Relationship between physical activity and disability in low back pain
It is often assumed that patients with pain-related disability due to low back pain (LBP) will have reduced physical activity levels, but recent studies have found that there is no significant correlation between physical activity level and disability in acute/subacute LBP. In chronic LBP, as might be expected, persons with higher levels of disability are less likely to be physically active, and whether increased activity would be helpful for them is largely unknown.
Reporting in the journal Pain, scientists from the George Institute in Sydney conducted a systematic review to examine the relationship between physical activity and disability in LBP. The literature search included 6 electronic databases and the reference list of relevant systematic reviews and studies to May 2010. The search identified 3213 records and 18 studies were eligible for inclusion.
The pooled results showed a weak relationship between physical activity and disability in acute or subacute (3months) LBP. That is, persons with acute or subacute LBP appear to vary in the levels of physical activity independent of their pain-related disability. Persons with chronic LBP with high levels of disability are also likely to have low levels of physical activity. Persons with acute or subacute back pain appear to vary in the levels of physical activity independent of disability. Persons with chronic back pain with high levels of disability will likely have low levels of physical activity.
Sensory innervation of the thoracolumbar fascia
There has been a debate on the role of the fascia as a potential source of pain in the low back because the lack of data on the sensory innervation of the thoracolumbar fascia (TLF). A recent study from Germany provided a quantitative evaluation of calcitonin gene-related peptide (CGRP) and substance P (SP)-containing free nerve endings in the rat TLF. A preliminary non-quantitative evaluation was also performed in specimens of the human TLF.
Their data show that the thoracolumbar fascia is a densely innervated tissue with marked differences in the distribution of the nerve endings over the fascial layers. In the rat, they distinguished three layers: (1) Outer layer (transversely oriented collagen fibers adjacent to the subcutaneous tissue), (2) middle layer (massive collagen fiber bundles oriented obliquely to the animal's long axis), and (3) inner layer (loose connective tissue covering the paraspinal muscles). The subcutaneous tissue and the outer layer showed a particularly dense innervation with sensory fibres.
Because of its dense sensory innervation, including presumably nociceptive fibres, the TLF may play an important role in low back pain. The very interesting fact that most proprioceptive (as well as nociceptive) nerve endings were found in superficial layers of this fascial region, which may explain the often dramatic effects of skin taping in sports medicine.
Reference Tesarz J, Hoheisel U, Wiedenhöfer B, Mense S.Neuroscience. 2011 Aug 2.
Whiplash, anxiety and depression
Whiplash is associated with an increased level of anxiety and depressive symptoms. This increase in psychological distress is generally understood as the consequence of the accident and related whiplash. Most studies have reported an association between whiplash injuries and psychological variables, with the hypothesis being that the pain and symptoms associated with the physical injury result in psychological distress.
The study examined the possibility of reverse causality, that is, if symptoms of anxiety and depression are associated with incident self-reported whiplash injury. This particular study used a large ongoing population survey in Norway to look at whether levels of anxiety and depression at one point in time predict whether or not someone is likely to report a Whiplash injury in the 11 years that followed.
After controlling for age, gender and alcohol-problems they found that higher levels on their depression and anxiety measure do in fact increase the likelihood that a person will report a whiplash injury down the track (Odds Ratio 1.6). Self-reported whiplash increased the chances of a subsequent disability pension award, even in the absence of neck pain.
This is the first published study with a prewhiplash prospective evaluation of psychological status. Our findings are in conflict with previous research suggesting whiplash to be the cause of associated psychological symptoms rather than their consequence. Self-reported whiplash injury was clinically relevant as it independently increased subsequent disability pension award. The strength of this effect, even in the absence of neck pain, suggests the ascertainment of this diagnostic label, or factors associated with this, are important predictors of disability.
Reference: Reverse causality in the association between whiplash and symptoms of anxiety and depression: the HUNT study. Mykletun A, Glozier N, Wenzel HG, Overland S, Harvey SB, Wessely S, Hotopf M.
Complementary and alternative medicine in the treatment of pain in fibromyalgia
A study was to systematically review the literature for randomized trials of complementary and alternative medicine (CAM) interventions for fibromyalgia (FM).
A comprehensive literature search was conducted. Inclusion criteria were (a) subjects were diagnosed with fibromyalgia and (b) the study design was a randomized controlled trial that compared a CAM therapy vs a control group. Studies were subgrouped by CAM treatment into 11 categories.
Synthesis of information for CAM categories represented by more than 5 studies revealed that balneotherapy and mind-body therapies were effective in treating FM pain. This study analyzed recent studies and focused exclusively on randomized controlled trials. Despite common use of manual therapies such as massage and manipulation to treat patients with FM, there is a paucity of quality clinical trials investigating these particular CAM categories.
The authors concluded as most of these studies identified were preliminary or pilot studies, thus had small sample sizes and were likely underpowered. Two CAM categories showed the most promising findings, balneotherapy and mind-body therapies. Most of the other CAM categories showed a trend favoring the treatment group. It appears that several CAM therapies show some preliminary treatment effect for FM pain, but larger trials that are more adequately powered are needed.
J Manipulative Physiol Ther. 2011 Sep;34(7):483-96. Complementary and alternative medicine in the treatment of pain in fibromyalgia: a systematic review of randomized controlled trials.
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