Articles: low-back-pain.
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J Orthop Sports Phys Ther · Apr 2019
Treatment Effect Sizes of Mechanical Diagnosis and Therapy for Pain and Disability in Patients With Low Back Pain: A Systematic Review.
Mechanical Diagnosis and Therapy (MDT) is a treatment-based classification system founded on 3 core principles: classification into diagnostic syndromes, classification-based intervention, and appropriate application of force. Many randomized controlled trials have investigated the efficacy of MDT for low back pain; however, results have varied. The inconsistent delivery of MDT across trials may explain the different findings. ⋯ Therapy, level 1a. J Orthop Sports Phys Ther 2019;49(4):219-229. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8734.
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Changes in central pain processing have been shown in patients with chronic low-back pain (cLBP). We used quantitative sensory testing methods to identify differences in pain sensitization between patients with cLBP (N = 167) and healthy controls (N = 33). Results indicated that, compared with healthy pain-free controls, cLBP patients showed increased sensitivity and greater painful aftersensations for mechanical pressure and pin-prick stimuli and lower tactile spatial acuity in the 2-point discrimination task (ps < 0.05). ⋯ Furthermore, deep-tissue pressure pain mediated the associations between catastrophizing and both pain in the past month and low-back pain severity. Taken together, these results indicate that not only do patients with cLBP demonstrate increased pain sensitization and decreased sensitivity to innocuous stimuli, but these changes are also linked with increased catastrophizing. Furthermore, both catastrophizing and sensitization are associated with increased clinical pain among cLBP patients.
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Physiotherapists' attitudes toward low back pain (LBP) are linked to patients' attitudes toward pain, chronicity, and disability. Nevertheless, there is a scarcity of studies exploring the variables associated with physiotherapists' attitudes. The present study seeks to explore whether there is an association between the physiotherapists' work setting and their attitudes toward LBP, whether there is an association between the physiotherapists' clinical experience with LBP patients and their attitudes toward LBP, and which variable best predicts physiotherapists' attitudes toward LBP. ⋯ There is an association between physiotherapists' work setting and clinical experience with LBP patients and their attitudes toward LBP. These findings have implications for future educational programs for physiotherapists and suggest the need to adapt programs to the work setting of physiotherapists and to their level of clinical experience.
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Pain expectancies are associated with altered pain sensitivity in individuals with chronic pain. However, little is known about the processes by which pain expectancies impact pain processing. This study assessed the association between pain expectancies and temporal summation (TS) of pain, and examined whether pain catastrophizing mediated this association. ⋯ Individuals with chronic low back pain who expect higher levels of pain and catastrophize about their pain are more likely to experience altered pain sensitivity. Our results point to catastrophizing as a mechanism of action through which psychological factors may operate and lead to the development and maintenance of chronic low back pain.
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Investigation of movement and sensory profiles across STarT Back risk subgroups. ⋯ In 290 people with chronic low back pain movement profile and two-point discrimination threshold differed across risk subgroups defined by the STarT Back Tool. Conversely, pain sensitivity did not differ across these subgroups. These findings may add further guidance for targeted care in these subgroups.