Treatment of Low Back Pain With Opioids and Nonpharmacologic Treatment Modalities for Army Veterans

Lower Back Pain can have causes that aren’t due to underlying diseases and this pain refers to the pain that usual- ly begins in the lower back region, radiating to the sacroiliac regions and buttocks.[1] People with chronic pain often find it difficult to cope with work, family and social activities which is the significant cause of disability worldwide. Eighty percent of the population is affected by this symptom sometimes in life.[2] Increased preva- lence of low back pain and temporary and reduced success rates in invasive contemporary treatment measures has drawn considerable attention towards alternative, effective, non-invasive treatment modalities. Katishoola, a Vata vyadhi diagnosed with cardinal symptoms as Pain in Kati Pradesha. In Ayurveda, a holistic approach has been adopted that includes the use of oral Ayurvedic formulations, Panchakarma procedures like Snehana karma (unc- tion therapy), Swedana karma (sudation therapy) etc. [3] Here In this article a case of low Back Pain treated with Kati Pichu with Masha taila with good outcomes are reported. Keywords: Katishoola, Low Back Pain, Masha Taila, Kati Pichu

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Analysis of State Insurance Coverage for Nonpharmacologic Treatment of Low Back Pain as Recommended by the American College of Physicians Guidelines

Global Advances in Health and Medicine ◽

10.1177/2164956119855629 ◽

2019 ◽

Vol 8 ◽

pp. 216495611985562 ◽

Cited By ~ 1

Author(s):

Robert Bonakdar ◽

Dania Palanker ◽

Megan M Sweeney

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Spinal Manipulation ◽

Tai Chi ◽

Insurance Coverage ◽

Low Back ◽

Chronic Pain Management ◽

Multidisciplinary Rehabilitation ◽

Nonpharmacologic Treatment

Background In 2017, the American College of Physicians (ACP) released guidelines encouraging nonpharmacologic treatment of chronic low back pain (LBP). These guidelines recommended utilization of treatments including multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (MBSR), tai chi, yoga, progressive relaxation, biofeedback, cognitive behavioral therapy (CBT), and spinal manipulation. Objective We aimed to determine status of insurance coverage status for multiple nonpharmacological pain therapies based on the 2017 Essential Health Benefits (EHB) benchmark plans across all states. Methods The 2017 EHB benchmark plans represent the minimum benefits required in all new policies in the individual and small group health insurance markets and were reviewed for coverage of treatments for LBP recommended by the ACP guidelines. Additionally, plans were reviewed for limitations and exclusionary criteria. Results In nearly all state-based coverage policies, chronic pain management and multidisciplinary rehabilitation were not addressed. Coverage was most extensive (supported by 46 states) for spinal manipulation. Acupuncture, massage, and biofeedback were each covered by fewer than 10 states, while MBSR, tai chi, and yoga were not covered by any states. Behavioral health treatment (CBT and biofeedback) coverage was often covered solely for mental health diagnoses, although excluded for treating LBP. Conclusion Other than spinal manipulation, evidence-based, nonpharmacological therapies recommended by the 2017 ACP guidelines were routinely excluded from EHB benchmark plans. Insurance coverage discourages multidisciplinary rehabilitation for chronic pain management by providing ambiguous guidelines, restricting ongoing treatments, and excluding behavioral or complementary therapy despite a cohesive evidence base. Better EHB plan coverage of nondrug therapies may be a strategy to mitigate the opioid crisis. Recommendations that reflect current research-based findings are provided to update chronic pain policy statements.

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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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A COMPARATIVE CLINICAL STUDY ON PARISHEKA SWEDA WITH VISHAGARBHA TAILA AND TILA TAILA IN KATIGRAHA

November 2020 - International Ayurvedic Medical Journal ◽

10.46607/iamj1108082020 ◽

2020 ◽

Vol 8 (8) ◽

pp. 4098-4106

Author(s):

Prabin. M. M ◽

Vikram Kumar

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Signs And Symptoms ◽

Body Part ◽

Whole Body ◽

Treatment Modalities ◽

Low Back ◽

Sacral Region ◽

Significant Difference ◽

Comparative Clinical Study

Swedana Karma is one among the Shadupakrama (Six treatment modalities), indicated in the management of various diseases caused by Vata. Parisheka Sweda is a type of Drava Sweda which can be applied as Ekanga (over a body part) or Sarvanga (whole body). Katigraha (low back pain with stiffness) is a condi-tion which is characterized by Shoola (pain) and Stabdhata (stiffness) in Kati Pradesha (lumbo - sacral region) due to vitiated Vata. Swedana helps to relieve the pain and stiffness. Parisheka Sweda acts over whole Kati Pradesha (lumbo - sacral region), hence it will be more beneficial in this condition. Vishagarbha Taila contains Tikshna and Ushna Guna drugs and is specially indicated in Katigraha (low back pain with stiffness). Tila Taila is best among Vatahara Dravyas. Hence this study was undertaken to compare the efficacy of Parisheka Sweda with Vishagarbha Taila and Tila Taila in the management of Katigraha (low back pain with stiffness) to ascertain the better modality. Total 40 patients were randomly selected and divided in two equal groups. Group VT patients were given Vishagarbha Taila Parisheka Sweda and group TT patients were given Tila Taila Parisheka Sweda for half an hour once a day for 1 week over Kati Pradesha (lumbo - sacral region). Statistical analysis showed that both groups showed good improvement in various parameters of Katigraha (low back pain with stiffness). When comparison was done between the groups, it revealed that there was no statistically significant difference between the groups except in stiffness (p<0.001) and left lateral flexion (p<0.05). Hence it can be concluded that both Vishagarbha Taila Parisheka Sweda and Tila Taila Parisheka Sweda may be accepted in treating patients with Katigraha (low back pain with stiffness) to reduce both signs and symptoms successfully.

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A study of the effectiveness of chiropractic spinal manipulation on its own versus chiropractic spinal manipulation combined with other treatment modalities used in a chiropractic practice, in the management of mechanical low back pain in nurses

10.51415/10321/2743 ◽

1995 ◽

Author(s):

◽

Elda Kristina Urli

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Randomised Controlled Trial ◽

Spinal Manipulation ◽

Controlled Trial ◽

Treatment Modalities ◽

Low Back ◽

Chiropractic Practice ◽

Randomised Controlled ◽

Single Blind

The efficacy of chiropractic spinal manipulation on its own versus chiropractic spinal manipulation combined with other treatment modalities used in a chiropractic practice was evaluated in a single blind, randomised, controlled trial using a patient population of thirty nurses who were experiencing mechanical low back pain

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The effect of interferential current treatment duration on chronic low back pain

10.51415/10321/2601 ◽

2017 ◽

Author(s):

◽

Ahmed Abdul Carim

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Rating Scale ◽

Treatment Modalities ◽

Low Back ◽

Group Effect ◽

Gate Control Theory ◽

Pressure Algometer ◽

Interferential Current

Background to the study: Chronic low back pain (CLBP) is a common musculoskeletal complaint, which results in increased absenteeism from work and other disabilities. Interferential current (IFC) is one of the treatment modalities used by manual and physical therapists to alleviate CLBP. Interferential current involves electrical stimulation of medium frequency using two currents that cross over each other. There have been numerous mechanisms proposed on how IFC works with regard to pain inhibition; however, these remain unconfirmed. Common theories include those based on the gate control theory of pain and integrated pain theories. Although the placement of the electrodes used in the IFC application has been well defined, the optimum treatment time for CLBP has not been well researched. Therefore, this study aimed to determine what protocol regarding the duration of IFC is most appropriate in the treatment of CLBP. Aim: The aim of this study was to investigate the effect of interferential current in the treatment of chronic low back pain using variable time intervals Methodology: This study was a randomised single-blinded clinical trial which consisted of 45 participants residing in the eThekwini municipality, divided into three groups of 15 each. The participants were randomly assigned using concealed allocation to one of three treatment groups of 15 each viz. 15, 20 or 30 minutes of interferential current (IFC). Low back pain level was determined using a numerical pain rating scale (NRS-101). Pain pressure thresholds (PPT) were measured with a pain pressure algometer. The effect of low back pain on participants’ activities of daily living was assessed using the Oswestry low back questionnaire (OLBQ).The participants received three treatments over a two week period with the fourth consultation being used for the final subjective and objective measurements a week later. Results: Repeated measures ANOVA testing was used to examine the intra-group effect of time and the inter-group effect of treatment on the outcomes of NRS-101 and algometer readings. Profile plots were used to assess the direction and trends of the effects. An intra-group analysis revealed that, objectively and subjectively, all groups responded positively to treatment over time, with no significant time-group interaction. Conclusion: This study concluded that neither group is more effective than the other with respect to participants’ pain perception and the OLBQ. However, groups one and three showed the largest individual improvement between consultation one and three, compared to group two which showed consistent improvement throughout for the NRS-101 readings. Based on the results collected from this study, the shortest time frame of 15 minutes of IFC application can be used in the treatment of CLBP.

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Patient with Lumbar Spondylosis and Diskogenic Pain

10.2310/pm.15016 ◽

2016 ◽

Author(s):

Jianguo Cheng

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Manifestations ◽

Compression Fracture ◽

Treatment Modalities ◽

Low Grade ◽

Type I ◽

Low Back ◽

Positive Effects ◽

Modic Type

Diskogenic low back pain (LBP), defined as pain that originates from a damaged vertebral disk, is a common cause of LBP. It is characterized by a three-phase cascade of degeneration marked by dysfunction, instability, and stabilization. A distinct pathologic characteristic of the disks from patients with diskogenic LBP has been found to be the formation of the zones of vascularized granulation tissue, with extensive innervation extending from the outer layer of the annulus fibrosus into the nucleus pulposus along a torn fissure. In addition, there appears to be an association between microbial infection and symptomatic disk degeneration. Low-virulence microorganisms, in particular Propionibacterium acnes, might be causing a chronic low-grade infection in the lower intervertebral disks in some patients. The diagnosis of diskogenic pain is primarily based on clinical manifestations, physical examinations, imaging studies, and provocative diskography. Diskogenic pain should be differentiated from other axial back pain conditions, such as facet arthropathy, sacroiliac joint pain, myofascial strain and pain, vertebral compression fracture, and other, less common conditions. Treatment options should be tailored to individual needs. Early and gradual physical and behavioral therapies are encouraged. Pharmacologic therapy, composed primarily of analgesics, nonsteroidal antiinflammatory drugs, muscle relaxants, and antidepressants, may have modest positive effects. A subset of patients with Modic type I changes in magnetic resonance imaging may benefit antibiotic therapy directed at the infected disks by P. acnes and other low-virulence microorganisms. There is evidence that supports the use of epidural steroid injections and intradiskal injections (methylene blue, ozone, steroids) for diskogenic pain. Additional options include intradiskal biacuplasty, gray ramus communicans nerve blocks/radiofrequency ablation, and intradiskal stem cell injections for disk repair/regeneration, all of which have gained support in clinical trials. These treatment modalities have shown promise to provide equal or even better outcomes compared with surgical spinal fusion or total disk replacement with an artificial disk. This review contains 2 figures and 149 references. Keywords: collagen, diskogenic low back pain (LBP), herniation, intervertebral disk, spondylosis

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P087: Overview of reviews: relevant treatment modalities for management of low back pain in the emergency department

CJEM ◽

10.1017/cem.2016.263 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S107-S107

Author(s):

B. Burgesson ◽

J. Hayden ◽

K. Magee

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Systematic Reviews ◽

Functional Limitation ◽

The United States ◽

Treatment Modalities ◽

Cochrane Library ◽

Low Back ◽

Nationally Representative

Introduction: Low Back Pain (LBP) remains a condition with relatively high incidence and prevalence. It affects 70-85% of people at some point in their lives and causes significant disability. LBP management may be best suited to a primary care setting, yet it is one of the most common reasons for presentation to Emergency Departments (ED). Nationally representative data from the United States found that LBP related disorders are a frequent cause of ED visits, accounting for 2.7 million visits to US EDs annually. There are numerous treatment modalities for LBP, however the task is identifying those that have relevance in an ED setting. Although there is extensive research available on management of LBP in primary care settings, treatment outcomes differ from that in the ED setting. This makes management of LBP a challenge for ED physicians. Few studies and no systematic reviews focus on treatment of LBP in the ED setting. Methods: The objective of our study is to compare effectiveness of treatment modalities relevant for management of LBP in the ED setting. We conducted an Overview of Systematic Reviews following robust methods advocated by Cochrane. We included systematic reviews of randomized controlled trials (RCTs). A medical librarian assisted in completing of an extensive search of the Cochrane Library, PubMed, and EMBASE. We used transparent criteria to select relevant reviews and assess interventions for ED relevance. We collected key data points from the included reviews including pain and functional limitation outcomes. Evidence will be synthesized for important outcome measures following the approach of Jones et al (2012). Results: We screened 4740 citations and identified 346 likely relevant systematic reviews. Comparative effectiveness review synthesis will be completed before the conference. We will report effectiveness of each of the included interventions and as well as make head to head comparisons of said relevant interventions. Conclusion: Currently most LBP patients presenting to the ED are inundated with a variety of potential treatment modalities, all alleging efficacy in LBP management. Physicians may use the evidence from this synthesis, and related knowledge translation tools, to guide decisions in effectively treating patients presenting to the ED with LBP.

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Physiotherapy Modalities used in the Management of Chronic Low Back Pain

South African Journal of Physiotherapy ◽

10.4102/sajp.v68i1.8 ◽

2012 ◽

Vol 68 (1) ◽

Author(s):

V. Naidoo ◽

W. Mudzi ◽

V. Ntsiea ◽

PJ. Becker

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Evidence Base ◽

Medical Problem ◽

Treatment Modalities ◽

Low Back ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Selection Of

Chronic low back pain (CLBP) is a costly andcommon medical problem accounting for 75-90% of compensationcosts as a result of repeated treatments, long term work absenteeismand social support-unemployment compensation. Physiotherapytreatment modalities are commonly used in the management ofCLBP. Data on the management of CLBP by physiotherapists inlow income countries are scarce.A cross-sectional survey was used to investigate the managementof CLBP by physiotherapists in Kwazulu-Natal (KZN). Theobjectives of the study were to establish: the commonly used physiotherapymodalities; reasons; and the evidence base used for their choice. Six hundred and eighty-five self-administeredquestionnaires were posted to all registered physiotherapists in KZN.Of 213 returned questionnaires, 141 (20.6%) met the inclusion criteria as they managed patients with CLBP.General exercises (30%); spinal mobilisation (28%); myofascial release (18%), education (12%) and training oflocal stabilisers(12%) were the commonly used treatment modalities. Key reasons for the selection of the treatmentmodalities were undergraduate education received; own clinical experience and the attendance of postgraduate courses/physiotherapy conferences.From the reasons specified for the selection of treatment modalities, the use of written current available literaturethrough reading of journal articles was sparsely utilized.

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Attitudes of nurses, physiotherapy assistants and masseurs towards low back pain treatment

Physiotherapy Practice and Research ◽

10.3233/ppr-200401 ◽

2021 ◽

pp. 1-10

Author(s):

Eszter Simoncsics ◽

Adrienne Stauder

Keyword(s):

Physical Activity ◽

Health Care ◽

Low Back Pain ◽

Back Pain ◽

Treatment Modalities ◽

Low Back ◽

Care Providers ◽

Fear Avoidance ◽

Professional Background ◽

Fear Avoidance Beliefs

PURPOSE: We evaluated the attitudes of nurses compared to physiotherapy assistants and medical masseurs (PAMs) regarding various treatment modalities used in the treatment of low-back pain (LBP) as their opinions might influence the patients’ attitudes to therapy. DESIGN: Cross sectional self-reported questionnaire survey. METHODS: 175 Hungarian health care providers completed questionnaires evaluating their opinions on the importance of various therapeutic interventions and the need for initiation of LBP treatment. Their personal LBP history and fear-avoidance beliefs (FABQ) were also investigated. FINDINGS: The importance of exercise therapy (p = 0.024) and massage (p < 0.01) was evaluated higher by the PAMs, while medication (p = 0.04) was scored higher by the nurses. Those who experienced moderate or severe LBP were more positive about pain medication than to those with mild pain (p = 0.048). Years in health care work had only a weak association with opinions. The nurses reported more fear-avoidance beliefs than the PAMs about both physical activity (p = 0.024) and work (p = 0.021). Those who experienced moderate or severe LBP had higher FABQ scores (p = 0,076), however the difference was significant only for FABQ activity (p = 0.035). CONCLUSIONS: Our study confirmed that professional background and years of experience can influence the attitudes towards the importance of certain therapies, although these differences were small. Experiencing moderate or severe LBP increased the fear-avoidance beliefs about work and physical activity independently of the professional background. CLINICAL RELEVANCE: Our study draws the attention to the importance of standardization of the information to be passed to the patients and to the need of discussing personal experiences and beliefs during professional training.

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