Movement-Evoked Pain Versus Widespread Pain: A Longitudinal Comparison in Older Adults With Chronic Low Back Pain From the Delaware Spine Studies

It is currently unknown which pain-related factors contribute to long-term disability and poorer perceived health among older adults with chronic low back pain (LBP). This investigation sought to examine the unique influence of movement-evoked pain (MeP) and widespread pain (WP) on longitudinal health outcomes (ie, gait speed, perceived disability, and self-efficacy) in 250 older adults with chronic LBP. MeP was elicited with 3 standardized functional tests, while presence of WP was derived from the McGill Pain Map. Robust regression with HC3 standard errors was used to examine associations between these baseline pain variables and health outcomes at 12-month follow-up. Covariates for these models included age, sex, body mass index, resting and recall LBP intensity, LBP duration, depression, pain catastrophizing, and baseline outcome (eg, baseline gait speed). Greater MeP was independently associated with worse 12-month LBP-related disability (b = .384, t = 2.013, P = .046) and poorer self-efficacy (b = -.562, t = -2.074, P = .039); but not gait speed (P > .05). In contrast, WP and resting and recall LBP intensity were not associated with any prospective health outcome after adjustment (all P > .05). Compared to WP and resting and recall LBP intensity, MeP is most strongly related to longitudinal health outcomes in older adults with chronic LBP.PerspectiveThis article establishes novel independent associations between MeP and worse perceived disability and self-efficacy at 12-months in older adults with chronic LBP. MeP likely has biopsychosocial underpinnings and consequences and may therefore be an important determinant of health outcomes in LBP and other geriatric chronic pain populations.     

Bidirectional Association Between Sleep Quality and Low Back Pain in Older Adults: A Longitudinal Observational Study

ObjectiveTo investigate the bidirectional relationship by determining whether baseline sleep quality predicts pain intensity and whether baseline pain intensity predicts sleep quality in older individuals with chronic low back pain (LBP).DesignA prospective longitudinal cohort study with a 6-month follow-up period.SettingCommunity.ParticipantsOlder adults with LBP aged 60 years or older (N=215).InterventionNot applicable.Main Outcome MeasuresData collection occurred at baseline and at 6 months. Pain intensity and sleep quality were measured in both time points of assessment using the numeric pain rating scale (range, 0-10) and the Pittsburg Sleep Quality Index. At baseline, we also collected information on demographic anthropometric variables, cognitive status, depression, and comorbidities. Multivariable linear regression analyses adjusted for potential covariates were performed.ResultsA total of 215 individuals with LBP were recruited. Poor sleep quality at baseline predicted high pain intensity at 6 months (β coefficient, 0.18; 95% confidence interval [CI], 0.07-0.30). High pain intensity at baseline predicted poor sleep quality 6 months later (β coefficient, 0.14; 95% CI, 0.01-0.26).ConclusionOur findings give some support to the bidirectional relationship between pain and sleep quality in older individuals with LBP. This bidirectional relationship may be used as prognostic information by clinicians when managing patients with LBP.     

Association Between Psychosocial Parameters and Response to Chiropractic Care Among Older Adults With Chronic Low Back Pain: Secondary Analysis of a Randomized Clinical Trial

ObjectivesThe purpose of this study was to determine whether baseline self-efficacy, fear of pain with movement (kinesiophobia), or change in either were associated with clinically important improvement in disability among older adults with chronic low back pain after 12 weeks of chiropractic spinal manipulation (CSM) and exercise.MethodsThis secondary analysis used randomized trial data from community-dwelling adults aged 65 years or older with chronic spinal disability who received non-pharmacological treatment of CSM and exercise. Those with ≥30% reduction in the Oswestry Disability Index (ODI) after 12 weeks of treatment were considered responders to care. Psychosocial measures included the Pain Self-Efficacy Questionnaire (PSEQ) and the Tampa Scale of Kinesiophobia (TSK). Logistic regression–assessed associations were between psychosocial, demographic, and low back predictors and 30% ODI improvement.ResultsThere were 176 community-dwelling older adults included in this analysis. Mean age was 71 years, 59.7% were women; 176 (96.7%) had complete data. Baseline disability (ODI = 26.1 ± 9.3) and back pain (5.0 ± 1.9, 0-10 scale) were moderate. Baseline PSEQ reflected higher self-efficacy (47.7 ± 7.8, 0-60 scale) with minimal kinesiophobia (TSK 34.3 ± 5.2, 17-68 scale). Seventy-two (40.9%) achieved 30% reduction in ODI (mean –5.4 ± 7.9) after 12 weeks of treatment. Mean self-efficacy improvement was clinically important (2.5 ± 6.5 points); kinesiophobia (–2.7 ± 4.4 points) and LBP (–1.6 points) also improved. Baseline PSEQ and percent improvement in PSEQ and TSK were associated with response to treatment in univariate regression analyses but not in multiple regression models that included low back predictors. LBP duration >4 years negatively impacted recovery.ConclusionsAmong this sample of older adults who received chiropractic manipulation and exercise, baseline self-efficacy and improvements in self-efficacy and kinesiophobia were individually associated with clinically important reductions in disability post-intervention, although not in adjusted models when LBP duration was included.     

Use of trunk muscle training and neuromuscular electrical stimulation to reduce pain and disability in an older adult with chronic low back pain: A case report

Among older adults, low back pain (LBP) is common, costly, and disabling. Trunk muscle training (TMT) and neuromuscular electrical stimulation (NMES) have both been found to be effective in reducing LBP, but studies among older adults have been limited. An 83-year-old female with left-sided chronic LBP participated in a randomized controlled trial consisting of supervised TMT and NMES to the paraspinal muscles two times per week for 12 weeks. She also participated in a home exercise program. At the end of the intervention, she reported reduced LBP and LBP-related disability per the modified Oswestry disability index (i.e., 60% at baseline to 40% at 12 weeks). Her Short Physical Performance Battery summary score improved from 4/12 at baseline to 10/12 at 12 weeks, while her Timed Up and Go test improved from 17.21 to 15.20 s and her Repetitive Trunk Rotation test from 2.72 to 1.93 s/right–left rotation. This case demonstrates a positive short-term treatment response to TMT supplemented with NMES of the paraspinal muscles in an older adult with chronic LBP. A packaged intervention of TMT plus NMES may be a means of addressing not only LBP, but also impaired physical function and resultant disability.     

Investigating key predictors of persistent low back pain: A focus on psychological stress

AimTo investigate the degree to which psychological stress, self-reported pain scores, and pain sensitivity during an acute state of low back pain (LBP) predict the development of persistent LBP trajectories.BackgroundIdentifying which factors influence LBP trajectories is critical to understand why some individuals experience persistent LBP and to illuminate areas for nursing intervention.MethodsA secondary data analysis of a prospective study examining trajectories of LBP was conducted. The sample was comprised of 217 adults with acute-onset LBP recruited from the community and followed over 24 weeks. Variables of interest included demographic data, perceived stress scores, self-reported pain scores, and somatosensory characteristics collected within the first 4 weeks of LBP onset. The data were analyzed using non-parametric bivariate comparisons and a semi-parametric Cox proportional hazards model with interval-censoring.ResultsIndividuals with higher psychological stress scores were less likely to experience pain resolution (Hazard ratio [HR] = 0.555, 95% confidence interval [CI] = 0.36–0.85, p = 0.02). After adjustment for covariates in the final model, the analysis revealed household income (HR = 2.79, 95% CI [1.63–4.67], p < 0.001) to be the dominant predictor of LBP persistence in this sample.ConclusionHeightened psychological stress and pain severity as well as decreased pressure pain thresholds were indicated as influential factors of LBP trajectories. Household income was identified as the dominant predictor, demonstrating that individuals with a higher household income were more likely to resolve their pain. Strategies which integrate assessment of stress, self-reported pain scores, pain sensitivity, and social determinants for patients experiencing pain are needed to advance nursing care.     

The Brazilian Back Complaints in the Elders (Brazilian BACE) study: characteristics of Brazilian older adults with a new episode of low back pain

Objective

Low back pain (LBP) is little explored in the aging population especially when considering age-relevant and culturally dependent outcomes. We aimed to describe socio-demographic and clinical characteristics of Brazilian older people with a new episode of LBP presenting to primary care.

General practitioners’ treatment orientations towards low back pain: Influence on treatment behaviour and patient outcome

Background: In low back pain (LBP) treatment and research attention has shifted from a biomedical towards a biopsychosocial approach. Patients’ LBP beliefs and attitudes were found to predict long‐term outcome, and recently it has been suggested that the health care providers’ ideas about LBP are also important predictors of treatment behaviour and outcome. Aims: In the present study we examined whether (1) differences in General Practitioners’ (GP) LBP treatment orientation are associated with differences in actual treatment behaviour and (2) whether treatment orientation is related to LBP outcome in patients. Methods: Two hundred twenty two patients consulting their GP with a new episode of LBP were recruited and completed questionnaires on (among others) LBP outcome (graded chronic pain scale) at baseline, during 12 months of follow‐up and at the end of the study. Data on treatment were collected from the GPs. The GPs also completed a set of questionnaires on LBP treatment orientation. Associations between measures of treatment orientation, treatment recommendations, treatment behaviour and LBP outcome were analysed. Results: A biomedical treatment orientation was found to be associated with more concern about tissue damage and the effect of physical activity on pain and recovery in vignettes. No associations were found between treatment orientation measures, actual treatment behaviour and LBP outcome. Conclusions: Associations were not found as expected. Still these findings are relevant and may feed a clinically important debate on widely accepted assumptions about the role and influence of health care providers in changing patients’ pain behaviours.     

Effects of meditation on pain intensity,physical function,quality of life and depression in adults with low back pain – A systematic review with meta-analysis

BackgroundLow back pain (LBP) is a common biopsychosocial health problem. Meditation may provide a complementary treatment option for LBP patients.ObjectivesThe aim of this systematic review with meta-analysis was to examine the effects of meditation on pain intensity, functional disability, quality of life, and depression in LBP populations.MethodsThis systematic review was conducted according to the PRISMA Guidelines. PubMed, Web of Science, CENTRAL, CamQuest and PubPsych were searched up to a publication date of June 2020. Inclusion criteria were RCTs or non-RCTs with LBP patients, aged at least 18 years, the application of a specific meditation technique, and pain intensity and/or functional disability as outcomes. Pooled SMDs were calculated at post-treatment and follow up. The Cochrane risk-of-bias tool was used to estimate risk of bias. The overall quality of evidence was assessed using the GRADE approach.Results12 studies with a total of 1005 participants were included in this review. Compared to controls, meditation solely showed a significant positive effect on pain intensity (SMD = −0.27 [CI −0.43; −0.11]; p = 0.001; based on 10 studies with 934 participants) and physical quality of life (SMD = 0.21 [CI 0.07; 0.36]; p = 0.005; based on 5 studies with 756 participants) at post-treatment. At follow up (mean 20 weeks, range 4–52) there were no significant effects anymore. The quality of the evidence was moderate due to study limitations and imprecision.ConclusionsMeditation seems to be promising with regard to reducing short-term pain intensity in patients with LBP. However, additional well-designed and large trials are required in order to draw more reliable conclusions.     

Key characteristics of low back pain and disability in college-aged adults: a pilot study

Handrakis JP, Friel K, Hoeffner F, Akinkunle O, Genova V, Isakov E, Mathew J, Vitulli F. Key characteristics of low back pain and disability in college-aged adults: a pilot study.ObjectiveTo identify which factors commonly associated with low back pain (LBP) and disability differ between college-aged persons with LBP and with no or minimal LBP.DesignClinical measurement, observational study. Subjects were assessed for LBP with the visual analog scale (VAS) and for disability from LBP using the Oswestry Disability Index (ODI). Subjects were measured for variables commonly associated with LBP and were grouped by both VAS (minimum [min]/no pain, pain) and ODI (no disability, disability) scores.SettingCollege campus at a university.ParticipantsA convenience sample (N=84) of English-speaking students (34 men, 50 women) between 18 and 30 years of age.InterventionsNot applicable.Main Outcome MeasuresSports activity (sports activity score of the Baecke Physical Activity Questionnaire), depression, hamstring and hip flexor range of motion, low back extensor endurance, abdominal strength and endurance.ResultsA significant main effect of group was found for both pain (P=.019) and disability groups (P=.006). The min/no pain and pain groups differed in back endurance (114.2±38.8s vs 94.5±44.5s, respectively; P=.04). The no disability and disability groups differed in back endurance (116.3±35.9s vs 97.1±45.7s, respectively; P=.03) and the sports activity score of the Baecke Physical Activity Questionnaire (2.98±.95 vs 2.48±.85, respectively; P=.01). Subjects with hyperkyphotic postures compared with the normative thoracic group had higher depression scores (49 vs 38.5, respectively; P=.03) and less hamstring flexibility (30.5 vs 49.9, respectively; P<.001).ConclusionsBack extensor endurance was consistently different between both the pain and disability groups. Addressing limited low back extensor endurance and low levels of physical activity in young adults may have clinical relevance for the prevention and treatment of LBP and disability.     

The importance of symptom duration in determining prognosis

Symptom duration is integral to clinical and epidemiological research on pain. It is widely used for sample selection and commonly assessed in clinical practice. However, there has been little specific investigation of the link between duration and outcome. This work aimed to examine the association of episode duration with symptoms and clinical course in primary care consulters with low back pain (LBP). In a cohort of general practice LBP consulters, 619 patients returned two or more questionnaires during a 12-month period. LBP episode duration at baseline consultation was defined by time since their last pain-free month. Associations of duration with pain, disability and psychological status at baseline were examined. Survival analysis was used to assess the association between episode duration and time taken for disability to improve by 30%. At baseline, increasing episode duration was associated with worse pain, disability and psychological status (p < 0.001), but there were no differences between people with more or less than 3 months of pain. People with 3 years' or more duration at baseline took significantly longer to improve than those with shorter duration (adjusted hazard ratio 1.57, 95% confidence interval 1.27-1.95). In conclusion, memory of LBP episode duration is associated with pain, disability and psychological status, and is an independent predictor of time to improvement. There are important differences between people who recall more or less than 3 years' duration. Mechanisms for these associations are poorly understood, but this research suggests that duration itself is an important focus for research.     

Development and proof of concept of a blended physiotherapeutic intervention for patients with non-specific low back pain

ObjectiveTo develop a blended physiotherapeutic intervention for patients with non-specific low back pain (e-Exercise LBP) and evaluate its proof of concept.DesignFocus groups with patients, physiotherapists, and eHealth and LBP experts were conducted to investigate values according to the development of e-Exercise LBP. Proof of concept was evaluated in a multicentre study.SettingDutch primary care physiotherapy practices (n = 21 therapists).ParticipantsAdults with non-specific LBP (n = 41).Interventione-Exercise LBP was developed based on clinical LBP guidelines and the focus groups, using the Center for eHealth Research Roadmap. Face-to-face physiotherapy sessions were integrated with a web application consisting of 12 information lessons, video-supported exercises and a physical activity module with the option to gradually increase individuals’ level of physical activity. The intervention could be tailored to patients’ risk of persistent disabling LBP, according to the STarT Back Screening Tool.Main outcome measuresFunctional disability, pain, physical activity, sedentary behaviour and fear-avoidance beliefs, measured at baseline and 12 weeks.ResultsAfter 12 weeks, improvements were found in functional disability [Quebec Back Pain Disability Scale: mean difference (MD) ?12.2/100; 95% confidence interval (CI) 8.3 to 16.1], pain (Numeric Pain Rating Scale: MD ?2.8/10; 95% CI 2.1 to 3.6), subjective physical activity (Short Questionnaire to Assess Health Enhancing Physical Activity: MD 11.5 minutes/day; 95% CI ?47.8 to 24.8) and objective sedentary behaviour (ActiGraph: MD ?23.0 minutes/day; 95% CI ?8.9 to 55.0). Small improvements were found in objective physical activity and fear-avoidance beliefs. The option to gradually increase physical activity was activated for six patients (15%). On average, patients received seven face-to-face sessions alongside the web application.ConclusionsThe results of this study provide the first indication of the effectiveness of e-Exercise LBP, particularly for disability and pain among patients with LBP. Future studies will focus on end-user experiences and (cost-) effectiveness.     

The use of pain neuroscience education in older adults with chronic back and/or lower extremity pain

Introduction: Chronic pain due to musculoskeletal disorders is the leading cause of disability among older adults and is associated with a lower quality of life, reduced function, and increased risk of institutionalization. Pain Neuroscience Education (PNE) has demonstrated effectiveness in reducing pain and improving pain self-efficacy in individuals under 60 years of age, but there is a paucity of research examining its use with older adults. If PNE has similar effects in older adults, it has the potential to be a useful non-pharmacological intervention for this population. Methods: This quasi-experimental feasibility study included 25 subjects over the age of 65 with a 3 month or greater history of lower back and/or lower extremity pain. Subjects participated in two semi-standardized one-on-one PNE sessions and were asked to read a booklet (Why Do I Hurt, Louw, International Spine and Pain Institute, USA) in between sessions. Subjects’ perception of PNE was measured after the second session and gait speed, pain disability, and fear of movement were measured pre- and post-PNE. Results: Subjects consistently reported a positive experience with PNE. There were statically significant positive improvements in gait speed, pain disability, and fear of movement after the intervention. Conclusion: PNE is a feasible and potentially efficacious treatment for older adults with chronic pain.     

A longitudinal study on the predictive validity of the fear-avoidance model in low back pain

Recently, fear-avoidance models have been quite influential in understanding the transition from acute to chronic low back pain (LBP). Not only has pain-related fear been found to be associated with disability and increased pain severity, but also treatment focused at reducing pain-related fear has shown to successfully reduce disability levels. In spite of these developments, there is still a lack in well-designed prospective studies examining the role of pain-related fear in acute back pain. The aim of the current study was to prospectively test the assumption that pain-related fear in acute stages successfully predicts future disability. Subjects were primary care acute LBP patients consulting because of a new episode of LBP (相似文献   

Individuals with recurrent low back pain exhibit further altered frontal plane trunk control in remission than when in pain

BackgroundMovement alterations due to low back pain (LBP) could lead to long-term adverse consequences if they do not resolve after symptoms subside. This study aims to determine if altered trunk control associated with recurrent low back pain persists beyond symptom duration.MethodsTwenty young adults with recurrent LBP were tested once during an LBP episode and once in symptom remission, and twenty matched back-healthy participants served as controls. Participants walked on a treadmill with five prescribed step widths (0.33, 0.67, 1, 1.33, 1.67 × preferred step width). Motion capture and surface electromyography were used to record trunk kinematics and muscle activation. Thorax-pelvis coordination was calculated using vector coding, and longissimus activation and co-activation were analyzed.FindingsYoung adults with recurrent LBP exhibited a “looser” trunk control strategy in the frontal plane during gait that was persistent regardless of pain status across multiple step widths compared to controls. The looser trunk control was demonstrated by a greater pelvis-only, less thorax-only coordination pattern, and decreased bilateral longissimus co-activation in individuals with recurrent LBP compared to controls. The looser trunk control strategy was further amplified when individuals were in symptom remission and exhibited greater trunk excursion and reduced in-phase coordination in the frontal plane.InterpretationThe amplification of aberrant movement during symptom remission may suggest that movement patterns or anatomical factors existing prior to the tested painful episode underlie altered trunk control in individuals with recurrent LBP. The symptom remission period of recurrent LBP may be a critical window into clinical evaluation and treatment.     

Does pain medication influence outcomes in elderly people seeking care for back pain? BACE cohort study

Background

Back pain is common among older adults resulting in the high societal and economic burden of persistent pain and disability. Pain medications are frequently prescribed for back pain, especially among older patients, but the efficacy of analgesics on back pain in this patient population remains under debate. In the present study, we investigated the outcomes (i.e. pain intensity and disability) of pain medication use in older people with back pain participating in a prospective cohort study.

Methods

A total of 669 patients aged >55 years consulting a general practitioner for a new episode of back complaints were included in this study. The association between pain medication use and outcomes (pain intensity and disability) was assessed at 3-month follow-up.

Results

Pain medication users were observed to experience more pain and disability at baseline compared with non-users. At 3-month follow-up, patients from all subgroups (e.g. pain medication users versus non-users) improved over time. Yet medication users had higher pain intensity and poorer disability scores compared with non-users. Patients who de-escalated or stopped pain medication had lower pain and disability than non-users. When comparing different types of medications (i.e. paracetamol, non-steroidal anti-inflammatory drugs, opioids), none of the groups showed better scores regarding pain and disability in users compared with non-users. Opioid users displayed the highest levels of pain and disability.

Conclusions

In the present study, although patients who de-escalated or stopped analgesics had less pain and disability, pain medication overall does not result in better outcomes in older people with back pain.

Significance

Older patients taking pain medication did not report better outcomes than the ones who did not, except for those who de-escalated or stopped pain medication. Caution should be taken in prescribing pain medication for older patients with back pain in primary care.     

First episode of acute low back pain – an exploratory cluster analysis approach for early detection of unfavorable recovery

Purpose: To identify recovery patterns in patients with a first episode of acute low back pain (LBP) and to define risk factors for unfavorable outcome.

Methods: One hundred and eight patients (55 male, 53 female; mean age?=?40.8, SD 14.2 years) rated pain (NRS) and disability [Oswestry Disability Index (ODI)] before the first treatment and 1 week, 1, 3, 6, and 12 months later. Hierarchical cluster analysis identified recovery patterns based on NRS data. Clusters were compared for age, NRS and ODI at baseline, pain reduction in the first week, gender, radicular signs and traumatic onset using one-way ANOVA (post hoc Bonferroni) and χ² tests.

Results: The cluster analysis revealed four clusters: moderate baseline pain/fast recovery; high baseline pain/fast recovery; high baseline pain/persistent mild pain; high baseline pain/persistent high pain. These clusters differed in baseline NRS [F(3,104)?=?39.61, p?F(3,104)?=?12.17, p?F(3,104)?=?11.51, p?χ²(3)?=?9.20, p?=?0.027].

Conclusions: These results suggest that an initial and regularly repeated assessment of pain intensity and functional disability is important. Initial pain intensity does not seem to be a prognostic factor per se, as it did not negatively affect recovery provided that it decreased early in treatment.

• Implications for Rehabilitation

• Prediction of outcome is particularly important in patients with a first episode of acute LBP as one third did not completely recover.

• Pain intensity and functional disability should be initially assessed and regularly repeated in the first phase of treatment.

• High initial pain intensity and disability combined with small pain reduction during the first week might predict unfavorable outcome and require adequate treatment.

     

Cancer-related pain and disability: a longitudinal study

Context

Although the cross-sectional association between cancer-related pain and disability is well established, their longitudinal relationship has been less studied.

Objectives

Data from the Indiana Cancer Pain and Depression (INCPAD) trial were analyzed to determine whether baseline cancer-related pain and changes in pain over time predict disability over 12 months.

Methods

A total of 274 cancer survivors with cancer-related pain were accrued in the INCPAD trial. Data were collected at baseline, one, three, six, and 12 months by interviewers blinded to treatment arm. Disability outcomes included a continuous measure (Sheehan Disability Scale [SDS] score) and a categorical measure (≥14 days in the past four weeks with a ≥50% reduction in usual activities). Predictor variables, operationalized by the Brief Pain Inventory, included baseline pain severity and changes in pain severity scores between each time point. Multivariable analyses were conducted adjusting for treatment group, baseline disability, and selected covariates including depression.

Results

Baseline pain severity did not predict disability outcomes at 12 months. However, improvement in pain severity predicted less disability over 12 months both in terms of SDS scores (b = −0.17, t = −5.33, P < 0.001) and ≥14 disability days in the past month (odds ratio = 0.85; 95% confidence interval, 0.79–0.93; P < 0.001).

Conclusion

Disability over 12 months in patients with cancer-related pain is predicted by changes in pain severity over time. Results suggest that effective pain management may reduce subsequent disability among cancer survivors.     

Immediate effect of pain neuroscience education for recent onset low back pain: an exploratory single arm trial

Study Design: A prospective, single-arm, pre-postintervention study.

Objective: To determine the preliminary usefulness of providing pain neuroscience education (PNE) on improving pain and movement in patients presenting with non-chronic mechanical low back pain (LBP).

Background: PNE has been shown to be an effective intervention for the treatment of chronic LBP but its usefulness in patients with non-chronic LBP has not been examined.

Methods: A single group cohort pilot study was conducted. Eighty consecutive patients with LBP < 3 months completed a demographics questionnaire, leg and LBP rating (Numeric Pain Rating Scale – NPRS), disability (Oswestry Disability Index), fear-avoidance (Fear-Avoidance Beliefs Questionnaire), pain catastrophizing (Pain Catastrophizing Scale), central sensitization (Central Sensitization Inventory), pain knowledge (Revised Neurophysiology of Pain Questionnaire), risk assessment (Keele STarT Back Screening Tool), active trunk flexion and straight leg raise (SLR). Patients received a 15-minute verbal, one-on-one PNE session, followed by repeat measurement of LBP and leg pain (NPRS), trunk flexion and SLR.

Results: Immediately after intervention, LBP and leg pain improved significantly (p < 0.001), but the mean change did not exceed minimal clinically important difference (MCID) of 2.0. Active trunk flexion significantly improved (p < 0.001), with the mean improvement (4.7 cm) exceeding minimal detectible change (MDC). SLR improved significantly (p = 0.002), but mean change did not exceed MDC.

Conclusions: PNE may be an interesting option in the treatment of patients with non-chronic mechanical LBP. The present pilot study provides the rationale for studying larger groups of patients in controlled studies over longer periods of time.     

Evaluation of the efficacy of Superior Cluneal Nerve Block in low back pain: A prospective observational study

IntroductionSuperior cluneal nerve (SCN) entrapment giving rise to low back pain (LBP) remains undiagnosed many times; in this clinical study authors have evaluated therapeutic role of lidocaine injection of SCN for low back pain relief in patients with SCN entrapment.MethodsThe present study was a prospective, observational study; 25 patients with unilateral LBP over the iliac crest and buttock for more than six months not responding to conservative measures were included in this clinical trial. SCN lidocaine injection was done under fluoroscopy guidance; patients having more than 50% reduction in numeric rating scale (NRS) score, for at least 2 h following SCN injection, were enrolled in the study and followed for 6 months. The primary outcome measure was severity of LBP, measured by NRS score. Secondary outcome measures were percentage pain relief; Oswestry Disability Index (ODI) score, reduction of analgesic usage, DSM-IV score for psychological assessment. All these assessments were done prior to the procedure and at 2 weeks, 1, 3 and 6 months after the procedure.ResultsA significant reduction in the NRS scores was observed at 2 weeks, 1, 3 and 6 months after SCN lidocaine injection as compared to the baseline (P value < 0.05); authors also observed a significant pain relief and significantly reduced ODI scores, analgesic consumption and DSM scores compared to the baseline values (P value < 0.05).ConclusionA single SCN lidocaine injection provided significant pain relief in LBP patients with SCN entrapment for a period of 6 months.