Trends in oxycodone and oxycodone-containing analgesics administration for back pain in emergency departments in the USA(2007–2018)

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS) from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period.RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3% from 2007(244,000 visits) to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8% to 57.6%),female patients(from 54.5% to 62.0%),black patients(from 22.5% to 30.4%),and Hispanic/Latino patients(from 9.4% to 19.6%).Oxycodone/acetaminophen was most prescribed and accounted for 90.2% of all oxycodone-containing analgesics in 2007,with a decrease to 68.5% in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1% in 2007 and 31.5% in 2018.CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.

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.

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.

Impact of Multifidus Muscle Morphometry on the Clinical Evolution of Chronic Low Back Pain

Purpose: The multifidus muscle is an important extensor muscle of the lumbar spine. It plays a major role in the stability and realization of axial rotation movements of the thoraco-lumbar spine. Its atrophy by fatty degeneration would be at the origin of the occurrence of chronic low back pain which constitutes a public health problem in Senegal. Taking into account its anatomy is essential for the etiopathogenic analysis and the treatment of low back pain. The purpose of our work was to investigate the impact of multifidus muscle morphometry on the anatomy-clinical evolution of low back pain. Material and method: this was a prospective study over a period of 30 months from November 2019 to May 2022. It involved 100 patients seen in the neurology department of Fann Hospital for chronic low back pain and who had already had a scanner falling within the criteria for low back pain. We used 3D Slicer, SPSS 20, Excel 2016 software to model and analyze the morphometric data of the multifidus muscle after physiotherapy and control lumbar scans. Results: The sex ratio was 2.23. The average age of the patients was 45 ± 7 years. On the initial CT scan, according to the Hadar classification, we noted a predominance of grade 2 with 56% in L5/S1, followed by grade 1 with 32% and grade 3 with 14%. In L4/L5, the majority of patients, 67%, had grade 1. A conflicting circumferential disc bulge with the roots predominating in L5/S1 was present in 94% of men (p-value = 0.02). Before physiotherapy, the average volume of the multifidus was 193 mm3 ± 39, after physiotherapy it was 203 mm3 ± 42 with a progression rate of 5.2%. Clinically, severe type pain had regressed from 86% before physiotherapy to 0% after physiotherapy (p-value = 0.03). Conclusion: Taking into account the morphometry of the multifidus is an essential element in the management of chronic low back pain.

Systematic Review and Meta-analysis of Efficacy and Safety of Tenghuang Jiangu Tablet(藤黄健骨片)in the Treatment of Discogenic Low Back Pain

Objective:To systematically evaluate the efficacy and safety of Tenghuang Jiangu Tablet(藤黄健骨片)in the treatment of discogenic low back pain.Methods:CNKI,WanFang,CBM,VIP,PubMed,EMbase,Cochrane Library and Web of Science were systematically searched to collect the randomized controlled trials(RCTs)of Tenghuang Jiangu Tablet in the treatment of discogenic low back pain.Literature screening and data extraction according to the set criteria were conducted.Cochrane Risk Bias assessment tool was used to evaluate the quality of included RCTs,and Meta-analysis was performed using RevMan 5.4.1 software.Results:A total of 4 studies were included,with a total sample size of 404 cases.The results of Meta-analysis suggested that Tenghuang Jiangu Tablet combined with conventional treatment in the treatment of discogenic low back pain was superior to conventional treatment alone in terms of total clinical response rate(RR=1.21,95%CI[1.09,1.35],P=0.0004),excellent rate of curative effect(RR=1.24,95%CI[1.10,1.41],P=0.0007),lower VAS score(MD=-0.62,95%CI[-0.79,-0.44],P<0.00001)and JOA score(MD=1.84,95%CI[1.35,2.33],P<0.00001).There was no statistical significance in the incidence of adverse reactions between Tenghuang Jiangu Tablet combined with conventional treatment and conventional treatment alone(RR=0.76,95%CI[0.04,15.42],P=0.86).Conclusion:Based on existing research and methods,Tenghuang Jiangu Tablet combined with conventional therapy is effective on discogenic low back pain.Conventional therapy combined with Tenghuang Jiangu Tablet for the treatment of discogenic low back pain may be better than conventional therapy alone.All the adverse reactions occurred during the treatment were mild.There is no evidence that Tenghuang Jiangu Tablet can cause serious adverse reactions.However,the number of existing clinical studies is small and the quality is generally not high.It is suggested to carry out more large-sample and high-quality RCTs,and pay more attention to the long-term efficacy of drugs and the occurrence of adverse reactions,so as to further verify the above conclusions.

Intraosseous Radiofrequency Ablation of the Basivertebral Nerve in Chronic Low Back Pain: A Meta-Analysis

Purpose: To review the literature on the value of basivertebral nerve abla-tion in the treatment of chronic low back pain. Materials and Method: A systematic review and meta-analysis of the English literature to March 2020 was undertaken. The inclusion criteria were patients with discogenic back pain of more than 3 months duration with modic type 1 or 2 change and suc-cessful disc block or discogram. Primary outcomes were VAS pain, ODI, EQ-5D and SF36 improvement. Secondary outcomes were complications. Results: 6 studies were included, all funded by the same company, but oth-erwise of low bias. All studies showed significant improvement in all scores over the first 3 months with evidence these would be maintained over the longer term. There was one reported compression fracture, but otherwise no significant adverse events. Conclusion: This study supports the conclusion that radiofrequency ablation of the basivertebral nerve is a safe and effective treatment for discogenic chronic low back pain.

Risk Factors of Low Back Pain among the Chinese Occupational Population:A Case-control Study

Objective To explore the risk factors of low back pain among the Chinese occupational population in several major industries. Methods A total of 7200 subjects （3600 cases and 3600 controls） were randomly sampled from a cross-sectional study, and they were investigated for individual and occupational factors of low back pain. The potential risk factors were first selected by using chi-square tests. Secondly, collinearity diagnosis proceeded by using the Kendall＇s rank correlation. Finally, binary logistic regression model was used for multi-factor analysis. Results Collinearity diagnosis showed that there was a severe collinearity problem among the potential risk factors of low back pain. Logistic regression model included 20 variables with statistical significance. Bending neck forward or holding neck in a forward posturefor long periods （0R=1.408） was the most important risk factor inducing low back pain in this study, followed by bending heavily with the trunk （0R=1.402）, carrying out identical work almost for the whole day （0R=1.340）. Additionally, suHicient normal break was a protective factor of low back pain. Conclusion Low back pain among the Chinese occupational population was associated with body height, occupation, work organization, physical work, working posture, and others. All these risk factors could be regarded as the indicators of low back pain, and some relevant preventive measures should be taken to reduce low back pain risk.

Resting-state connectivity in the default mode network and insula during experimental low back pain

Functional magnetic resonance imaging studies have shown that the insular cortex has a signif- icant role in pain identification and information integration, while the default mode network is associated with cognitive and memory-related aspects of pain perception. However, changes in the functional connectivity between the defauk mode network and insula during pain remain unclear. This study used 3.0 T functional magnetic resonance imaging scans in 12 healthy sub- jects aged 24.8 ± 3.3 years to compare the differences in the functional activity and connectivity of the insula and default mode network between the baseline and pain condition induced by intramuscular injection of hypertonic saline. Compared with the baseline, the insula was more functionally connected with the medial prefrontal and lateral temporal cortices, whereas there was lower connectivity with the posterior cingulate cortex, precuneus and inferior parietal lobule in the pain condition. In addition, compared with baseline, the anterior cingulate cortex exhibited greater connectivity with the posterior insula, but lower connectivity with the anterior insula, during the pain condition. These data indicate that experimental low back pain led to dysfunction in the connectivity between the insula and default mode network resulting from an impairment of the regions of the brain related to cognition and emotion, suggesting the impor- tance of the interaction between these regions in pain processing.

Do people with low back pain walk differently? A systematic review and meta-analysis

Background:The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain(LBP).Despite substantial research,it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP.The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls.Methods:A search was conducted in PubMed,CINAHL,SPORTDiscus,and PsycINFO in June 2019 and was repeated in December 2020.Studies were included if they reported biomechanical characteristics of individuals with and without LBP during steady-state or perturbed walking and running.Biomechanical data included spatiotemporal,kinematic,kinetic,and electromyography variables.The reporting quality and potential for bias of each study was assessed.Data were pooled where possible to compare the standardized mean differences(SMD)between back pain and back-healthy control groups.Results:Ninety-seven studies were included and reviewed.Two studies investigated acute pain and the rest investigated persistent pain.Nine studies investigated running gait.Of the studies,20%had high reporting quality/low risk of bias.In comparison with back-healthy controls,individuals with persistent LBP walked slower(SMD=-0.59,95%confidence interval(95%CI):-0.77 to-0.42)and with shorter stride length(SMD=-0.38,95%CI:-0.60 to-0.16).There were no differences in the amplitude of motion in the thoracic or lumbar spine,pelvis,or hips in individuals with LBP.During walking,coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the persistent LBP groups(SMD=-0.60,95%CI:-0.90 to-0.30),and individuals with persistent LBP exhibited greater amplitude of activation in the paraspinal muscles(SMD=0.52,95%CI:0.23-0.80).There were no consistent differences in running biomechanics between groups.Conclusion:There is moderate-to-strong evidence that individuals with persistent LBP demonstrate differences in walking gait compared to back-healthy controls.

Paraspinal strength and electromyographic fatigue in patients with sub-acute back pain and controls:Reliability,clinical applicability and between-group differences

BACKGROUND Paraspinal muscle strength and fatigue are considered important in low back pain(LBP)prevention and rehabilitation.High reliability of paraspinal strength and electromyographic(EMG)-fatigue parameters has not been universally reported.Moreover,the discriminative validity of these parameters requires further exploration,under the threat of potentially poor reliability of the methods examined.AIM To investigate the reliability and discriminative validity of paraspinal strength and EMG-related fatigue in subjects with recurrent LBP and healthy participants.METHODS Test-retest measurements were performed in 26 healthy and 66 LBP volunteers,for reliability.Paraspinal isometric maximal and mean strength were determined with a maximum voluntary isometric contraction(MVIC)protocol,performed in a custom-made device.For the fatigue test,participants performed a 60% MIVC level continuous isometric contraction of the paraspinals,in conjunction with EMG analysis from 4 muscle sites of the lumbar spine.Initial median frequency(IMF),the median frequency slope(MFslope),as well as the root mean square(RMS)slope EMG parameters were used as fatigue measures.Data were analysed with repeated measures ANOVA for test-retest differences.For reliability,the intraclass correlation coefficient(ICC3,1),standard error of the measurement(SEM)and the smallest detectable difference(SDD)were reported.Group-related differences for fatigue measures were analysed with a Multivariate Analysis of Covariance,with age,weight and strength as covariates.RESULTS Isometric strength presented statistically significant between-day differences(P<0.01),however these did not exceed 10%(healthy:7.2%/LBP-patients:9.7%)and ICC reliability values were excellent,yet test-retest error was increased for the patient group(healthy:ICC3,1:0.92-0.96,SEM:5.72-5.94 Hz,SDD:18.51%-18.57%/LBP-patients:ICC3,1:0.91-0.96,SEM:6.49-6.96,SDD:30.75%-31.61%).For the frequency data,IMF reliability was excellent(healthy:ICC3,1:0.91-0.94,SEM:3.45-7.27 Hz,SDD:9.56%-20.14%/patients:ICC3,1:0.90-0.94,SEM:6.41-7.59 Hz,SDD:17.75%-21.02%)and of MF raw and normalised slopes was good(healthy:ICC3,1:0.78-0.82,SEM:4.93-6.02 Hz,SDD:13.66-16.67%/LBP-patients:ICC3,1:0.83-0.85,SEM:6.75-7.47 Hz,SDD:18.69%-20.69%).However,the reliability for RMS data presented unacceptably high SDD values and were not considered further.For discriminative validity,less MVIC and less steep MFslopes were registered for the patient group(P<0.01).CONCLUSION Reliability and discriminative ability of paraspinal strength and EMG-related frequency parameters were demonstrated in healthy participants and patients with LBP.

Morphological changes of the lateral abdominal muscles in adolescent soccer players with low back pain: A prospective cohort study

Background:Most papers examining the lateral abdominal muscles(LAMs)and low back pain(LBP)are cross-sectional,with groups of participants being divided into a control and an LBP group.We hypothesized that morphological measurements of the LAMs in adolescent soccer players may predict future LBP incidence.The aim of this study was to examine the associations between the morphology of LAMs and LBP incidence rate among adolescent soccer players.Methods:Ninety-seven adolescent male soccer players with no LBP at baseline were recruited into the prospective cohort study.The thickness of the LAMs was measured at baseline by ultrasound imaging in a supine rest position.Nine cases of LBP occurred during the follow-up 6-month observation.Results:An obliquus internus(OI)asymmetry was related to increasing LBP risk(odds ratio=19.99;95%CI:2.4-167.9).Spearman correlation also showed a linear relationship between OI asymmetry value and duration of LBP(R=0.75,p=0.02).An OI side-to-side difference greater than 1.25 mm suggests possible LBP incidence in the 6-month observation among adolescent soccer players.Conclusion:The morphological changes of the OI may be related to LBP’s incidence in adolescent soccer players.The presence of OI asymmetry increases the odds of LBP by at least 2.4 times.Hypertrophy of the OI on one side of the body may contribute to trunk muscle imbalance.

Barriers to mesenchymal stromal cells for low back pain

Intervertebral disc degeneration is the main cause of low back pain.In the past 20 years,the injection of mesenchymal stromal cells(MSCs)into the nucleus pulposus of the degenerative disc has become the main approach for the treatment of low back pain.Despite the progress made in this field,there are still many barriers to overcome.First,intervertebral disc is a highly complex loadbearing composite tissue composed of annulus fibrosus,nucleus pulposus and cartilaginous endplates.Any structural damage will change its overall biomechanical function,thereby causing progressive degeneration of the entire intervertebral disc.Therefore,MSC-based treatment strategies should not only target the degenerated nucleus pulposus but also include degenerated annulus fibrosus or cartilaginous endplates.Second,to date,there has been relatively little research on the basic biology of annulus fibrosus and cartilaginous endplates,although their pathological changes such as annular tears or fissures,Modic changes,or Schmorl's nodes are more commonly associated with low back pain.Given the high complexity of the structure and composition of the annulus fibrosus and cartilaginous endplates,it remains an open question whether any regeneration techniques are available to achieve their restorative regeneration.Finally,due to the harsh microenvironment of the degenerated intervertebral disc,the delivered MSCs die quickly.Taken together,current MSC-based regenerative medicine therapies to regenerate the entire disc complex by targeting the degenerated nucleus pulposus alone are unlikely to be successful.

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.

Slacklining as therapy to address non-specific low back pain in the presence of multifidus arthrogenic muscle inhibition

Low back pain(LBP)represents the most prevalent,problematic and painful of musculoskeletal conditions that affects both the individual and society with health and economic concerns.LBP is a heterogeneous condition with multiple diagnoses and causes.In the absence of consensus definitions,partly because of terminology inconsistency,it is further referred to as non-specific LBP(NSLBP).In NSLBP patients,the lumbar multifidus(MF),a key stabilizing muscle,has a depleted role due to recognized myocellular lipid infiltration and wasting,with the potential primary cause hypothesized as arthrogenic muscle inhibition(AMI).This link between AMI and NSLBP continues to gain increasing recognition.To date there is no‘gold standard’or consensus treatment to alleviate symptoms and disability due to NSLBP,though the advocated interventions are numerous,with marked variations in costs and levels of supportive evidence.However,there is consensus that NSLBP management be cost-effective,self-administered,educational,exercise-based,and use multi-modal and multi-disciplinary approaches.An adjuvant therapy fulfilling these consensus criteria is‘slacklining’,within an overall rehabilitation program.Slacklining,the neuromechanical action of balance retention on a tightened band,induces strategic indirect-involuntary therapeutic muscle activation exercise incorporating spinal motor control.Though several models have been proposed,understanding slacklining’s neuro-motor mechanism of action remains incomplete.Slacklining has demonstrated clinical effects to overcome AMI in peripheral joints,particularly the knee,and is reported in clinical case-studies as showing promising results in reducing NSLBP related to MF deficiency induced through AMI(MF-AMI).Therefore,this paper aims to:rationalize why and how adjuvant,slacklining therapeutic exercise may positively affect patients with NSLBP,due to MF-AMI induced depletion of spinal stabilization;considers current understandings and interventions for NSLBP,including the contributing role of MF-AMI;and details the reasons why slacklining could be considered as a potential adjuvant intervention for NSLBP through its indirect-involuntary action.This action is hypothesized to occur through an over-ride or inhibition of central down-regulatory induced muscle insufficiency,present due to AMI.This subsequently allows neuroplasticity,normal neuro-motor sequencing and muscle re-activation,which facilitates innate advantageous spinal stabilization.This in-turn addresses and reduces NSLBP,its concurrent symptoms and functional disability.This process is hypothesized to occur through four neuro-physiological processing pathways:finite neural delay;movement-control phenotypes;inhibition of action and the innate primordial imperative;and accentuated corticospinal drive.Further research is recommended to investigate these hypotheses and the effect of slacklining as an adjuvant therapy in cohort and control studies of NSLBP populations.

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.

Self-Management of Low Back Pain Using Neural Network

Low back pain(LBP)is a morbid condition that has afflicted several citizens in Europe.It has negatively impacted the European economy due to several man-days lost,with bed rest and forced inactivity being the usual LBP care and management steps.Direct models,which incorporate various regression analyses,have been executed for the investigation of this premise due to the simplicity of translation.However,such straight models fail to completely consider the impact of association brought about by a mix of nonlinear connections and autonomous factors.In this paper,we discuss a system that aids decision-making regarding the best-suited support system for LBP,allowing the individual to avail of reinforcement and improvement in its self-management.These activities are monitored with the help of a wearable sensor that helps in their detection and their classification as those that soothe or aggravate LBP and hence,should or should not be performed.This system helps the patients set their own boundaries and milestones with respect to suitable activities.This system also does windowing and feature extraction.The present study is an empirical and comparative analysis of the most suitable activities that patients suffering from low back pain can select.The evaluation shows that the system can distinguish between nine common daily activities effectively and helps self-monitor these activities for the efficient management of LBP.

Efficacy of gabapentin for low back pain at a tertiary hospital: A prospective observational study

Objective:To assess the efficacy of gabapentin in the treatment of low back pain patients.Methods:This prospective observational study was conducted over 6 months to assess the efficacy of gabapentin in patients suffering from low back pain.Past medical history,pain severity by Visual Analogue scale(VAS)and sleep quality by Pittsburgh Sleep Quality Index(PQSI)were collected.VAS scores and PQSI scores before and after gabapentin treatment were compared,and gabapentin satisfaction post treatment were recorded.Results:This study included 100 low back pain patients with 65 males and 35 females,and the mean age was(39.0±10.5)years.The commonest presentation was non-radiating low back pain(40%).The mean VAS score and the mean PQSI score in the study before treatment were 7.70±1.91 and 10.95±5.02,respectively.After treatment with gabapentin,the mean VAS score and the mean PQSI score decreased to 2.75±1.79 and 4.90±2.20,respectively,and the differences before and after the treatment were significantly different(both P=0.001).Overall,62%of the patients were extremely satisfied with gabapentin because they reported no adverse drug reaction.Besides,31%of the patients were satisfied and 7%were strongly dissatisfied with the therapy.Conclusion:Gabapentin can improve sleep quality and reduce lower back pain as measured by the VAS and PQSI.The efficacy of this drug is relatively good,but further improvement is required.

Low back pain-related meta-analysis:Caution is needed when interpreting published research results

The systematic reviews(SRs) including a meta-analysis are considered as the top level of evidence.Although the existence of more than a hundred of low back pain(LBP)-related SRs seems very appealing and might therefore suggest significant evidence on the topic,adeep analysis indicates that several of these SRs included only very few studies.Other SRs raise concerns because they included some randomized controlled trials which had a low methodological quality,or some studies which differed significantly regarding the studied populations and/or the experimental procedure.The sometimes controversial results of different SRs conducted on the same topic also highlight the significant influence of the inclusion/exclusion criteria used in the SRs to select the articles.To conclude,although meta-analysis is at the top of the evidence pyramid and have several strengths,the conclusions drawn from SRs should always be interpreted with caution because they can also have weaknesses.This is true,whether it be for LBP-related SRs including a meta-analysis,or any other.Therefore a critical analysis of any SR is always needed before integrating the results of the SR in its own clinical practice.Furthermore,clinical reasoning remains crucial,especially to consider the potential differences between one's patient and the patients included in the meta-analysis.

Trends and risk factors for opioid administration for non-emergent lower back pain

BACKGROUND Non-emergent low-back pain(LBP)is one of the most prevalent presenting complaints to the emergency department(ED)and has been shown to contribute to overcrowding in the ED as well as diverting attention away from more serious complaints.There has been an increasing focus in current literature regarding ED admission and opioid prescriptions for general complaints of pain,however,there is limited data concerning the trends over the last decade in ED admissions for non-emergent LBP as well as any subsequent opioid prescriptions by the ED for this complaint.AIM To determine trends in non-emergent ED visits for back pain;annual trends in opioid administration for patients presenting to the ED for back pain;and factors associated with receiving an opioid-based medication for non-emergent LBP in the ED METHODS Patients presenting to the ED for non-emergent LBP from 2010 to 2017 were retrospectively identified from the National Hospital Ambulatory Medical Care Survey database.The“year”variable was transformed to two-year intervals,and a weighted survey analysis was conducted utilizing the weighted variables to generate incidence estimates.Bivariate statistics were used to assess differences in count data,and logistic regression was performed to identify factors associated with patients being discharged from the ED with narcotics.Statistical significance was set to a P value of 0.05.RESULTS Out of a total of 41658475 total ED visits,3.8%(7726)met our inclusion and exclusion criteria.There was a decrease in the rates of non-emergent back pain to the ED from 4.05%of all cases during 2010 and 2011 to 3.56%during 2016 and 2017.The most common opioids prescribed over the period included hydrocodone-based medications(49.1%)and tramadol-based medications(16.9),with the combination of all other opioid types contributing to 35.7%of total opioids prescribed.Factors significantly associated with being prescribed narcotics included age over 43.84-years-old,higher income,private insurance,the obtainment of radiographic imaging in the ED,and region of the United States(all,P<0.05).Emergency departments located in the Midwest[odds ratio(OR):2.42,P<0.001],South(OR:2.35,<0.001),and West(OR:2.57,P<0.001)were more likely to prescribe opioid-based medications for non-emergent LBP compared to EDs in the Northeast.CONCLUSION From 2010 to 2017,there was a significant decrease in the number of nonemergent LBP ED visits,as well as a decrease in opioids prescribed at these visits.These findings may be attributed to the increased focus and regulatory guidelines on opioid prescription practices at both the federal and state levels.Since nonemergent LBP is still a highly common ED presentation,conclusions drawn from opioid prescription practices within this cohort is necessary for limiting unnecessary ED opioid prescriptions.

Effects of Chinese tuina on the level changes of lumbar muscle temperature and serum 5-HT and β-EP in patients with low back pain

Objective:To analyze the level changes of the degree of back pain by visual analogue scale(VAS),lumbar function(Japanese Orthopaedic Association Scores,JOA),muscle temperature,serum serotonin 5-hydroxytryptamine(5-HT)andβ-endorphin(β-EP)in patients of low back pain(LBP).Methods:64 LBP patients treated in the tuina department of first affiliated hospital of Hainan Medical University were randomly divided into observation group(32 cases)and control group(32 cases).The control group was treated with traditional filiform acupuncture needling,the observation group was treated with Chinese tuina.VAS,JOA,muscle temperature,5-HT,β-EP,these indexes were tested before and after treatment.Results:The VAS and JOA score in the observation group were significantly lower than those in the control group(P<0.01),the muscle temperature in the observation group and the control group increased significantly(P<0.01),and the observation group was higher than that in the control group(P<0.05);5-HT、β-EP was significant difference before and after treatment(P<0.01),and the level in observation group was significantly higher than that in the control group,the difference was statistically significant(P<0.05).Conclusion:Chinese tuina has significant clinical efficacy in the treatment of LBP.The medical infrared thermal imaging technology and serum pain detection technology is conducive to objectively helpful to analyze the exact efficacy of tuina in the treatment of LBP and its impact on relevant indexes.