Ketofol vs Dexamedetomidine Effect on Conscious Sedation for Patients with Chronic Nonsurgical Low Back Pain

Abstract Context Treatment of low back pain is challenging. A variety of therapeutic interventions is available, but no single modality appears to be superior, and evaluations vary depending on the cause of pain and on individual, social, and occupational factors. Scientific evidence supports the use of some nonsurgical treatment alternatives in patients with acute and chronic low back pain. Dexmedetomidine had been successfully used in conscious (moderate) sedation as a good competitive to the popular agent (midazolam). Also different concentrations of ketamine and propofol combinations (ketofol) have been used for procedural sedation and analgesia. Objective The aim of this study is to compare the effect of dexamedetomidine and ketofol on conscious sedation in patients undergoing non-surgical interventions for chronic low back pain regards the efficacy of sedation, hemodynamic stability, respiratory effects, speed of recovery, analgesic effects and incidence of complications. Methodology This study was conducted in Ain Shams University affiliated hospitals on 60 patients of both sexes between 30 and 50 years old, of ASA physical status I–II scheduled for nonsurgical intervention for chronic low back pain. In the current study, the patients were randomly divided into 2 equal groups of 30 patients each. Patients received either sedation with Ketofol (group K) or Dexmedetomidine (group D). Results As regards the demographic data (age, sex and body weight); there was no statistically significant variation between the two study groups. This provided a uniform platform to evenly compare the results obtained. Concerning the duration of the procedure, the time recorded for each patient showed statistically non-significant difference between the two groups. Regarding sedation of the patients during the procedure evaluated according to Ramsay sedation score, there was a highly significant difference between the two groups (p-value < 0.001), where the dexmedetomidine group needed more time (17.71 ± 2.86 min) to reach the targeted Ramsay sedation score (3-4) to commence the surgical procedure while the ketofol group needed less time (9.79 ± 1.87 min) to reach the same score. Conclusion Both drugs provided hemodynamic stability althrough the procedure although dexmedetomidine group showed lower heart rates and lower mean arterial blood pressures towards the end of the procedure which makes it difficult to be used in older population or those having low baseline heart rates. Both drugs proved to be safe concerning respiration, SPO2 and CO2 values, however dexmedetomidine showed higher respiratory rates during the procedure.

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Association of Serum Serotonin and Pain in Patients with Chronic Low Back Pain before and after Spinal Surgery

Pain Research and Treatment ◽

10.1155/2018/4901242 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Afshin Farhanchi ◽

Behrouz Karkhanei ◽

Negar Amani ◽

Mashhood Aghajanloo ◽

Elham Khanlarzadeh ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Low Back ◽

Significant Difference ◽

Before And After ◽

Postoperative Serum ◽

Serum Serotonin

Introduction. In this study we are aiming to evaluate the changes of serum serotonin and its association with pain in patients suffering from chronic low back pain before and after lumbar discectomy surgery. Patients and Methods. A prospective study was performed on the patients referring to the outpatient clinic in Besat hospital, Hamadan University of Medical Sciences, Hamadan, Iran, during 2016. A 2 mL fasting blood sample was collected from each patient at preoperative day 1 and postoperative day 14 and they were measured for level of serum serotonin. Besides, all patients were asked for severity of their low back pain in preoperative day 1 and postoperative day 14 and scored their pain from zero to ten using a Numerical Rating Scale. Results. Forty patients with the mean age of 47 ± 13 yrs/old (range 25–77) including 15 (37.5%) males were enrolled into the study. The overall mean score of preoperative pain was significantly decreased from 7.4 ± 2.18 (range 4–10) to the postoperative pain score 3.87 ± 2.92 (range 0–10) (P < .001). The overall levels of pre- and postoperative serum serotonin were 3.37 ± 1.27 (range 1.1–6.4) and 3.58 ± 1.32 (range .94–7.1) ng/mL, respectively, with no significant difference (P = .09). The levels of pre- and postoperative serum serotonin were significantly higher in males and patients older than 50 yrs/old compared to the females and patients younger than 50 yrs/old, respectively (P = .03 and .005, respectively). A significant inverse correlation between the postoperative levels of pain and serum serotonin was observed (r = -.36 and P = .02). Conclusion. A negative medium strength linear relationship may exist between the postoperative serum serotonin and low back pain.

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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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A comparative study of the therapeutic efficacy of vertical oscillatory pressure and transverse oscillatory pressure in the management of Chronic Low Back Pain

Revista Pesquisa em Fisioterapia ◽

10.17267/2238-2704rpf.v8i2.1916 ◽

2018 ◽

Vol 8 (2) ◽

pp. 216-222

Author(s):

Oluwadare Akanni Ogundipe ◽

Olufemi Opeyemi Ogundiran

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Outcome Measures ◽

Chronic Low Back Pain ◽

Low Back ◽

Significant Difference ◽

Before And After ◽

Treatment Data ◽

Quasi Experimental ◽

Oscillatory Pressure

BACKGROUND: The use of physical modalities in treatment of Chronic Low Back Pain (CLBP) is potentially beneficial, but the general evidence still leaves questions about its security application. OBJECTIVE: This study sought to investigate and compare the relative efficacy of Vertical Oscillatory Pressure (VOP) and Transverse Oscillatory Pressure (TOP) in the management chronic low back pain (CLBP) of mechanical origin. METHODS: A two-group, quasi-experimental design was utilized, involving a total of forty-two participants purposively recruited with due consideration of the specific inclusion and exclusion criteria. Five research questions were raised with corresponding hypotheses formulated for them, which were tested at 0.05 level of significance. The participants were randomly assigned to the VOP and TOP groups, and were subsequently managed thrice weekly for a duration of six weeks. The pain intensity rating, straight leg raising, and spinal range of motion were the outcome measures selected, which were assessed before and after treatment. Data were collected, organized, and analyzed using descriptive and T-Student test analytical statistics. RESULTS: The results of the study showed a significant difference in each of the outcome measures for both groups (p<0,05). CONCLUSION: This suggested that both VOP and VOP were relatively effective in managing CLBP.

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Effects of Lumbar Stability and Hip Joint Mobility Exercise with Pilates Devices on Pain Level and Muscle-Joint Function in Middle-Aged Women with Chronic Low Back Pain

Exercise Science ◽

10.15857/ksep.2021.00542 ◽

2021 ◽

Vol 30 (4) ◽

pp. 547-555

Author(s):

Da Eun Park ◽

Seung Kil Lim

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

External Rotation ◽

Low Back ◽

Pain Level ◽

Middle Aged ◽

Joint Function ◽

Oswestry Disability Index Score ◽

Significant Difference

PURPOSE: This study aimed to compare the effects of 10 weeks of lumbar stability and hip mobility exercises using Pilates devices on pain level and muscle joint function in middle-aged women with chronic low back pain (CLBP). Further, we aimed to investigate the efficacy of Pilates hip mobility exercise (HME) as an exercise for improving CLBP in middle-aged women by comparing the effectiveness of lumbar stability exercise (LSE) and HME.METHODS: Thirty-two middle-aged women with CLBP were enrolled and randomly divided and placed into two groups: the LSE group (n=16) and HME group (n=16). Both groups performed Pilates exercises for 50 minutes twice a week for 10 weeks.RESULTS: The Korean Oswestry Disability Index score in both the LSE and HME groups decreased at 5 weeks (p<.05). Hip internal rotation range of motion (ROM) and external rotation ROM increased at 5 and 10 weeks in both the LSE and HME groups (p<.01). Lumbar mobility increased at 5 weeks in both the LSE (p<.01) and HME groups (p<.001). Lumbar stability in the prone plank test significantly increased at 5 weeks in the LSE group (p<.001) and at 5 and 10 weeks in the HME group (p<.001). Lumbar stability by the side plank test significantly increased at 5 and 10 weeks in both the LSE and HME groups (p<.001).CONCLUSIONS: We found that using Pilates to perform both LSE and HME helped relieve back pain and improve muscle joint function in middle-aged women with CLBP. There was no significant difference between LSE and HME in terms of efficacy. HME is a highly effective exercise for improving CLBP in middle-aged women.

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Imagined and Actual Acupuncture Effects on Chronic Low Back Pain: A Preliminary Study

Neural Plasticity ◽

10.1155/2020/8579743 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Jin Cao ◽

Scott P. Orr ◽

Georgia Wilson ◽

Jian Kong

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Treatment Method ◽

Sham Acupuncture ◽

Treatment Modalities ◽

Low Back ◽

Brain Responses ◽

Significant Difference ◽

New Treatment

Background. Research suggests that imagined experiences can produce brain responses similar to those produced by actual experiences. Shared brain responses that support both imagination and perception may underlie the functional nature of mental imagery. In a previous study, we combined acupuncture and imagery to develop a new treatment method, video-guided acupuncture imagery treatment (VGAIT). We found that VGAIT significantly increased pain thresholds in healthy subjects. The aim of this study is to extend our previous finding by investigating whether VGAIT can relieve symptoms in patients with chronic low back pain. Methods. We first performed a single-arm study in which we administered video-guided acupuncture imagery treatment (VGAIT) on patients with chronic low back pain (cLBP) (Study 1, n=18, 12 females). We then compared our findings to those from a recently published study in which real or sham acupuncture treatment was applied on patients with cLBP (Study 2, n=50, 31 females) using a similar protocol. All patients in Studies 1 and 2 received 6 treatments over 4 weeks. Results. All three treatments (VGAIT, real, and sham acupuncture) significantly reduced pain severity as measured by a low back pain bothersomeness score. VGAIT produced similar effects to real acupuncture (p=0.97) and nonsignificantly greater pain bothersomeness relief compared to sham acupuncture (p=0.14). Additional analysis showed that there was no significant difference on the sensations evoked by different treatment modalities. Conclusion. These findings support VGAIT as a promising method for pain management.

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Smartphone-Based Remote Self-Management of Chronic Low Back Pain: A Preliminary Study

Journal of Healthcare Engineering ◽

10.1155/2019/4632946 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Jingyi Yang ◽

Quan Wei ◽

Yanlei Ge ◽

Lijiao Meng ◽

Meidan Zhao

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Bodily Pain ◽

Management Program ◽

Self Management ◽

Control Group ◽

Positive Trend ◽

Low Back ◽

Significant Difference

Objective. To assess the additional effect of self-management on physiotherapy via the use of APPS on management of chronic low back pain. Method. A single-blinded randomized control trial was conducted. 8 participants (male: 4; female: 4) were recruited from the Rehabilitation Clinic of The Hong Kong Polytechnic University. Participants in the treatment group received self-management plus physiotherapy and the control group received physiotherapy only. Assessment was carried out pretreatment, midterm (week 2), and posttreatment (week 4), including Visual Analog Scale (VAS), Pain Self-Efficacy Questionnaire (PSEQ), Roland Morris Disability Questionnaire (RMDQ), and SF36. Results. Compared with the physiotherapy group, the self-management plus physiotherapy group had significance in PSEQ (p=0.035), RMDQ (p=0.035), SF36-Bodily Pain (p=0.008), and SF36-Mental Health (p=0.013). VAS showed a positive trend although there was no significant difference. Conclusion. This pilot study indicated that smartphone APPS-based self-management program appears to bring additional benefits to physiotherapy for patients with CLBP. Self-management is a potential approach for people with CLBP.

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Effect of Auriculotherapy on Sleep Quality in Elderly With Chronic Low Back Pain: A Single-blind Randomized Clinical Trial

Complementary Medicine Journal ◽

10.32598/cmja.10.4.589.3 ◽

2021 ◽

Vol 10 (4) ◽

pp. 308-327

Author(s):

Maryam Pourmohammadi ◽

◽

Zahra Tagharrobi ◽

Khadijeh Sharifi ◽

Zahra Sooki ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Sleep Quality ◽

Chronic Low Back Pain ◽

Sham Group ◽

Intervention Group ◽

The Elderly ◽

Low Back ◽

Significant Difference ◽

Single Blind

Objective: One of the common problems that leads to poor sleep quality in the elderly is low back pain. This study aims to evaluate the effect of auriculotherapy (ear acupressure) on the sleep quality of elderly people with chronic low back pain. Methods: This single-blind randomized clinical trial was conducted in 2019 on 70 older adults with chronic low back pain in Kashan, Iran, who were selected using a convenience sampling technique. After obtaining a written informed consent, they were assigned into intervention and sham groups using the block randomization method. In the intervention group, the pressure was applied to ShenMen, sympathetic, subcortex and low back points of the ear, while in the sham group, the pressure was applied to the points that were not associated with the low back pain. The Pittsburgh Sleep Quality Index (PSQI) and McGill Pain Questionnaire (MPQ) were completed at the beginning of the study, at the end of intervention, and one month after the end of intervention. Six patients from the Sham group and 2 patients from the intervention group were excluded from the study. The data of 62 elderly (in sham group 29 and in intervention group 33) according to Per-Protocol (PP) and data of all samples as Intention to Treat (ITT) were analyzed using covariance analysis and repeated measures ANOVA. Results: There was a statistically significant difference between the intervention and sham groups in terms of the duration of disease at baseline (P=0.012). The interaction effect of time and group on the sleep quality was significant (P<0.0001). Sleep quality in the intervention group was significantly better than in the sham group at the end of the intervention and also during the one-month follow-up period (P<0.0001). Within-group comparison results reported a significant difference in the sleep quality between three evaluation times in the intervention group (P<0.0001). Conclusion: Auriculotherapy can improve sleep quality in the elderly with chronic low back pain. It is recommended to use auriculotherapy as a complementary therapy for treating these elderly groups.

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MRI Assessment of Degeneration of Multifidus and Erector Spinae Muscles in Patients with Chronic Low Back Pain

10.21203/rs.3.rs-549319/v2 ◽

2021 ◽

Author(s):

Alikemal Yazici ◽

Tuba Yerlikaya ◽

Adile Oniz

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Erector Spinae ◽

Low Back ◽

Cross Sectional ◽

Fat Infiltration ◽

Significant Difference ◽

Healthy Control ◽

The Right

Abstract Background The aim of this study was to examine degeneration in the lumbar musculus multifidus (L.MF) and lumbar musculus erector spina (L.ES) muscles in patients with mechanical chronic low back pain, non-radiculopathy chronic low back pain with discopathy, and healthy individuals. The relationships with low back pain were examined by comparing the results according to gender, pain, and lumbar segments. Material and Method: Evaluation was made of 36 healthy control subjects (Group 1), 37 patients with mechanical low back pain (Group 2) and 41 non-radiculopathy, lumbar discopathy patients (Group 3). On axial magnetic resonance images at the L3-S1 level, asymmetry between the left and right sides was examined in respect of L.MF and L.ES surface cross-sectional areas (CSA), total surface cross-sectional area (TCSA = L.MF + L.ES), and fat infiltration. Results The mean CSA values showed a significant difference only in the right L.MF in the healthy control group (p = 0.011). No statistically significant difference was seen between the groups in the comparisons of TCSA, and a statistically significant difference was determined in respect of fat infiltration in the right and left L.MF and the left L.ES (p = 0.011, p = 0.001, p = 0.027, respectively). When the CSA and TCSA were examined according to gender within the groups, the values were found to be statistically significantly higher in males (p < 0.001). The CSA and TCSA values of the L.MF and L.ES showed a significant difference between segments (L3-L4, L4-L5, L5-S1) (p < 0.001). No asymmetry was observed between the left /right CSA and TCSA values of the groups. Fat infiltration showed a significant difference according to gender and segments (p < 0.001). Conclusion Fat infiltration in the L.MF muscle is related to mechanical low back pain and lumbar discopathy. That there was no difference between the groups in the CSA and TCSA values demonstrates the need for measurement of muscle atrophy associated with fat infiltration or functional cross-section area rather than CSA and TCSA.

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Deep Tissue Massage and Nonsteroidal Anti-Inflammatory Drugs for Low Back Pain: A Prospective Randomized Trial

The Scientific World JOURNAL ◽

10.1155/2014/287597 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 10

Author(s):

Marian Majchrzycki ◽

Piotr Kocur ◽

Tomasz Kotwicki

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Pain Reduction ◽

Control Group ◽

Low Back ◽

Deep Tissue ◽

Significant Difference ◽

Inflammatory Drugs ◽

Anti Inflammatory

Objective. To investigate whether chronic low back pain therapy with deep tissue massage (DTM) gives similar results to combined therapy consisting of DTM and non-steroid anti-inflammatory drugs (NSAID).Design. Prospective controlled randomized single blinded trial.Settings. Ambulatory care of rehabilitation.Participants. 59 patients, age 51.8 ± 9.0 years, with chronic low back pain.Interventions. 2 weeks of DTM in the treatment group (TG) versus 2 weeks of DTM combined with NSAID in the control group (CG).Main Outcome Measures. Visual analogue scale, Oswestry disability index (ODI), and Roland-Morris questionnaire (RM).Results. In both the TG and the CG, a significant pain reduction and function improvement were observed. VAS decreased from 58.3 ± 18.2 to 42.2 ± 21.1 (TG) and from 51.8 ± 18.8 to 30.6 ± 21.9 (CG). RM value decreased from 9.8 ± 5.1 to 6.4 ± 4.4 (TG), and from 9.3 ± 5.5 to 6.1 ± 4.6 (CG). ODI value decreased from 29.2 ± 17.3 to 21.4 ± 15.1 (TG) and from 21.4 ± 9.4 to 16.6 ± 9.4 (CG). All pre-post-treatment differences were significant; however, there was no significant difference between the TG and the CG.Conclusion. DTM had a positive effect on reducing pain in patients with chronic low back pain. Concurrent use of DTM and NSAID contributed to low back pain reduction in a similar degree that the DTM did.

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Effects of rehabilitation on the patients with chronic low back pain

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v12i1.37610 ◽

2019 ◽

Vol 12 (1) ◽

pp. 6-9

Author(s):

Md. Abdus Shakoor ◽

M. Tariqul Islam ◽

A. K. M. Salek ◽

Md. Moyeenuzzaman

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Visual Analogue Scale ◽

Chronic Low Back Pain ◽

Analogue Scale ◽

Low Back ◽

Nsaid Group ◽

Significant Difference ◽

The Mean ◽

Pre Treatment

This study was done to observe the effects of rehabilitation on chronic low back pain on 139 patient. They were divided into two groups: a) One group (n=71) received naproxen (non-steroidal anti-inflammatory drug, NSAID) with selective rehabilitation and b) another group (n= 68) treated with NSAID only. The patients were followed up weekly for eight weeks. The improvement was found in both groups after treatment. In patients with rehabilitation, the pre-treatment and post-treatment mean scores (Oswastry Disability Index, Visual Analogue Scale and Modified Zung Index) were 34.3 ± 9.8 and 9.9 ± 8.0 respectively (p<0.001). Treatment with NSAID only reduced the mean scores from 34.9 ± 13.5 to 16.0 ± 14.4 (p<0.001) after treatment. There was no significant difference in clinical improvement between the groups in pre-treatment compare with week one, rehabilitation group (29.7 ± 8.7) vs NSAID group (31.5 ± 13.8). While significant improvement was found in rehabilitation group in comparison to NSAID group after 8th week, rehabilitation group vs NSAID group scores were 10.0 ± 7.9 vs 15.9 ± 14.5 respectively (p= 0.004). In conclusion, rehabilitation can be used as an adjunct to NSAID for better improvement.

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