慢性腰痛を抱える女性に対してアクセプタンス&コミットメント・セラピー(ACT)を適用した症例研究

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Although the association of chronic pain (CP) with a poor work-life balance has been well studied, the interaction effect of multiple pain sites on work-life balance is unknown. To evaluate the most prevalent CP site among healthcare workers, the demographic characteristics of the individuals with the predominant pain type, and to assess the interaction of multiple pain sites on work-life balance. Using data from the National Health Interview Survey, 2,458 healthcare works were identified for this study. The independent variables were chronic low back and hip pain. The dependent variables were (1) if pain affected their family or significant other, (2) if pain limited their life or work activities, and (3) Usually working >35 hours/week. Multiple logistic regression and an interaction analysis were used to analyze the impact of different pain sites on work-life balance. Among healthcare workers, chronic low back pain was more prevalent than chronic hip pain (69.4% vs 61.4%, p-value<0.001). Respondents with chronic low back pain were mostly 40 - 64 years of age (49.6%), females (71.2%), white (77.6%), married (55.5%), had no college degree (85.4%), earn greater than $75,000 (50.0%). In the interaction analysis, in the presence of chronic hip pain, those with chronic low back pain had an AOR of 2.20 (1.05 - 4.64), p-value 0.038 of chronic low back pain affecting their family and significant others, and an AOR of 2.18 (1.17- 4.05), p-value 0.014 of chronic low back pain affecting their life or work. Chronic low back pain was more prevalent than chronic hip pain among healthcare workers. Together both pain sites had a significant impact on the work-life balance of this population. Further studies should assess other dimensions of work-life balance and chronic pain.

Intradiscal electrothermal treatment for chronic discogenic low back pain: a prospective outcome study with minimum 1‐year follow‐up. (SOAR, Physiatry Medical Group, Menlo Park, CA) <i>Spine</i> 2000;25:2622–2627.

Іntroduction. Chronic low back pain is a global problem for people of working age worldwide, leading to impaired functioning, quality of life, and social activity. Modifiable risk factors are risks that are more related to human behavioral strategies and can be changed. The main modifiable risk factors for chronic low back pain include a sedentary lifestyle, bad habits, obesity, comorbidities, and high stress levels. Studying risk factors for chronic low back pain is important for developing preventive strategies and effective rehabilitation interventions in patients with chronic low back pain. Objective. To investigate the relationship between modifiable factors and chronic low back pain, and to assess the severity of modifiable risk factors for chronic low back pain in different age groups. Materials and methods. To achieve this goal, a questionnaire was conducted based on the Rehabilitation Department of the University Clinic of the Bogomolets National Medical University (NMU), which included an assessment of socio-demographic and anthropometric indicators, an assessment of the level of stress according to the PSS-10 (Perceived Stress Scale) in people aged 18–60 years. All patients were divided into two groups: the control group, consisting of practically healthy individuals, and the comparison group, consisting of individuals with chronic nonspecific low back pain. Results. The study involved 240 people, with a mean age of 34.3±12.7, 121 women (36.2±15.3) and 119 men (32.3±9.1). Comparative analysis revealed that individuals with chronic low back pain had statistically significant risk factors: higher BMI (p&lt;0.01), lower physical activity (p=0. 001), higher sedentary time (p=0.010), higher prevalence of smoking (p=0.016), sleep disturbances (p&lt;0.001), higher stress levels (p&lt;0.001) and comorbidities (p=0.002). The results of a comparative analysis of the relationship between modifiable risk factors among patients with chronic low back pain, depending on age, revealed differences in BMI, smoking prevalence, physical inactivity, sleep disturbance, and comorbidities. Conclusions. Individuals with chronic low back pain, compared to practically healthy individuals, have significantly higher rates of modifiable risk factors. Among patients with chronic low back pain in the age group of 18–24, a more significant risk factor is underweight; in the age group of 25–44, smoking; in the age group of 45–60, overweight and obesity, insufficient physical activity, sleep disorders and comorbidities.

Chronic non-specific low back pain is a musculoskeletal disorder that has a significant tendency to spread among working-age people throughout their lives worldwide. Lower back pain is the leading cause of disability worldwide among people of working age and is a significant social and economic burden on the healthcare system. In patients with chronic low back pain, assessment of functional impairment is of important clinical significance, as it allows for evaluation of the complexity of the course, the effectiveness of treatment, and the prognosis for the disease. To assess the degree of functional impairment in patients with chronic non-specific low back pain depending on the dominant type of pain. A retrospective single-center pilot study was conducted and included patients with chronic non-specific low back pain who underwent rehabilitation in the rehabilitation department of the Bogomolets National Medical University. All participants were divided into three groups depending on the dominant type of pain: with a predominance of nociplastic pain, with a predominance of neuropathic pain, and with a predominance of nociceptive pain. The subjects underwent an assessment of socio-demographic and anthropometric indicators, pain status, and functional impairment using the Oswestry Disability Index (ODI) questionnaire, and subjective assessment of stress level (PSS-10). Among 102 subjects with chronic non-specific low back pain, 63% were women and 37% were men of working age, with a mean age of 39.0±12.3 and 40.4±10.5 years, respectively. Among the subjects, nociceptive pain was dominant in 53.9% (CI 44.1-63.6%), nociplastic pain was present in 22.5% (CI 14.9-31.2%), 15.7% (CI 9.2-23.4%) had neuropathic pain, and in 7.8% (CI 3.4-13.9%) of the subjects, the dominant type of pain could not be determined. In the group of patients with a dominant nociplastic type of pain, the ODI dysfunction index was 27.2±14.0%, which corresponds to moderate dysfunction. In the group with a dominant neuropathic type of pain, this indicator was 22.0±12.1%, which also indicates moderate impairment. Among patients with nociceptive type of pain, the ODI indicator corresponded to minimal impairment, 13.6±10.7%, the difference was significant compared to the group of patients with dominant nociplastic and neuropathic pain, respectively (p&lt;0.001, p=0.009). Most patients with chronic non-specific low back pain with a dominant nociplastic type of pain have moderate functional impairment. In this group of patients, low back pain most significantly limits functioning during sitting, standing, social and sexual life, and traveling. Most patients with nociceptive and neuropathic type of pain have minimal functional impairment.

Introduction For patients with persistent and disabling chronic low back pain (CLBP) who failed to improve after less intensive interventions, a combined physical and psychological (CPP) program including exercises and a cognitive behavioral approach, is recommended.1–3 These patients with CLBP participating in a two-week CPP-program improve in functional status and quality of life during the program and these positive results are maintained at one4 and at two-year follow-up assessment.5 Purpose To evaluate the long-term results of a short, intensive, evidence based CPP-program. Material and Methods A consecutive cohort study with a mean follow up of 6.5 years (range: 5.5–7.5) was performed. At follow up a response rate of 85% ( n = 277) was achieved. Primary outcome was functional status (Oswestry Disability Index [ODI;0–100]). Secondary outcomes were pain intensity, quality of life, and patient reported satisfaction. A Repeated Measures analysis of variance was used to identify changes over time. The two-week residential program is in line with recommendations in international guidelines1–3 and provided in collaboration with orthopedic spine surgeons at Sint Maartenskliniek Nijmegen, The Netherlands. Results At pre-treatment assessment the mean age was 46.1years (SD9.3) and the mean CLBP-duration 12.3 years (SD10.9). The mean ODI-score showed improvement at post-treatment and maintenance of results over time (ODI df[1,276],F = 0.146, p = 0.703). Secondary outcomes showed the same pattern. At long-term follow up more than half of the CLBP-patients (59.2%) showed a clinically relevant improvement of ≥10 points on the ODI and 45.3% of the patients reached a functional status equivalent to an acceptable, normal healthy population value (ODI ≤ 22). This is comparable to the one-year follow-up assessment. 80.1% of the participants are satisfied with the treatment results and 76.2% would recommend the program to family/friends. Conclusion The positive short-term effectiveness at one-year follow up of a two-week CPP-program is demonstrated to maintain over time. Patients demonstrate continued improvement of functional status and quality of life after 6.5 years of follow up. Moreover, at long-term follow up a high percentage of patients were satisfied with the results of the program and they would recommend the program to family and/or friends. References National Institute for Health and Care Excellence. Clinical Guideline 88. Low back pain: Early management of persistent non-specific low back pain. May 2009 Chou R, Loeser JD, Owens DK, et al; American Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine 2009;34(10):1066–1077 Airaksinen O, Brox JI, Cedraschi C, et al; COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006;15(Suppl 2):S192–S300 van Hooff ML, van der Merwe JD, O'Dowd J, et al. Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management. Eur Spine J 2010;19(9):1517–1526 van Hooff ML, Ter Avest W, Horsting PP, et al. A short, intensive cognitive behavioral pain management program reduces health-care use in patients with chronic low back pain: two-year follow-up results of a prospective cohort. Eur Spine J 2012;21(7):1257–1264

Study Design.Prospective study.Objective.To compare the burden between chronic nonspecific low back pain (LBP) and axial spondyloarthropathy (SpA).Summary of Background Data.Chronic nonspecific LBP and SpA are two debilitating yet different chronic musculoskeletal disorders. To compare their burden, propensity score matching is used to control for potential confounders and match the study subjects.Materials and Methods.Two prospectively collected cohorts of LBP (n=269) and SpA (n=218) patients were studied. Outcomes included current LBP, 36-item Short Form Questionnaire, Oswestry Disability Index, EuroQol 5-dimension 5-level Questionnaire, and EuroQol Visual Analog Scale. With the inherent differences between the two types of patients, propensity score matching was performed for comparing the two groups. Baseline covariates of age, sex, education level, occupation, smoking, and drinking history were selected for the estimation of propensity scores for each subject with the logistic regression model. Significant independent variables for the outcome of current back pain were included in the multivariate logistic regressions.Results.A total of 127 matched pairs were identified, with 254 patients. In the matched cohort, more patients with chronic LBP had current back pain (95.3%) as compared with SpA (71.7%). Patients with SpA were younger (P<0.001), with more males (P<0.001), and better educated (P=0.001). There was less current back pain and higher nonsteroidal anti-inflammatory drug use (P<0.001). Most SpA patients had lower Oswestry Disability Index than LBP patients and with low disease activity. Patients with LBP had worse outcome scores as compared with SpA patients given the same Visual Analog Scale. LBP patients had 8.6 times the odds (95% CI: 3.341–20.671; P<0.001) of experiencing current back pain compared with SpA patients.Conclusions.The disease activity of SpA patients is well controlled. However, patients with chronic LBP have worse pain severity, disability, and health-related quality of life. This has implications on resource utilization and the necessity of advancing LBP understanding and management.Level of Evidence.Type I prognostic study.

Study DesignA cross-sectional study.PurposeTo clarify the prevalence of chronic nonspecific low back pain (CNSLBP) and its associated factors among middle-aged and elderly Japanese individuals using data from a musculoskeletal examination conducted in general Japanese populations.Overview of LiteratureMost studies evaluating low back pain-associated factors have been conducted in Western countries, but they have not always evaluated CNSLBP.MethodsWe obtained data on 213 subjects aged >50 years who responded to a survey regarding age, gender, body mass index, lifestyle-related diseases (diabetes mellitus, hypertension, and hyperlipidemia), glucocorticoid use, smoking and alcohol-drinking habits, labor intensity, and chronic low back pain (CLBP) and underwent screening for lumbar spinal stenosis, evaluation for quality of life (QOL), and evaluation for specific spinal pathology via thoracolumbar spine X-rays. We investigated the prevalence of CNSLBP and association between CNSLBP and measured variables.ResultsThe prevalence of CNSLBP and chronic specific low back pain (CSLBP) was 15.4% and 9.3%, respectively. Among the subjects with CLBP, 62.2% had CNSLBP. In age-adjusted logistic models, smoking habits (p=0.049, odds ratio [OR]=2.594), low back pain (p<0.001, OR=0.974), lumbar function (p=0.001, OR=0.967), and social function (p=0.023, OR=0.976) in the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were significantly associated with CNSLBP, whereas EQ-5D utility score (p=0.024, OR=0.068), low back pain (p=0.007, OR=0.981), lumbar function (p=0.001, OR=0.963), walking ability (p=0.001, OR=0.968), and social function (p=0.002, OR=0.966) in JOABPEQ were significantly associated with CSLBP.ConclusionsCNSLBP among middle-aged and elderly individuals was associated with smoking habits and decreased QOL; however, CSLBP was considered to be more multilaterally associated decreased QOL.

There is a lack of studies investigating the effects of instrument-assisted soft tissue mobilization on chronic low back pain, and the level of evidence is low. This study aimed to examine and compare the time-dependent effects of two different instrument-assisted soft tissue mobilization protocols in individuals with chronic nonspecific low back pain. This was a comparative study. University Physiotherapy and Rehabilitation department in Cyprus. Seventy-four patients with chronic nonspecific low back pain were randomized into two groups (Group 1 (n = 37) and Group 2 (n = 37)). 6 sessions were implemented with the participants, twice weekly for 3 weeks. The same instrument-assisted soft tissue mobilization protocol (7-step) was applied to both groups, but in different positions (fixed prone vs. extended child pose and knee flexion-extension). Pain levels (visual analogue scale), spinal mobility (Modified Schober Test), flexibility (Sit and Reach Test, Maximal Hip Flexion Active Knee Extension Test, Active Knee Extension Test, Thoracolumbar Fascia Flexibility Test), muscle endurance of trunk extensors (The Biering-Sorenson Test), and disability (Oswestry Disability Index) were assessed. The pain and disability values of both groups decreased, and their spinal mobility, spinal flexibility, hamstring flexibility, thoracolumbar fascia flexibility, and endurance values increased after the 1st and 6th interventions (P < .05). Intra-group comparisons revealed a significant improvement only in pain levels at rest in the group in which instrument-assisted soft tissue mobilization was applied during functional exercises (P < .05). Both instrument-assisted soft tissue mobilization methods instantly reduced levels of pain and disability and improved spinal mobility, flexibility, and trunk extensor endurance. Applying instrument-assisted soft tissue mobilization with functional exercises to individuals with chronic nonspecific low back pain is more effective in reducing pain levels at rest. Low back pain, fascia, spine, soft tissue therapy, comparative study.

Objective: To assess the relationship between hypovitaminosis D and chronic low back pain in South Punjab. Materials and Methods: Retrospective research was done from January 2021 to June 2022. 173 chronic nonspecific low back pain patients presenting in outpatient clinics were included in our study. Two groups were made of all patients, one was vitamin-D level deficient, and the other was a vitamin-D normal group. The blood level of 30 ng/ml of vitamin D was taken as normal. Chronic Low back pain status was analyzed by VAS score. All the demographic data of patients were recorded. The relationship between vitamin D and VAS score was assessed by the spearman coefficient and p &lt;0.05 was taken as significant. Results: The majority of patients had a mean age of 36.45 ± 21 years, were female preponderance, married, and vegetarians with a mean sun exposure time of about 2 hours. In group 1, the vitamin D level was 13.41 ± 3.8 and in group 2 vitamin D was 38.71 ± 5.8 with p value&lt; 0.0001. Spearman rho coefficient was used to assess the relationship between vitamin D and pain score. The result was a negative correlation between these 2 variables (r=-0.572) and p &lt;0.0001. Conclusion This research work showed the significant probability of association between vitamin D level and patients having nonspecific chronic low back pain. There was a negative association between vitamin D level and VAS score of patients having chronic low back pain.

Background and Objectives Chronic non-specific back pain is one of the causes of disability in people, and chronic pain is one of the most important medical problems in the world.The aim of this study was to the effectiveness of Pilates exercises on pain, Disability, in patients with chronic nonspecific low back pain. Subjects and Methods From internal and external search engines Scopus, Semantic Scholar, Google Scholar, Pubmed, ISC SID, Magiran, Irandoc, Doaj with time limit 2010 to 2024 and the keywords Pilates,Pain, Disability, Non-Specific, Chronic Low Back The present study was Prisma (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes). Results Eleven articles were selected based on inclusion criteria. A systematic review on the effectiveness of Pilates exercises on Pain, Disability, in people with non-specific chronic low back pain. Conclusion According to the research conducted in the present study, Pilates exercises can increase the cross-sectional area of ​​the lumbar multifidus muscle and increase the strength of the abdominal muscle. it seems that Pilates exercises improve pain and disability in patients with chronic low back pain.

Back School and McKenzie methods are popular active treatment approaches that include both exercises and information for patients with chronic nonspecific low back pain. The purpose of this study was to compare the effectiveness of Back School and McKenzie methods in patients with chronic nonspecific low back pain. The study was a prospectively registered, 2-arm randomized controlled trial with a blinded assessor. The study was conducted in the outpatient physical therapy clinic in São Paulo, Brazil. The study participants were 148 patients with chronic nonspecific low back pain. The 4-week treatment program (one session/week) was based on the Back School (delivered to the group) or McKenzie (delivered individually) principles. The participants also were instructed to perform a daily set of home exercises. Clinical outcomes were assessed at follow-up appointments at 1, 3, and 6 months after randomization. Primary outcome measures were pain intensity (measured by the 0-10 pain numerical rating scale) and disability (measured by the 24-item Roland-Morris Disability Questionnaire) 1 month after randomization. Secondary outcome measures were pain intensity and disability at 3 and 6 months after randomization, quality of life (measured by the World Health Organization Quality of Life-BREF instrument) at 1, 3, and 6 months after randomization, and trunk flexion range of motion measured by an inclinometer at 1 month after randomization. The data were collected by a blinded assessor. Participants allocated to the McKenzie group had greater improvements in disability at 1 month (mean effect=2.37 points, 95% confidence interval=0.76 to 3.99) but not for pain (mean effect=0.66 points, 95% confidence interval=-0.29 to 1.62). No between-group differences were observed for all secondary outcome measures. It was not possible to monitor the home exercise program. Therapists and participants were not blinded. The McKenzie method (a more resource-intensive intervention) was slightly more effective than the Back School method for disability, but not for pain intensity immediately after treatment in participants with chronic low back pain.

Dear Editor, Discogenic pain affects approximately 45% of patients suffering from chronic low back pain, and it is caused by chemical and mechanical changes of the intervertebral disc [1]. Many different minimally invasive techniques have been used for the treatment of this condition, with various results. We report the combination of intradiscal pulsed radiofrequency combined to gelified ethanol application for the treatment of chronic discogenic low back pain. Pulsed radiofrequency mechanism of action has been well discussed [2,3]. Gelified ethanol is an implantable medical device in which an opaque agent in X-rays (the tungsten) was added [4,5]. The implant is administered within the affected intervertebral disc's nucleus pulposus, via a fine needle that is guided into the center of the disc, transdermally, under fluoroscopic guidance [4,5]. To our knowledge, this is the first report of the combination of the two methods via the same radiofrequency needle, for the treatment of chronic discogenic low back pain. The patients enrolled suffered from discogenic low back pain, refractory to conservative treatment and physiotherapy for at least 6 months, and reported concordant pain during provocative discography. Pain scores (numeric rating scale 0–10) and satisfaction rates (visual analogue scale 0–10, where 0: “worst” satisfaction and …

In China, the number of chronic pain patients has exceeded 300 million, making chronic pain the third major health problem after tumors and cardiovascular diseases. Particularly concerning is the gradual emergence of hypertension and chronic low back pain as public health problems that threaten public health and increase the global economic burden. Modern research shows that the incidence of coexisting hypertension is higher among patients with chronic low back pain. Additionally, evidence indicates that the use of NSAIDs for pain relief can have adverse effects on blood pressure, and some antihypertensive medications may trigger symptoms of low back pain. Thus, addressing chronic pain in hypertensive patients while stabilizing blood pressure is one of the important research questions in the modern treatment of hypertension among middle-aged and elderly individuals. From ancient to modern traditional Chinese medicine(TCM) theory, kidney deficiency has been regarded as the core pathogenesis of low back pain. Recent clinical practices and literature indicate that kidney deficiency plays a crucial role in the modern pathogenesis of hypertension. Both hypertension and chronic low back pain are closely associated with kidney deficiency in TCM theory, revealing a potential mechanism linking the two conditions. Combining the theories of &quot; kidney-essence-marrow&quot; and &quot; nourishing water to moisten wood&quot;, a therapeutic strategy centered on tobifying kidney was proposed, including selecting single drugs with kidney-tonifying effects as well as compound formulations and elaborating modern research evidence. The aim is to achieve stable blood pressure control in hypertension patients with chronic low back pain while providing a new treatment perspective for chronic low back pain. This article systematically elaborates on the understanding of hypertension combined with chronic low back pain from both TCM and modern medicine, as well as the therapeutic strategy involving kidney-tonifying drugs, to offer useful references for clinical practice.

Exercise therapy encompasses a heterogeneous group of interventions. There continues to be uncertainty about the most effective exercise approach in chronic low back pain. To identify particular exercise intervention characteristics that decrease pain and improve function in adults with nonspecific chronic low back pain. MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004 and citation searches and bibliographic reviews of previous systematic reviews. Randomized, controlled trials evaluating exercise therapy in populations with chronic (>12 weeks duration) low back pain. Two reviewers independently extracted data on exercise intervention characteristics: program design (individually designed or standard program), delivery type (independent home exercises, group, or individual supervision), dose or intensity (hours of intervention time), and inclusion of additional conservative interventions. 43 trials of 72 exercise treatment and 31 comparison groups were included. Bayesian multivariable random-effects meta-regression found improved pain scores for individually designed programs (5.4 points [95% credible interval (CrI), 1.3 to 9.5 points]), supervised home exercise (6.1 points [CrI, -0.2 to 12.4 points]), group (4.8 points [CrI, 0.2 to 9.4 points]), and individually supervised programs (5.9 points [CrI, 2.1 to 9.8 points]) compared with home exercises only. High-dose exercise programs fared better than low-dose exercise programs (1.8 points [CrI, -2.1 to 5.5 points]). Interventions that included additional conservative care were better (5.1 points [CrI, 1.8 to 8.4 points]). A model including these most effective intervention characteristics would be expected to demonstrate important improvement in pain (18.1 points [CrI, 11.1 to 25.0 points] compared with no treatment and 13.0 points [CrI, 6.0 to 19.9 points] compared with other conservative treatment) and small improvement in function (5.5 points [CrI, 0.5 to 10.5 points] compared with no treatment and 2.7 points [CrI, -1.7 to 7.1 points] compared with other conservative treatment). Stretching and strengthening demonstrated the largest improvement over comparisons. Limitations of the literature, including low-quality studies with heterogeneous outcome measures and inconsistent and poor reporting; publication bias. Exercise therapy that consists of individually designed programs, including stretching or strengthening, and is delivered with supervision may improve pain and function in chronic nonspecific low back pain. Strategies should be used to encourage adherence. Future studies should test this multivariable model and further assess specific patient-level characteristics and exercise types.