Articles: low-back-pain.
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The lumbar spine displays its greatest mobility in ventral flexion, which is a potential risk factor for low back pain. The relative contribution of each segment to the complete flexion is denoted the spine rhythm, which is required to distinguish between normal and abnormal spinal profiles, and as well to calculate the spinal forces in musculoskeletal models. Nevertheless, different spine rhythms have been reported in literature and the effect of arm position has not been demonstrated. We therefore aimed to investigate the effects of different arm positions on spine rhythm during ventral flexion. ⋯ The lumbar spine displayed greater flexion in the middle and lower levels and its flexion rhythm remained unchanged at different arm positions. These results strike importance to explore for more reasons explaining the different lumbar flexion rhythms reported in literature.
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A multi-cohort, case-control rodent study. ⋯ Mechanical injury of L4/5-IVDs induces delayed radiating pain and degeneration of adjacent discs; increased physical activity positively mitigated both.
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Randomized Controlled Trial
Does aerobic exercise training alter responses to opioid analgesics in individuals with chronic low back pain?: a randomized controlled trial.
We tested whether aerobic exercise training altered morphine analgesic responses or reduced morphine dosages necessary for adequate analgesia. Patients with chronic back pain were randomized to an 18-session aerobic exercise intervention (n = 38) or usual activity control (n = 45). Before and after the intervention, participants underwent 3 laboratory sessions (double-blinded, crossover) to assess effects of saline placebo, i.v. morphine (0.09 mg/kg), and i.v. naloxone (12 mg) on low back pain and evoked heat pain responses. ⋯ Of clinical significance were findings that relative to the control group, aerobic exercise produced analgesia more similar to that observed after receiving ≈7 mg morphine preintervention (P < 0.045). Greater pre-post intervention increases in endogenous opioid function (from any source) were significantly associated with larger pre-post intervention decreases in morphine analgesia (P < 0.046). The overall pattern of findings suggests that regular aerobic exercise has limited direct effects on morphine responsiveness, reducing morphine analgesia in males only.
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Randomized Controlled Trial
Medial Prefrontal High-Definition Transcranial Direct Current Stimulation to Improve Pain Modulation in Chronic Low Back Pain: A Pilot Randomized Double-blinded Placebo-Controlled Crossover Trial.
Chronic low back pain (CLBP) is highly disabling, but often without identifiable source. Focus has been on impaired anti-nociceptive mechanisms contributing to pain maintenance, though methods of targeting this impairment remain limited. This randomised-controlled cross-over pilot trial used active versus sham medial prefrontal cortex (mPFC) high-definition transcranial direct current stimulation (HD-tDCS) for 3-consecutive days to improve descending pain inhibitory function. ⋯ TRIAL REGISTRATION: : ClinicalTrials.gov (NCT03864822). PERSPECTIVE: Medial prefrontal HD-tDCS did not alter pain, psychological nor psychophysical outcomes, though correlational analysis suggested response may depend on baseline pain inhibitory efficacy, with best potential effects in patients with severe impairments in descending pain inhibitory mechanisms. Future work should focus on appropriate patient selection and optimising stimulation targeting.