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.

Analgesic effects of balanced acupuncture versus body acupuncture in low-back and leg pain patients with lumbar disc herniation, as assessed by resting-state functional magnetic resonance imaging

Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain patients with lumbar disc herniation were treated with balanced acupuncture or body acupuncture. Central mechanisms of vaded acupunctures were compared using resting-state functional MRI. Patients from both groups received functional MRI before and after acupuncture. Functional connectivity in brain regions that were strongly associated with the bilatera amygdala was analyzed utilizing AFNI software. Visual analogue scale scores were greater in the balanced acupuncture group compared with the body acupuncture group. Function of the endogenous pain regulation network was enhanced in patients in the balanced acupuncture group, but was not changed in the body acupuncture group. This result indicates that the analgesic effects of body acupuncture do not work through the central nervous system. These data suggest that balanced acupuncture exerts analgesic effects on low-back and leg pain patients with lumbar disc herniation by regulating the function of the endogenous pain regulation network.

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.

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.

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.

Prevalence and influencing factors of low back pain among nurses in China:a systematic review and meta-analysis

Background:Low back pain(LBP)is one of the most common occupational injuries that nurses experience in their daily work,which ultimately causes disability or difficulty in performing heavy physical activity.There is scarce information that presents a direct figure about the prevalence of LBP in Chinese nurses.Objective:To systematically review and analyze the prevalence and influencing factors of LBP among nurses in China.Methods:Related literature extracted from PubMed,Web of Science,Scopus,China National Knowledge Infrastructure databases were selected and reviewed based on the PRISMA guideline.Random effects models were used for data analysis,where heterogeneity was tested through I2.Egger’s test was used to analyze the literature publication bias.Results:The combined data indicated that the prevalence of LBP among nurses in China was 78%[95%confidence interval(CI)=0.72–0.83].The prevalence of LBP among nurses in China has declined in the past decade.Nurses presented a high risk of LBP in terms of female(OR=2.38,95%CI=1.23–3.44,P<0.0001),married(OR=2.79,95%CI=1.57–3.86,P<0.0001),24≤BMI<28(OR=2.03,95%CI=1.18–3.08,P<0.0001),and working for more than ten>10 years(OR=2.54,95%CI=2.03–3.32,P<0.0001).Conclusions:There is a high prevalence of LBP among nurses in China.Interventions that include healthy dietary habits and physical activity mainly focusing on female married nurses who are working for at least 10 years should be implemented.Furthermore,nurses ought to apply ergonomic principles for personal protection at the workplace.

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.

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.

Burden of Chronic Low Back Pain in Low and Middle-Income Settings: Case of the Yaounde Central Hospital, Cameroon

Background: Chronic low back pain is a leading cause of morbidity and disability globally. Low and Middle-Income Countries (LMICs) tend to be more affected, with chronic low back pain (CLBP) being among the leading presenting complaints at specialist consultation. The exact burden of this disease is sparingly known in our setting. Objective: To evaluate the burden of chronic low back pain at the Yaounde Central Hospital. Methods: This was a descriptive cross-sectional study for a period of 3 months, from March 2022 to May 2022. After obtaining ethical clearance and research authorisations, data was collected using structured questionnaires from patients with chronic low back pain presenting at the Yaounde Central Hospital during the aforementioned time frame. This data was then tabulated with the Statistical Package for Social Sciences (SPSS 23.0), and disability was assessed using the modified Roland Morris Disability Questionnaire and the Oswestry Disability Index. Data analysis was done using the International Business Machines Statistical Package for Social Sciences (IBM-SPSS) VERSION 23.0. Results: 115 cases of CLBP were included. The mean age was 52.62 years, and the sex ratio was 0.3. The average monthly income was less than 50,000 frs CFA, in 37.4% of cases. In 57.9%, patients had a job that involved physical labour. The patients had a secondary level of education in 40.9%, and alcohol consumption was observed in 36%. The average number of days of a work stoppage due to LBP was 12.75 days (±12SD), and the median duration of CLBP was 7.15 (7.5SD) years. The median pain intensity was 7 (±2SD), with leg pain and sensory neuropathy observed in 67.8% and 63.5% respectively. Lumbar X-ray was done in 45.2% and revealed lumbar osteoarthrosis in 62.4%. Hypertension as a comorbidity was observed in 26.1%. Medical treatment was used at least once in 98.3% of cases. The average cost of management per month was assessed, and the median was 52,000 FCFA (±20,876 SD). Using the Oswestry Disability Questionnaire, 46 patients, that is 40% of the study population, were classified as severely disabled with a median ODI score of 40%. The factors which were independently associated with disability were level of education, alcohol consumption, treatment modality, pain intensity, body mass index (BMI), psychological wellbeing and number of sick leave days. Conclusion: Chronic low back pain is common in our setting. There is a female predominance with the mean age of the study population situated in the 5th decade. Low-income earners and patients with a job involving physical labour were the most affected. Medical treatment was the main therapeutic modality, with the average cost of management per month being above the average monthly income of the greater majority of the patients. Several factors influenced disability, some of which were independently associated with it, such as level of education, alcohol consumption and treatment modality.

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.

Efficacy of Low Dose Naltrexone on Pain Reduction in Chronic Pain Syndromes: A Meta Analysis

Chronic pain is a multifaceted debilitating experience often associated with significant physical and emotional burden. Low dose naltrexone (LDN) has gained attention in recent years for its potential utility in the management of fibromyalgia, irritable bowel syndrome, multiple sclerosis, and painful diabetic neuropathy. LDN’s analgesic effects have been associated with its ability to increase the production of endorphins while reducing the production of tumor necrosis factor-alpha, interleukin-6, reactive oxygen species and nitric oxide. This meta-analysis aims to systematically review and synthesize the available evidence on efficacy of LDN as an analgesic in pain syndromes, with a focus on chronic (neuro) inflammatory diseases. The goal is to provide clinicians with a more comprehensive estimate of the effectiveness of LDN as a non-opioid option for managing chronic pain and guide future research in the area. Thirteen randomized control trials, published from 1990 to 2022, were selected for the analysis that satisfied inclusion criteria. The overall effects in these studies were calculated using the standardized mean difference (SMD) between the LDN and placebo groups. We found an overall SMD of -10.77 (95% CI: -13.96 to -7.58) with a p-value of 0.002. This indicated that the LDN group experienced a statistically significant reduction in pain compared to placebo. This meta-analysis provides evidence for the potential efficacy of low dose naltrexone in reducing pain and enhancing analgesia in various pain syndromes. LDN may be a useful treatment option for patients suffering from chronic pain, particularly with fibromyalgia, multiple sclerosis, or diabetic neuropathy. However, further research is needed to confirm the efficacy and safety of low dose naltrexone for chronic pain conditions, especially with larger sample sizes, standardized dosing regimens and treatment durations.

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.

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.

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.

Exploration of the therapeutic effect and clinical outcomes of acupuncture at pain-sensitive points to treat chronic nonspecific low back pain:Application of the acupoint sensitization theory

Objectives:To investigate the clinical and therapeutic effects of acupuncture at the pain-sensitive points of patients with chronic nonspecific low back pain and optimize the acupuncture treatment for chronic nonspecific low back pain.Methods:Using the FDK 20 pressure algometer,the pain-sensitive points were probed in 30 patients with chronic nonspecific low back pain.The top 5 points that elicited the most painful reaction were selected and stimulated with an even-needling technique after deqi.The needles were retained for 30 min.TDP irradiation was concurrently administered.The treatment was administered once daily on weekdays(Monday to Friday) and discontinued for 2 days during the weekend(Saturday and Sunday).The treatment lasted for 2 consecutive weeks.The changes in the range of motion(ROM) of the lumbar vertebrae,visual analogous scale(VAS) score,and the Oswestry disability index(ODI) score of the lumbar vertebrae were assessed before treatment and after 5 and 10 treatment sessions.Results:Compared with the data before treatment,the spinal ROM increased after 5 and 10 treatment sessions in the patients with chronic nonspecific low back pain.The ROM after 10 treatment sessions was remarkably wider than that after 5 treatments,with statistical significance(all P<0.05).Compared with that before treatment,the immediate VAS score showed statistically significant reduction after 5 treatment sessions(P<0.05).Moreover,compared with the score after 5 treatment sessions,the immediate VAS score reduced after 10 treatment sessions,but without any statistical significance.After 5 and 10 treatment sessions,the ODI score was reduced in the patients and it was significantly different from that before treatment(both P<0.05).Conclusion:Acupuncture at the pain-sensitive points alleviates pain and improves lumbar vertebral function in patients with chronic nonspecific low back pain.Thus,further research is needed to confirm whether acupuncture can be a better intervention for chronic nonspecific low back pain.

Acu-moxi Around the World Analysis and reflection of characteristics of evidence review by CMS on acupuncture treatment for chronic low back pain

On January 21,2020,the Centers for Medicare&Medicaid Services issued the Decision Memo for Acupuncture for Chronic Low Back Pain,which included acupuncture treatment for chronic low back pain in Medicare.This paper analyzed the characteristics and analytic methods of CMS evidence review.The evidence review of CMS is characterized by focusing on reviewing domestic and international review studies,U.S.evidence-based guidelines,public consultation and patient needs and personnel coverage.The evidence review and analytic method of CMS includes reviewing the literature to evaluate relevant evidence,reviewing the quality and basis of evidence and determining the universality of evidence.The evidence review method of CMS provides enlightenment for the development of acupuncture and moxibustion and the promotion of Traditional Chinese Medicine.China can learn from the experience of CMS and carry out evidence-based medical evaluation of acupuncture and moxibustion around the common diseases in China.We can improve the coverage of medical insurance according to the needs of patients and encourage physicians to give patient education on non-drug therapy.

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.

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。

慢性腰痛患者疼痛灾难化轨迹的纵向研究

目的:探索慢性腰痛患者疼痛灾难化的变化轨迹。方法:选取符合纳入排除标准的183慢性腰痛患者,采用自编一般资料问卷、疼痛灾难化量表(PCS)、社会支持量表(PSSS)、10条目简易心理弹性量表(CD-RISC-10)、广泛性焦虑量表(GAD-7)、负性情绪量表(NAS)分别在住院时、住院2周时、出院时、出院3个时间进行测评。使用潜在类别增长模型识别疼痛灾难化轨迹类别。结果:患者PCS、CD-RISC-10、GAD-7和NAS各时间点得分具有统计学意义(F=15.302,40.108,55.353,27.420;P<0.05),CD-RISC-10得分在住院2周最低,出院时最高;GAD-7、NAS和PCS得分在住院2周最高,出院时最低。疼痛灾难化轨迹分为疼痛灾难化低水平先升后降组(34.97%)、疼痛灾难化高水平下降组(38.80%)、疼痛灾难化持续高水平组(26.23%)3个亚组。结论:慢性腰痛患者从住院到出院3个月间疼痛灾难化呈现不同的变化轨迹,临床工作人员对住院2周时患者的疼痛、心理状况应给予重点关注。