Long-term trajectories of patients with neck pain and low back pain presenting to chiropractic care: A latent class growth analysis

Abstract

Background

Information on the course of neck pain (NP) and low back pain (LBP) typically relies on data collected at few time intervals during a period of up to 1 year.

Methods

In this prospective, multicentre practice-based cohort study, patients consulting a chiropractor responded weekly for 52 weeks to text messages on their cell phones. Data from 448 patients (153 NP, 295 LBP) who had returned at least one set of answers in the first 26 weeks were used. Outcome measures were pain intensity (VAS) and functional outcome, assessed using four different questions: pain intensity, limitation in activities of daily living (ADL), number of days with pain in the previous week and number of days limited in ADL. Distinct patterns of pain were analysed with quadratic latent class growth analysis.

Results

The final model was a 4-class model for NP and LBP. The ‘recovering from mild baseline pain’ is most common (76.3% of NP patients/58.3% of LBP patients) followed by the ‘recovering from severe baseline pain’ class (16.3% NP/29.8% LBP). They follow similar trajectories when considered over a period of 6 months. Pain at baseline, duration of complaints, functional status, limitations in ADL and the score on psychosocial scales were the variables that most contributed to distinguish between groups.

Conclusions

Most patients with NP or LBP presenting in chiropractic care show a trajectory of symptoms characterized by persistent or fluctuating pain of low or medium intensity. Only a minority either experience a rapid complete recovery or develop chronic severe pain.

Significance

Ninety percentage of patients with neck pain or low back pain presenting to chiropractors have a 30% improvement within 6 weeks and then show a trajectory of symptoms characterized by persistent or fluctuating pain of low or medium intensity. Only a minority either experience a rapid complete recovery or develop chronic severe pain.

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Clinical benefits of joint mobilisation on ankle sprains: a systematic review and meta-analysis

Exercise for the prevention of low back and pelvic girdle pain in pregnancy: A meta-analysis of randomized controlled trials

Abstract

Background and objective

The effect of exercise in prevention of low back and pelvic girdle pain during pregnancy is uncertain. This study aimed to assess the effect of exercise on low back pain, pelvic girdle pain and associated sick leave.

Databases and data treatment

Literature searches were conducted in PubMed, EMBASE, Cochrane Library, Google Scholar, ResearchGate and ClinicalTrials.gov databases from their inception through May 2017. Randomized controlled trials (RCTs) were eligible for inclusion in the review if they compared an exercise intervention with usual daily activities and at least some of the participants were free from low back pain and/or pelvic girdle pain at baseline. Methodological quality of included studies was evaluated using the Cochrane Collaboration's tool. A random-effects meta-analysis was performed, and heterogeneity and publication bias were assessed.

Results

Eleven randomized controlled trials (2347 pregnant women) qualified for meta-analyses. Exercise reduced the risk of low back pain in pregnancy by 9% (pooled risk ratio (RR) = 0.91, 95% CI 0.83–0.99, I² = 0%, seven trials, N = 1175), whereas it had no protective effect on pelvic girdle pain (RR = 0.99, CI 0.81–1.21, I² = 0%, four RCTs, N = 565) or lumbopelvic pain (RR = 0.96, CI 0.90–1.02, I² = 0%, eight RCTs, N = 1737). Furthermore, exercise prevented new episodes of sick leave due to lumbopelvic pain (RR = 0.79, CI 0.64–0.99, I² = 0%, three RCTs, N = 1168). There was no evidence of publication bias.

Conclusion

Exercise appears to reduce the risk of low back pain in pregnant women, and sick leave because of lumbopelvic pain, but there is no clear evidence for an effect on pelvic girdle pain.

Significance

Exercise has a small protective effect against low back pain during pregnancy.

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What is the longitudinal profile of impairments and can we predict difficulty caring for the profoundly-affected arm in the first year post-stroke?

Visual reminders of death enhance nociceptive–related cortical responses and event-related alpha desynchronisation

Rubber Hand Illusion Increases Pain Caused by Electric Stimuli.

• We tested the effect of the rubber hand illusion on pain caused by electric stimuli.• Both real hands were covered and stimulated in a double-blind procedure.• Electric stimuli was experienced as more painful on the hand under the illusion.• The pain was experienced as located between the real hand and the rubber hand.• Uncertainty about the location of pain could increase its intensity.

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Index indicates cholesterol management strategy for statin related muscle pain

US researchers have developed an index to evaluate whether muscle symptoms may be due to statin treatment, as well as a strategy to reduce cardiovascular risk in patients affected, after reviewing...

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