A comparative study on safety and efficacy of tolperisone with etodolac and thiocolchicoside with etodolac in patients of acute low back pain with musculoskeletal spasm

Background: Low back pain is one of the most common health problems in society which leads to considerable disability, loss of work days, and puts a huge burden on socioeconomic and healthcare system. It is often associated with musculoskeletal spasm. The aim of the study was to compare the efficacy and safety of tolperisone and thiocolchicoside in combination with etodolac in patients of acute low back pain associated with musculoskeletal spasm.Methods: it was a prospective, randomized, open label study which included patients of either sex between age 18-50 years of acute low back pain with musculoskeletal spasm. Patients were allocated in two groups. Patients in 慓roup A� were given tolperisone 150 mg + etodolac 400 mg twice a day and patients in 慓roup B� were given thiocolchicoside 4 mg + etodolac 400 mg twice a day. Efficacy of two drugs was assessed by decrease in finger to floor distance (FFD), decrease in pain as per visual analog scale (VAS) and global assessment of efficacy of treatment by physician. Follow-up of the patients was done on day 3 and 7 of treatment. Various side effects reported by patients in both the groups were also recorded and compared.Results: Both tolperisone and thiocolchicoside caused significant decrease in FFD, reduced pain score thus indicating decrease in pain and spasm. Side effects reported in both groups were mild and did not result in discontinuation of therapy.Conclusions: Tolperisone was found to have efficacy similar to that of thiocolchicoside though number of side effects reported was more with tolperisone.

Effects of Repetitive Peripheral Magnetic Stimulation on Patients With Acute Low Back Pain: A Pilot Study

OBJECTIVE: To investigate the effects of real repetitive peripheral magnetic stimulation (rPMS) treatment compared to sham rPMS treatment on pain reduction and functional recovery of patients with acute low back pain. METHODS: A total of 26 patients with acute low back pain were randomly allocated to the real rPMS group and the sham rPMS group. Subjects were then administered a total of 10 treatment sessions. Visual analogue scale (VAS) was assessed before and after each session. Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ) were employed to assess functional recovery at baseline and after sessions 5 and 10. RESULTS: Real rPMS treatment showed significant pain reduction immediately after each session. Sustained and significant pain relief was observed after administering only one session in the real rPMS group. Significant functional improvement was observed in the real rPMS group compared to that in the sham rPMS group after sessions 5 and 10 based on ODI and after session 5 based on RMDQ. CONCLUSION: Real rPMS treatment has immediate effect on pain reduction and sustained effect on pain relief for patients with acute low back pain compared to sham rPMS.

Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial

Intracutaneous sterile water injection (ISWI) is used for relief of low back pain during labor, acute attacks of urolithiasis, chronic neck and shoulder pain following whiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief of acute low back pain (aLBP). A total of 68 patients (41 females and 27 males) between 18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an 11-point visual analogue scale [VAS]) were recruited and randomly assigned to receive either ISWIs (n=34) or intracutaneous isotonic saline injections (placebo treatment; n=34). The primary outcome was improvement in pain intensity using the VAS at 10, 45, and 90 min and 1 day after treatment. The secondary outcome was functional improvement, which was assessed using the Patient-Specific Functional Scale (PSFS) 1 day after treatment. The mean VAS score was significantly lower in the ISWI group than in the control group at 10, 45, and 90 min, and 1 day after injection (P<0.05, t-test). The mean increment in PSFS score of the ISWI group was 2.9±2.2 1 day after treatment, while that in the control group was 0.9±2.2. Our study showed that ISWI was effective for relieving pain and improving function in aLBP patients at short-term follow-up. ISWI might be an alternative treatment for aLBP patients, especially in areas where medications are not available, as well as in specific patients (e.g., those who are pregnant or have asthma), who are unable to receive medications or other forms of analgesia because of side effects.

Observation on Clinical Effect of Modified Wu-Fu Ma-Xin Gui-Jiang Decoction for Treatment of Nonspecific Low Back Pain / 世界科学技术-中医药现代化

This study was aimed to observe clinical effect of Wu-Fu Ma-Xin Gui-Jiang (WFMXGJ) decoction treatment for patients with nonspecific low back pain. A total of 60 nonspecific low back pain cases were selected and randomly divided into the treatment group and the control group, with 30 cases in each group. Patients in the treatment group were treated with modified WFMXGJ decoction, while cases in the control group were given rou-tine treatment of oral administration of nimesulide sustained-release tablets. Seven days were one treatment course. Comparison was made on Visual Analogue Scale/Score (VAS), clinical symptoms and body signs before and after treatment between two groups. The results showed that compared with pretreatment, low back pain were relieved with obviously improved VAS among patients in both groups (P<0.05). However, there was no significant difference between the treatment group and the control group. In the treatment group, acute low back pain VAS was obviously improved than the chronic low back pain VAS (P<0.05). There was no statistical significance between the acute and chronic low back pain in the control group. In the treatment group, the total effective rate was 93.33%;and the con-trol group was 73.33%. The clinical effect of treatment group was more significant than the control group (P<0.05). There was no statistical significance on acute and chronic low back pain in the treatment group and the control group. The recurrent rate of the treatment group was significantly lower than the control group (P<0.05). In the treatment group, the recurrence rate of chronic low back pain patients was higher (P<0.05). There was no significant difference on the comparison between acute and chronic low back pain in the control group. It was concluded that modified WFMXGJ decoction had obvious therapeutic effect on treatment of nonspecific low back pain, especially for the improvement of acute low back pain, with non-toxic side effects and low recurrence rate. It is worthy of fur-ther research and promotion.

Diagnosis and Treatment of Acute Low Back Pain.

Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare cases of serious underlying pathology. Certain red flags should prompt aggressive treatment or referral to a spine specialist, whereas others are less concerning. Serious red flags include significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis), major or progressive motor or sensory deficit, new-onset bowel or bladder incontinence or urinary retention, loss of anal sphincter tone, saddle anesthesia, history of cancer metastatic to bone, and suspected spinal infection. Without clinical signs of serious pathology, diagnostic imaging and laboratory testing often are not required. Although there are numerous treatments for nonspecific acute low back pain, most have little evidence of benefit. Patient education and medications such as nonsteroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants are beneficial. Bed rest should be avoided if possible. Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain and need for health care services. Spinal manipulation and chiropractic techniques are no more effective than established medical treatments, and adding them to established treatments does not improve outcomes. No substantial benefit has been shown with oral steroids, acupuncture, massage, traction, lumbar supports, or regular exercise programs.

Consideraciones generales del dolor lumbar agudo / General considerations on the acute low back pain

Introducción: La lumbalgia representa un síntoma muy frecuente en la práctica médica, las causas que la producen, los mecanismos fisiopatológicos y el modo de enfrentarla. Objetivo. Actualizar al lector sobre las consideraciones generales del dolor lumbar agudo. Desarrollo: Además de las estructuras intrínsecas y extrínsecas que provocan dolor en la región lumbar, existen otros elementos relacionados con la fisiopatología como son los factores: anatómico, compresivo, vascular, inmunitario, inflamatorio y neural, que serán bien descritos en este artículo a modo de conocer cómo funciona cada uno en la aparición del dolor lumbar agudo y crónico, para posteriormente asumir nuestra responsabilidad como médicos en el tratamiento de este mal que aqueja a nuestra población. Conclusiones: el síndrome doloroso lumbar es de presentación frecuente en la consulta médica. El diagnóstico incluye la búsqueda de los signos de alarma que traducen enfermedades sistémicas, cáncer, infecciones, fracturas, entre otras. Sin embargo en la mayoría de los pacientes la lumbalgia es de tipo vertebral mecánica, con un curso benigno y puede ser resuelta favorablemente con un tratamiento adecuado en la atención primaria de salud.

Introduction: The low back pain is a very frequent symptom in the medical practice, its causes, the pathophysiological mechanisms and the way to face it. Objective: To update reader on the general considerations of acute low back pain. Development: Besides the intrinsic and extrinsic structures provoking low back pain, there are other elements related to the pathophysiology including the following factors: anatomical, compressive, vascular, immune, inflammatory an neural which will be well described in present paper to know how functioning each in the appearance of chronic and acute low back pain for later to assume our responsibility as physicians in treatment of this illness involving our population. Conclusions: The lumbar painful syndrome is frequent in medical consultation. The diagnosis includes the search of alarming signs as manifestation of systemic diseases, cancer, infections, and fractures, among others. However, in most of patients the low back pain is of mechanic vertebral origin with a benign course and may be favorably solved with an appropriate treatment in the primary health care.

Eficácia e tolerabilidade de celecoxibe versus diclofenaco: resultados de um estudo multicêntrico, randomizado, duplo-cego, de não inferioridade, em indivíduos com lombalgia aguda / Efficacy and tolerability of celecoxib versus diclofenac: results of a multicenter, randomized, double-blind, noninferiority study in subjects with acute low back pain

Objetivo: Comparar a eficácia de celecoxibe 200 mg duas vezes ao dia com diclofenaco 75 mg duas vezes ao dia no tratamento de lombalgia aguda (ALBP).Desenho da pesquisa e métodos: Estudo de não inferioridade multicêntrico, randomizado, duplo-cego. Pacientes com lombalgia aguda, Quebec Task Force classe 1 ou 2, com um escore na escala analógica visual (VAS) maior que 50 mm (escala de 100 mm), e dor moderada a grave em uma escala categórica foram randomizados para receber celecoxibe 400 mg mais 200 mg no dia 1, seguido por 200 mg duas vezes ao dia daí em diante (N =123) ou diclofenaco 75 mg duas vezes ao dia (N =121) durante 7 dias. Principais medidas de resultado: O resultado (end point) primário foi a alteração na intensidade da dor (PI) (VAS, mm) do período basal ao dia 3 para a população por protocolo. Os end points secundários incluíram dor e resultados de funcionalidade, além de avaliações de segurança e tolerabilidade. Resultados: As reduções médias pelo método dos mínimos quadrados em intensidade da dor (PI) do período basal ao dia 3 foram semelhantes para celecoxibe (-40,00) e diclofenaco (-42,55). Celecoxibe foi comparável ao diclofenaco, já que o limite inferior do intervalo de confiança de 95% (IC) da diferença estimada (diclofenaco - celecoxibe [-2,56 mm IC 95%: -7,67 a 2,56 mm]) ficou dentro da margem de não inferioridade pré-especificada de - 10 mm. No geral, as taxas de evento adverso foram ligeiramente mais altas no grupo diclofenaco (21,5%) do que no grupo celecoxibe (16,3%). Nove eventos adversos gastrointestinais superiores de intensidade moderada a grave foram relatados em pacientes que utilizaram celecoxibe (7,3%) e 15 em pacientes que utilizaram diclofenaco (12,4%). Conclusão: Celecoxibe 400 mg mais 200 mg no dia 1, seguido por 200 mg duas vezes ao dia daí em diante, proporciona alívio eficaz para dor lombar aguda e foi pelo menos tão eficaz quanto diclofenaco 75 mg duas vezes ao dia, com incidência mais baixa de eventos adversos...

The Role of Electric Field Therapeutic Device (HEALTHTRON) in The Therapy of Acute Low Back Pain / 日本温泉気候物理医学会雑誌

Thirty-one outpatients with acute low back pain were all educated about activities of daily living. They also received spinal manipulation and SSP (TENS), and took NSAID for a certain period of time. Half of them were additionally exposed an electric field using HEAL THTRON, an electric field therapeutic decice, in order to analyze its efficacy.<br>The patients were randomly divided (non-blind test) into two groups. Those who received ordinary treatment were called the Non-HEALTHTRON group (NH-group); those who received HEALTHTRON treatment in addition to ordinary treatment were called the HEALTHTRON Treatment group (H-group). During the 15-day study period, the patients were subjected to a total of four electric field exposures using HEALTHTRON. Efficacy of the treatment was measured as an objective evaluation by measuring range of motion (ROM) using an inclinometer, and Peak torque and Total work using a dynamometer. A subjective evaluation was performed using the Oswestry Low Back Pain Disability Questionnaire, ADL pain questionnaire, Visual analog scale for Patient global assessment, VAS (Patient) and Visual analog scale for Physician global assessment, VAS (Physician). After ordinary treatment, significant improvement was found in all 31 patients with acute low back pain. The VAS (Physician), ADL pain questionnaire and ROM were more significantly improved in the H-group than in the NH-group.

The Effect of Spinal Manipulation for Patients with Acute Low Back Pain

OBJECTIVE: To assess the efficacy of spinal manipulation for the patients with acute low back pain. METHOD: Twenty patients with acute low back pain have been received spinal manipulation 3 times per week. The 10-point scale and the distance of the fingertips from the floor on maximum forward flexion (fingertip-flexion test) were checked pretreatment, immediately posttreatment, 2 days posttreatment, 1 week posttreatment, and 2 weeks posttreatment. RESULTS: The results were as follows: 1) The 10-point scale at pretreatment, immediately posttreatment, 2 days posttreatment, 1 week posttreatment, and 2 weeks post-treatment were 10.0+/-0.0, 5.8+/-1.4, 2.2+/-1.0, 1.1+/-0.2, and 1.0+/-0.0, respectively (P<0.01). 2) The fingertip-flexion test at pretreatment, immediately posttreatment, 2 days posttreatment, 1 week posttreatment, 2 weeks posttreatment were 35.4+/-8.4 cm, 22.4+/-7.0 cm, 14.1+/-4.9 cm, 7.4+/-3.6 cm, and 5.4+/-4.6 cm, respectively (P<0.01). CONCLUSION: In our study, the spinal manipulation for the patients with acute low back pain offered significant efficacy and appeared to be a reasonable therapeutic option. But the effectiveness of this method leaves a critical aspect that should be dealt with in future studies.