Pharmacological and non-pharmacological treatment approaches to chronic lumbar back pain

Ketenci, Ayşegül; Zure, Mert

doi:10.5606/tftrd.2021.8216

Cited by 22 publications

(25 citation statements)

References 56 publications

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“…Published guidelines have proposed non-pharmacological approaches such as exercise and physical therapy (massage, acupuncture, spinal manipulative therapy) as first-line treatments for lower back pain primarily due to concerns about the risk-benefit ratio of opioids and suboptimal opioid-related results in clinical trials [65][66][67]. A major gap in LBP research includes the contribution of musculoskeletal tissues (unspecialized muscles and connective tissues) in the lower back of the spine [68].…”

Section: Clinical Perspectives and Future Directionsmentioning

confidence: 99%

Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving In Vivo and Ex Vivo Studies

Sinhorim

Amorim

Ortiz

et al. 2021

JCM

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Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over the past few decades; however, these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting lower back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane, and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies satisfied the following: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, after which data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met the inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in lower back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Additional knowledge of fascial neurological components could impact LBP treatment.

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Section: Clinical Perspectives and Future Directionsmentioning

confidence: 99%

Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving In Vivo and Ex Vivo Studies

Sinhorim

Amorim

Ortiz

et al. 2021

JCM

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“…8 Accordingly, clinical practice guidelines for CLBP have promoted inconsistent recommendations on acupuncture due to a lack of what has been deemed high-quality evidence. [4][5][6][9][10][11] In RCTs evaluating the efficacy of acupuncture, it is very important to set up a physiologically inert control that has the potential to serve as a true placebo. 12 However, in almost all RCTs, when researchers set up sham acupuncture as a control, they never demonstrate the sham needling technique as being physiologically inert, although it is usually different from acupuncture.…”

Section: Introductionmentioning

confidence: 99%

“…Although many randomized clinical trials (RCTs) evaluating the outcomes of acupuncture on CLBP have been performed, the results continue to be controversial, and questions about the appropriateness of sham acupuncture control have been raised . Accordingly, clinical practice guidelines for CLBP have promoted inconsistent recommendations on acupuncture due to a lack of what has been deemed high-quality evidence …”

Section: Introductionmentioning

confidence: 99%

Needling Point Location Used in Sham Acupuncture for Chronic Nonspecific Low Back Pain

Lee,

Kwon,

Lee

et al. 2023

JAMA Netw Open

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ImportanceWhen sham acupuncture is set as a control in evaluating acupuncture, the sham needling technique is usually different from acupuncture. However, the sham procedure is conducted either at the same points that are used for the acupuncture group or at nonindicated points.ObjectiveTo assess whether the outcome of sham acupuncture varies according to the needling points in sham-controlled trials of acupuncture for chronic nonspecific low back pain (CLBP) as an example.Data sourcesSearches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the Allied and Complementary Medicine Database were conducted on February 12, 2023.Study selectionRandomized clinical trials (RCTs) assessing the outcomes of acupuncture in sham acupuncture–controlled or waiting list–controlled trials on CLBP were included.Data extraction and synthesisTwo researchers independently extracted data on study characteristics and outcomes and assessed quality. Sham acupuncture was classified according to whether it was conducted at the same acupuncture points used in the acupuncture group, referred to as sham acupuncture therapy (verum) (SATV) or at different points, referred to as sham acupuncture therapy (sham) (SATS). Clinical similarity, transitivity, and consistency tests were conducted, followed by a random-effects frequentist network meta-analysis (NMA).Main outcomes and measuresThe primary outcome was pain, and the secondary outcome was back-specific function. The first assessment after the end of treatment was chosen for analysis. Effect sizes are reported as standardized mean differences (SMD) with 95% CIs. The risk of bias was assessed using the Cochrane risk of bias tool, and the certainty of evidence for findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach.ResultsTen RCTs involving 4379 participants were included. In comparison with SATS, acupuncture was significantly associated with improvements in both pain (SMD, −0.33; 95% CI, −0.52 to −0.15) and function outcomes (SMD, −0.13; 95% CI, −0.25 to −0.02); however, there were no differences between acupuncture and SATV. In comparison with SATS, SATV was significantly associated with better pain (SMD, −0.45; 95% CI, −0.88 to −0.03) and function outcomes (SMD, −0.30; 95% CI, −0.56 to −0.05). The risk of bias that could affect the interpretation of the results was usually low, and the certainty of evidence was moderate to low.Conclusions and relevanceIn this NMA, sham acupuncture needling at the same points as those in acupuncture was not a true placebo control for assessing the efficacy of acupuncture for CLBP and might underestimate the outcome of acupuncture in clinical settings.

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“…Numerous studies show that due to potential adverse effects, pharmacological treatments should only be utilized at lower dosages for brief periods of time for treating non-specific low back pain. However, it has been hypothesized that non-pharmacological methods, such as physical activity, pain education, and manual treatment, function by increasing pelvic blood flow and catalyzing the release of beta-endorphins, which have non-specific analgesic properties [8].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Static Cupping Therapy in Non-specific Low Back Pain for Primary Dysmenorrhea

Siddiqui¹,

Khan²,

Narwade³

et al. 2022

Cureus

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Dysmenorrhea is often referred to as painful menstruation with cramping sensations in the lower abdomen, resulting in discomfort. This pain commonly radiates to both the thighs and lumbosacral regions. A 23-yearold female presented with a complaint of severe abdominal pain during menses, accompanied by low back pain (LBP) that typically started at the onset of menstrual flow and lasted for the first 24-48 hours for which no analgesics were taken by the patient. The pain intensity was recorded on a numerical pain rating scale (NPRS) that showed 6 out of 10 for abdominal and low back pain during activity and 4 out of 10 at rest, on account of which a two-day supervised static cupping therapy protocol was devised for the patient. After treatment, the NPRS recorded a remarkable decrease in pain intensity to 2 out of 10 for abdominal and low back pain during activity, as well as at rest. As static cupping therapy is used to target deeper muscles in the lower back and abdomen; this case report aims to highlight the beneficial effects of static cupping on primary dysmenorrhea and related non-specific low back pain.

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Pharmacological and non-pharmacological treatment approaches to chronic lumbar back pain

Abstract: Low back pain is a common and important cause of disability. Chronic pain increases disability and cost. In this review, we discuss pharmacological and non-pharmacological treatment approaches for chronic low back pain in the light of current data and guidelines.

Cited by 22 publications

References 56 publications

Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving In Vivo and Ex Vivo Studies

Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving In Vivo and Ex Vivo Studies

Needling Point Location Used in Sham Acupuncture for Chronic Nonspecific Low Back Pain

The Effect of Static Cupping Therapy in Non-specific Low Back Pain for Primary Dysmenorrhea

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