Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function

ObjectivesTo study the efficacy and safety of fasinumab in moderate-to-severe, chronic low back pain (CLBP).MethodsIn this phase II/III, double-blind, placebo-controlled study, patients with CLBP aged ≥35 years with inadequate pain relief/intolerance to acetaminophen, non-steroidal anti-inflammatory drugs and opioids were randomised to fasinumab 6 or 9 mg subcutaneous every 4 weeks (Q4W), 9 mg intravenous every 8 weeks (Q8W) or placebo. Primary endpoint was change from baseline to week 16 in average daily low back pain intensity (LBPI) numeric rating score. Key secondary efficacy variables included Roland-Morris Disability Questionnaire (RMDQ) and Patient Global Assessment (PGA). The results are based on a modified intent-to-treat analysis of 563/800 planned patients when enrolment was stopped early given emerging signals of joint risk in other osteoarthritis (OA) studies at doses being tested here.ResultsSignificant placebo-adjusted LBPI reductions at week 16 were observed for fasinumab 9 mg Q4W and Q8W (least squares mean (standard error) −0.7 (0.3); both nominal p<0.05), but not 6 mg (–0.3 (0.3); p=0.39). RMDQ and PGA improvements to week 16 were greatest for fasinumab 9 mg intravenous. Numerically greater efficacy occurred in patients with, versus those without, peripheral OA (pOA) over 16 weeks. Treatment-emergent adverse events (AEs) occurred in 274/418 (65.6%) patients in the combined fasinumab groups and 94/140 (67.1%) placebo patients. Joint AEs, mostly rapid progressive OA type 1, were more frequent in the combined fasinumab groups (19 events in 16 patients (3.8%) vs 1 event in 1 patient (0.7%) for placebo); all except one occurred in pOA patients.ConclusionsFasinumab highest doses, but not lower dose, improved both CLBP pain and function. Most joint AEs occurred in pOA patients, consistent with earlier findings in symptomatic OA. Further study is needed of patients with CLBP with and without pOA to determine optimal benefit–risk.

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The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials

Disability and Rehabilitation ◽

10.1080/09638288.2017.1410730 ◽

2017 ◽

Vol 41 (6) ◽

pp. 622-632 ◽

Cited By ~ 11

Author(s):

Carla Vanti ◽

Simone Andreatta ◽

Silvia Borghi ◽

Andrew Anthony Guccione ◽

Paolo Pillastrini ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Randomized Trials ◽

Meta Analysis ◽

Low Back ◽

And Function

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Moderators of the effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain

Spine ◽

10.1097/brs.0000000000003814 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Annemarie de Zoete ◽

Michiel R. de Boer ◽

Sidney M. Rubinstein ◽

Maurits W. van Tulder ◽

Martin Underwood ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Relief ◽

Chronic Low Back Pain ◽

Spinal Manipulative Therapy ◽

Low Back ◽

Manipulative Therapy ◽

And Function

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Effect of Self-Compassion Training Combined With Core Stability Exercise For Patients With Non-Specific Chronic Low Back Pain: Study Protocol For A Randomized Controlled Trial

10.21203/rs.3.rs-685299/v1 ◽

2021 ◽

Author(s):

Fuming Zheng ◽

Weihui Xiao ◽

Jiajia Yang ◽

Shufeng Liu ◽

Yiyi Zheng ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Effective Treatment ◽

Treatment Option ◽

Chronic Low Back Pain ◽

Chronic Back Pain ◽

Core Stability ◽

Low Back ◽

Self Compassion ◽

Average Pain

Abstract Background: Non-specific chronic low back pain (NCLBP) has a high incidence, which has a significant impact on a patient's body and mind, and is a common condition affecting people's quality of life. Core Stability Exercise (CSE) is a modestly effective treatment for NCLBP; however, NCLBP has only been shown to be a useful treatment option in the short-term. Many clinical practice guidelines recommend the use of a biopsychosocial framework to guide management of NCLBP. Self-Compassion Training（SCT）is a promising psychotherapy treatment option for NCLBP; however, there is still a lack of research on CSE combined with SCT. In this study, we will seek to determine whether CSE combined with SCT is an effective treatment option for patients with NCLBP compared to CSE alone.Methods: In this study, we will randomize 60 adults with NCLBP to a combined SCT and CSE arm or a CSE alone arm (30 participants per group). Both interventions will consist of four weekly 1.5-hour group sessions of CSE supplemented by home practice. The combined group protocol also includes 2 hours of SCT before CSE. Interviewers masked to the treatment assignments will assess outcomes at 4 and 12 weeks post-randomization. The primary outcomes will be back pain disability (based on the Roland-Morris Disability Questionnaire) and Pain intensity (NRS; average pain, worst pain, average pain) at 12 weeks.Discussion: If SCT is found to enhance the effectiveness of CSE for patients with chronic back pain, the results of the study may promote the development of mind–body therapies for chronic low back pain.Trial registration: The trial was prospectively registered with the Chinese Clinical Trials Registry Number:ChiCTR2100042810 .Registered on 21 Jan 2021.

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Pain Reconceptualisation after Pain Neurophysiology Education in Adults with Chronic Low Back Pain: A Qualitative Study

Pain Research and Management ◽

10.1155/2018/3745651 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Richard King ◽

Victoria Robinson ◽

Helene L. Elliott-Button ◽

James A. Watson ◽

Cormac G. Ryan ◽

...

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

A Priori ◽

Personal Relevance ◽

Low Back ◽

Prior Beliefs ◽

Framework Approach ◽

And Function

Pain neurophysiology education (PNE) is an educational intervention for patients with chronic pain. PNE purports to assist patients to reconceptualise their pain away from the biomedical model towards a more biopsychosocial understanding by explaining pain biology. This study aimed to explore the extent, and nature, of patients’ reconceptualisation of their chronic low back pain (CLBP) following PNE. Eleven adults with CLBP underwent semistructured interviews before and three weeks after receiving PNE. Interviews were transcribed verbatim and thematically analysed in a framework approach using four a priori themes identified from our previous research: (1) degrees of reconceptualisation, (2) personal relevance, (3) importance of prior beliefs, and (4) perceived benefit of PNE. We observed varying degrees of reconceptualisation from zero to almost complete, with most participants showing partial reconceptualisation. Personal relevance of the information to participants and their prior beliefs were associated with the degree of benefit they perceived from PNE. Where benefits were found, they manifested as improved understanding, coping, and function. Findings map closely to our previous studies in more disparate chronic pain groups. The phenomenon of reconceptualisation is applicable to CLBP and the sufficiency of the themes from our previous studies increases confidence in the certainty of the findings.

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