Physical activity in patients with nonspecific low back painin therapy

Introduction. Kinesitherapy (KT) – one of the leading areas of patient care with chronic nonspecific (musculoskeletal pain) low back pain. For chronic lumbar pain, a standard KT is commonly used, that includes group sessions with a medical specialist. Often not taking into account the individual characteristics of patients, their attitude to KT, does not use a backpain education program in combination with KT (extended KT). Physical activity and hypodynamia are compared in patients with chronic nonspecificlow back pain in standard KT and extended KT.

Aim of study is to assess the effectiveness of the standard and extended KT in the enhancement of physical activity.

Materials and methods. 71 patients were observed (17 men and 54 women, average age 55.09 ± 13 years) with chronic nonspecific low back pain. Patients received non-steroidal anti-inflammatory drugs (NSAIDs) as painkillers. 34 patients received a standard KT, 37 patients – an extended KT. Patients were asked to complete the Numeric Pain Rating Scale (NPRS), the Oswestry Low Back Pain Disability Questionnaire, and the International Physical Activity Questionnaire (IPAQ) at baseline, after 7 days and 90 days.

Results and discussion. In the extended KT group, physical activity increased from 11 (7–16) points to 16 (13–19) points after 7 days (p = 0.001) and up to 23 (15–26) points after 3 months (p = 0.0002). There has been a statistically significant decrease in the proportion of patients with hypodynamy (p = 0.0015). There is no statistically significant increase in physical activity in the standard therapy group. The use of NSAIDs in non-specific low back pain is discussed, the effectiveness of the use of dexketoprofen (Dexalgin) during lumbar pain is noted.

Conclusion. In the case of nonspecific low back pain, the extended KTimprovesphysical activity and reduce hypodynamy.

1. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. https://doi.org/10.1016/S0140-6736(15)60692-4.

2. Maher C., Underwood M., Buchbinder R. Non-specific low back pain. Lancet Neurol. 2017;389(10070):736–747. https://doi.org/10.1016/S0140-6736(16)30970-9.

3. Enthoven W.T., Roelofs P.D., Deyo R.A., van Tulder M.W., Koes B.W. Nonsteroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev. 2016;2(2):CD012087. https://doi.org/10.1002/14651858.CD012087.

4. Koes B.W., van Tulder M., Lin C.W., Macedo L.G., McAuley J., Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075–2094. https://doi.org/10.1007/s00586-010-1502-y.

5. National Guideline Centre (UK). Low Back Pain and Sciatica in Over 16s: Assessment and Management. London: National Institute for Health and Care Excellence (UK); 2016. Available at: https://pubmed.ncbi.nlm.nih.gov/27929617.

6. Wong J.J., Côté P., Sutton D.A., Randhawa K., Yu H., Varatharajan S.K. et al. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 2017;21(2):201–216. https://doi.org/10.1002/ejp.931.

7. Sletten C.D., Kurklinsky S., Chinburapa V., Ghazi S. Economic analysis of a comprehensive pain rehabilitation program: a collaboration between Florida Blue and Mayo Clinic Florida. Pain Med. 2015;16(5):898–904. https://doi.org/10.1111/pme.12679.

8. Takahashi N., Omata J.I., Iwabuchi M., Fukuda H., Shirado O. Therapeutic efficacy of nonsteroidal anti-inflammatory drug therapy versus exercise therapy in patients with chronic nonspecific low back pain: a prospective study. Fukushima J Med Sci. 2017;63(1):8–15. https://doi.org/10.5387/fms.2016-12.

9. Magalhães M.O., Comachio J., Ferreira P.H., Pappas E., Marques A.P. Effectiveness of graded activity versus physiotherapy in patients with chronic nonspecific low back pain: midterm follow up results of a randomized controlled trial. Braz J Phys Ther. 2018;22(1):82–91. https://doi.org/10.1016/j.bjpt.2017.07.002.

10. Paolucci T., Attanasi C., Cecchini W., Marazzi A., Capobianco S.V., Santilli V. Chronic low back pain and postural rehabilitation exercise: a literature review. J Pain Res. 2018;12:95–107. https://doi.org/10.2147/JPR.S171729.

11. Sitthipornvorakul E., Klinsophon T., Sihawong R., Janwantanakul P. The effects of walking intervention in patients with chronic low back pain: A meta-analysis of randomized controlled trials. Musculoskelet Sci Pract. 2018;34:38–46. https://doi.org/10.1016/j.msksp.2017.12.003.

12. Qaseem A., Wilt T.J., McLean R. M., Forciea M.A. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514–530. https://doi.org/10.7326/M16-2367.

13. Stochkendahl M.J., Kjaer P., Hartvigsen J., Kongsted A., Aaboe J., Andersen M. et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018;27(1):60–75. https://doi.org/10.1007/s00586-017-5099-2.

14. Niederer D., Mueller J. Sustainability effects of motor control stabilisation exercises on pain and function in chronic nonspecific low back pain patients: A systematic review with meta-analysis and meta-regression. PLoS One. 2020;15(1):e0227423. https://doi.org/10.1371/journal.pone.0227423.

15. Hayden J.A., Wilson M.N., Stewart S., Cartwright J.L., Smith A.O., Riley R.D. et al. Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials. Br J Sports Med. 2020;54(21):1277–1278. https://doi.org/10.1136/bjsports-2019-101205.

16. Saner J., Bergman E.M., de Bie R.A., Sieben J.M. Low back pain patients’ perspectives on long-term adherence to home-based exercise programmesinphysiotherapy. Musculoskelet Sci Pract. 2018;38:77–82. https://doi.org/10.1016/j.msksp.2018.09.002.

17. Saragiotto B.T., Maher C.G., Yamato T.P., Costa L.O. P., Costa L.C. M., Ostelo R.W. J. G., Macedo L.G. Motor Control Exercise for Nonspecific Low Back Pain: A Cochrane Review. Spine (Phila Pa 1976). 2016;41(16):1284–1295. https://doi.org/10.1097/BRS.0000000000001645.

18. Owen P.J., Miller C.T., Mundell N.L., Verswijveren S.J. J. M., Tagliaferri S.D., Brisby H. et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med. 2020;54(21):1279–1287. https://doi.org/10.1136/bjsports-2019-100886.

19. Wewege M.A., Booth J., Parmenter B.J. Aerobic vs. resistance exercise for chronic non-specific low back pain: A systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2018;31(5):889–899. https://doi.org/10.3233/BMR-170920.

20. Searle A., Spink M., Ho A., Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomizedcontrolled trials. Clin Rehabil. 2015;29(12):1155–1167. https://doi.org/10.1177/0269215515570379.

21. O’Connor S.R., Tully M.A., Ryan B., Bleakley C.M., Baxter G.D., Bradley J.M., McDonough S.M. Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis. Arch Phys Med Rehabil. 2015;96(4):724–734.e3. https://doi.org/10.1016/j.apmr.2014.12.003.

22. Vanti C., Andreatta S., Borghi S., Guccione A.A., Pillastrini P., Bertozzi L. The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials. Disabil Rehabil. 2019;41(6):622–632. https://doi.org/10.1080/09638288.2017.1410730.

23. Kuritzky L., Samraj G.P. Nonsteroidal anti-inflammatory drugs in the treatment of low back pain. J Pain Res. 2012;5:579–590. https://doi.org/10.2147/jpr.s6775.

24. Moore R.A., Barden J. Systematic review of dexketoprofen in acute and chronic pain. BMC Clin Pharmacol. 2008;8:11. https://doi.org/10.1186/1472-6904-8-11.

25. Brzeziński K., Wordliczek J. Comparison of the efficacy of dexketoprofen and diclofenac in treatment of non-specific low back pain. Ann Agric Environ Med. 2013;20(Special Issue 1):52–56. Available at: https://pubmed.ncbi.nlm.nih.gov/25000843.

26. Perna A., Ricciardi L., Barone G., Tamburrelli F.C., Proietti L., Pola E. Medical management of acute non-specific low back pain: comparison of different medical treatments, one center’s retrospective analysis. J Biol Regul Homeost Agents. 2018;32(6 Suppl. 1):121–129. Available at: https://pubmed.ncbi.nlm.nih.gov/30644292.

27. Barulin A.E., Kurushina O.V. Back pain: gender differences and approaches to the therapy. Meditsinskiy sovet = Medical Council. 2018;(6):38–42. (In Russ.) https://doi.org/10.21518/2079-701X-2018-6-38-42.

28. Alekseeva L.I., Taskina E.A., Kashevarova N.G., Sharapova E.P., Feklistov A. Yu., Strebkova E.A. Evaluating the efficacy and safety of the stepwise dexketoprofen trometamol therapy in patients with acute back pain and aggravationof the osteoarthritis of large joints. Lechebnoye delo. 2017;(2):66–73. (In Russ.) Available at: https://cyberleninka.ru/article/n/otsenka-effektivnosti-i-bezopasnosti-stupenchatoy-terapii-deksketoprofena-trometamolom-u-patsientov-s-ostroy-bolyu-v-spine-i-obostreniem.