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Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain

Chiro.Org Blog: Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). […]

Individual Courses of Low Back Pain in Adult Danes

Chiro.Org Blog: In this study, it was evident that when applying the more ‘severe’ definitions of LBP (‘>30 days’, ‘seeking care’, and ‘non-trivial’) as risk factors for future LBP of the same definitions, the associations were stronger than for ‘year’ and ‘month’. We therefore suggest that composite measures of LBP outcomes should be further explored in future epidemiologic studies of risk factors and less attention should be paid to the LBP definitions ‘year’ and ‘month’, which may include both slight LBP with low clinical impact and severe disabling LBP. […]

Clinical Practice Guidelines for the Noninvasive Management
of Low Back Pain

Chiro.Org Blog: Most high-quality guidelines recommend education, staying active/exercise, manual therapy and paracetamol/NSAIDs as first-line treatments for LBP. Recommendation of paracetamol for acute LBP is challenged by recent evidence and needs updating. […]

Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society

Chiro.Org Blog: Many options are available for evaluation and management of low back pain. However, there has been little consensus, either within or between specialties, on appropriate clinical evaluation [9] and management [10] of low back pain. Numerous studies show unexplained, large variations in use of diagnostic tests and treatments. [11, 12] Despite wide variations in practice, patients seem to experience broadly similar outcomes, although costs of care can differ substantially among and within specialties. [13, 14] […]

Clinical Decision Rule for Primary Care Patient with Acute Low Back Pain at Risk of Developing Chronic Pain

Chiro.Org Blog: Despite these limitations, we conclude that our study provides a clinical decision rule that is urgently needed for one of the most frequent and most costly conditions in primary care. [50] It contains 8 items for the 6-month and 8 items for the 2-year risk classification (5 are common to both) into 3 levels of risk for developing chronic pain in patients presenting in primary care with a new-onset episode of strictly defined acute low back pain. The next step is to prospectively validate this tool in an independent population. […]

Mechanisms of Low Back Pain:
A Guide for Diagnosis and Therapy

Chiro.Org Blog: CLBP represents the leading cause of disability worldwide and is a major welfare and economic problem. [1] Given this complexity, the diagnostic evaluation of patients with LBP can be very challenging and requires complex clinical decision-making. Answering the question, “what is the pain generator?” among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a diagnosis not based on specific pain generator can lead to therapeutic mistakes. This article aims to provide a brief clinical guide that could help in the identification of pain generators through a careful anatomical description, thereby directing clinicians towards the correct diagnosis and therapeutic approach. […]

An Updated Overview of Clinical Guidelines for the Management of Non-specific Low Back Pain in Primary Care

Chiro.Org Blog: This updated review includes national clinical guidelines from 13 countries and 2 international clinical guidelines from Europe published from 2000 until 2008. The content of the guidelines appeared to be quite similar regarding the diagnostic classification (diagnostic triage) and the use of diagnostic and therapeutic interventions. Consistent features for acute low back pain were the early and gradual activation of patients, the discouragement of prescribed bed rest and the recognition of psychosocial factors as risk factors for chronicity. […]

Estimating the Risk of Chronic Pain: Development and Validation of a Prognostic Model (PICKUP) for Patients with Acute Low Back Pain

Chiro.Org Blog: Low back pain (LBP) is a major global health problem that, compared to all other diseases and health conditions, is responsible for the most years lived with disability, an estimated 80 million years lived with disability in 2010. [1] The costs of care, investigations, and lost productivity associated with LBP are a significant economic burden for industrialized nations. [2] For example, estimates for treatments alone are US$50 billion per annum in the United States [3] and US$4 billion in the United Kingdom. [4] The impact of LBP can be profound; in Australia, LBP is the leading cause of early retirement [5] and of income poverty in older adults. [6] […]

Identification Of Subgroups Of Inflammatory And Degenerative MRI Findings In The Spine And Sacroiliac Joints:

Chiro.Org Blog: The two subgroups with MRI findings at the sacroiliac joints [SIJs] (Subgroups 4 and 5) had a higher activity limitation score and a higher level of hsCRP, compared with the three other subgroups. Previous LBP episodes and being overweight were also more common among patients with MRI findings at the SIJs compared with patients with no or few MRI findings (Subgroup 1). Furthermore, the two SIJ subgroups had a higher prevalence of women compared with the two subgroups with spinal degeneration (Subgroups 2 and 3). The two SIJ subgroups differed according to age and prevalence of HLA-B27-positive status: Subgroup 5 was younger and had a higher prevalence of HLA-B27-positive status compared with patients in Subgroup 4. […]

Cost-Effectiveness of Non-Invasive and
Non-Pharmacological Interventions for Low Back Pain

Chiro.Org Blog: Thirty-three studies were identified. Study interventions were categorised as: (1) combined physical exercise and psychological therapy, (2) physical exercise therapy only, (3) information and education, and (4) manual therapy. Interventions assessed within each category varied in terms of their components and delivery. In general, combined physical and psychological treatments, information and education interventions, and manual therapies appeared to be cost effective when compared with the study-specific comparators. There is inconsistent evidence around the cost effectiveness of physical exercise programmes as a whole, with yoga, but not group exercise, being cost effective. […]

Chiropractic Management of Pregnancy-Related
Lumbopelvic Pain

Chiro.Org Blog: There are discrepancies to defining lumbopelvic pain in the pregnant population. [1, 2] Current terminology, pain topography, functional disabilities, and positive correlation of clinical testing have demarcated the classification of pregnancy-related lumbopelvic pain (PR LPP) into 2 bgroups: […]

Aging Baby Boomers and the Rising Cost of Chronic Back Pain

Chiro.Org Blog: The “Baby Boomer Generation” is a demographic bulge in the US population considered by the US Census Bureau to encompass those individuals born during the demographic birth boom between 1946 and 1964 (Figure 1). [1] A “pig in a python” metaphor aptly describes the effect of this birth cohort on society, [2] as entire social infrastructures have adapted over time, first expanding and then contracting to meet the changing needs of the boomers. For example, municipal school systems were first overbuilt and then later dismantled or repurposed, to accommodate the boomers as they passed through the educational system. With boomers now approaching retirement age, the US health care system must prepare for the coming shockwave of their increasing health care needs, which will likely include a greater and more costly burden of musculoskeletal conditions such as back pain. […]

Long-term Trajectories of Back Pain:
Cohort Study With 7-year Follow-up

Chiro.Org Blog: Four clusters with different back pain trajectories at follow-up were identified: (1) no or occasional pain, (2) persistent mild pain, (3) fluctuating pain and (4) persistent severe pain. Trajectory clusters differed significantly from each other in terms of disability, psychological status and other symptoms. Most participants remained in a similar trajectory as 7 years previously (weighted ? 0.54; 95% CI 0.42 to 0.65). […]

Trajectories of Low Back Pain

Chiro.Org Blog: Low back pain is not a self-limiting problem, but rather a recurrent and sometimes persistent disorder. To understand the course over time, detailed investigation, preferably using repeated measurements over extended periods of time, is needed. New knowledge concerning short-term trajectories indicates that the low back pain ‘episode’ is short lived, at least in the primary care setting, with most patients improving. Nevertheless, in the long term, low back pain often runs a persistent course with around two-thirds of patients estimated to be in pain after 12 months. Some individuals never have low back pain, but most have it on and off or persistently. Thus, the low back pain ‘condition’ is usually a lifelong experience. However, subgroups of patients with different back pain trajectories have been identified and linked to clinical parameters. Further investigation is warranted to understand causality, treatment effect and prognostic factors and to study the possible association of trajectories with pathologies. […]

What Have We Learned From Ten Years of Trajectory Research in Low Back Pain?

Chiro.Org Blog: Non-specific low back pain (LBP) is often categorised as acute, subacute or chronic by focusing on the duration of the current episode. However, more than twenty years ago this concept was challenged by a recognition that LBP is often an episodic condition. This episodic nature also means that the course of LBP is not well described by an overall population mean. Therefore, studies have investigated if specific LBP trajectories could be identified which better reflect individuals’ course patterns. Following a pioneering study into LBP trajectories published by Dunn et al. in 2006, a number of subsequent studies have also identified LBP trajectories and it is timely to provide an overview of their findings and discuss how insights into these trajectories may be helpful for improving our understanding of LBP and its clinical management. […]