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Back Pain: Pathophysiology, Diagnosis, and Treatment
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Back Pain: Pathophysiology, Diagnosis, and Treatment

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Pain Management".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 16683

Special Issue Editor

Prof. Dr. Vicente Vanaclocha Vanaclocha

E-Mail Website
Guest Editor
Department of Neurosurgery, Universitat de València, 46010 Valencia, Spain
Interests: low back pain; sacroiliac joint disfunction

Special Issue Information

Dear Colleagues,

Low back pain is a complex symptom with many underlying causes, which is particularly important not only to individual persons but to society as a whole. From an individual perspective, few have never suffered from this disease. As a society, it is the most common cause of sick leave and permanent disability, causing an immense loss in working hours. The amount of resources devoted to the treatment of this conglomerate of pathologies is huge, but the money is not always well spent. Certainly, in too many cases, the initial diagnosis is based mostly on radiological findings, leading to unnecessary surgical procedures and then to bad clinical results with negative consequences for the patient, their family, their job/career, and society as a whole. In fact, for many doctors, it seems that disc protrusion and spinal stenosis are the only causes of low back pain, and the consequence is that spinal arthrodesis is, perhaps, a too-often implemented treatment. Other pathologies such as sacroiliac joint problems, pertrochanteric bursitis, pyramidal muscle syndrome, or (more commonly) zygapophyseal joint arthritis seem to be neglected. This Special Issue is an alert to all in the medical profession to carry out a thorough medical history and clinical examination before ordering radiological studies, which may lead us to a false diagnosis, missing the real cause of the patient’s low back pain.

Prof. Dr. Vicente Vanaclocha Vanaclocha
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • low back pain
  • sacroiliac joint disfunction
  • failed back syndrome
  • spinal arthrodesis
  • zygapophyseal joint arthritis

Published Papers (7 papers)

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Editorial

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3 pages, 192 KiB  
Editorial
Back Pain: Pathophysiology, Diagnosis, and Treatment
by Vicente Vanaclocha
Healthcare 2023, 11(7), 953; https://doi.org/10.3390/healthcare11070953 - 26 Mar 2023
Viewed by 991
Abstract
Although back pain is one of the most common medical conditions [...] Full article
(This article belongs to the Special Issue Back Pain: Pathophysiology, Diagnosis, and Treatment)

Research

Jump to: Editorial

13 pages, 292 KiB  
Article
An Assessment of the Longitudinal Construct Validity of the Pain Behavioral Scale (PaBS) in a Saudi Population with Chronic Low Back Pain: A Preliminary Study
by Dalia Alimam, Ahmed Alhowimel, Faris Alodaibi, Mazyad Alotaibi, Hosam Alzahrani, Nouf Almutairi, Ali Alqahtani, Lolwah Alrashed Alhumaid, Andrew Leaver and Martin Mackey
Healthcare 2023, 11(12), 1743; https://doi.org/10.3390/healthcare11121743 - 14 Jun 2023
Viewed by 927
Abstract
Background: The Pain Behavioral Scale (PaBS) measures the presence and severity of pain behavior. We examine the longitudinal construct validity of the PaBS using convergent and known-groups approaches on a population of 23 participants with chronic lower back pain (LBP) undergoing routine physiotherapy [...] Read more.
Background: The Pain Behavioral Scale (PaBS) measures the presence and severity of pain behavior. We examine the longitudinal construct validity of the PaBS using convergent and known-groups approaches on a population of 23 participants with chronic lower back pain (LBP) undergoing routine physiotherapy care and pain neuroscience education. Methods: Participants who satisfied study inclusion and exclusion criteria were recruited from patients who attended two testing sessions at physiotherapy clinics in Saudi Arabia. Participant pain behavior was initially measured using the PaBS scale; participants performed standardized physical tests (e.g., repeated trunk flexion) and provided baseline demographic, clinical data, and self-reported measurements using the Modified Roland and Morris disability questionnaire (MODI), fear-avoidance questionnaire (FABQ), and pain catastrophizing scale (PCS). In subsequent visits, a physiotherapist provided usual care to participants, and weekly sessions were established for online pain-neuroscience education. During week six, participants repeated the same questionnaires and physical performance tests with the PaBS. Paired t-tests are used to compare changes in health characteristics from baseline responses to those in week six. Correlations between changes in PaBS from baseline to week six, with changes in outcome measures (i.e., disability, pain intensity, fear-avoidance beliefs, catastrophizing), were determined. To assess known-group validity, we also used a general linear model. Results: A total of 23 participants completed the PNE and follow-up data collection. The mean change from baseline in the PaBS score was statistically significant, as were changes in MODI, FABQ, and PCS. Almost 70% of participants improved their PaBS scores over the six-week period, with PaBS scores of almost 40% of them improving by three units or more. The change in PaBS score correlated significantly with changes in the PCS-rumination subscale, supporting a proposed approach to estimate convergent validity (r = 0.44, 95% CI = 0.04–0.72, p = 0.035). Conclusions: The mean change from baseline in the PaBS score is statistically significant, as are changes in MODI, FABQ, and PCS, supporting its convergent validity. According to our STarT Back groups, the medium to low-risk group had a lower PaBS score, and high-risk group had a higher PaBS score, indicating that PaBS use in clinical assessment may identify people according to pain-behavior severity, or those at increased risk of developing disability. Full article
(This article belongs to the Special Issue Back Pain: Pathophysiology, Diagnosis, and Treatment)
13 pages, 808 KiB  
Article
Substantiating the Therapeutic Effects of Simultaneous Heat Massage Combined with Conventional Physical Therapy for Treatment of Lower Back Pain: A Randomized Controlled Feasibility Trial
by Tae-Hwan Kim, Soon-Kwon Park, Il-Young Cho, Jong-Hoo Lee, Hong-Young Jang and Yong-Soon Yoon
Healthcare 2023, 11(7), 991; https://doi.org/10.3390/healthcare11070991 - 30 Mar 2023
Cited by 3 | Viewed by 2047
Abstract
Background: There are various therapeutic options for the conservative management of lower back pain (LBP). A combination of two or more treatment options may be more effective in the clinical management of non-specific LBP. In this study, we compared the effects of simultaneous [...] Read more.
Background: There are various therapeutic options for the conservative management of lower back pain (LBP). A combination of two or more treatment options may be more effective in the clinical management of non-specific LBP. In this study, we compared the effects of simultaneous heat massage with conventional physical therapy in patients with subacute LBP. Methods: A single-center randomized controlled trial in which 40 participants with LBP were allocated to one of two groups: a heat massage group (HMG) and physical therapy group (PTG). The HMG received simultaneous heat massage therapy using a mechanical device (CGM MB-1401, Ceragem, Republic of Korea). The PTG received conventional physical therapy. Both groups received 40 min of therapy once daily, five times a week, for a total of four weeks. Changes in serum cortisol, epinephrine (EP), and norepinephrine (NE) were assessed. The outcomes were measured using the pain numeric rating scale (PNRS), the Oswestry disability index (ODI), the Roland–Morris disability questionnaire (RMDQ), the short-form McGill pain questionnaire (SF-MPQ), the multidimensional fatigue inventory (MFI-20), the Beck depression inventory (BDI), surface EMG (sEMG), and sympathetic skin response (SSR) at baseline (PRE), at 2 (2 W) and 4 weeks (4 W) following the intervention. Results: The serum EP and NE levels in the HMG decreased after treatment. The PNRS, ODI, RMDQ, and SF-MPQ scores improved without significance in both groups. The BDI score showed improvement in the HMG before the PTG. The MFI-20 score improved in both groups, but the results were better in the HMG than in the PTG at 4 W. All the activities of sEMG were significantly decreased in both groups. However, the improvement of the %MVIC in the HMG was better than that in the PTG at 4 W. The SSR latency on sEMG decreased while the amplitude increased in the HMG at 2 W and 4 W, respectively. Conclusions: Following 4 weeks of combined therapies, heat massage was not superior to conventional physical therapy alone. Both treatments were shown to be effective in improving LBP and pain-related disability. However, heat massage was shown to have a better effect on the control of autonomic nerve function and underlying moods. Full article
(This article belongs to the Special Issue Back Pain: Pathophysiology, Diagnosis, and Treatment)
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10 pages, 447 KiB  
Article
The Impact of Low Back Pain on the Quality of Life of Children between 6 and 12 Years of Age
by Elisiane de Souza Santos, João Marcos Bernardes, Luana Schneider Vianna, Carlos Ruiz-Frutos, Juan Gómez-Salgado, Melissa Spröesser Alonso, Matias Noll and Adriano Dias
Healthcare 2023, 11(7), 948; https://doi.org/10.3390/healthcare11070948 - 24 Mar 2023
Cited by 1 | Viewed by 1368
Abstract
This study aimed to evaluate the impact of low back pain on the perceived health-related quality of life of children between 6 and 12 years of age. This is a cross-sectional study of three hundred seventy-seven students from three schools (two private and [...] Read more.
This study aimed to evaluate the impact of low back pain on the perceived health-related quality of life of children between 6 and 12 years of age. This is a cross-sectional study of three hundred seventy-seven students from three schools (two private and one public) located in the city of Botucatu, São Paulo. Data were collected using the Pediatric Quality of Life Inventory (PedsQL, version 4.0), a questionnaire comprising questions on personal background, sociodemographic and socioeconomic information, and a questionnaire about quality of life. Comparisons were made between groups with and without low back pain. The chi-squared test was used for analyzing categorical variables, and the non-parametric Mann–Whitney test was used for continuous variables. According to the findings obtained in this study, it was observed that low back pain in the last month was reported by 27.3% of the total participants. The perceived health-related quality of life was lower among individuals who had low back pain, and the scores of physical and emotional functioning domains were also lower in the presence of low back pain. The prevalence of low back pain among children and adolescents is relatively high. Furthermore, the repercussions of low back pain may lead to a lower overall perception of the health-related quality of life in this population and affect aspects of physical and emotional functioning. Full article
(This article belongs to the Special Issue Back Pain: Pathophysiology, Diagnosis, and Treatment)
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11 pages, 864 KiB  
Article
Establishing Responsiveness and Minimal Clinically Important Difference of Quebec Back Pain Disability Scale (Hindi Version) in Chronic Low Back Pain Patients Undergoing Multimodal Physical Therapy
by Irshad Ahmad, Akhil Sharma, Sahar Zaidi, Mastour Saeed Alshahrani, Ajay Prashad Gautam, Abdullah Raizah, Ravi Shankar Reddy, Shalini Verma, Tarushi Tanwar, Mohammad Ejaz Hussain, Deepak Malhotra, Shadab Uddin and Emadeldin Mohammed Mukhtar
Healthcare 2023, 11(4), 621; https://doi.org/10.3390/healthcare11040621 - 20 Feb 2023
Viewed by 2067
Abstract
Increasing emphasis is placed on physical functional measures to examine treatments for chronic low back pain (CLBP). The Quebec Back Pain Disability Scale (Hindi version) (QBPDS-H) has never been evaluated for responsiveness. The objectives of this study were to (1) examine the internal [...] Read more.
Increasing emphasis is placed on physical functional measures to examine treatments for chronic low back pain (CLBP). The Quebec Back Pain Disability Scale (Hindi version) (QBPDS-H) has never been evaluated for responsiveness. The objectives of this study were to (1) examine the internal and external responsiveness of the Quebec Back Pain Disability Scale (Hindi version) (QBPDS-H) and (2) find out the minimal clinically important difference (MCID) and minimal detectable change (MDC) in the functional ability of patients with chronic low back pain (CLBP) undergoing multimodal physical therapy treatment. In this prospective cohort study, QBPDS-H responses were recorded at the baseline and after eight weeks from 156 CLBP patients undergoing multimodal physiotherapy treatment. To differentiate between the clinically unimproved (n = 65, age: 44.16 ± 11.8 years) and clinically improved (n = 91, age: 43.28 ± 10.7 years) scores of patients from the initial assessment to the last follow-up, the Hindi version of the Patient’s Global Impression of Change (H-PGIC) scale was utilized. Internal responsiveness was large (E.S. (pooled S.D.) (n = 91): 0.98 (95% CI = 1.14–0.85) and Standardized Response Mean (S.R.M.) (n = 91): 2.57 (95% CI = 3.05–2.17)). In addition, the correlation coefficient and receiver operative characteristics (R.O.C.) curve were used to assess the QBPDS-H external responsiveness. MCID and MDC were detected by the R.O.C. curve and standard error of measurements (S.E.M.), respectively. The H-PGIC scale showed moderate responsiveness (ρ = 0.514 and area under the curve (A.U.C.) = 0.658; 95% CI, 0.596–0.874), while the MDC achieved 13.68 points, and the MCID was found have 6 points (A.U.C. = 0.82; 95% CI: 0.74–0.88, sensitivity = 90%, specificity = 61%). This study shows that QBPDS-H has moderate levels of responsiveness in CLBP patients receiving multimodal physical therapy treatment, so it can be used to measure the changes in disability scores. MCID and MDC changes were also reported with QBPDS-H. Full article
(This article belongs to the Special Issue Back Pain: Pathophysiology, Diagnosis, and Treatment)
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13 pages, 581 KiB  
Article
Thoracic Spine Pain in High School Adolescents: A One-Year Longitudinal Study
by Alberto De Vitta, Matias Noll, Manuel Monfort-Pañego, Vicente Miñana-Signes and Nicoly Machado Maciel
Healthcare 2023, 11(2), 196; https://doi.org/10.3390/healthcare11020196 - 09 Jan 2023
Cited by 2 | Viewed by 6594
Abstract
Thoracic spine pain (TSP) is a common condition in the general adult population, with a similar prevalence in children and adolescents. An in-depth understanding of risk factors can assist in the identification of potential targets for effective prevention strategies. This study aimed to [...] Read more.
Thoracic spine pain (TSP) is a common condition in the general adult population, with a similar prevalence in children and adolescents. An in-depth understanding of risk factors can assist in the identification of potential targets for effective prevention strategies. This study aimed to determine the incidence of TSP and ongoing TSP and identify its predictors in high school students. This longitudinal study was conducted in 2017 (baseline-T1), and follow-up surveys were completed in 2018 (T2). The variable “thoracic spine pain” was observed using the Nordic questionnaire, and associated variables were observed through the Baecke questionnaire and the Strengths and Difficulties Questionnaire. Statistical association methods were used for bivariate and multivariate logistic regression analysis. Among the participants, the one-year prevalence (ongoing TSP) was 38.4%, and the one-year incidence (new TSP) was 10.1%. Significant risk factors for ongoing TSP were adolescent females (RR = 2.14), in the age group of 15 to 18 years (RR = 1.41), clinical mental health problems (RR = 3.07), borderline mental health problems (RR = 2.02), mental health problems, sitting while using a tablet (RR = 1.93), distance of the eye from cell phone screen of or more than 20 cm (RR = 1.69), distance of the eye from the PC screen of or more than 30 cm (RR = 1.53), cell phone mobile use duration of or more than 3 h (RR = 1.60), tablet use time of or more than 3 h (RR = 2.08), and semi-lying prone position while using the cell phone (RR= 1.47), and these were also significant predictors of TSP episodes. Significant risk factors for new TSP were adolescent female sex (RR = 1.88), level, clinical mental health problems (RR = 4.26), borderline mental health problems (RR = 2.07), semi-lying prone position while using cell phone (RR = 1.71) or tablet (RR = 2.31), and mobile phone use duration equal to or greater than 3 h (RR = 1.72). We conclude that there is a high prevalence of TSP in high school students, which is associated with the female sex, mental health problems, and use of electronic devices for an inappropriate duration in an improper position. Full article
(This article belongs to the Special Issue Back Pain: Pathophysiology, Diagnosis, and Treatment)
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9 pages, 411 KiB  
Article
Cross-Cultural Adaptation, Reliability, and Validity of a Hebrew Version of the Physiotherapist Self-Efficacy Questionnaire Adjusted to Low Back Pain Treatment
by Ron Shavit, Talma Kushnir, Uri Gottlieb and Shmuel Springer
Healthcare 2023, 11(1), 85; https://doi.org/10.3390/healthcare11010085 - 28 Dec 2022
Viewed by 1869
Abstract
Background: Clinician self-efficacy may be an important factor in the success of treatment for low back pain (LBP), which has unique clinical features and a high prevalence rate. Therefore, it is important to assess clinicians’ self-efficacy in this particular condition. The Physiotherapist Self-Efficacy [...] Read more.
Background: Clinician self-efficacy may be an important factor in the success of treatment for low back pain (LBP), which has unique clinical features and a high prevalence rate. Therefore, it is important to assess clinicians’ self-efficacy in this particular condition. The Physiotherapist Self-Efficacy (PSE) questionnaire was designed to measure self-efficacy of physiotherapy students. Objectives: To translate and trans-culturally adapt the PSE into Hebrew, to adjust the questionnaire to assess clinicians’ self-efficacy in the treatment of LBP, and to assess the construct validity and reliability of the PSE in the Hebrew version. Methods: After adjustment for LBP and cross-cultural adaptation, test–retest reliability was assessed with 140 physiotherapists. The analyses used included exploratory factor analysis for structural validity, Cronbach’s alpha for internal consistency, and intraclass correlation coefficients (ICC) for test–retest reliability. Results: Factor analysis revealed a unidimensional structure with an acceptable model fit. The PSE translated into Hebrew exhibited a very high internal consistency (α = 0.93) and excellent test–retest reliability (ICC = 0.94). The standard error of measurement (SEM) and minimal detectable change (MDC) were 1.75 and 4.85, respectively. Conclusions: The Hebrew-translated PSE showed adequate validity and excellent reliability, indicating its suitability to measure clinician self-efficacy in treating patients with LBP. Full article
(This article belongs to the Special Issue Back Pain: Pathophysiology, Diagnosis, and Treatment)
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