Angiogenesis, Inflammation & Therapeutics | Online ISSN  2207-872X
RESEARCH ARTICLE   (Open Access)

Specialized Physiotherapy and Pharmacological Management Strategies in Optimizing Chronic Lower Back Pain Rehabilitation

Shazal Kumar Das1, Abid Hasan Khan2, Muhammad Shahidul Islam3, Nadira Alam4, Md. Nesaruddin5, Md. Jonaied Alam6, Tanvir Rahman7, Afroza Alam Shawon8, Proshoun Rakshit Himel9, Md. Anowar Khasru Parvez 10*

+ Author Affiliations

Journal of Angiotherapy 8(5) 1-10 https://doi.org/10.25163/angiotherapy.859674

Submitted: 31 March 2024  Revised: 14 May 2024  Published: 19 May 2024 

Abstract

Background: Low back pain (LBP) is a prevalent health concern globally, posing significant challenges for prevention and treatment. This study addressed the pressing need for effective interventions for chronic lower back pain (CLBP), aiming to compare the efficacy of unique physiotherapy techniques, conventional physiotherapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) in alleviating symptoms and improving functional outcomes. Methods: Sixty-five patients with CLBP were enrolled in a randomized controlled trial conducted at the Centre for the Rehabilitation of the Paralysed (CRP) in Bangladesh. Participants were assigned to receive either a specific physiotherapy regimen or conventional physiotherapy with NSAID medication. Pain intensity and disability were measured using the Numerical Pain Rating Scale and Oswestry Disability Index, respectively. Results: Both treatment groups experienced significant reductions in pain intensity and disability scores post-intervention (p < 0.01). However, the group receiving specialized physiotherapy exhibited greater improvements compared to the conventional therapy with NSAIDs group. Socio-demographic characteristics indicated that participants were predominantly married individuals aged 31-44, with varying educational backgrounds and employment statuses. Notably, specialized physiotherapy interventions focusing on core stability, strengthening, stretching, posture, and core muscle activation demonstrated superior outcomes in reducing pain intensity, improving functional activity, and enhancing flexibility. Conclusion: Specialized physiotherapy interventions showed superior efficacy over conventional physiotherapy combined with NSAIDs in alleviating pain and improving functional outcomes in individuals with CLBP. Core stability exercises and targeted physiotherapy approaches appear to offer promising benefits for managing chronic low back pain, underscoring the importance of tailored rehabilitation strategies in clinical practice.

Keywords: Chronic lower back pain, physiotherapy, NSAIDs, treatment efficacy, Bangladesh

References

Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis SH, Staal JB, Ursin H, et al. Chapter 4 European Guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(S2):S192-300. doi:10.1007/s00586-006-1072-1

Ali M, Ahsan GU, Hossain A. Prevalence and associated occupational factors of low back pain among the bank employees in Dhaka City. J Occup Health. 2020;62(1):e12131. doi:10.1002/1348-9585.12131

Alvi MM, Sivasankaran S, Singh M. Pharmacological and non-pharmacological efforts at prevention, mitigation, and treatment for covid-19. J Drug Target. 2020;28(7–8):742–54. doi:10.1080/1061186x.2020.1793990

Anderson DB, Shaheed CA. Medications for treating low back pain in adults. Evidence for the use of paracetamol, opioids, nonsteroidal anti-inflammatories, muscle relaxants, antibiotics, and antidepressants: An overview for musculoskeletal clinicians. J Orthop Sports Phys Ther. 2022;52(7):425–31. doi:10.2519/jospt.2022.10788

Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. The Lancet. 2012;379(9814):482–91. doi:10.1016/s0140-6736(11)60610-7

Cairns MC, Foster NE, Wright C. Randomized controlled trial of specific spinal stabilization exercises and conventional physiotherapy for recurrent low back pain. Spine. 2006;31(19):E670–81. doi:10.1097/01.brs.0000232787.71938.5d

Chen Q-Y, Zhuo M. Glutamate acts as a key neurotransmitter for itch in the mammalian spinal cord. Mol Pain. 2023;19:174480692311521. doi:10.1177/17448069231152101

Cho NH, Jung YO, Lim SH, Chung C-K, Kim HA. The prevalence and risk factors of low back pain in rural community residents of Korea. Spine. 2012;37(24):2001–10. doi:10.1097/brs.0b013e31825d1fa8

Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, Owens DK. Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478–91. doi:10.7326/0003-4819-147-7-200710020-00006

Cohen SP, Mao J. Neuropathic pain: Mechanisms and their clinical implications. The BMJ. 2014;348(348):f7656. doi:10.1136/bmj.g2323

Delitto A, Patterson CG, Stevans JM, Freburger JK, Khoja SS, Schneider MJ, Greco CM, Freel JA, Sowa GA, Wasan AD, et al. Stratified care to prevent chronic low back pain in high-risk patients: The target trial. A multi-site pragmatic cluster randomized trial. EClinicalMedicine. 2021;34:100795. doi:10.1016/j.eclinm.2021.100795

Donohue JM, Pincus HA. Reducing the societal burden of depression. Pharmacoeconomics. 2007;25(1):7–24. doi:10.2165/00019053-200725010-00003

Eksi MS, Kara M, Özcan-Eksi EE, Aytar MH, Güngör A, Özgen S, Pamir MN. Is diabetes mellitus a risk factor for modic changes? A novel model to understand the association between intervertebral disc degeneration and end-plate changes. J Orthop Sci. 2020;25(4):571–5. doi:10.1016/j.jos.2019.09.005

El Mansy Y, Migliorini F, Tingart M, Madarassy G. Minimally versus conventional-invasive transforaminal lumbar interbody fusion in patients with failed back surgery syndrome. Musculoskelet Surg. 2020;105(3):297–302. doi:10.1007/s12306-020-00659-7

Fakhri S, Abbaszadeh F, Jorjani M. On the therapeutic targets and pharmacological treatments for pain relief following spinal cord injury: A mechanistic review. Biomed Pharmacother. 2021;139:111563. doi:10.1016/j.biopha.2021.111563

Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int. 2019 Mar 8;39(4):619–26. doi:10.1007/s00296-019-04273-0

Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, et al. Prevention and treatment of low back pain: Evidence, challenges, and promising directions. The Lancet. 2018;391(10137):2368–83. doi:10.1016/s0140-6736(18)30489-6

Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, Castel LD, Kalsbeek WD, Carey TS. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251–8. doi:10.1001/archinternmed.2008.543

Fu JL, Perloff MD. Pharmacotherapy for spine-related pain in older adults. Drugs & Aging. 2022;39(7):523–50. doi:10.1007/s40266-022-00946-x

Ghosh R, Alajbegovic A, Gomes AV. NSAIDs and cardiovascular diseases: Role of reactive oxygen species. Oxid Med Cell Longev. 2015;2015:1–25. doi:10.1155/2015/536962

Gold SM, Köhler-Forsberg O, Moss-Morris R, Mehnert A, Miranda JJ, Bullinger M, Steptoe A, Whooley MA, Otte C. Comorbid depression in medical diseases. Nat Rev Dis Primers. 2020;6(1):69. doi:10.1038/s41572-020-0200-2

Gros M, Gros B, Mesonero JE, Latorre E. Neurotransmitter dysfunction in irritable bowel syndrome: Emerging approaches for management. J Clin Med. 2021;10(15):3429. doi:10.3390/jcm10153429

Grotle M, Brox JI, Vøllestad NK. Functional status and disability questionnaires: What do they assess? Spine. 2005;30(1):130–40. doi:10.1097/01.brs.0000149184.16509.73

Grover S, Sarkar S, Avasthi A. Management of systemic medical emergencies associated with psychotropic medications. Indian J Psychiatry. 2022;64(8):S252–80. doi:10.4103/indianjpsychiatry.indianjpsychiatry_1014_21

Henschke N, Lorenz E, Pokora R, Michaleff ZA, Quartey JNA, Oliveira VC. Understanding cultural influences on back pain and back pain research. Best Pract Res Clin Rheumatol. 2016;30(6):1037–49. doi:10.1016/j.berh.2017.08.004

Hossain A. Prevalence and occupational factors associated with low back pain among the female garment workers: A cross-sectional study in Bangladesh. J Glob Health Perspect. 2018;2(1):1–8. doi:10.26535/gpms.v2i1.10

Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, et al. The global burden of low back pain: Estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74. doi:10.1136/annrheumdis-2013-204428

Hu B, Ning X. The changes of trunk motion rhythm and spinal loading during trunk flexion and extension motions caused by lumbar muscle fatigue. Ann Biomed Eng. 2015;43(9):2112–9. doi:10.1007/s10439-015-1248-0

Ishtiak-Ahmed K, Liu X, Christensen KS, Gasse C. Treatment indications and potential off-label use of antidepressants among older adults: A population-based descriptive study in Denmark. Int J Geriatr Psychiatry. 2022;37(12):1–11. doi:10.1002/gps.5841

Jo H, Lim O, Ahn Y-S, Chang S, Koh S-B. Negative impacts of prolonged standing at work on musculoskeletal symptoms and physical fatigue: The fifth Korean Working Conditions Survey. Yonsei Med J. 2021;62(6):510–9. doi:10.3349/ymj.2021.62.6.510

Ketenci A, Zure M. Pharmacological and non-pharmacological treatment approaches to chronic lumbar back pain. Turk J Phys Med Rehabil. 2021;67(1):1–10. doi:10.5606/tftrd.2021.8216

Khan JS, Ladha KS, Abdallah F, Clarke H. Treating persistent pain after breast cancer surgery. Drugs. 2019;80(1):23–31. doi:10.1007/s40265-019-01227-5

Kim S, Rush BS, Rice TR. A systematic review of therapeutic ketamine use in children and adolescents with treatment-resistant mood disorders. Eur Child Adolesc Psychiatry. 2020;30(10):1485–501. doi:10.1007/s00787-020-01542-3

Knoop J, Esser J, Dekker J, de Joode JW, Ostelo RWJG, van Dongen JM. No evidence for stratified exercise therapy being cost-effective compared to usual exercise therapy in patients with knee osteoarthritis: Economic evaluation alongside Cluster Randomized Controlled Trial. Braz J Phys Ther. 2023;27(1):100469. doi:10.1016/j.bjpt.2022.100469

Kuukkanen T, Mälkiä E. Muscular performance after a 3 month progressive physical exercise program and 9 month follow-up in subjects with low back pain. A controlled study. Scand J Med Sci Sports. 1996;6(2):112–21. doi:10.1111/j.1600-0838.1996.tb00078.x

Leuchter AF, Cook IA, Hunter AM, Korb AS. A new paradigm for the prediction of antidepressant treatment response. Dialogues Clin Neurosci. 2009;11(4):435–46. doi:10.31887/dcns.2009.11.4/afleuchter

Lewis J, Hernández D, Geronimus AT. Energy efficiency as energy justice: Addressing racial inequities through investments in people and places. Energy Effic. 2019;13(3):419–32. doi:10.1007/s12053-019-09820-z

Maher C, Underwood M, Buchbinder R. Non-specific low back pain. The Lancet. 2017;389(10070):736–47. doi:10.1016/s0140-6736(16)30970-9

Major-Hesloot M, Crous L, Grimmers-Somers K, Louw Q. Management of LBP at primary care level in South Africa: Up to standards? Afr Health Sci. 2014;14(3):698–706. doi:10.4314/ahs.v14i3.28

Mei Q, Li C, Yin Y, Wang Q, Wang Q, Deng G. The relationship between the psychological stress of adolescents in school and the prevalence of chronic low back pain: A cross-sectional study in China. Child Adolesc Psychiatry Ment Health. 2019;13(1):1–10. doi:10.1186/s13034-019-0283-2

Migliorini F, Maffulli N, Eschweiler J, Betsch M, Catalano G, Driessen A, Tingart M, Baroncini A. The pharmacological management of chronic lower back pain. Expert Opin Pharmacother. 2021;22(1):109–19. doi:10.1080/14656566.2020.1817384

Mikocka-Walus A, Ford AC, Drossman DA. Antidepressants in inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2020;17(3):184–92. doi:10.1038/s41575-019-0259-y

Nicol V, Verdaguer C, Daste C, Bisseriex H, Lapeyre É, Lefèvre-Colau MM, Rannou F, Rören A, Facione J, Nguyen C. Chronic low back pain: A narrative review of recent international guidelines for diagnosis and conservative treatment. J Clin Med. 2023;12(4):1685. doi:10.3390/jcm12041685

Obata H. Analgesic mechanisms of antidepressants for neuropathic pain. Int J Mol Sci. 2017;18(11):2483. doi:10.3390/ijms18112483

Rodriguez CS. Pain measurement in the elderly: A Review. Pain Manag Nurs. 2001;2(2):38–46. doi:10.1053/jpmn.2001.23746

Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2008 Jan 23;2011(2):CD000396. doi:10.1002/14651858.cd000396.pub3

Rossignol M, Poitras S, Dionne C, Tousignant M, Truchon M, Arsenault B, Allard P, Coté M, Neveu A. An interdisciplinary guideline development process: The clinic on low-back pain in interdisciplinary practice (clip) low-back pain guidelines. Implement Sci. 2007;2(1):1–8. doi:10.1186/1748-5908-2-36

Roughan WH, Campos AI, García-Marín LM, Cuéllar-Partida G, Lupton MK, Hickie IB, Medland SE, Wray NR, Byrne EM, Ngo TT, et al. Comorbid chronic pain and depression: Shared risk factors and differential antidepressant effectiveness. Front Psychiatry. 2021;12:643609. doi:10.3389/fpsyt.2021.643609

Sanchis-Sánchez E, Lluch-Girbés E, Guillart-Castells P, Georgieva S, García-Molina P, Blasco J-M. Effectiveness of mechanical diagnosis and therapy in patients with non-specific chronic low back pain: A literature review with Meta-analysis. Braz J Phys Ther. 2021;25(2):117–34. doi:10.1016/j.bjpt.2020.07.007

Schnitzer TJ, Ferraro A, Hunsche E, Kong SX. A comprehensive review of clinical trials on the efficacy and safety of drugs for the treatment of low back pain. J Pain Symptom Manage. 2004;28(1):72–95. doi:10.1016/j.jpainsymman.2003.10.015

Scholz J, Finnerup NB, Attal N, Aziz Q, Baron R, Bennett MI, Benoliel R, Cohen M, Cruccu G, Davis KD, et al. The IASP classification of chronic pain for ICD-11: Chronic neuropathic pain. Pain. 2019;160(1):53–9. doi:10.1097/j.pain.0000000000001365

Shiri R, Coggon D, Falah-Hassani K. Exercise for the prevention of low back pain: Systematic review and meta-analysis of controlled trials. Am J Epidemiol. 2017;187(5):1093–101. doi:10.1093/aje/kwx337

Simon J, McAuliffe M, Shamim F, Vuong N, Tahaei A. Discogenic low back pain. Phys Med Rehabil Clin N Am. 2014;25(2):305–17. doi:10.1016/j.pmr.2014.01.006

Sudhir G, Jayabalan V, Sellayee S, Gadde S, Kailash K. Is there an interdependence between paraspinal muscle mass and lumbar disc degeneration? A MRI based study at 2520 levels in 504 patients. J Clin Orthop Trauma. 2021;22:101576. doi:10.1016/j.jcot.2021.101576

Sundell C, Bergström E, Larsén K. Low back pain and associated disability in Swedish adolescents. Scand J Med Sci Sports. 2018;29(3):393–9. doi:10.1111/sms.13335

Suri P, Stanaway IB, Zhang Y, Freidin MB, Tsepilov YA, Carrell DS, Williams FM, Aulchenko YS, Hakonarson H, Namjou B, et al. Genome-wide association studies of low back pain and lumbar spinal disorders using electronic health record data identify a locus associated with lumbar spinal stenosis. Pain. 2021;162(8):2263–72. doi:10.1097/j.pain.0000000000002221

Theberath M, Bauer D, Chen W, Salinas M, Mohabbat AB, Yang J, Chon TY, Bauer BA, Wahner-Roedler DL. Effects of covid-19 pandemic on Mental Health of Children and Adolescents: A systematic review of Survey Studies. SAGE Open Med. 2022;10:205031212210867. doi:10.1177/20503121221086712

Tu Y, Fu Z, Mao C, Falahpour M, Gollub RL, Park J, Wilson G, Napadow V, Gerber J, Chan ST, et al. Distinct thalamocortical network dynamics are associated with the pathophysiology of chronic low back pain. Nat Commun. 2020;11(1):3948. doi:10.1038/s41467-020-17788-z

Umeda M, Kim Y. Gender differences in the prevalence of chronic pain and leisure time physical activity among us adults: A NHANES study. Int J Environ Res Public Health. 2019;16(6):988–99. doi:10.3390/ijerph16060988

Urits I, Peck J, Orhurhu MS, Wolf J, Patel R, Orhurhu V, Kaye AD, Viswanath O. Off-label antidepressant use for treatment and management of chronic pain: Evolving understanding and comprehensive review. Curr Pain Headache Rep. 2019;23:66–76. doi:10.1007/s11916-019-0803-z

van Dongen JM, Ketheswaran J, Tordrup D, Ostelo RWJG, Bertollini R, van Tulder MW. Health economic evidence gaps and methodological constraints in low back pain and neck pain: Results of the Research Agenda for Health Economic Evaluation (RAHEE) project. Best Pract Res Clin Rheumatol. 2016;30(6):981–93. doi:10.1016/j.berh.2017.09.001

Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, Blyth FM, Smith E, Buchbinder R, Hoy D. Global low back pain prevalence and years lived with disability from 1990 to 2017: Estimates from the global burden of disease study 2017. Ann Transl Med. 2020;8(6):299–299. doi:10.21037/atm.2020.02.175

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