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      Predetermined physical factors and alternative factors in the treatment of chronic pain in discogenic lumbosacral radiculitis

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          Abstract

          Objectives

          Evolution of acute pain in discogenic lumbosacral radiculopathy to subacute and chronic pain reflects pharmacotherapeutic issues and even helplessness in some cases. It has social significance since 80% of people in working age have faced it at least once in their working lifetime. Most of the acute and subacute (> 6 weeks) episodes resolve within 3 months while in 10–15% of patients their condition does not resolve and they develop chronic (> 3 months) lumbosacral syndrome.

          Material and methods

          We present our experience in non-pharmaceutical treatment of chronic pain in discogenic lumbosacral radiculopathy after comparison of different predetermined and alternative therapies that have been given to patients who were selected by highly informative assessment indicators for the extent of spinal root lesion. Sixty patients were enrolled in this study and were divided into two groups of 30 patients each. The first group was treated with classic acupuncture, and the second group with two predetermined factors from conventional physiotherapy. The effect of the two treatments applied was followed up after each procedure in the therapeutic course, and also a month later.

          Results

          As a result of the obtained statistical data, we present a variant of non-invasive treatment of chronic pain that would be useful in clinical practice.

          Conclusions

          In cases of chronic pain in this particular disease, a recommendation should be given for the combination of two physical factors – paravertebral application of ultrasound in impulse mode with an appropriate anti-inflammatory medicament as a mediator in the area of the lumbosacral spine segment, by a labile method, combined with low frequency impulse magnet field in the low back area and the affected leg. Also, acupuncture could be used in fighting against pain, especially in patients contraindicated for predetermined factors (those with a pacemaker, or an oncological process in the small pelvis area).

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          Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline

          Roger Chou, Richard A Deyo, Janna Friedly … (2017)
          A 2007 American College of Physicians guideline addressed nonpharmacologic treatment options for low back pain. New evidence is now available.
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            Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.

            Roger Chou, Laurie Huffman (2007)
            Many nonpharmacologic therapies are available for treatment of low back pain. To assess benefits and harms of acupuncture, back schools, psychological therapies, exercise therapy, functional restoration, interdisciplinary therapy, massage, physical therapies (interferential therapy, low-level laser therapy, lumbar supports, shortwave diathermy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography), spinal manipulation, and yoga for acute or chronic low back pain (with or without leg pain). English-language studies were identified through searches of MEDLINE (through November 2006) and the Cochrane Database of Systematic Reviews (2006, Issue 4). These electronic searches were supplemented by hand searching of reference lists and additional citations suggested by experts. Systematic reviews and randomized trials of 1 or more of the preceding therapies for acute or chronic low back pain (with or without leg pain) that reported pain outcomes, back-specific function, general health status, work disability, or patient satisfaction. We abstracted information about study design, population characteristics, interventions, outcomes, and adverse events. To grade methodological quality, we used the Oxman criteria for systematic reviews and the Cochrane Back Review Group criteria for individual trials. We found good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or subacute (>4 weeks' duration) low back pain. Benefits over placebo, sham therapy, or no treatment averaged 10 to 20 points on a 100-point visual analogue pain scale, 2 to 4 points on the Roland-Morris Disability Questionnaire, or a standardized mean difference of 0.5 to 0.8. We found fair evidence that acupuncture, massage, yoga (Viniyoga), and functional restoration are also effective for chronic low back pain. For acute low back pain (<4 weeks' duration), the only nonpharmacologic therapies with evidence of efficacy are superficial heat (good evidence for moderate benefits) and spinal manipulation (fair evidence for small to moderate benefits). Although serious harms seemed to be rare, data on harms were poorly reported. No trials addressed optimal sequencing of therapies, and methods for tailoring therapy to individual patients are still in early stages of development. Evidence is insufficient to evaluate the efficacy of therapies for sciatica. Our primary source of data was systematic reviews. We included non-English-language trials only if they were included in English-language systematic reviews. Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation. For acute low back pain, the only therapy with good evidence of efficacy is superficial heat.
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              Is acupuncture effective for the treatment of chronic pain? A systematic review.

              Jeanette Ezzo, Brian Berman, Victoria A Hadhazy … (2000)
              Pain is the major complaint of the estimated one million U.S. consumers who use acupuncture each year. Although acupuncture is widely available in chronic pain clinics, the effectiveness of acupuncture for chronic pain remains in question. Our aim was to assess the effectiveness of acupuncture as a treatment for chronic pain within the context of the methodological quality of the studies. MEDLINE (1966-99), two complementary medicine databases, 69 conference proceedings, and the bibliographies of other articles and reviews were searched. Trials were included if they were randomized, had populations with pain longer than three months, used needles rather than surface electrodes, and were in English. Data were extracted by two independent reviewers using a validated instrument. Inter-rater disagreements were resolved by discussion. Fifty one studies met inclusion criteria. Clinical heterogeneity precluded statistical pooling. Results were positive in 21 studies, negative in 3 and neutral in 27. Three fourths of the studies received a low-quality score and low-quality trials were significantly associated with positive results (P=0.05). High-quality studies clustered in designs using sham acupuncture as the control group, where the risk of false negative (type II) errors is high due to large sample size requirements. Six or more acupuncture treatments were significantly associated with positive outcomes (P=0.03) even after adjusting for study quality. We conclude there is limited evidence that acupuncture is more effective than no treatment for chronic pain; and inconclusive evidence that acupuncture is more effective than placebo, sham acupuncture or standard care. However, we have found an important relationship between the methodology of the studies and their results that should guide future research.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Reumatologia
                Journal ID (iso-abbrev): Reumatologia
                Journal ID (publisher-id): RU
                Title: Reumatologia
                Publisher: Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie
                ISSN (Print): 0034-6233
                ISSN (Electronic): 2084-9834
                Publication date (Electronic): 18 May 2022
                Publication date (Print): 2022
                Volume: 60
                Issue: 2
                Pages: 110-115
                Affiliations
                [1 ]Department of Physiotherapy, Tsaritsa Yoanna-ISUL University Hospital, Sofia, Bulgaria
                [2 ]Department of Physical Medicine and Rehabilitation, Medical University Sofia, Bulgaria
                [3 ]Department of Anesthesiology and Intensive Care, Tsaritsa Yoanna-ISUL University Hospital, Sofia, Bulgaria
                Author notes
                Address for correspondence: Aycha Zaralieva, Department of Physical Medicine and Rehabilitation, Tsaritsa Yoanna-ISUL University Hospital, 8 Byalo more St., 1527 Sofia, Bulgaria. e-mail: aichazaralieva@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-8954-5781
                Article
                Publisher ID: 47006
                DOI: 10.5114/reum.2022.116143
                PMC ID: 9238309
                SO-VID: 778a4aa9-86d4-4e8a-9df2-86038e246026
                Copyright © Copyright: © 2022 Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                History
                Date received : 22 February 2022
                Date accepted : 14 April 2022
                Categories
                Subject: Original Paper

                Keywords: discogenic lumbosacral radiculitis,chronic pain,predetermined physical factors
                Data availability:
                Keywords: discogenic lumbosacral radiculitis, chronic pain, predetermined physical factors

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