Articles: low-back-pain.
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Measures of body fat accumulation are associated with back pain, but a causal association is unclear. We hypothesized that BMI would have causal effects on back pain. We conducted a two-sample Mendelian randomization (MR) study to assess the causal effect of body mass index (BMI) on the outcomes of (1) back pain and (2) chronic back pain (duration > 3 months). ⋯ In this first MR study of BMI and back pain, we found a significant causal effect of BMI on both back pain and chronic back pain. These slides can be retrieved under Electronic Supplementary Material.
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International clinical practice guidelines for low back pain (LBP) contain consistent recommendations including universal provision of information and advice to remain active, discouraging routine referral for imaging, and limited prescription of opioids. This systematic review describes usual care provided by first-contact physicians to patients with LBP. Studies that reported the assessments and care provided to people with LBP in family practice and emergency departments (EDs) from January 2000 to May 2019 were identified by searches of PubMed, EMBASE, and CINAHL. ⋯ Large numbers of patients who saw a physician for LBP received care that is inconsistent with evidence-based clinical practice guidelines. Usual care included overuse of imaging and opioid prescription and underuse of advice and information. Suboptimal care may contribute to the massive burden of the condition worldwide.
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Case Reports
Sharp lower back pain • left-side paraspinal tenderness • anterior thigh sensory loss • Dx?
► Acute-onset, sharp nonradiating lower back pain ► Left-side paraspinal tenderness ► Anterior thigh sensory loss.
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Clinical practice guidelines suggest that magnetic resonance imaging of the lumbar spine (LS-MRI) is unneeded during the first 6 weeks of acute, uncomplicated low-back pain. Unneeded LS-MRIs do not improve patient outcomes, lead to unnecessary surgeries and procedures, and cost the US healthcare system about $300 million dollars per year. However, why primary care providers (PCPs) order unneeded LS-MRI for acute, uncomplicated low-back pain is poorly understood. ⋯ Results describe how diverse environmental, patient, and provider factors contribute to unneeded LS-MRI for acute, uncomplicated low-back pain. Prior research using a single intervention to reduce unneeded LS-MRI has been ineffective. Results suggest that multifaceted de-implementation strategies may be required to reduce unneeded LS-MRI.
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Observational Study
Lumbopelvic motor control function between patients with chronic low back pain and healthy controls: a useful distinguishing tool: The STROBE study.
Although lumbopelvic stability exercise improves lumbopelvic motor control function in patients with chronic low back pain (CLBP), the difference in lumbopelvic motor control function between the patients with CLBP and the healthy controls is unclear. The purpose of this study was to compare lumbopelvic motor control function between patients with CLBP and healthy controls and to determine the prevalence of CLBP according to core stability function. For this study, 278 participants were recruited, including patients with CLBP (n = 137) and healthy controls (n = 141). ⋯ Lumbopelvic motor control function demonstrated a significant difference between the patients with CLBP and the healthy controls. The lumbopelvic motor control function test was demonstrated to be an effective diagnostic tool for distinguishing CLBP. This information can be applied in assessments and interventions for CLBP in clinical settings.