Chronic Back Pain

Cost-effectiveness of spinal manipulation, exercise, and self-management for spinal pain.

Leininger BD, Kuntz KM, Hodges JS, Evans R, Enns E, Johnson PJ · Chiropractic & manual therapies · 2025 · n=1803

The United States spends more money on the care of back and neck pain than any other health condition. Despite this, the cost-effectiveness for many recommended treatments is unclear. Our primary objective for this project was to estimate the cost-effectiveness of spinal manipulative therapy (SMT), supervised exercise therapy (ET), and home exercise and advice (HEA) for spinal pain in the U.S. We analyzed cost and clinical outcome data from eight randomized trials conducted in the U.S. using an individual participant data meta-analysis approach. We calculated cost-effectiveness from the societal and healthcare perspective of various comparisons between SMT, ET, and HEA. Incremental cost-effectiveness ratios (ICERs) were calculated using quality-adjusted life years as the main outcome. The trials included a total of 1803 participants and 1488 (83%) provided complete data. Incremental cost-effectiveness ratios and probabilities of cost-effectiveness varied substantially between studies

Causal effects of psychosocial factors on chronic back pain: a bidirectional Mendelian randomisation study.

Williams FMK, Elgaeva EE, Freidin MB, Zaytseva OO, Aulchenko YS, Tsepilov YA · European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2022

Risk factors for chronic back pain (CBP) may share underlying genetic factors, making them difficult to study using conventional methods. We conducted a bi-directional Mendelian randomisation (MR) study to examine the causal effects of risk factors (education, smoking, alcohol consumption, physical activity, sleep and depression) on CBP and the causal effect of CBP on the same risk factors. Genetic instruments for risk factors and CBP were obtained from the largest published genome-wide association studies (GWAS) of risk factor traits conducted in individuals of European ancestry. We used inverse weighted variance meta-analysis (IVW), Causal Analysis Using Summary Effect (CAUSE) and sensitivity analyses to examine evidence for causal associations. We interpreted exposure-outcome associations as being consistent with a causal relationship if results with IVW or CAUSE were statistically significant after accounting for multiple statistical testing (p < 0.003), and the d

Genome-Wide Association Study of Opioid Cessation.

Cox JW, Sherva RM, Lunetta KL, Johnson EC, Martin NG, Degenhardt L · Journal of clinical medicine · 2020

The United States is experiencing an epidemic of opioid use disorder (OUD) and overdose-related deaths. However, the genetic basis for the ability to discontinue opioid use has not been investigated. We performed a genome-wide association study (GWAS) of opioid cessation (defined as abstinence from illicit opioids for >1 year or <6 months before the interview date) in 1130 African American (AA) and 2919 European ancestry (EA) participants recruited for genetic studies of substance use disorders and who met lifetime Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for OUD. Association tests performed separately within each ethnic group were combined by meta-analysis with results obtained from the Comorbidity and Trauma Study. Although there were no genome-wide significant associations, we found suggestive associations with nine independent loci, including three which are biologically relevant: rs4740988 in PTPRD (pAA + EA = 2.24 × 10-6), rs3

A Systematic Review of the Effect of Arts-Based Interventions on Patient Care in Nigeria.

Oladeji EO, Ezeme C, Bamigbola S · Cureus · 2022 · n=541

The utilization of art for therapeutic purposes in the formal healthcare setting is gradually gaining prominence in Nigeria. However, there is a paucity of evidence on the effectiveness of these interventions. Therefore, we explored the pooled effect of the various arts-based interventions in managing clinical disorders in hospitalized and out-patients in Nigeria. An electronic search of PubMed, African Journal Online, Web of Science, Google Scholar, Cochrane Library, and Scopus databases was carried out from the inception of the databases to October 31, 2021. Three researchers using Rayyan QCRI software independently screened and de-duplicated the identified studies. Eight eligible studies were selected for this review, with a total of 541 participants. The earliest study was published in 2012. Seven of the eight studies were conducted in the Southern part of Nigeria. There were four quasi-experimental studies, two randomized controlled trials, and two comparative cross-sectional stud

Systematic Literature Review of Spinal Cord Stimulation in Patients With Chronic Back Pain Without Prior Spine Surgery.

Eckermann JM, Pilitsis JG, Vannaboutathong C, Wagner BJ, Province-Azalde R, Bendel MA · Neuromodulation : journal of the International Neuromodulation Society · 2022

Low back pain is the leading cause of disability worldwide and one of the most common reasons for seeking healthcare. Despite numerous care strategies, patients with low back pain continue to exhibit poor outcomes. Spinal cord stimulation (SCS) is an evidence-based therapeutic modality for patients with failed back surgery syndrome. For patients without a surgical lesion or history, minimally invasive interventions that provide long-term reduction of chronic back pain are needed. Therefore, we conducted a systematic review of the evidence on SCS therapy in patients with chronic back pain who have not undergone spinal surgery. A systematic literature search was performed to identify studies reporting outcomes for SCS in chronic back pain patients (with or without secondary radicular leg pain) without prior surgery using date limits from database inception to February 2021. Study results were analyzed and described qualitatively. A total of ten primary studies (16 publications) were in

Anxiety and depression in spine surgery-a systematic integrative review.

Strøm J, Bjerrum MB, Nielsen CV, Thisted CN, Nielsen TL, Laursen M · The spine journal : official journal of the North American Spine Society · 2018 · n=26

Symptoms of preoperative anxiety and depression occur in approximately one-third of patients with chronic back pain undergoing surgery. In the last 2 decades, several studies have established that preoperative anxiety and depression are important outcome predictors of greater pain and physical impairments, and lower health-related quality of life in patients undergoing spine surgery. To accommodate symptoms of anxiety and depression and thereby better surgical outcomes, we need to identify factors associated with these symptoms. We aimed to identify factors associated with symptoms of anxiety and depression in adults both before and after undergoing spinal surgery. An integrative literature review was carried out. The independent charity Helsefonden supported this literature review by contributing $45,000 to remunerate a dedicated investigator. A systematic literature search was conducted in PubMed, CINAHL, PsycINFO, Embase, Scopus, Cochrane, and Web of Science. A three-step selecti

Low back pain and sciatica in over 16s: assessment and management

NICE

This guideline covers assessing and managing low back pain and sciatica in people aged 16 and over. It offers recommendations on non-invasive and invasive treatments, patient education, and when to refer for specialist opinion.

Paddle leads for the treatment of nonsurgical back pain-The DISTINCT study.

Falowski S, Dorsi MJ, Heros R, Sales R, Tavel E, Lansford T · Pain practice : the official journal of World Institute of Pain · 2025 · n=50

DISTINCT is a randomized controlled trial evaluating passive recharge burst SCS compared with CMM in improving pain and pain-related physical function in patients suffering from chronic back pain without prior lumbar surgery, and for whom corrective surgery is not an option. Sub-analyses of outcome measures are presented for a subset implanted with paddle leads at both 6 and 12 months. To investigate the treatment effect of using BurstDR-capable SCS in nonsurgical low back pain (NSLBP) patients with paddle leads. An independent board-certified spine surgeon reviewed each case, confirming a lack of corrective surgical options. Out of 29 sites and 115 implants, 10 sites implanted 50 patients with paddle leads. Primary and secondary endpoints assessed improvements in low back pain intensity (NRS), low back pain-related disability (ODI), pain catastrophizing (PCS), and patient global impression of change (PGIC). Data for patients with NSLBP and implanted with paddle leads are ava

ECAP-Controlled Closed-Loop Spinal Cord Stimulation for Chronic Nonsurgical Refractory Back Pain: Subgroup Analysis From Two Prospective Multicenter Clinical Trials.

Hunter CW, Raskin JS, Mekhail NA, Petersen EA, Lad SP, Pope JE · Spine · 2025 · n=68

Subgroup analysis of patients with chronic nonsurgical refractory back pain (NSRBP) from two prospective multicenter clinical trials to 12-month follow-up. To evaluate pain-related and holistic response, safety events as well as neurophysiological metrics associated with the use of evoked compound action potential (ECAP)-controlled closed-loop spinal cord stimulation (SCS) for patients with chronic back pain without prior surgery. Innovations in SCS such as the development of physiological ECAP-controlled closed-loop SCS overcome limitations of traditional, fixed-output SCS for the treatment of NSRBP. The outcomes of closed-loop SCS to 12-month follow-up for patients with NSRBP have not been previously reported. Patient-reported outcome measures for pain intensity, physical function, health-related quality of life, sleep quality, and emotional function were collected from 68 patients with NSRBP in two prospective multicenter clinical trials. Change in opioid use, its reduction or el

Impact of the digital health application ViViRA on spinal mobility, physical function, quality of life and pain perception in spondyloarthritides patients: a randomized controlled trial.

Blaskowitz PPVA, Liphardt AM, Bouzas C, Coppers B, Petit P, Vuillerme N · Arthritis research & therapy · 2024 · n=59

Spondyloarthritides (SpAs) are a group of common rheumatic diseases that often cause limited mobility and lower back pain. Physiotherapy is an integral part of treatment, but access to physiotherapy limits treatment success. Digital health applications (DHAs) enable home-based physiotherapy and could significantly improve access for SpAs patients. The aim is to investigate the clinical effects of the DHA ViViRA compared with those of standard physiotherapy. SpAs patients with chronic back pain were enrolled in a randomized controlled trial. The intervention group received ViViRA DHA, whereas the control group received standard physiotherapy. Pain (verbal rating scale, PAIN-Detect), quality of life (SF-36) and mobility (BASMI) were assessed at baseline and after 12 weeks as the primary outcomes. Data from 59 participants (71.2% female, mean age 45.2 years) were analyzed. The intervention group showed a significant improvement in mobility (average BASMI score: baseline: 1.1 [range 0.7-

A Systematic Review of Pain Catastrophizing and Chronic Musculoskeletal Pain.

Shimada S, Doorenbos AZ, Goldstein E, Wi D · Pain management nursing : official journal of the American Society of Pain Management Nurses · 2026

This study was designed to synthesize recent randomized controlled trials examining the associations between pain catastrophizing and four key pain-related outcomes (i.e., pain intensity, disability, pain interference, and physical function) among adults with chronic musculoskeletal pain. This review clarifies the role of pain catastrophizing in pain outcomes to inform targeted interventions. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cumulative Index of Nursing and Allied Health Literature, PubMed, Excerpta Medica Database, PsycINFO, Scopus, and Web of Science were searched. The key search terms "pain catastrophizing," "chronic musculoskeletal pain," and "pain-related outcomes" were combined to find randomized controlled trials published in English from October 2018 to 2024 and study quality was assessed using the revised Cochrane Risk-of-Bias tool for randomized trials. The data were descriptive

Associations of body fat and inflammation with non-communicable chronic diseases and mortality: a prospective cohort study of the UK Biobank.

Wiebe N, Tonelli M · BMJ open · 2025 · n=107

Certain leading medical organisations are considering alternatives to the Body Mass Index (BMI) as a predictor of the risk for non-communicable chronic disease (NCD) or death. Our objective was to evaluate the associations between various measures of body fat and the risk of incident NCDs or mortality, independent of inflammation. Population-based prospective cohort study (the UK Biobank cohort). The UK. Adults (aged between 40 and 69 years) were accrued between March 2006 and October 2010 and followed until December 2022. There were 500 107 participants: the median age was 58 years (IQR 50-63) at baseline, 45.6% were male and 94.7% were white. BMI, waist-to-hip ratio (WHR), body fat percentage measured by bioimpedance analysis (BIA; fatBIA), C-reactive protein (CRP) and various other measures of body fat obtained by dual-energy X-ray absorptiometry (DXA; including visceral adipose tissue (VAT)) and magnetic resonance imaging (MRI). All-cause death, cardiovascular disease (

Intermuscular adipose tissue and lean muscle mass assessed with MRI in people with chronic back pain in Germany: a retrospective observational study.

Ziegelmayer S, Häntze H, Mertens C, Busch F, Lemke T, Kather JN · The Lancet regional health. Europe · 2025 · n=12

Chronic back pain (CBP) affects over 80 million people in Europe, contributing to substantial healthcare costs and disability. Understanding modifiable risk factors, such as muscle composition, may aid in prevention and treatment. This study investigates the association between lean muscle mass (LMM) and intermuscular adipose tissue (InterMAT) with CBP using noninvasive whole-body magnetic resonance imaging (MRI). This cross-sectional analysis used whole-body MRI data from 30,868 participants in the German National Cohort (NAKO), collected between 1 May 2014 and 1 September 2019. CBP was defined as back pain persisting >3 months. LMM and InterMAT were quantified via MRI-based muscle segmentations using a validated deep learning model. Associations were analyzed using mixed logistic regression, adjusting for age, sex, diabetes, dyslipidemia, osteoporosis, osteoarthritis, physical activity, and study site. Among 27,518 participants (n = 12,193/44.3% female, n = 14,605/55.7% male; me

Chronic Pain: In Depth

NCCIH

This NCCIH resource provides in-depth information on chronic pain, including various complementary health approaches.

Back pain

NHS

The NHS provides an overview of back pain, covering common causes, self-care advice, and when to seek medical help. It includes information on exercises and treatment options available in the UK.

Low back pain

WHO

The World Health Organization provides an overview of low back pain as a major public health problem globally. It highlights the burden of the condition and efforts towards its prevention and management.

MC5-A Scrambler Therapy for the Treatment of Chronic Neuropathic Extremity Pain

n=58 · NCT02701075 · UNKNOWN · UNKNOWN

The FDA-approved MC5-A Scrambler Therapy (MC5-A ST) is an electroanalgesia device that interferes with pain signal transmission by using nerve fibers as a passive means to convey a message of normality (sans pain) to the central nervous system. While preliminary research has demonstrated its efficacy in treating chronic neuropathic pain secondary to cancer and failed back surgery syndrome, its effectiveness in treating chronic neuropathic pain secondary to traumatic musculoskeletal injuries like those experienced in combat has not been investigated. The purpose of this prospective, double-blind, randomized controlled, study is to determine if the MC5-A ST is efficacious in altering the biological, psychological, and social components of the chronic neuropathic pain experience in military Service Members (SMs) with traumatic musculoskeletal extremity injuries.

Effectiveness of Pressure Release Technique in Patients With Chronic Low Back Pain

n=16 · NCT04326621 · UNKNOWN · UNKNOWN

A Pressure Release Technique will be test in patient with low back pain compared to a sham

Randomized Controlled Trial of Mindfulness Meditation and Cognitive Behavioral Therapy Intervention for Opioid-treated Chronic Low Back Pain

n=35 · NCT01775995 · COMPLETED · COMPLETED

Chronic low back pain (CLBP) is one of the most common, costly and disabling conditions. It is often refractory to treatment, with patients requiring long-term opioid therapy. Mindfulness meditation is a promising treatment for chronic pain, mental health and addictive disorders. When combined with cognitive behavioral therapy (CBT), a standard of care for CLBP, it may produce additive benefits. The goal of this randomized controlled trial (RCT) is to evaluate the feasibility and efficacy of an innovative behavioral intervention to improve the health of adults with opioid-treated CLBP. This RCT will test the hypotheses that, at 26 weeks, meditation-CBT group participants (meditation-CBT + usual care), compared to those in a wait-list control group (usual care alone), will improve health-related quality of life (primary outcomes: pain severity and physical function) and reduce opioid medication use (secondary outcome). In addition, they will also decrease alcohol and drug use/misuse, and improve stress-sensitive measures and economic outcomes.

Chronic back pain

TRIP Database

TRIP Database is a clinical search engine designed to allow users to quickly and easily find high-quality research evidence to support their practice.

Cochrane reviews on chronic low back pain

Cochrane

Cochrane provides systematic reviews of primary research in human health care and health policy, offering high-quality, relevant, and up-to-date evidence.

Chronic low back pain

TRIP Database

TRIP Database offers a comprehensive search engine for clinical evidence, including guidelines, systematic reviews, and research for chronic low back pain.