study group than those in the control group(all P<0.05).The level of oxidative stress in the study group also exhibited significant improvement(P<0.05),and the levels of inflammatory factors were considerably lower than those in the control group.CONCLUSION The combination of ear point embedding beans and Wenjing Sanhan prescription demonstrates promising clinical efficacy in alleviating resting pain associated with ASO.

Bilateral Ectopic Kidneys Presenting as Lower Abdominal Pain

Background: Bilateral Ectopic Kidney is uncommon and usually diagnosed during a routine medical checkup. It could be misdiagnosed as an abdominopelvic mass. In-depth knowledge of its presentation will aid in its management. A poor anatomical relation of the kidneys with other abdominopelvic organs could lead to renal complications and surgical errors. This is of gynaecological importance and worthy of discussion for a lady of her reproductive age. Case presentation: A 20-year-old nulliparous lady of African descent presented with a long-standing history of dull lower abdominal pain. The pain has been intermittent and occasionally associated with a sensation of movement in the lower abdomen. She has a regular and normal menstrual cycle and has no lower urinary tract symptoms. Physical examination was unremarkable with intact secondary sexual characteristics. The abdomen was soft, non-tender and without any organomegaly. Abdominal ultrasonography, renal pyelogram and urinalysis were carried out after her consent was sought in accordance with the institution’s protocol. Urine analysis was normal and culture was negative. However further imaging revealed a bilateral pelvic ectopic kidney. Conclusion: Most of the cases reported are usually unilateral ectopic kidneys. It is, therefore, our belief that this information will be useful to medical practitioners such as surgeons, urologists, radiologists and gynaecologists. Such a diagnosis will enable clinicians to follow up with the client and preserve the renal function whiles preventing iatrogenic injuries during surgical procedures.

Lower Back Pain and Forearm Tendinitis Linked to Irritation of Oral Mucosa by Teeth

We present a case of a woman with refractory lower back pain and forearm tendinitis, which improved dramatically after morphological modification of natural teeth. The subject was a 35-year-old Japanese woman, who was suffering from lower back pain when bending forward and she had severe pain from her right thumb to her wrist. These symptoms were not improved by massage and orthopedic treatment. On the other hand, once modifying the morphology of natural teeth, those symptoms improved dramatically. No side effects were observed, and the prognosis was good. Our observation suggested a close relationship between the oral situation and remote musculoskeletal conditions, and further multidisciplinary studies are needed to clarify the mechanisms.

运动疗法激活臀肌改善青年男性膝前痛患者的下肢肌力

背景:目前发现膝前痛与下肢生物力学有关,但仍缺少臀肌训练对膝关节及下肢日常活动影响的研究。目的:探究臀肌激活运动疗法对青年男性膝前痛患者髋、膝关节肌群肌肉力量和疼痛的影响。方法:纳入25例男性青年膝前痛患者,随机分为2组,臀肌激活组12例和空白对照组13例。臀肌激活组进行40 min/次、3次/周、为期6周的臀肌激活运动;空白对照组不进行任何干预。入组和干预6周后评估患侧髋关节、膝关节在60(°)/s和180(°)/s下等速屈伸运动测试的相对峰力矩、总功、屈伸肌群比值、肌肉耐力值,爬楼运动测试中停止爬楼的楼层,以及目测类比评分。结果与结论:①等速屈伸运动测试:髋关节,干预后臀肌激活组在60(°)/s和180(°)/s的相对峰力矩较干预前显著提高29.74%和25.95%(P=0.022,P=0.024);空白对照组在180(°)/s时的肌耐力较干预前降低12.12%(P=0.000)。膝关节,干预后臀肌激活组在60(°)/s和180(°)/s的相对峰力矩较干预前显著提高18.69%和7.27%(P=0.006,P=0.033);空白对照组各指标干预前后无著性变化(P>0.05)。②爬楼运动测试:臀肌激活组爬楼运动停止时的楼层数较空白对照组高(6.41±6.1)层(P=0.024),干预后较干预前增高(P=0.016);空白对照组干预前后无显著改变(P>0.05)。③疼痛评估:干预后臀肌激活组目测类比评分显著低于空白对照组(P=0.036),干预后较干预前降低(P=0.000);空白对照组干预前后无显著性变化(P>0.05)。结果表明:6周臀肌激活运动疗法可改善下肢肌群的爆发力和耐力,减轻膝前痛程度,对于膝前痛患者有必要进行臀肌训练,以促进康复。

运动疗法通过机械-化学偶联治疗慢性非特异性下背痛

背景:目前运动疗法是非药物治疗腰痛的有效方法,运动疗法可通过骨骼和肌肉之间的机械-化学偶联维持腰椎的稳定,但目前尚无关于运动疗法通过机械-化学偶联缓解慢性非特异性下背痛之间研究进展及最佳治疗方案的明确阐述。目的:综述运动疗法时椎旁肌通过机械-化学偶联影响腰椎稳定性进而缓解慢性非特异性下背痛的相关研究进展,以及目前运动疗法治疗慢性非特异性下背痛的最佳方案。方法:在万方数据库、中国知网、维普、Web of Science和PubMed数据库进行文献检索,以“慢性非特异性下背痛,腰椎稳定,椎旁肌,运动疗法”为中文检索词,以“chronic nonspecific low back pain,lumbar stabilization,paravertebral muscle,exercise therapy”为英文检索词,检索各数据库建库至2024年1月发表的相关文献,最终纳入93篇文献进行归纳总结。结果与结论:运动疗法可以通过适当的机械刺激作用于椎旁肌和骨骼并使其产生相应的变化。运动疗法主要通过机械-化学偶联方式来提高椎旁肌的质量,进而维持腰椎稳定,从而更好地缓解慢性非特异性下背痛,是慢性非特异性下背痛的重要干预措施。但是,对于运动疗法通过腰椎稳定来治疗慢性非特异性下背痛的确切有效方案尚无明确报道。个体化运动方案的制定对于慢性非特异性下背痛的治疗和预后尤为重要。同一个体的肌肉质量与骨骼质量是密切相关的,影像学评估椎旁肌的质量和体积对于疾病的发现和干预具有重要意义。

腰椎融合术后下肢疼痛成因分析

腰椎融合术广泛应用于治疗腰椎退行性疾病,但术后下肢疼痛仍是临床面临的主要挑战之一,了解术后下肢疼痛的成因并尽早采取预防手段,对于降低术后下肢疼痛的发生率有重要意义。这一术后并发症的成因复杂,包括直接原因(如神经根损伤、椎弓根螺钉置入失败、椎间孔狭窄、术后血肿)以及间接原因(如硬膜外纤维化、深静脉血栓形成、神经根过度肿胀)。精神因素和术前腿痛持续时间对术后疼痛也有显著影响。因此,早期识别腰椎融合术后可能发生下肢疼痛的高危人群,选择恰当的术式,并针对性地采取术前措施十分必要。

Effectiveness of a 12-Week Program of Active and Passive Stretching in Improving Low Back and Neck Pain in Japanese Sedentary Men

Purpose: Muscle stretching is frequently prescribed in physical therapy to manage lower back and neck pain. However, there is no clear evidence regarding the differences in effectiveness of active and passive stretching. Therefore, we aimed to evaluate the relative effectiveness of a 12-week program of active and passive stretching on selected physical and mental stress variables of sedentary men with lower back and neck pain. Methods: A cohort of 28 sedentary men, 30 - 49 years old, were divided into two intervention groups: the passive stretching group (PSG, n = 15) and the active stretching group (ASG, n = 13). A trainer assisted with static passive stretching, while participants in the ASG were provided with an instructional video. The following outcomes were measured at the start and end of the first and twelfth week of the stretching program: physical measures (visual analogue scale score of lower back and neck pain;finger-to-floor distance, gravimetric assessment of pelvic tilt, muscle hardness of the biceps femoris, and straight-leg raising) and mental stress measures (α-amylase and cortisol levels in saliva samples). Results: Although both active and passive stretching produced acute changes in lower back and neck pain, only passive stretching yielded long-term improvement in pain, finger-to-floor distance, pelvic tilt, hardness of biceps femoris muscle and cortisol levels (p Conclusion: Passive stretching is superior to active stretching in reducing pain, increasing muscle extensibility and correcting posture among a group of sedentary men with lower back and neck pain.

Effect of Tuina-SET Sling Exercise Therapy on Analgesic Substances in Serum of Patients with Nonspecific Low Back Pain

[Objectives]This paper aimed to investigate the effect of Tuina combined with sling exercise therapy(SET)and psoas&abdominal training on serum 5-hydroxytryptamine(5-HT)andβ-endorphin(β-EP)levels in patients with nonspecific low back pain(NLBP).[Methods]Total 46 patients with NLBP who visited the Tuina Department of the First Affiliated Hospital of Hainan Medical University from August 2019 to May 2020 were randomly and evenly divided into control group and treatment group.On the basis of Tuina therapy,the patients in the control group and treatment group were treated with psoas&abdominal training and SET,respectively.After the treatment,the serum 5-HT andβ-EP levels of the patients were detected.[Results]The serum 5-HT andβ-EP levels in the treatment group were significantly improved compared with the control group(P<0.05).[Conclusions]The nerve&muscle reconstruction techniques of Tuina combined with SET or psoas&abdominal training can improve serum 5-HT andβ-EP levels in patients with NLBP.

Unusual glomus tumor of the lower leg: A case report

BACKGROUND Glomus tumors are rare neoplasms,usually found on the fingers or toes.Glomus tumours that occur in the lower leg are even rarer and is likely to be misdiagnosed or underdiagnosed.This article will document the diagnosis,treatment,and follow-up of a rare glomus tumor of the lower leg,which had been misdiagnosed for up to 15 years.CASE SUMMARY The patient was a A 36-year-old woman who had suffered from localized pain in her left lower leg for 15 years.After a complete physical examination,a glomus tumor on her lower leg was considered and removed surgically.The specimen was pathologically diagnosed as a glomus tumor.There was no relapse at a 4-year follow-up.CONCLUSION Correct diagnosis and complete removal of the glomus tumor is important.