Articles: low-back-pain.
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Identifying factors that influence the course of low back pain (LBP) is important to help clinicians to identify those patients at higher risk of non-recovery. The objective of this systematic review was to investigate the prognostic role of physical activity in the course of LBP. ⋯ Despite recent research in the area, this systematic review shows that there is low quality evidence that physical activity may not be a prognostic factor for predicting pain and disability in patients with LBP.
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Randomized Controlled Trial
Early occupational intervention for people with low back pain in physically demanding jobs: A randomized clinical trial.
Occupational medicine seeks to reduce sick leave; however, evidence for an add-on effect to usual care is sparse. The objective of the GOBACK trial was to test whether people with low back pain (LBP) in physically demanding jobs and at risk of sick leave gain additional benefit from a 3-month complex intervention that involves occupational medicine consultations, a work-related evaluation and workplace intervention plan, an optional workplace visit, and a physical activity program, over a single hospital consultation and an MRI. ⋯ When given a single hospital consultation and MRI, people in physically demanding jobs at risk of sick leave due to LBP did not benefit from a complex additional occupational intervention. Occupational interventions aimed at limiting biopsychological obstacles (e.g., fear-avoidance beliefs and behaviors), barriers in the workplace, and system barriers seem essential to reduce sick leave in patients with LBP. This study indicates that these obstacles and barriers may be addressed by thorough usual care.
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Multicenter Study
An Open-Label, 52-Week, Phase III Trial of Duloxetine in Japanese Patients with Chronic Low Back Pain.
To evaluate the safety and efficacy of duloxetine treatment for 52 weeks. ⋯ Japanese patients with CLBP had significant pain reduction over 52 weeks without new safety concerns.
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Central sensitization is considered to have a pathophysiological role in chronic low back pain (LBP). Whether individuals with increased central sensitization early in their condition are more likely to develop persistent pain or whether it increases over time is unclear. This study aimed to determine whether sensory profiles during acute LBP differ between individuals who did and did not recover by 6 months and to identify subgroups associated with outcomes. ⋯ Two subgroups were identified that associated with more ("high sensitivity") or less ("high sensitivity and negative psychological state") recovery. These data seem to suggest that central sensitization during the acute phase resolves for many patients, but is a precursor to the transition to chronicity when combined with other psychological features. PERSPECTIVE: Central sensitization signs during early acute LBP does not necessarily precede poor outcome, but may be sustained in conjunction with other psychological factors and facilitate pain persistence.
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Chronic musculoskeletal pain (CMSP) disorders are among the most prevalent and disabling conditions worldwide. It would be advantageous to have common outcome measures when comparing results across different CMSP research studies. ⋯ Two scales comprising eight items are recommended as core outcome measures for pain intensity and interference in all studies of chronic musculoskeletal pain, and brief scales comprising 13 additional items can be added when possible to assess important secondary domains.