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This study systematically searched and sorted out randomized controlled trial(RCT) of acupuncture-moxibustion treatment for non-specific low back pain by scoping review, so as to demonstrate the current state of the research evidence and provide a reference point for future clinical research and healthcare decision-making. Eight commonly used Chinese and English databases were searched, and the search time was from the establishment of the databases to July 7, 2023, so as to analyze the characteristics of the current status of the current research through visualization methods. A total of 50 studies were included, including 23 studies in Chinese and 27 studies in English. The overall number of studies showed an increasing trend. The percentage of studies published in Chinese non-core journals was 42.0%. The disease subtypes of interest were mainly chronic non-specific low back pain, accounting for 68.0% of the studies. The sample sizes of the studies were mainly concentrated in the range of 50-100 cases. A total of 15 types of interventions were categorized, with acupuncture interventions being the most studied. Duration of treatment did not exceed one month in 80.0% of the studies. Only 8.0% of the studies used minimal clinical important difference(MCID) as a basis for judgment. The follow-up period was set within 3 months in 28.0% of the studies, and 82.0% of the studies concluded that acupuncture-moxibustion was effective in the treatment of non-specific lower back pain. Adverse events were reported in 20.0% of the studies. The risk of bias in the included studies was dominated by low risk of bias and uncertain risk of bias, with fewer studies focusing on high risks of bias. In most of the studies, acupuncture-moxibustion was significantly more effective than the control group. The research on acupuncture-moxibustion treatment for non-specific low back pain is developing rapidly, but there are still insufficient studies on psychological state, safety, and other indicators, and there are still some studies with uncertain risks of bias, which is not conducive to the generalization and application of the findings. Therefore, future studies should improve and refine these shortcomings.
Subject(s)
Humans , Acupuncture Therapy/methods , Low Back Pain/etiology , Moxibustion/methods , Randomized Controlled Trials as TopicABSTRACT
Objective:To explore the potential mechanisms of anterior cingulate cortex (ACC) in modulating pain behavior and anxiety-like behavior of rats with chronic non-specific low back pain induced by nerve growth factor (NGF).Methods:Ninety-six male SPF grade SD rats aged 8 weeks were randomly divided into four groups according the random number table method: control group, model group, control+ D-2-amino-5-phosphonopentanoate (D-AP5) group (control+ D-AP5 group) and model+ D-AP5 group, with 24 rats in each group.Low back pain model of rat was established by injection of NGF into multifidus muscle (left side) of the low backs of rats(two times with a five-day interval). Five days after modeling, rats in model+ D-AP5 group and control+ D-AP5 group were injected with the N-methyl-D-aspartate (NMDA) receptor antagonist D-AP5(2 μg, 0.3 μL) at the right side of the ACC once a day for consecutive 3 days, and rats in control group and model group were injected with the same amount of 0.9% sodium chloride solution. Seven days after modeling, the pain threshold of rats was evaluated by mechanical stimulation test and hot and cold plate test.The anxiety-like behavior was tested by open field test.The density of glial fibrillary acidic protein (GFAP) positive cells and c-Fos(a kind of immediate early gene) positive cells of the spinal cord were observed by immunofluorescence. The expression of GFAP, c-Fos, phosphorylated-c-Jun N-terminal kinases (p-JNK), monocyte chemoattractant protein-1 (MCP-1), and chemokine (C-X-C motif) ligand 1 (CXCL-1) proteins in the L2 segment of the spinal cord were detected by Western blot. SPSS 23.0 software was used for statistical analysis. One-way ANOVA was used to analyze normal distribution measurement data for comparison among multiple groups, and Tukey test was used for further pairwise comparisons. The Kruakal-Wallis H test was used for non-normal distribution measurement data, and Mann-Whitney U test was used for further pairwise comparisons with Bonferroni-corrected P-values. Results:In the experiments measuring pressure pain threshold (PPT) and paw withdrawal threshold (PWT), there were statistically significant differences in the PPT and PWT of rats among the four groups ( F=53.498, 41.939, both P<0.001). Seven days after modeling, PPT ((418.5±46.9) g) and PWT ( (55.6±7.1) g) in the ipsilateral side of the rats in model+ D-AP5 group were higher than those in model group ((290.0±32.0) g, (30.5±7.5) g) (both P<0.001). In the open field test, there were statistically significant differences in percentage of the inner zone distance ( H=11.922, P<0.01) and the percentage of inner zone time ( H=21.614, P<0.001) of rats among the four groups. The percentage of inner zone time in model+ D-AP5 group was higher than that in model group (5.6(4.3, 7.9) %, 3.1(2.1, 3.8) %) ( P<0.01). The results of immunofluorescence showed that there were statistically significant differences in the density of GFAP positive cells and c-Fos positive cells at the ipsilateral side of the superficial laminae of rats among the four groups ( H=49.085, F=18.120, both P<0.001). The density of GFAP positive cells (34.3(21.1, 47.5) cells/mm 2) and c-Fos positive cells ((52.7±39.4) cells/mm 2) at the ipsilateral side of the superficial laminae in model+ D-AP5 group were less than those in model group (76.5(68.6, 94.9) cells/mm 2, (112.4±63.7) cells/mm 2) (both P<0.001). The Western blot results showed that there were statistically significant differences in the protein expression of GFAP, c-Fos, p-JNK, MCP-1 and CXCL-1 in the L2 segment of rats among the four groups ( F=49.413, 38.437, 41.867, 36.735, 130.951, all P<0.001). The protein expression of GFAP (1.7±0.5), c-Fos (1.1±0.1), p-JNK (1.7±0.3), MCP-1 (1.0±0.4) and CXCL-1 (0.8±0.1) in the L2 segment in model+ D-AP5 group were lower than those in model group ((4.3±0.7), (2.6±0.5), (2.8±0.4), (2.9±0.4), (3.5±0.4)) (all P<0.01). Conclusion:ACC modulates mechanical hyperalgesia and anxiety-like behavior in chronic non-specific low back pain rats, which might be associated with the involvement of spinal astrocytes, p-JNK signal pathway and chemokines such as MCP-1 and CXCL-1.
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Based on the physiological and pathological characteristics of meridian sinew theory, the staging treatment of non-specific low back pain (NLBP) is explored to provide the reference of clinical practice. The twelve meridian sinews of the human body communicate with the bones and joints of the whole body, which governs the movement, body protection and defense, and meridian regulation. Physiologically, the meridian sinew maintains the functions of the lumbar region. In pathology, the meridian sinew may encounter stasis and pain, contraction and spasm or "transverse collateral" formation. According to the pathological staging of meridian sinew disorders, the progress of NLBP is divided into 3 phases and the corresponding treatments are provided. Mild stimulation and rapid analgesia is suggested to promote tissue repair at the early phase; muscle spasm is relieved to adjust muscular status at the middle phase; and the "cord-like" muscle foci is removed at the later phase of the disease.
Subject(s)
Humans , Low Back Pain , Meridians , Pain Management , Analgesia , Lumbosacral RegionABSTRACT
ObjectiveTo explore the immediate and short-term effects of pressure biofeedback therapy combined with Flexi-bar exercise in the sitting position on chronic non-specific low back pain (CNSLBP). MethodsFrom June to September, 2022, 27 CNSLBP students in Xuzhou Medical University and other universities around were randomly divided into pressure biofeedback unit (PBU) group (n = 9), Flexi-bar group (n = 9) and combined group (n = 9). On the basis of routine rehabilitation guidance, the PBU group accepted pressure biofeedback therapy, the Flexi-bar group accepted active vibration therapy, and the combined group accepted pressure biofeedback therapy and active vibration therapy, for three weeks. They were measured core stability with Stabilizer, lumbar joint repositioning error (LJRE) with iHandy, and bilateral transverse abdominis thickness and multifidus muscle cross-sectional area with ultrasonography; and assessed with Visual Analogue Scale for pain (VAS), Oswestry Disability Index (ODI) before and after treatment; and the core stability were measured immediately after the first treatment. ResultsThe indexes of core stability improved after the first treatment (|t| > 3.000, P < 0.05) in all groups, and improved the most in the combined group (F > 10.909, P < 0.001). All the indexes improved after three weeks of treatment (|t| > 2.604, P < 0.05), except for LJRE in PBU group; and they were the best in the combined group (|F| > 4.061, P < 0.05), except LJRE was not significantly different from the Flexi-bar group (P > 0.05). ConclusionPressure biofeedback therapy combined with Flexi-bar exercise in the sitting position can more effectively improve core stability and core muscles, proprioception, and pain for patients with CNSLBP.
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We developed a portable non-specific low back pain measurement system EasiLBP and evaluated its performance in collecting EMG signals:during the wearer's movement without the assistance of a doctor, the collection of EMG signals by portable devices met problems such as large noise interference, difficulty in accurately calibrating the start and end points of the action interval, and imbalanced samples for feature recognition, et al. To challenge these problems, we proposed a small group-based noise removal method, a dynamic dual-threshold automatic method for identifying the start and end points of the motion interval, and a sampling method to balance group samples, respectively. Portable device and a medical EMG acquisition equipment Thought Technology FlexComp Infiniti 10 were used to perform EMG measurements on 15 patients with non-specific low back pain and 15 normal people. Clinical experiments and statistical analysis show that the portable EMG acquisition system has significant differences in EMG signal characteristics between normal people and non-specific low back pain patients, and it has good measurement consistency and accuracy with the medical EMG acquisition equipment.
Subject(s)
Humans , Electromyography , Low Back Pain , Motion , Movement , Pain MeasurementABSTRACT
Background: An array of risk factors contributes to non-specific low back pain. Apart from age, female gender, low educational status, obesity, occupation, and psychological factors, postural variations (including variations in the lower extremity) play a significant role in predisposing an individual to low back pain. Hence, while evaluating/examining a patient with back pain, the alignment of the lower extremity should be taken into consideration rather than restricting the evaluation to the lumbosacral region. Methods: 36 subjects (12 Males, 24 Females) with non-specific low back pain were assessed for pain and disability using the Oswestry Disability Index (ODI). The measurements for lower extremity alignment factors (Pelvic angle, Angle of torsion of the femur, Quadriceps angle, Tibial torsion, and Navicular drop) were recorded bilaterally Results: There was a positive correlation of non-specific low back pain and disability index with the right pelvic angle (p=0.0012, r=0.51, and p=0.0003, r=0.56 respectively). Non-specific low back pain and disability index had no correlation with left pelvic angle (p=0.9101, r=0.01 and p=0.9794, r=0.00 respectively). Non-specific low back pain and disability index had a positive correlation with angle of torsion (AOT) of femur (Rt: p=0.0027, r=0.48, Lt: p=0.0084, r=0.43 and Rt: p=0.0039, r=0.46, Lt: p=0.0023, r=0.49 respectively), quadriceps angle (Q-angle) (Rt: p=0.0020, r=0.49, Lt: p=0.0014, r=0.51 and Rt: p=0.0019, r=0.49, Lt: p=0.0024, r=0.49 respectively) and navicular drop (Rt: p=<0.0001, r=0.61, Lt: p=0.0053, r=0.45 and Rt: p=0.0002, r=0.58, Lt: p=0.0048, r=0.46 respectively) bilaterally. Non-specific low back pain had no correlation with right tibial torsion (p=0.9269, r=0.01). Disability index had a positive correlation (not significant) with right tibial torsion (p=0.2427, r=0.19). There was a positive correlation (not significant) of non-specific low back pain and disability with left tibial torsion (p=0.1757, r=0.23 and p=0.0703, r=0.30 respectively). Conclusion: There was an association of non-specific low back pain and disability index with lower extremity alignment factors.
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Introduction: Low back pain is the one of the common musculoskeletal disorder faced by people in today’s genera-tion. It is more common in health-care workers especially nursing students and staff. Pilates is a new and innovative technique that focuses on the back and core of the body. Hence, this study is carried out to determine the effective-ness of Pilates techniques to treat and prevent the chances of low back pain. Materials and methods:Subjects were received the Pilates protocol for exercises. They were asked to fill the Oswestry Low Back Pain Disability Question-naire before and after giving the Pilates protocol. The pain was assessed by Numerical Pain Rating Scale (NPRS), both at rest and on movement before and after giving the Pilates. Results: The P value in Numerical Pain Rating Scale (NPRS) and Oswestry Low Back Pain Disability Questionnaire before and After the Pilates and was 0.000 which shows that there is significant difference between the two groups. Conclusion: The study concluded that Pilates exercises were efficient in treating non-specific low back pain.
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OBJECTIVE@#To compare the differences in the clinical therapeutic effects on chronic non-specific low back pain (CNLBP) between the combined treatment of the superficial needling technique and mild moxibustion and the traditional warm acupuncture.@*METHODS@#A total of 60 patients were randomized into a combined treatment group and a warm acupuncture group, 30 cases in each one. In the combined treatment group, the superficial needling technique was used in combination with the mild moxibustion with moxa box at the muscle region of the bladder meridian on the back. In the warm acupuncture group, the traditional warm acupuncture was adopted on the lumbar region and the upper back. Each treatment lasted 30 min, 3 times a week. The treatment was provided continuously for 3 weeks. The follow-up visit lasted 3 months. Separately, before, 3 times after treatment and at the end of treatment, as well as after the follow-up visit, the visual analogue scale (VAS), the range of motion of the lumbar region (ROM) and the Oswestry disability index (ODI) were observed in the patients of the two groups.@*RESULTS@#During and at the end of treatment, as well as at the follow-up visit, VAS score, ROM and ODI were all improved as compared with those before treatment in the two groups (all <0.05). The results in the combined treatment group were better than those in the warm acupuncture (all <0.05). At the end of treatment and the follow-up stage, VAS score, ROM and ODI were better than those during treatment in the two groups (all <0.05). At the follow-up stage, VAS score, ROM of the backward extension and rotation of spine, as well as ODI were better than those at the end of treatment in the two groups (all <0.05).@*CONCLUSION@#The combined treatment of the superficial needling technique and mild moxibustion relieves pain, improves the ROM of the lumbar region and reduces the functional disability in CNLBP. This combined therapy achieves the better effects as compared with the traditional warm acupuncture and is high in the patient's compliance.
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Chronic Pain , Therapeutics , Low Back Pain , Therapeutics , Moxibustion , Treatment OutcomeABSTRACT
@#Objective To investigate the position sense in chronic non-specific low back pain (CNLBP) patients, and the correlation to pain and endurance of psoas muscles. Methods From January, 2014 to May, 2015, 30 patients with CNLBP and other 30 healthy subjects were measured spine flexion and extension position sense absolute error (AE) and psoas endurance with Biodex System 3 synchronously, and the patients were self-assessed the pain in lumbar with Numerical Rating Scale (NRS). The Pearson correlation coefficient of AE to pso-as endurance and NRS was calculated. Results AE of flexion and extension was both more in the patients than in the healthy (t>1.862, P<0.05), and the psoas muscle endurance was less (t=2.307, P<0.05). AE of flexion (r=-0.71) and extension (r=-0.47) negatively correlated with the psoas muscle endurance in the patients, and positively correlated with NRS score (r=0.78 for flexion, and r=0.49 for extension). AE mildly negative correlated with the psoas muscle endurance (r=-0.38 for flexion, and r=-0.29 for extension). Conclusion Spine sensation has been impaired in CNLBP patients, and may associate with pain and psoas muscles endurance loss.
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Objective To systematically review the clinical efficacy of sling exercise therapy(SET)on patients with chronic non-specif-ic low back pain (CNLBP). Methods Randomized controlled trials (RCT) about SET for CNLBP were electronically searched in CNKI, VIP,Wanfang Data,PubMed,Web of Science,The Cochrane Library and Embase from June,2007 to June,2017.After literatures screening, data extraction,quality evaluation and risk assessment,the results of meta-analysis were conducted by RevMan 5.3 software.Results Final-ly, 15 RCTs involving 789 patients were included. SET was better in improving Visual Analogue Scale (VAS) score (MD=-1.15, 95% CI[-1.41,-0.90],Z=8.82,P<0.00001)and Oswestry Low Back Pain Disability Index(ODI)score(MD=-1.29,95%CI[-1.80,-0.78],Z=4.94, P<0.00001) than physical therapy, and was better than other exercise therapies in improving the VAS score (MD=-0.94, 95% CI[-1.52,-0.37],Z=3.21,P=0.001)and ODI score(MD=-5.96,95%CI[-9.41,-2.51],Z=3.38,P=0.0007).However,no significant dif-ference was found in improving the NPRS score between SET and other exercise therapies(MD=0.35,95%CI[-0.23,0.93],Z=1.19,P=0.23),nor in improving VAS score between SET and traditional Chinese medical therapies(MD=-5.29,95%CI[-20.27,9.70],Z=0.69,P=0.49).Conclusion SET may play a role in relieving pain and functional limitations in patients with CNLBP.Due to the limited quantity and quality of the included studies,larger scale and high quality RCTs are needed to verify the aforementioned conclusion.
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Objective To observe the clinical effect of repetitive peripheral magnetic stimulation (RPMS) on chronic non-specific low back pain (CNLBP) patients. Methods 43 CNLBP patients were assigned to experimental group (n=22) and control group (n=21). Both groups received routine physical therapy. The experimental group accepted RPMS and core stability training (CST), and the control group accepted sham magnetic stimulation and CST in addition. Clinical effect was evaluated by Visual Analogue Scale (VAS) and Oswestry Dys-function Index (ODI). All the patients were assessed with Modified Clinical Test of Sensory Integration of Balance (mCTSIB) to observe the center of gravity (COG) sway velocity under 4 testing conditions. Results 4 weeks after treatment, the VAS and ODI scores were significant-ly decreased in both groups (P0.05). The scores of VAS and ODI were sig-nificantly lower in the experiment group than in the control group after treatment (P<0.001). The COG sway velocity under eye open foam support and eye close foam support were lower in the experiment group than in the control group after treatment (P<0.05). Conclusion Com-bination of RPMS could improve the clinical symptoms and the posture control ability under complex environment.
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Objective To investigate the features of surface electromyography of lumbar muscles in non-specific low back pain (NLBP) patients when they were practicing different types of bridging exercise. Methods 18 healthy subjects (control group) and 18 NLBP patients (NLBP group) were included and asked to practice bridging exercise with single and double feet. The root mean square (RMS) of surface electromyography of both sides of lumbar muscles were recorded. Results No significant difference was found in the control group. The RMS of erector spinae was more in the supported side than in the contra side for NLBP patients in bridging exercise with single foot. There was no significant difference among different time points in the same muscle. Conclusion The contractions of erector spinae in both sides are not equal in asymmetric bridging exercise in NLBP patients.
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@#Objective To investigate the features of surface electromyography of lumbar muscles in non-specific low back pain (NLBP) patients when they were practicing different types of bridging exercise. Methods 18 healthy subjects (control group) and 18 NLBP patients (NLBP group) were included and asked to practice bridging exercise with single and double feet. The root mean square (RMS) of surface electromyography of both sides of lumbar muscles were recorded. Results No significant difference was found in the control group. The RMS of erector spinae was more in the supported side than in the contra side for NLBP patients in bridging exercise with single foot. There was no significant difference among different time points in the same muscle. Conclusion The contractions of erector spinae in both sides are not equal in asymmetric bridging exercise in NLBP patients.
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The effects of acupuncture and moxibustion on lower back pain in clinical trials were reviewed. First, the effects of Western medicine on lower back pain, patients with specific and nonspecific lower back pain, were systematically reviewed based on online data, and possible mechanisms were discussed. Secondly, the role and potential of acupuncture and moxibustion on lower back pain were considered based on a review of research literature. Finally, the effectiveness of acupuncture and moxibustion on several kinds of lower back pain was systematically examined based on online data. These results suggest that acupuncture and moxibustion may be more effective on non-specific lower back pain.
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The goal of this panel discussion<BR>The understanding of lumbago has been changing in recent years.<BR>It has moved from "Trouble of the spine"to recognizing the importance of catching the concept of "Living thing, psychology, and social pain syndrome".<BR>It is a way of thinking that is going to grasp the clinical condition of lumbago along with the invisible dysfunction and provide better viewpoint in order to understand the aberration which we call a disorder of conventional intervertebral disc clinical condition of lumbago.<BR>This view point supports the appropriate technical use of acupuncture and moxibustion.<BR>It is important for the medical man not to begin treatment until the complete condition is understood.<BR>In keeping with this viewpoint, the panel of four will be joined by an orthopedist and a physical therapist, and this panel discussion 1 planned "primary care for lumbago".<BR>Each panelist described how to catch condition of a patient, a way of the correspondence, the advantages and disadvantages of acupuncture and moxibustion, therapeutic method and evaluation method in this method of treating lumbago.
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@#Objective To observe the therapeutic effect of balance cupping therapy on non-specific low back pain.Methods 75 patients with non-specific low back pain were randomly divided into the control group (n=25), cupping therapy group (n=25) and balance cupping therapy group (n=25). The patients in the control group were received diclofenac sodium enteric-coated capsule; the cases in other two groups were treated with cupping therapy and balance cupping therapy separately. After 3 weeks' treatment, the changes of the visual analogous scores and Oswestry disability index of two groups' patients were observed.Results The visual analogous scores and Oswestry disability index of the balance cupping therapy group were significantly lower than that of the control group and cupping therapy group ( P<0.05) after 3 weeks' treatment. But between the control group and cupping therapy group there was no difference.Conclusion Balance cupping therapy is one of effective treatment methods for non-specific low back pain.