Pain provocation following sagittal plane repeated movements in people with chronic low back pain: Associations with pain sensitivity and psychological profiles

AbstractBackground and aimsProvocative pain responses following standardised protocols of repeated sagittal plane spinal bending have not been reported in people with chronic low back pain (CLBP). Potential differing pain responses to movement likely reflect complex sensorimotor interactions influenced by physical, psychological and neurophysiological factors. To date, it is unknown whether provocative pain responses following repeated bending are associated with different pain sensitivity and psychological profiles. Therefore the first aim of this study was to determine whether data-driven subgroups with different, clinically-important pain responses following repeated movement exist in a large CLBP cohort, specifically using a standardised protocol of repeated sagittal plane spinal bending. The second aim was to determine if the resultant pain responses following repeated movement were associated with pain and disability, pain sensitivity and psychological factors.MethodsClinically-important (≥2-points, 11-point numeric rating scale) changes in pain intensity following repeated forward/backward bending were examined. Participants with different provocative pain responses to forward and backward bending were profiled on age, sex, pain sensitivity, psychological variables, pain characteristics and disability.ResultsThree groups with differing provocative pain responses following repeated movements were derived: (i) no clinically-important increased pain in either direction (n = 144, 49.0%), (ii) increased pain with repeated bending in one direction only (unidirectional, n = 112, 38.1%), (iii) increased pain with repeated bending in both directions (bidirectional, n = 38, 12.9%). After adjusting for psychological profile, age and sex, for the group with bidirectional pain provocation responses following repeated spinal bending, higher pressure and thermal pain sensitivity were demonstrated, while for the group with no increase in pain, better cognitive and affective psychological questionnaire scores were evident. However, these associations between provocative pain responses following movement and pain sensitivity and psychological profiles were weak.ConclusionsProvocative pain responses following repeated movements in people with CLBP appear heterogeneous, and are weakly associated with pain sensitivity and psychological profiles.ImplicationsTo date, suboptimal outcomes in studies examining exercise interventions targeting directional, movement-based subgroups in people with CLBP may reflect limited consideration of broader multidimensional clinical profiles associated with LBP.This article describes heterogeneous provocative pain responses following repeated spinal bending, and their associated pain sensitivity and psychological profiles, in people with CLBP. These findings may help facilitate targeted management.For people with no increase in pain, the lack of pain provocation following repeated spinal bending, in combination with a favourable psychological profile, suggests this subgroup may have fewer barriers to functional rehabilitation. In contrast, those with pain provoked by both forward and backward bending may require specific interventions targeting increased pain sensitivity and negative psychological cognitions and affect, as these may be may be important barriers to functional rehabilitation.

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Correction of Posture Deviations in the Sagittal Plane Using the Pilates Method

SPORT AND SOCIETY ◽

10.36836/uaic/fefs/10.50 ◽

2019 ◽

pp. 3-13

Author(s):

Alexandru Cîtea ◽

George-Sebastian Iacob

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Postural Control ◽

Human Body ◽

Sagittal Plane ◽

The Body ◽

Lower Limbs ◽

Low Back ◽

Pilates Method ◽

The Relationship

Posture is commonly perceived as the relationship between the segments of the human body upright. Certain parts of the body such as the cephalic extremity, neck, torso, upper and lower limbs are involved in the final posture of the body. Musculoskeletal instabilities and reduced postural control lead to the installation of nonstructural posture deviations in all 3 anatomical planes. When we talk about the sagittal plane, it was concluded that there are 4 main types of posture deviation: hyperlordotic posture, kyphotic posture, rectitude and "sway-back" posture.Pilates method has become in the last decade a much more popular formof exercise used in rehabilitation. The Pilates method is frequently prescribed to people with low back pain due to their orientation on the stabilizing muscles of the pelvis. Pilates exercise is thus theorized to help reactivate the muscles and, by doingso, increases lumbar support, reduces pain, and improves body alignment.

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Changes in pain sensitivity and spinal stiffness in relation to responder status following spinal manipulative therapy in chronic low Back pain: a secondary explorative analysis of a randomized trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03873-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Casper Glissmann Nim ◽

Gregory Neil Kawchuk ◽

Berit Schiøttz-Christensen ◽

Søren O’Neill

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Randomized Trial ◽

Clinical Improvement ◽

Spinal Manipulation ◽

Pain Sensitivity ◽

Spinal Manipulative Therapy ◽

Low Back ◽

Manipulative Therapy ◽

Pressure Pain Thresholds

Abstract Background In a prior randomized trial, we demonstrated that participants receiving spinal manipulative therapy at a pain-sensitive segment instead of a stiff segment experienced increased mechanical pressure pain thresholds. We hypothesized that the targeted segment mediated this increase through a segment-dependent neurophysiological reflective pathway. Presently, it is not known if this decrease in pain sensitivity is associated with clinical improvement. Therefore, we performed an explorative analysis to examine if changes in experimental pain sensitivity (mechanical and thermal) and lumbar stiffness were further dependent on clinical improvement in disability and patient-reported low back pain. Methods This study is a secondary explorative analysis of data from the randomized trial that compared 132 participants with chronic low back pain who received lumbar spinal manipulative therapy applied at either i) the stiffest segment or ii) the segment having the lowest pain threshold (i.e., the most pain-sensitive segment). We collected data at baseline, after the fourth session of spinal manipulation, and at 14-days follow-up. Participants were dichotomized into responders/non-responders using different clinical variables (disability and patient-reported low back pain) with varying threshold values (0, 30, and 50% improvement). Mixed models were used to assess changes in experimental outcomes (stiffness and pain sensitivity). The fixed interaction terms were time, segment allocation, and responder status. Results We observed a significant increase in mechanical pressure pain thresholds for the group, which received spinal manipulative therapy at the most pain-sensitive segment independent of whether they improved clinically or not. Those who received spinal manipulation at the stiffest segment also demonstrated increased mechanical pain sensitivity, but only in the subgroup with clinical improvement. We did not observe any changes in lumbar stiffness. Conclusion Our results suggest the existence of two different mechanistic pathways associated with the spinal manipulation target. i) A decrease of mechanical pain sensitivity independent of clinical outcome (neurophysiological) and ii) a decrease as a reflection of the clinical outcome. Together, these observations may provide a novel framework that improves our understanding of why some respond to spinal manipulative therapy while others do not. Trial registration ClinicalTrials.gov identifier: NCT04086667 registered retrospectively September 11th 2019.

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Effect of Medicinal Cannabis Therapy (Mct) On Severity of Chronic Low Back Pain, Sciatica and Lumbar Range of Motion

Journal of Anesthesia & Pain Medicine ◽

10.33140/japm/01/02/00006 ◽

2016 ◽

Vol 1 (2) ◽

Cited By ~ 1

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Range Of Motion ◽

Chronic Low Back Pain ◽

Sagittal Plane ◽

Treatment Protocol ◽

Adjunctive Treatment ◽

Low Back ◽

Patient Reported ◽

Medicinal Cannabis

Background: Anecdotal evidence indicates the possible efficacy of cannabis use as an adjunctive treatment in chronic low back pain. The purpose of the current study was to assess the results of treatment of patients suffering from chronic low back pain by medicinal cannabis (MCT). Methods: A cohort of 46 patients was followed for a minimum of twelve months. They were evaluated at baseline prior to MCT, 3 months later when MCT was begun and up to 12 months of MCT by patient reported outcome questionnaire (SF-12), visual analogue scale (VAS) and the Brief Pain Inventory (BPI), back specific function was assessed using the Oswestry score, range of motion was measured using the Saunders digital inclinometer. Opiate use was assessed using pharmacy dispensation records at baseline and after 12 months of MCT. Inclusion criteria included: age over 25 years, sciatica with documented treatment for at least 12 months, evidence on CT or MRI scan of disc herniation or spinal stenosis, failure of at least two narcotic drugs, and consent to use medicinal cannabis. Exclusion criteria included evidence of bone cancer, evidence of diabetic neuropathy, and evidence of prior psychotic reactions. Treatment protocol: Cannabis usage was at a fixed dosage of 20 grams per month, dose increase was considered at least after 6 months of treatment. The cannabis was smoked at a recommended rate of 4 dosages per day. Results: After 12 months of MCT BPI VAS decreased from 8.4 ± 1.4 to 2.0 ± 2.0; SF12-PCS improved from 47 ± 14 to 55 ± 12; SF12-MCS improved from 44 ± 6 to 50 ± 10; and sagittal plane active range of motion improved from 34º ± 8º degrees to 48º ± 8º, In conclusion, short term usage of smoked medicinal cannabis appear to improve both physical and mental function while decreasing pain levels of chronic low back pain sufferers.

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Effect of the duration of chronic low back pain on pain sensitivity of patients undergoing lumbar fusion surgery

Pain medicine ◽

10.31636/pmjua.v5i4.2 ◽

2021 ◽

Vol 5 (4) ◽

pp. 8-15

Author(s):

Mei-ping Qian ◽

Mei-rong Dong ◽

Fang Kang ◽

Juan Li

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Hospital Stay ◽

Chronic Low Back Pain ◽

Pain Sensitivity ◽

Lumbar Fusion ◽

Low Back ◽

Fusion Surgery ◽

Lumbar Fusion Surgery

Background: chronic low back pain is a serious social problem. In recent years, patients who choose lumbar fusion surgery due to chronic low back pain has been increasing. Pre-existing chronic pain has been associated with severe postoperative pain. In this study, we have sought to prospectively analyze the association between the duration of chronic low back pain and pain sensitivity after lumbar fusion surgery. Methods: 400 patients who underwent lumbar fusion surgery were divided into three groups based on the duration of chronic pain. During the first postoperative day, the maximum pain scores of each patient day and night, the pain scores at the day of discharge, the consumption of postoperative analgesics and the length of hospital stay were recorded. Results: of 400 patients recruited, 369 patients completed the experiment. There was no significant difference in gender, age, height, weight, pre-operative pain at rest, and operation time in the three groups. During the day, the pain sensitivity of the three groups were 1.71 ± 0.66, 2.40 ± 0.74, 2.90 ± 0.80. During the night, the pain sensitivity of the three groups were 3.45 ± 0.81, 4.31 ± 1.06, 4.86 ± 1.05. At the day of discharge, the pain sensitivity of three groups were 1.26 ± 0.46, 1.47 ± 0.58, 1.96 ± 0.64. There were significant differences in pain sensitivity among the three groups during the day and night on the first postoperative day and at the day of discharge (p < 0.05). The length of hospital stay (7.31 ± 1.36 days, 8.82 ± 1.48 days, 9.60 ± 1.61 days) and analgesic consumption (25.04 ± 36.56 mg, 33.52 ± 24.04 mg, 45.15 ± 24.89 mg, morphine equivalent) were also significant differences (p < 0.05). Conclusion: we found the duration of chronic low back pain before lumbar fusion surgery affects patient’ postoperative pain sensitivity, consumption of analgesic drugs and hospital stay. The longer the preoperative chronic pain lasts, the higher the postoperative VAS score is, the more analgesic drugs were consumed, and the longer hospital stay is.

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Body Image in Athletes and Nonathletes With Low Back Pain: Avoidance–Endurance-Related Subgroups and Sports Status Play a Role

Journal of Sport Rehabilitation ◽

10.1123/jsr.2019-0245 ◽

2020 ◽

pp. 1-8

Author(s):

Claudia G. Levenig ◽

Michael Kellmann ◽

Jens Kleinert ◽

Johanna Belz ◽

Tobias Hesselmann ◽

...

Keyword(s):

Body Image ◽

Low Back Pain ◽

Back Pain ◽

Psychosocial Aspects ◽

Pain Behavior ◽

The Body ◽

Low Back ◽

Positive Body Image ◽

Main Effect ◽

Pain Responses

Context: Low back pain (LBP) is a serious health problem, both in the general population as well as in athletes. Research has shown that psychosocial aspects, such as dysfunctional pain responses, play a significant role in the chronification of LBP. Recent research supports the relevance of the multidisciplinary concept of body image in the interpretation of LBP. Objective: To examine the differences in 2 psychosocial aspects, body image and pain responses, between athletes and nonathletes with LBP. Design: Cross-sectional design. Setting: The questionnaires were distributed in the course of LBP treatment. Participants: Data from 163 athletes (mean age = 28.69 [9.6] y) and 75 nonathletes (mean age = 39.34 [12.63] y) were collected. Interventions: Data were collected by questionnaires assessing body image, pain behavior, training activity, and LBP. Main Outcome Measures: To examine group differences between athletes and nonathletes regarding body image and pain behavior, the authors performed 2-way analyses of variance with Bonferroni post hoc tests. Results: The results showed (1) a significant main effect regarding pain responses and body image, showing that participants with eustress endurance or adaptive pain behavior revealed a more positive body image in both groups compared with participants with distress endurance or fear-avoidance behavior, and (2) a significant main effect for the factor group in the body image dimension of physical efficacy, indicating a more positive body image for athletes. Conclusion: These results suggest that considering multiple risk factors for LBP, such as body image and dysfunctional pain behavior, as well as subgrouping, might be valuable for research and for broadening therapy options.

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Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain: An Experimental Controlled Study

Physical Therapy ◽

10.2522/ptj.20130118 ◽

2014 ◽

Vol 94 (4) ◽

pp. 477-489 ◽

Cited By ~ 105

Author(s):

Jorge Fuentes ◽

Susan Armijo-Olivo ◽

Martha Funabashi ◽

Maxi Miciak ◽

Bruce Dick ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Therapeutic Alliance ◽

Pain Intensity ◽

Muscle Pain ◽

Pain Sensitivity ◽

Controlled Study ◽

Low Back ◽

Mean Differences

Background Physical therapy influences chronic pain by means of the specific ingredient of an intervention as well as contextual factors including the setting and therapeutic alliance (TA) between provider and patient. Objective The purpose of this study was to compare the effect of enhanced versus limited TA on pain intensity and muscle pain sensitivity in patients with chronic low back pain (CLBP) receiving either active or sham interferential current therapy (IFC). Design An experimental controlled study with repeated measures was conducted. Participants were randomly divided into 4 groups: (1) AL (n=30), which included the application of active IFC combined with a limited TA; (2) SL (n=29), which received sham IFC combined with a limited TA; (3) AE (n=29), which received active IFC combined with an enhanced TA; and (4) SE (n=29), which received sham IFC combined with an enhanced TA. Methods One hundred seventeen individuals with CLBP received a single session of active or sham IFC. Measurements included pain intensity as assessed with a numerical rating scale (PI-NRS) and muscle pain sensitivity as assessed via pressure pain threshold (PPT). Results Mean differences on the PI-NRS were 1.83 cm (95% CI=14.3–20.3), 1.03 cm (95% CI=6.6–12.7), 3.13 cm (95% CI=27.2–33.3), and 2.22 cm (95% CI=18.9–25.0) for the AL, SL, AE, and SE groups, respectively. Mean differences on PPTs were 1.2 kg (95% CI=0.7–1.6), 0.3 kg (95% CI=0.2–0.8), 2.0 kg (95% CI=1.6–2.5), and 1.7 kg (95% CI=1.3–2.1), for the AL, SL, AE, and SE groups, respectively. Limitations The study protocol aimed to test the immediate effect of the TA within a clinical laboratory setting. Conclusions The context in which physical therapy interventions are offered has the potential to dramatically improve therapeutic effects. Enhanced TA combined with active IFC appears to lead to clinically meaningful improvements in outcomes when treating patients with CLBP.

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77 Comparison between Swiss Ball Exercise and Sling Exercise on Lumbar Stability and Postural Stability in Patients with Non-Specific Chronic Low Back Pain: A Pilot Study

Age and Ageing ◽

10.1093/ageing/afz164.77 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv18-iv27

Author(s):

Apinkarn Jaroenlarp ◽

Pitsinee Fuengjit ◽

Jirapat Sukeeyuti ◽

Parichart Sophap ◽

Chadarat Chirasaengthong

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Functional Disability ◽

Sagittal Plane ◽

Postural Sway ◽

Neuromuscular Control ◽

Coronal Plane ◽

Low Back ◽

Significant Difference

Abstract Objective This study was to comparison of level of lumbar stability and postural sway in sagittal plane and coronal plane between exercise with ball and sling in the patients with non-specific chronic low back pain (NCLBP). Methodology Twenty participants with NCLBP aged 20 to 55 years were randomly divided into exercise with ball group (BG) and exercise with sling group (SG). Both groups performed 8 exercise sessions; two times per week for four weeks. The visual analog scale (VAS), modified oswestry disability questionnaire (MODQ), modified isometric stability test (MIST) were used to measure at baseline, week 2 and week 4 after exercise. Moreover, the sway area and sway velocity were evaluated at before and after training. Both group performed exercise 15 repetitions per set for 3 sets with 1-minute resting between set. A repeated two-way ANOVA was used to analyze the difference variables between both groups. Results The results showed significant difference between pre and post treatment of pain intensity, functional disability, MIST and postural sway in both groups (p<.001). When compared between both groups, the reduction in all parameters for the BG group was significantly higher than the SG group (p<.05). Moreover, the findings represented that the postural sway in both sagittal and coronal plane showed no significant difference between both groups after complete treatment. Conclusion The core stabilization exercise with ball and with sling can provided reduction of pain and functional disability. Moreover, the BG group is more effective for decreasing of pain, disability and improving of lumbar stability may described by greater perturbation of the ball. During perform exercise on ball bring to unstable and increasing of neuromuscular control. These results can applied to clinical practice for choosing the appropriate exercise program in the patients with NCLBP.

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