Objective To quantitatively assess the structural changes of the lumbar paraspinal muscles in patients with chronic non-specific low back pain (CNLBP) using conventional magnetic resonance imaging ...(MRI) and diffusion tensor imaging (DTI) in order to provide a reference for the clinical diagnosis and treatment of CNLBP. Methods A total of 45 CNLBP patients admitted to our hospital from April 2022 to March 2023 were enrolled and assigned into CNLBP group, and another 28 healthy volunteers were recruited and assigned into control group. Sagittal and axial T2WI and DTI MRI scans were performed to all the subjects at the same time. The axial T2WI and DTI images at the L3/4, L4/5 and L5/S1 intervertebral disc levels were used to measure the functional cross-sectional area (FCSA), fat infiltration rate (FIR), fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the bilateral multifidus and erector spinae muscle. Visual analog scale (VAS) and Oswestry disability index (ODI) were employed to a
Prolonged release tolperisone hydrochloride 450 mg (PRTH 450) is a dosage form that is convenient for patients, since it reduces the frequency of drug administration per day: from three immediate ...release tablets of 150 mg (TH 150) to one tablet of PRTH 450.Objective: to evaluate the therapeutic efficacy and safety of the new dosage form of PRTH 450 (Mydocalm® Long, once a day) in comparison with TH 150 (Mydocalm® administered three times per day) in acute non-specific lower back pain (LBP).Patients and methods. Study No. 84158 – a multicenter, randomized, double-blind, phase III, active control study of no less efficiency in two parallel groups of adult patients (mean age: 41.3 and 41.88 years) with acute non-specific LBP. From 05.09.2017 to 07.05.2018, 239 patients with acute non-specific LBP were included in the study. The two placebo method was used to mask the prescribed treatment. Inpatients or outpatients were randomly assigned to therapy with PRTH 450 once a day in combination with placebo three times a day or TH 150 three times a day in combination with placebo once a day.For 14 days, after a meal, patients received oral PRTH 450 once a day as an active drug and placebo three times per day or oral TH 150 three times per day and placebo once a day. Follow-up visits were carried out after 3.7±1 and 14±2 days. Patients in whom the study drugs did not significantly reduce pain were allowed to additionally use diclofenac tablets up to 50 mg three times a day. The primary efficacy endpoint was the percentage change in baseline disability assessed by the Roland-Morris Disability Questionnaire (RMQ) at 14 days (treatment completion). Secondary efficacy endpoints were the percentage change in baseline disability after 3 and 7 days, the difference in pain intensity on the visual analogue scale (VAS) after 3, 7, and 14 days, the patient's overall impression of the daily change in his condition, the time before symptoms began to decrease, change in range of motion, measured by the fingertips to floor distance during an attempt to reach for the floor with the fingertips after 3, 7 and 14 days, as well as the total dose of diclofenac for additional pain relief. Safety indicators and their changes were assessed at each visit and in each treatment group. The presence of adverse events (AEs) was determined based on patient complaints and general examination results, measurements of vital signs (blood pressure, heart rate), 12-lead electrocardiography results, and blood and urine tests throughout the study.Results and discussion. In 14 days, the limitation of daily activity according to RMQ decreased by 80.5±18.19% in the PRTH 450 group and by 78.9±15.79% in the TH 150 group, after 3 days – by 21.9±17.07 and 19,9±15.72%, respectively. There was a significant decrease in pain at rest and during movement according to the VAS during treatment, as well as an increase in the range of motion in the lumbar spine in both groups. During the follow-up period, patients took an average of 15.1 tablets of diclofenac in the PRTH 450 group and 16.1 tablets in the TH 150 group. At the end of the study, 74.3% of patients in the PRTH 450 group and 70.9% of patients in the TH 150 group noted a «marked improvement» on the scale of the overall assessment of their condition. 21 AEs in 16 (13.4%) patients in the PRTH 450 group and 23 AEs in 21 (17.5%) patients in the TH 150 group were registered. No statistically significant differences were found between the two groups for the primary study endpoint (p=0.475, Fisher's exact test), AEs, and for all secondary study endpoints. Conclusion. The results of the study showed that in acute nonspecific LBP, PRTH 450 (Mydocalm® Long) administered once daily has no less efficacy and safety than TH 150 (Mydocalm®).
This is a single-center retrospective study designed to assess the correlation between the location of “hots spots” on single-photon emission computed tomography (SPECT) and the severity of joint ...degeneration on computed tomography (CT), in addition to understanding whether these hot spots correlate with the pain generating sites causing the non-specific lower back pain.
All patients who had undergone hybrid SPECT-CT imaging of the lower back over a one-year period at our institution were identified. Twenty joints were assessed from each patient. Joints for assessment were chosen from the intervertebral discs, facet (zygapophysial) and sacroiliac joints. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves and quantified using the area under the receiver operating characteristic curve (AUROC).
Over a one-year period, 111 patients were identified, with the primary indication being non-specific lower back pain in 73 (66%). Hot spots were observed on SPECT in 79% of patients, with 86% having some degree of degeneration in at least one joint on CT. Degeneration was found to be significantly associated with the presence of hot spots for the majority of joints, with the strongest association seen in the L3/L4 intervertebral joint, for which the rates of hot spots were 1% for grade 0, 26% for grade 1 and 78% for grades 2–3 (AUROC: 0.91, p<0.001). Neither the presence of hot spots nor degeneration were found to be significantly predictive of non-specific lower back pain for any of the joints considered.
Hot spots identified on SPECT are correlated with the presence of degeneration on CT but have limited diagnostic ability to identify potential causes of non-specific lower back pain.
Zusammenfassung
Ein junger Patient wird aufgrund typischer immobilisierender Schmerzen des unteren Rückens vom Rettungsdienst in die Notaufnahme eingeliefert. Eine im Verlauf plötzlich auftretende ...Vigilanzminderung ist der erste Hinweis auf einen hämorrhagischen bzw. obstruktiven Schock durch ein rupturiertes Interkostalarterienaneurysma mit spontanem Hämatothorax als seltene Komplikation einer Neurofibromatose Typ 1. Der Fall zeigt, dass sich hinter dem vermeintlich nichtspezifischen Rückenschmerz als einem der häufigsten Vorstellungsgründe in Notaufnahmen seltene lebensgefährliche Ursachen verbergen können. Auch eine korrekt durchgeführte präklinische notärztliche Untersuchung und eine erweiterte Ersteinschätzung in der Notaufnahme warnen nicht immer vor einem zu erwartenden lebensbedrohlichen Verlauf. Eine Herausforderung für jede Notaufnahme.
La lombalgie commune affectera 4 personnes sur 5 au cours de leur vie et plus de la moitié de la population française a eu au moins un épisode de douleur lombaire dans les 12 derniers mois. La ...lombalgie commune peut être classée en trois catégories, la poussée aiguë, celle à risque de chronicité et la récidivante. Différents types de douleur peuvent y être associés, à savoir la douleur neuropathique, nociceptive et/ou nociplastique. Les recommandations de bonnes pratiques encouragent le recours à des interventions kinésithérapiques et à l’activité physique adaptée pour le traitement de la lombalgie commune à risque de chronicité afin, d’une part, de diminuer les symptômes et les incapacités du patient mais surtout d’améliorer sa qualité de vie.
Examen narratif.
Décrire les outils utiles pour l’évaluation du risque de chronicité auprès de personnes souffrant de lombalgie commune ainsi que les types et la posologie des interventions kinésithérapiques et des activités physiques adaptées à leur proposer.
Dans cette revue, une recherche documentaire a été effectuée à l’aide de PubMed, Google Scholar, et Embase pour identifier les recommandations de pratiques cliniques rendant compte des outils d’évaluation du risque de chronicité en cas de lombalgie commune ainsi que des interventions kinésithérapiques et des activités physiques adaptées à proposer à ces personnes. Les articles ont été sélectionnés en fonction de leur pertinence par rapport à l’objectif de cet article.
L’évaluation des facteurs de risque de chronicité est un élément indispensable à maîtriser pour proposer un plan de traitement approprié à l’état de santé de la personne. L’identification précoce des facteurs de chronicisation et la mise en place précoce d’interventions kinésithérapiques et d’activité physique adaptée permettront de réduire le risque de passage à la lombalgie récidivante, nécessairement plus complexe à prendre en soins et nécessitant une coopération étroite entre les différents acteurs de santé intervenant. Toutefois, le choix des interventions kinésithérapiques et des activités physiques adaptées doit être défini selon le type de douleur que présente le patient et selon les facteurs psychosociaux présents. L’activité physique adaptée et sa posologie doit être personnalisée à chaque personne afin d’obtenir les meilleurs effets possibles pour réduire la lombalgie commune.
Non-specific low back pain will affect 4 out of 5 individuals during their lifetime, and over half of the French population has experienced at least one episode of lower back pain in the last 12 months. Non-specific low back pain can be classified into three categories: acute onset, at risk of chronicity, and persistent. Various types of pain may be associated with it, including neuropathic, nociceptive, and/or nociplastic pain. Clinical guidelines recommend using physiotherapy interventions and adapted physical activity in the treatment of non-specific low back pain at risk of chronicity to reduce the symptoms and disability of the person affected but, most importantly, to improve their quality of life.
Narrative review.
To describe useful tools for assessing the risk of chronicity in individuals suffering from non-specific low back pain, as well as the types and dosages of physiotherapy interventions and adapted physical activities to offer them.
In this review, a literature search was conducted using PubMed, Google Scholar, and Embase to identify clinical practice recommendations that report on tools for assessing the risk of chronicity in cases of non-specific low back pain, as well as physiotherapy interventions and adapted physical activities to propose to these individuals. Articles were selected based on their relevance to the objectives of this article.
Assessing the risk factors for chronicity is an essential element to master in order to propose a treatment plan appropriate to the individual's health status. Early identification of factors leading to chronicity and the early implementation of physiotherapy interventions and adapted physical activity can reduce the risk of progressing to recurrent low back pain, which is necessarily more complex to manage and requires close cooperation among various health care providers involved. However, the choice of physiotherapy interventions and adapted physical activities must be defined according to the type of pain the person affected presents and the psychosocial factors involved. The adapted physical activity and its dosage must be personalized for each individual to achieve the best possible effects to reduce non-specific low back pain.
Zusammenfassung
Das Ziel dieser Pilotstudie war es, die direkten jährlichen Krankheitskosten in Österreich bei Patienten zu erheben, die in aktueller Behandlung waren oder ein rehabilitatives ...Heilverfahren absolvierten. Die durchschnittlichen direkten medizinischen Kosten pro Patientenjahr (von den Sozialversicherungsträgern getragen) waren € 1443,–, wo bei die stationären Heilverfahren den höchsten Anteil mit € 575,– ausmachten. Nichtmedizinische direkte Kosten (in erster Linie Haushaltshilfen und Adaptationen) machten € 394,– aus; medizinische Selbstkosten € 329,–. Durchschnittlich hatten die PatientInnen 2,7 (Männer: 2,2; Frauen: 2,9) Komorbiditäten.
La prise en charge des lombalgies non spécifiques (LNS) (absence de red flags) répond à des recommandations internationales. Leur connaissance ainsi que celle du diagnostic standardisé des LNS ...doivent être éprouvées par les praticiens. Les facteurs psycho-socioprofessionnels (yellow flags) sont des facteurs de risque d’évolution vers la LNS chronique. Leur évaluation par des questionnaires et leur prise en charge doivent se conjuguer à la rééducation des déficiences.
Non adapté.
Management of non-specific low back pain (absence of red flags) responds to international guidelines. Practitioners need to be aware of these guidelines and of the standardized diagnostic procedure for non-specific low back pain. Psychosocial and occupational factors (yellow flags) are risk factors for progression towards chronic non-specific low back pain. Questionnaire assessment and management of yellow flags must be associated to physical therapy for impairment.
Not applicable.
Les recommandations professionnelles préconisent les exercices thérapeutiques comme traitement des lombalgies non spécifiques sans en préciser le type. La méthode McKenzie utilise un système de ...classification afin de déterminer un exercice effectué dans une direction de mouvement dite « préférentielle ».
Il s’agit d’un essai contrôlé randomisée.
Cinquante-quatre patients, répartis aléatoirement en deux groupes, ont bénéficié d’un traitement, soit selon les principes développés par McKenzie, soit selon les recommandations de la Haute Autorité de santé (HAS). Les évaluations initiales et finales étaient réalisées sur une semaine, incluant trois séances. Les variables dépendantes étaient l’échelle fonctionnelle d’Oswestry, la localisation et l’intensité de la douleur.
Parmi les patients du groupe test, 62,5 % ont modifié de façon disto-proximale la localisation de leur douleur (centralisation) contre 16,7 % pour le groupe contrôle (p = 0,008). Les autres variables n’étaient pas significativement améliorées.
L’utilisation d’une « préférence directionnelle » permet de modifier de façon disto-proximale la localisation de la douleur (centralisation) de façon plus importante qu’avec un traitement de référence. Trois séances de traitement n’améliorent pas les autres variables étudiées.
2b
Guidelines recommend therapeutic exercises as a treatment for non-specific low back pain in a generic way, without specifications. The McKenzie method uses a classification system to determine a specific exercise program performed in a particular direction of motion called “directional preference”.
Randomized controlled trial.
A total of 54 patients randomly assigned in two groups were treated either according to McKenzie’s principles of treatment, or according to the guidelines recommendations. Initial and final assessments were done on the same week, which included 3 sessions of care. Outcomes were Oswestry scale, pain location and pain intensity.
62.5% of the test group’s patients modified in a distal to proximal manner the pain location (centralization) versus 16.7% of the control group (p=0.008). Others outcomes were not significantly improved.
The use of a directional preference allows a significant modification of the pain location in a distal to proximal manner compared to a reference treatment. Three sessions of care spread over only one week do not significantly improve others outcomes.
2b
