Efficacy and safety of thermobalancing therapy with Dr Allen’s Device for chronic low back pain:A randomised controlled trial

BACKGROUND Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients’health-related quality of life(HRQoL).Although empirical evidence has demonstrated that novel Thermobalancing therapy and Dr Allen’s Device can relieve chronic low back pain,there have been no randomised controlled trials for these indications.AIM To evaluate the efficacy of Dr Allen’s Device in lumbar disc herniation(LDH)and non-specific low back pain(NSLBP).METHODS A randomised clinical trial was conducted investigating 55 patients with chronic low back pain due to LDH(n=28)or NSLBP(n=27),out of which 15 were randomly assigned to the control group and 40 were assigned to the treatment group.The intervention was treatment with Dr Allen’s Device for 3 mo.Changes in HRQoL were assessed using the Numerical Pain Rating Scale and the Japanese Orthopedic Association Back Pain Questionnaire.RESULTS Thermobalancing therapy with Dr Allen’s Device showed a significant reduction in pain in the treatment group(P<0.001),with no recorded adverse effects.Both pain assessment scales showed a significant improvement in patients’perception of pain indicating improvement in HRQoL.CONCLUSION The out-of-hospital use of Thermobalancing therapy with Dr Allen’s Device for Low Back Treatment relieves chronic low back pain significantly and without adverse effects,improves the level of activity and HRQoL among patients with LDH and NSLBP.This study demonstrates the importance of this safe first-line therapy that can be used for effective at-home management of chronic low back pain.

Finding the Needle in the Haystack—An Unusual Case of Astasia-Abasia Following Sacro-Iliac Joint Injection for Chronic Low Back Pain

We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or walk, a condition known as astasia-abasia. Initial concern had been that this neurological phenomenon was as a result of complications of his chronic pain intervention. Despite an essentially normal neurological examination and dedicated battery of neurological imaging and special testing, no cause was identified. Over a 7-day period of in-patient admission and physical rehabilitation symptoms resolved entirely. In the course of the workup for this episode, it was suggested that the phenomenon was the result of a side effect of dexamfetamine, an agent that had been prescribed for the patient by his neurologist for treatment of his narcolepsy. On the back of this episode, this treatment was discontinued by his neurologist following an outpatient consultation. Subsequent repeated SIJ injections were entirely uneventful and the patient experienced no further occurrences of this phenomenon.

Effect of Verbal Instructions in Pain Assessment during a Passive Straight Leg Raise Test in People with Chronic Low Back Pain

The most prevalent issue in physical therapy is pain. Due to the subjective nature of pain, assessment tools are essential in understanding it as objective data. However, assessment of pain may result in distress for the patient. A physical therapist (PT) should conduct these tests as quickly and accurately as possible. Straightforward instructions are vital in such cases. This study aimed to clarify the effect of verbal instructions for pain assessment during a passive straight leg raise (PSLR) test for participants with chronic low back pain (CLBP). This study included 22 participants who provided informed consent and received three consecutive PSLR tests with measurement of the hip flexion range of motion (HFROM) and were instructed to cease the test at submaximal pain before the first test. Following the second and third tests, participants were given specific verbal instructions to remember pain intensity, quality, and location. After each test, participants were to circle the pain location on the body chart and rate their pain intensity on a numeric rating scale (NRS) and pain quality. All participants were then interviewed about the differences between having and not having specific verbal instructions. The results of HFROM, NRS, and pain extent were not significantly different between the first and second tests or between the second and third tests using a paired t-test. Eleven changes in pain location were found in the second test compared to those in the first test. In the third test, only three participants circled a different area than in the second test. Ten participants showed similar changes with pain location in pain quality in the three PSLR tests. This study revealed the effect of specific verbal instructions prior to PSLR tests. Particularly, participants could notice exact pain location. Our findings may help PT to understand pain cause and reduce patients’ stress during pain assessment in clinical settings.

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.

Prevalence and Factors Associated with Chronic Low Back Pain in the Mining Sector in Burkina Faso

Introduction: Low back pain is nowadays a real public health problem in companies. The objective of the study was to determine the prevalence and factors associated with chronic low back pain among workers of a mining company in Burkina Faso. Material and Methods: This was a descriptive and analytical cross-sectional study with a retrospective collection that took place from August 1, 2021 to March 16, 2022 in a gold mine in Burkina Faso. It focused on mine workers who participated in the 2019 annual medical visit. Results: Out of a total workforce of 880 workers who took part in the annual medical visit in 2019, 165 had chronic common low back pain, i.e. a prevalence of 18.75%. The average age of low back pain workers was 37.21 ± 7.5 years. Among the workers suffering from low back pain, 62 (37.58%) held the position of machine operator. Clinically, mechanical pain was found in 113 low back pain workers (76%) and twenty-nine (17.58%) had radicular pain. Standard radiography of the lumbar spine was abnormal in 129 workers (78.18%. In the univariate analysis, the factors associated with the pathology were sex, level of study, work station and seniority in the position. After a logistic regression, the factors associated with its occurrence were whole-body vibration (Fisher’s test = 12.7541;P = 0.000), male sex (Fisher’s test = 8.363;P = 0.004), and seniority for 4 to 5 years (Chi2 = 4.0234;p = 0.046). Conclusion: The study reveals the existence of chronic low back pain cases among the workers of the mining company. There is a predominance of the pathology in men, workers exposed to vibrations and those with a seniority of 4 to 5 years. It is necessary to establish a policy of prevention of low back pain for the benefit of workers, in particular those exposed to vibrations.

Botulinum toxin type A for treating chronic low back pain:A double blinded randomized control study

BACKGROUND Low back pain(LBP)is a prevalent issue that orthopedic surgeons frequently address in the outpatient setting.LBP can arise from various causes,with stiffness in the paraspinal muscles being a notable contributor.The administration of Botulinum toxin type A(BoNT-A)has been found to alleviate back pain by relaxing these stiff muscles.While BoNT-A is approved for use in numerous conditions,a limited number of randomized clinical trials(RCTs)validate its efficacy specifically for treating LBP.AIM To study the safety and the efficacy of BoNT-A in minimizing pain and improving functional outcomes in patients of chronic LBP(CLBP).METHODS In this RCT,adults aged 18-60 years with mechanical LBP persisting for at least six months were enrolled.Participants were allocated to either the Drug group,receiving 200 Ipsen Units(2 mL)of BoNT-A,or the Control group,which received a 2 mL placebo.Over a 2-month follow-up period,both groups were assessed using the Visual Analog Scale(VAS)for pain intensity and the Oswestry Disability Index(ODI)for disability at the start and conclusion of the study.A decrease in pain by 50%was deemed clinically significant.RESULTS The study followed 40 patients for two months,with 20 in each group.A clinically significant reduction in pain was observed in 36 participants.There was a statistically significant decrease in both VAS and ODI scores in the groups at the end of two months.Nonetheless,when comparing the mean score changes,only the reduction in ODI scores(15 in the placebo group vs 16.5 in the drug group,clinically insignificant)was statistically significant(P=0.012),whereas the change in mean VAS scores was not significant(P=0.45).CONCLUSION The study concludes that BoNT-A does not offer a short-term advantage over placebo in reducing pain or improving LBP scores in CLBP patients.

Acupuncture is ineffective for chronic low back pain?A critical analysis and rethinking

Acupuncture is a promising treatment for relieving pain and improving lower back function in clinical practice.However,evidence from randomized clinical trials(RCTs)remains controversial.Most RCTs conclude that acupuncture procedures for chronic low back pain(CLBP)had no significant difference in efficacy and belonged to placebo.We carefully reviewed and analyzed the methodology and implementation of sham acupuncture in RCTs.Controversial evidence of acupuncture for CLBP is only a microcosm of the evaluation methodological limitation of acupuncture.Inappropriate selection of sham acupuncture controls,rigorous RCT research models,and incorrect interpretation of results may contribute to negative evidence.Evaluating and disregarding the holistic efficacy of acupuncture with an explanatory RCT model based on evaluation drugs may be unwise.Moreover,sham acupuncture is often proven to be non-inert,unreasonable,and with low fidelity.Pitfalls of the explanatory RCT model and sham acupuncture design should be avoided.Establishing a new evaluation system that is in line with the clinical characteristics of acupuncture and obtaining high-quality evidence are difficult but promising tasks.

Anxiety and Depression Disorders in Chronic Non-Specific Low Back Pain in Lomé(Togo)

Chronic non-specific low back pain has an important psychological impact. Objectives: To determine the prevalence of anxiety and depressive disorders (ADD) and factors associated to their apparition in patients suffering from chronic non-specific low back pain in rheumatological consultation in Lomé. Patients and Methods: It was a cross-sectional study, conducted from October 1st, 2015 to 31st March 2016. This study focused on all patients suffering from common chronic low back pain without psychiatric history in the Rheumatology Ward at the Sylvanus Olympio’s Teaching Hospital of Lomé and who have given their consent. The psychological evaluation was carried out through Hamilton scale. The processing, the statistical treatment and analysis of our data have been carried out using Epiinfo software, version 7.1.5. The investigation was approved by the local Ethics Committee. Results: 48 (39 women and 09 men) out of 123 patients with chronic lower back pain presented anxiety and depressive disorders (ADD) accounting for a prevalence rate of 39%. Their average age was 50.3 years old. The most frequent ADD was: psychic anxiety (58.6%), depressive mood (51.3%), difficulties to feel asleep (47.9%) and disturbed or agitated sleep (43.1%). Factors associated with the anxiety and depressive disorders in common chronic low back pain were: female gender (p = 0.02), dependent children (p = 0.02), occupation (reseller (p = 0.002), liberal profession (p = 0.009), monthly financial income (p = 0.002), surroundings family (0.009), medical history (p = 0.0002) and pain’s intensity > 7 (p = 0.04). Conclusion: This study shows the high frequency of anxiety and depressive disorders in common chronic low back pain and their influence by socio-economic and demographic factors.

Differences in brain structure in patients with distinct sites of chronic pain:A voxel-based morphometric analysis

A reduction in gray matter volume is common in patients with chronic back pain, and different types of pain are associated with gray matter abnormalities in distinct brain regions. To examine differ- ences in brain morphology in patients with low back pain or neck and upper back pain, we investi- gated changes in gray matter volume in chronic back pain patients having different sites of pain using voxel-based morphometry. A reduction in cortical gray matter volume was found primarily in the left postcentral gyrus and in the left precuneus and bilateral cuneal cortex of patients with low back pain. In these patients, there was an increase in subcortical gray matter volume in the bilateral putamen and accumbens, right pallidum, right caudate nucleus, and left amygdala. In upper back pain patients, reduced cortical gray matter volume was found in the left precentral and left postcen- tral cortices. Our findings suggest that regional gray matter volume abnormalities in low back pain patients are more extensive than in upper back pain patients. Subcortical gray matter volume in- creases are found only in patients with low back pain.

Effectiveness of hip upslip correction method on ambulation and back pain in patients with lumbar discopathy:a case report

Background:Low back pain can be caused by a variety of accidents,ailments,or diseases,the most common of which is a back muscle problem or tendon injury.The intensity of pain varies from mild to severe.Lower back pain usually improves with rest,pain medications,and physical therapy(PT).Injections of cortisone and manual treatments such as osteopathic or chiropractic manipulation can help reduce pain and speed up the healing process.Some back injuries and disorders necessitate surgery.Methods:A multidisciplinary team evaluation was applied.The patient received medications for a prolonged period that lasted more than 4 to 6 weeks without improvement.Seven sessions of conservative and physical therapy manipulation were applied over a period of two weeks to correct the lower body mechanics and realign the body posture properly.Results:The neglected adolescent patients responded well to physical therapy sessions.The patient can walk with normal body posture and practice his activities of daily life without obstacles.The right up-slip hip was corrected successfully,and both posterior iliac spine joints were functional after the intervention.The patient expressed his satisfaction with physical therapy treatment.Conclusion:Corrections of body mechanics in patients with discopathy should be taken into consideration during treatment.

Research Findings Using Mindfulness-Based Interventions for Chronic Pain

Chronic pain is a complex condition that is very detrimental to physical and psychological wellbeing. It carries a significant level of disability and economic burden. Pain patients frequently experience comorbid mental illness (e.g. depression, anxiety, PTSD, insomnia) and often require psychotherapeutic interventions in addition to medication management. Mindfulness-based interventions (MBIs) have emerged as a means to treat several chronic conditions (e.g. chronic pain, depression, anxiety, substance abuse, stress, insomnia). The objective of this review is to evaluate the current research on the use of MBIs in chronic pain managment. Although there are several controlled trials on the use of MBIs in chronic pain management, only a few studies were found that demonstrated significant effects on pain intensity, quality of life, as well as physical and psychological functioning. Therefore, the current evidence is mixed and there are insufficient data to definitively confirm the full impact of the use of MBIs in chronic pain conditions such as fibromyalgia, chronic low back pain, rheumatoid arthritis, and chronic musculoskeletal pain. The lack of compelling evidence at this time signals a demand for higher quality investigations in this area. Research examining MBIs and concomitant CBT may be of great value in order to synergize and strengthen patient outcomes.

Physical activity and chronic back conditions:A population-based pooled study of 60,134 adults

Background:Little is known about the association between different types of physical activity(PA)and chronic back conditions(CBCs)at the population level.We investigated the association between levels of total and type-specific PA participation and CBCs.Methods'.The sample comprised 60,134 adults aged>16 years who participated in the Health Survey for England and Scottish Health Survey from 1994 to 2008.Multiple logistic regression models,adjusted for potential confbunders,were used to examine the association between total and type-specific PA volume(walking,domestic activity,sport/exercise,cycling,football/rugby,running/jogging,manual work,and housework)and the prevalence of CBCs.Results'.We found an inverse association between total PA volume and prevalence of CBCs.Compared with inactive participants,the fully adjusted odds ratio(OR)for very active participants(≥15 metabolic equivalent h/week)was 0.77(95%confidence interval(CI):0.69—0.85).Participants reporting≥300 min/week of moderate-intensity activity and≥75 min/week of vigorous-intensity activity had 24%(95%CI:6%—39%)and 21%(95%C1:11%—30%)lower odds of CBCs,respectively.Higher odds of CBCs were observed for participation in high-level manual domestic activity(OR=1.22;95%CI:1.00-1.48).Sport/exercise was associated with CBCs in a less consistent manner(e.g.,OR=1.18(95%CI:1.06—1.32)for low levels and OR=0.82(95%CI:0.72—0.93)for high levels of sport/exercise).Conclusion'.PA volume is inversely associated with the prevalence of CBCs.

针刺核心肌群联合康复训练治疗慢性非特异性腰痛的临床观察

【目的】观察针刺核心肌群联合康复训练治疗慢性非特异性腰痛的临床疗效。【方法】将96例慢性非特异性腰痛患者随机分为观察组和对照组,每组各48例,对照组给予康复训练,观察组在对照组治疗的基础上,给予针刺核心肌群训练。2组患者均连续治疗2周。治疗2周后,评价2组临床疗效,观察2组患者治疗前后腹横肌与多裂肌均方根(RMS)值的变化情况,以及Oswestry功能障碍指数评分、Roland-Morris功能障碍调查表评分、魁北克腰痛障碍量表评分的情况。比较2组患者治疗前后血清β-内啡肽、血清P物质、血清前列腺素E2水平的变化情况。治疗后随访5个月,评价2组患者的复发情况。【结果】(1)观察组总有效率为93.75%(45/48),对照组为81.25%(39/48)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的Oswestry功能障碍指数评分、Roland-Morris功能障碍调查表评分、魁北克腰痛障碍量表评分明显改善(P<0.05),且观察组在改善Oswestry功能障碍指数评分、Roland-Morris功能障碍调查表评分、魁北克腰痛障碍量表评分方面明显优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者的腹横肌、多裂肌RMS值明显改善(P<0.05),且观察组在改善腹横肌、多裂肌RMS值方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗后,2组患者β-内啡肽、P物质、前列腺素E2水平均明显改善(P<0.05),且观察组在改善β-内啡肽、P物质、前列腺素E2水平方面均明显优于对照组,差异均有统计学意义(P<0.05)。(5)治疗后观察组复发率为6.25%(3/48),对照组为20.83%(10/48),观察组复发率明显低于对照组,差异有统计学意义(P<0.05)。【结论】针刺核心肌群联合康复训练治疗慢性非特异性腰痛,能明显改善患者的临床症状,改善患者β-内啡肽、P物质、前列腺素E2水平,临床疗效显著。

美式整脊联合核心肌力训练对慢性非特异性下腰痛患者的疗效观察

目的探讨美式整脊联合核心肌力训练对慢性非特异性下腰痛患者的疗效。方法采用随机数表法将120例慢性非特异性下腰痛患者分为整脊组(40例)、联合组(39例)和常规组(41例)。每组患者均采用短波及超声波的常规治疗,整脊组在此基础上增加美式整脊治疗,联合组则增加美式整脊及核心肌力训练。比较3组患者治疗前后数字评定量表(NRS)、Oswestry腰椎功能障碍指数(ODI)、腰痛功能障碍调查表(RMDQ)评分及棘突双侧温差变化情况。结果治疗结束后,联合组患者的NRS、ODI和RMDQ评分及温差结果均较治疗前改善,分别为(2.06±0.63)分、(13.00±3.53)分、(6.25±1.20)分,且效果优于整脊组的(2.44±0.84)分、(17.11±4.41)分、(9.42±2.49)分与常规组的(4.03±0.82)分、(21.31±5.68)分、(11.09±2.78)分,比较差异均有统计学意义(P均<0.05)。结论在常规治疗的基础上,采用美式整脊联合核心肌力训练对慢性非特异性下腰痛患者进行干预,可有效改善患者症状及生活质量。

不同感觉条件干扰对慢性非特异性腰痛消防员姿势控制能力的影响

目的:探讨患有慢性非特异性腰痛(chronic nonspecific low back pain,CNLBP)消防员和正常消防员在不同感觉条件下自身姿势控制能力的差异,剖析CNLBP消防员姿势控制的特征和问题,以期为CNLBP消防员制订训练康复计划和提升姿势控制能力提供科学依据。方法:以CNLBP组消防员(n=10)和对照组消防员(n=10)为受试者。采用视觉模拟评分量表(visual analogue scale,VAS)、Oswestry功能障碍指数问卷(Oswestry disability index,ODI)评估CNLBP组疼痛和功能障碍程度,并收集所有受试者睁眼、闭眼、睁眼+平衡垫、闭眼+平衡垫站立时压力中心的横向速度(V_(x))、纵向速度(Vy)、路径长度和摇摆速度,通过平板支撑、3 min屈腿仰卧起坐评估消防员的核心力量,对测试结果进行双因素重复测量方差分析与相关性分析。结果:感觉条件对V_(x)(F=51.557,P<0.01,η_(p)^(2)=0.741)、Vy(F=75.846,P<0.01,η_(p)^(2)=0.808)、路径长度(F=76.667,P<0.01,η_(p)^(2)=0.810)和摇摆速度(F=76.592,P<0.01,η_(p)^(2)=0.810)的主效均显著;CNLBP对V_(x)(F=13.154,P<0.01,η_(p)^(2)=0.422)、Vy(F=6.106,P<0.05,η_(p)^(2)=0.253)、路径长度(F=13.059,P<0.01,η_(p)^(2)=0.420)和摇摆速度(F=13.058,P<0.01,η_(p)^(2)=0.420)的主效应均显著;CNLBP和感觉条件对V_(x)(F=11.822,P<0.01,η_(p)^(2)=0.396)、Vy(F=4.961,P<0.05,η_(p)^(2)=0.216)、路径长度(F=9.206,P<0.01,η_(p)^(2)=0.338)和摇摆速度(F=9.203,P<0.01,η_(p)^(2)=0.338)的交互作用均显著。闭眼时,CNLBP组的VAS评分和ODI评分与摇摆速度和路径长度呈显著正相关(P<0.05);闭眼+平衡垫时,CNLBP组VAS评分与和ODI评分与V_(x)、摇摆速度和路径长度呈显著正相关(P<0.05),平板支撑成绩与V_(x)、摇摆速度和路径长度呈显著负相关(P<0.05),3 min曲腿仰卧起坐成绩与Vy、摇摆速度和路径长度呈显著负相关(P<0.05)。结论:1)躯体感觉和视觉双重干扰对CNLBP组消防员的影响最大,同时视觉单一干扰大于躯体感觉单一干扰;视觉与躯体感觉单一干扰对CNLBP组消防员侧方向稳定性的影响大于对前后方向的影响,对对照组消防员前后稳定性的影响大于对侧方向的影响;双重干扰对2组消防员前后稳定性的影响均大于对侧方向的影响。2)视觉干扰对CNLBP组消防员的侧方向稳定性影响大于对照组,双重感觉干扰对2组消防员姿势控制能力的影响较大;CNLBP组在双重感觉干扰下姿势稳定性显著下降,这可能与CNLBP消防员腰部疼痛程度、核心肌肉力量有关。

超声剪切波弹性成像评价不同针刺取穴法干预慢性非特异性腰痛患者临床研究

目的观察不同针刺取穴法干预慢性非特异性腰痛(CNLBP)患者腰骶部多裂肌的杨氏模量值,根据其差异性为超声剪切波弹性成像(SWE)评价CNLBP的临床应用提供理论依据。方法将64例患者随机分为观察组(32例)和对照组(32例)。其中对照组给予常规针刺配穴干预,观察组在对照组的基础上根据本地五运六气配穴针刺干预。各组每日治疗1次,连续治疗6 d后休息1 d,共治疗2周。观察两组患者干预前后及治疗结束4周后(随访期)的日本骨科协会腰椎功能评分(JOA)、视觉模拟疼痛评分(VAS)。应用SWE评价两组患者干预前后双侧腰骶部多裂肌(俯卧位)杨氏模量值。比较两组患者干预前后血清β-内啡肽(β-EP)水平。结果治疗后,两组患者多裂肌杨氏模量值均较治疗前降低(P<0.05),组间对比差异无统计学意义(P>0.05);两组血清β-EP水平较治疗前均升高(P<0.05),观察组高于对照组(P<0.05);两组患者JOA评分较治疗前均升高(P<0.05),观察组高于对照组(P<0.05);两组患者VAS评分均较治疗前降低(P<0.05),组间对比差异无统计学意义(P>0.05)。随访时,两组患者JOA评分较治疗前均升高(P<0.05),观察组高于对照组(P<0.05);VAS评分较治疗前降低(P<0.05),组间对比差异无统计学意义(P>0.05)。结论SWE可为临床CNLBP针刺治疗方案提供评价依据。运气理论指导下的取穴针刺能够降低腰骶部多裂肌杨氏模量值,上调血清β-EP水平,改善患者临床症状,疗效优于常规针刺。

基于ALFF评估腰椎间盘突出症的脑静息态功能磁共振成像研究

目的分析腰椎间盘突出症(lumbar disc herniation,LDH)静息态功能磁共振成像(resting-state functional magnetic resonance imaging,rs-fMRI)改变,探讨其可能存在的神经影像学机制。材料与方法前瞻性纳入24例LDH患者,选取30例慢性非特异性腰背痛患者(chronic nonspecific low back pain,CNLBP)及27例健康对照(health control,HC)作为对照组。对LDH组及CNLBP组进行疼痛视觉模拟量表(Visual Analogue Scale,VAS)、腰椎Oswestry功能障碍指数(Oswestry Disability Index,ODI)及日本骨科学会评分表(Japanese Orthopedic Association,JOA)评估,LDH组、CNLBP组及HC组均接受rs-fMRI扫描,比较三组间低频振幅(amplitude of low-frequency fluctuation,ALFF)差异,提取LDH组与CNLBP组差异脑区的ALFF值与VAS、ODI、JOA评分进行相关性分析。结果LDH组和CNLBP组在VAS评分间无差异,在ODI、JOA评分间存在差异,LDH组腰椎功能障碍更明显。三组间ALFF值改变的脑区为双侧距状裂周围皮层/楔叶、左侧丘脑(GRF校正,体素水平P<0.005,团块水平P<0.01)。两组间比较:与HC组相比,LDH组在双侧距状裂周围皮层/楔叶的ALFF值减低,在左侧丘脑的ALFF值增高,CNLBP组在双侧距状裂周围皮层/楔叶的ALFF值减低,未发现ALFF值增高的脑区;与CNLBP组相比,LDH组在左侧丘脑的ALFF值增高,未发现ALFF值减低的脑区。相关性分析示LDH组和CNLBP组差异脑区的ALFF值与VAS、ODI、JOA评分无明显相关(P>0.05)。结论LDH存在与CNLBP共有及特异的疼痛中枢调节机制,左侧丘脑功能活动强弱变化可能是LDH的中枢机制的重要特征。

骨内椎基神经射频消融术治疗症状性Modic改变的研究进展

退变椎体终板引起的慢性腰背部疼痛一直困扰着广大患者与临床工作者,骨内椎基神经射频消融术是一种新的脊柱微创治疗手段,其通过对退变椎体终板进行射频消融术,使相应椎体椎基神经发生变性,阻断椎基神经的伤害性信号传导,从而减轻由退化椎体终板引起的腰痛症状。目前国外已有骨内椎基神经射频消融术的手术原理、手术方式、临床疗效及相关并发症较多报道。本文的主要目的是对目前已有的相关研究进行综合分析,为后续的临床研究提供参考依据。

生物反馈助力电刺激对慢性非特异性腰痛患者下肢步行功能的改善

背景:国内外关于慢性非特异性腰痛生物反馈疗法和三维步态功能分析的相关研究已开展很多,但是对二者结合的研究少有报道。目的:利用三维步态分析采集步态参数数据,研究生物反馈助力电刺激对慢性非特异性腰痛患者步行能力的改变效果。方法:选择2021年6月至2022年9月在广东药科大学附属第一医院收治的60例慢性非特异性腰痛患者,男34例,女26例,年龄32-58岁。采用随机数字表法将60例患者分为对照组(n=30)与试验组(n=30),两组患者均接受腰部动态干扰电的常规治疗(20 min/次,1次/d,每周5次,持续治疗20次),对照组患者在常规治疗的基础上进行仰卧搭桥和俯卧搭桥的悬吊核心肌群训练(每周5次,持续治疗20次),试验组在对照组治疗的基础上进行生物反馈助力电刺激治疗(20 min/次,1次/d,每周5次,持续治疗20次)。比较分析两组患者治疗前后的腰痛评分、肌电信号平均值和步态参数。结果与结论:①两组患者治疗结束后的数字类比表评分、日本骨科协会(JOA)评分、Oswestry功能障碍指数均较治疗前明显改善(P<0.05),试验组治疗结束后的数字类比表评分、JOA评分、Oswestry功能障碍指数均优于对照组(P<0.05);②两组患者治疗结束后的腹直肌、臀大肌、竖脊肌表面肌电平均值均高于治疗前(P<0.05),试验组治疗结束后的腹直肌、臀大肌、竖脊肌表面肌电平均值均高于对照组(P<0.05);③两组患者治疗结束后的步宽、步速、步频、健患侧步长比值、健患侧支撑相比值、患健侧摆动相比值、健患侧髋关节及膝关节矢状面活动度和健患侧足偏角均优于治疗前(P<0.05),试验组治疗结束后的上述指标均优于对照组(P<0.05);④结果表明,生物反馈助力电刺激能明显缓解慢性非特异性腰痛,改善了患者下肢步行功能。

慢性腰痛临床预测模型建立与验证

目的 探究慢性腰痛相关致病因素,建立并验证慢性腰痛临床预测模型。方法 采用自行设计的慢性腰痛危险因素调查问卷,于2022年5-10月,对四川省成都市火车南站、龙州路等10个社区卫生服务中心共760名门诊患者进行问卷调查,收集相关信息。使用LASSO回归筛选潜在危险因素,以Logistic回归建立慢性腰痛临床预测模型,并验证模型准确性。通过ROC曲线、AUC值来判断模型的区分度,HL拟合优度检验、校准曲线图和计算C指数来判断模型的准确度。用Bootstrap法对模型进行内部验证,检验模型的内部稳定性,并对模型进行外部验证。结果 760名研究对象中有慢性腰痛434人,患病率为56.8%,通过LASSO回归从27个潜在因素中筛选出7个相关因素,其中6个是慢性腰痛发生的独立影响因素;据此构建的预测模型区分度C指数为0.815(95%CI:0.772~0.857)、准确度C指数为0.778(95%CI:0.772~0.857)。结论 以患者年龄、工作要求、桌椅舒适度、社会支持程度、运动强度、三餐是否规律构建的慢性腰痛预测模型,能够有效预测患者慢性腰痛的患病风险。