Search Results (663)

Background and objectives: Pain neuroscience education (PNE) is a therapeutic strategy aimed at reconceptualizing pain in patients with chronic low back pain (CLBP). This systematic review with a meta-analysis (SRMA) aimed to assess the effectiveness of PNE in reducing pain, disability, kinesiophobia, and catastrophizing in patients with CLBP at the end of the intervention, and at 1 and 3 months of follow-up. Materials and Methods: Following PRISMA guidelines, an SRMA was conducted after searching in PubMed Medline, Scopus, Web of Science, and PEDro databases from inception up to June 2025. The inclusion criteria agreed with the PICOS tool: population (patients with CLBP), intervention (PNE), comparator (physiotherapy or non-intervention), outcomes (pain, disability, kinesiophobia, and catastrophizing), and study design (randomized controlled trials (RCTs) and pilot RCTs). The PEDro scale was used to assess the methodological quality and risk of bias of the RCTs included. The pooled effect was assessed using the Cohen standardized mean difference (SMD) and its 95% confidence interval (95% CI) in a random-effects model. Results: Fifteen RCTs, including data from 810 patients (43.7 ± 5.2 years; 61% female) with CLBP were included. The mean methodological quality of the RCTs included was good (6.8 ± 1.1 on the PEDro scale). Selection, performance, and detection were the most important biases identified. Our meta-analysis demonstrated, at the end of the intervention, and at 1 and 3 months of follow-up, respectively, that PNE is effective in reducing pain intensity (SMD = −0.65, p = 0.005; SMD = −1.1, p < 0.001; SMD = −1; p < 0.001), disability (SMD = −0.6, p = 0.009; SMD = −0.78, p = 0.002; SMD = −0.84; p = 0.004), and kinesiophobia (SMD = −1.12, p < 0.001; SMD = −1.51, p < 0.001; SMD = −1.57; p = 0.001). In reducing catastrophizing, PNE was largely effective at the end of intervention (SMD = −0.9, p = 0.016) and at 1 month of follow-up (SMD = −1.36, p = 0.007). Conclusions: Our findings demonstrate that PNE is an effective therapeutic approach for the management of CLBP, reducing pain, disability, kinesiophobia, and catastrophizing in patients with CLBP. Full article

Chronic pain is a pervasive global health issue that significantly impairs quality of life and remains inadequately managed by current therapeutic options. Traditional pharmacological treatments often offer limited relief and are associated with significant side effects, highlighting the urgent need for safer and more effective alternatives. Among emerging strategies, mesenchymal stem cell (MSC)-derived secretome, an acellular product composed of bioactive molecules such as cytokines, growth factors and extracellular vesicles, has gained increasing attention for its potent anti-inflammatory, neuroprotective and immunomodulatory properties. Unlike whole-cell therapies, secretome-based interventions offer advantages, including lower immunogenicity, higher safety and easier standardization and storage. Preclinical studies demonstrated that MSC secretome effectively alleviates pain-like behavior across various models of neuropathic, inflammatory and degenerative pain, primarily through neuroimmune modulation and glial cell reprogramming. In vitro experiments confirm its role in promoting neuronal survival, regulating opioid receptor expression and modulating (neuro)inflammatory responses. Preliminary clinical evidence supports its analgesic efficacy in conditions such as osteoarthritis, chronic low back pain and post-surgical pain, with a favorable safety profile and promising therapeutic outcomes. However, challenges remain, including variabilities in secretome composition, lack of standardized production protocols and absence of large-scale clinical trials. Despite these limitations, MSC secretome therapy represents a transformative approach in pain medicine. Continued research efforts are essential to optimize formulation, dosing and delivery strategies, as well as to clarify the regulatory landscape. With further validation, the MSC secretome could emerge as a novel, scalable and clinically viable solution for the management of chronic pain, bridging critical gaps in current treatment paradigms. Full article

Introduction: Persistent Spinal Pain Syndrome Type 2 (PSPS-T2) is associated with changes in the brain’s pain processing. This is often due to problems with the body’s natural way of handling the pain management system. Exercise therapy, such as motor control and spinal stabilization, can help reduce pain and disability. However, exercise alone may not be sufficient. Approaches that consider both body mechanics and brain function are gaining popularity. Since brain changes play a role in muscle and bone problems, noninvasive brain stimulation (NIBS) is considered a helpful adjunctive treatment. Studies have shown that NIBS may help people with spinal pain and mood disorders. The aim of this study is to assess the impact of combining tDCS targeting the dorsolateral prefrontal cortex with spinal motor control exercises in patients diagnosed with PSPS-T2. This investigation is based on the hypothesis that such a combined intervention could result in a more significant reduction in disability. Methods/Materials: This randomized controlled trial (RCT) is structured as a double-blind, comparative, longitudinal design in accordance with the CONSORT guidelines. This RCT has been registered at ClinicalTrials.gov (NCT06969456). Forty-two participants diagnosed with PSPS-T2 will be randomized in a 1:1 ratio into two groups: tDCS + rehabilitation (E_tDCS) or sham tDCS + rehabilitation (E_SHAM). The intervention will use tDCS to deliver low-intensity direct current to modulate cortical excitability. The intervention will consist of 24 supervised sessions (2 per week, 60 min each) over 12 weeks. Neuromodulation and exercise protocols will be adapted to the intervention phases based on previous research. The sample size has been calculated using GPower^®, assuming an effect size of 0.81, α = 0.05, power = 0.95, and a 40% dropout rate. Data will be collected from October 2025 to January 2027. Impact Statement: This study integrates neurophysiological modulation via tDCS with targeted exercise therapy, presenting an innovative approach to enhance pain modulation, functional recovery, and cortical reorganization in patients with PSPT-2. This approach has the potential to inform future evidence-based strategies for neurorehabilitation and pain management. Full article

Background/Objectives: Sacroiliitis is a painful inflammatory disorder of the sacroiliac joint, estimated to account for up to 25% of chronic low back pain. Treatment options are often limited, and many patients continue to experience symptoms despite conservative or interventional management. High-Intensity Focused ultrasound (HIFU) has emerged as a novel noninvasive neuromodulation technique. However, the contribution of individual lumbosacral nerve branches (L5–S3) to pain generation during such interventions remains unclear. This study aimed to characterize the distribution of pain-related interruptions during HIFU procedures, with a particular focus on identifying the most pain-sensitive targets. Methods: Eight patients with clinically confirmed sacroiliitis underwent HIFU ablation targeting the L5–S3 branches. Procedural data, including the total number of sonications and interruptions due to pain, were prospectively recorded. Statistical analyses were performed using chi-square tests, including overall distribution testing, pairwise branch comparisons, and an aggregated comparison of S3 versus all other branches combined. Effect sizes were calculated using Cohen’s w. Results: Across 243 sonications, 162 interruptions (66.7%) occurred due to pain. Interruptions were unevenly distributed: 81% occurred at S2 and S3, with S3 alone accounting for 42%. S3 showed significantly more interruptions than L5 (p = 0.0022), S1 (p = 0.0150), S2 (p = 0.0055), and all other branches combined (p < 0.001; w = 0.58, large effect). S2 also demonstrated greater sensitivity than L5 (p = 0.003) and S1 (p = 0.001). Subdivision analysis revealed uniformly high sensitivity across S3, whereas S1 and S2 displayed heterogeneous patterns. Conclusions: HIFU stimulation revealed disproportionate pain sensitivity in sacral branches, with S3—and to a lesser extent S2—emerging as dominant contributors. These findings provide new insight into sacroiliitis pathophysiology and suggest prioritization of S3 in targeted interventional management. Full article

Chronic low back pain (cLBP) is a pervasive and debilitating condition that can result in motor control deficits and often leads to opioid dependence. Conventional rehabilitation approaches generally rely on internally driven tasks, which fail to capture adaptive motor responses to external perturbations. This study focuses on the design and evaluation of a pneumatic-actuated active balance board integrating pneumatic artificial muscles (PAMs), electromyography (EMG), and inertial measurement units (IMUs) to assess seated postural control responses. With PAM-powered perturbations, the balance board introduces controlled challenges to evaluate postural control dynamics and motor adaptation. EMG sensors monitor muscle activity in key postural muscles, while IMU systems track movement responses. The system was evaluated through an experimental trial with 15 healthy participants performing balance tasks on both a passive and active balance board. The active balance board’s effectiveness is assessed using signal processing techniques, including root mean square (RMS) analysis, Fast Fourier Transform (FFT), autoregressive (AR) modeling, and the Welch t-test. Experimental trials were conducted with healthy participants to establish baseline performance. Results demonstrate that the active balance board successfully induces adaptive motor responses, with higher EMG activation levels compared to passive boards. Frequency-domain analyses confirm significant differences in muscle activation patterns, supporting the hypothesis that external perturbations enhance postural control retraining. The pneumatic-actuated balance board presented in this study represents a novel approach to postural control assessment that may be applied in future rehabilitation studies involving individuals with cLBP, addressing the limitations of traditional methods. Future research will focus on clinical trials with cLBP patients to further evaluate its therapeutic efficacy and long-term benefits in rehabilitation. Full article

Background: Chronic low back pain (CLBP) patients present with morphological and functional deficits to the lumbar multifidus. Electromyostimulation (EMS) can be used to improve activation and strength in atrophied skeletal muscle, but its effect on multifidus morphology and function in CLBP patients is understudied. The aims of this study were to compare the effect of two EMS protocols on lumbar multifidus morphology, function, and patient-reported outcomes. Methods: Two-arm randomized control trial (RCT). Individuals with CLBP were randomized to receive either the ‘phasic’ or ‘combined’ muscle therapy protocol with the StimaWELL 120MTRS, a medium-frequency EMS device. T-tests and non-parametric equivalents were used to assess change in imaging-based outcomes, and a repeated-measures ANOVA was used for patient-reported outcomes. Results: Apart from a significant within-group decrease in fatty infiltration at left L5-S1 in the combined group (MD = −1.51, 95% CI = −2.79, −0.23, p = 0.024), results revealed no significant within- or between-group changes to multifidus morphology or function. Pairwise comparisons revealed that both groups experienced significant improvements in multiple pain outcome measures, with a significant group*time effect for LBP with sitting (p = 0.019) and pain interference (p = 0.032) in favor of the phasic group. Additionally, there were significant improvements in the phasic group in disability, pain interference, and pain catastrophizing (all p < 0.01). Conclusions: A 10-week EMS intervention produced no between-group differences in multifidus muscle morphology or function. Participants in both groups experienced significant improvements in a variety of patient-reported outcomes. Full article

Climate change-related weather extremes and air pollution have wide-ranging health effects, with emerging evidence suggesting a potential influence on pain. This narrative review explores the relationship between climate-related weather parameters/air pollution with pain across various conditions, including chronic and acute musculoskeletal pain, postoperative pain, headache/migraine, dysmenorrhea, and chest pain. Included studies were published in 2014 or later. Findings indicate that higher humidity/dampness may exacerbate pain in individuals with knee osteoarthritis, while extremes in temperature and humidity are linked to a higher risk of gout arthritis attacks. No clinically meaningful associations were found between weather parameters and acute low-back pain. However, lower barometric pressure, elevated temperatures, and possibly higher humidity may influence postoperative pain levels. Headache and migraine episodes were more frequent during heat waves and periods of high humidity or rainfall, as well as in areas with elevated traffic-related air pollutants and particulate matter. Air pollution exposure was also associated with increased risk of dysmenorrhea, while lower temperatures and higher humidity correlated with more severe menstrual cramps. Temperature extremes were linked to chest pain in patients with asthma and other conditions. Overall, this review highlights the disproportionate pain-related burden of climate change and air pollution on women and emphasizes the need for further research. Full article

This study examines the occupational health challenges faced by artisans in Ghana’s Ashanti Region. The study employed a purposive sampling technique to select 425 masons through questionnaires. The data collected included workers’ mass, block weights, and health problems. The analysis identified fourteen health problems, with headaches, muscle pain, lower back pain, chronic pain, and bruises being most prevalent. Artisan weight negatively correlated with weights of 125 mm blocks (r = −0.202, p < 0.01) and 150 mm blocks (r = −0.248, p < 0.01). Additionally, artisan weight showed a negative correlation with working hours (coefficient = −0.133, p < 0.05), as did body weight with resting hours (coefficient = −0.217, p < 0.05). Higher educational qualifications correlated positively with lifting-related health issues (coefficient = 0.259, p = 0.000) and negatively with weather-related issues (coefficient = −0.154, p = 0.002). Moreover, the number of working days per week was positively correlated with lifting problems (coefficient = 0.270, p < 0.05). The study recommends redesigning block sizes to reduce physical strain. Additionally, policy measures such as reducing machinery import taxes are suggested to encourage mechanisation. The study further emphasises the need for training institutions to incorporate occupational health education into artisan training programs. Full article

Objectives: Pilates is frequently recommended for patients with Chronic Nonspecific Low Back Pain (CNLBP) due to its potential to enhance posture, muscle strength, trunk flexibility, and stability. However, to date, there is no robust evidence supporting the effectiveness of Pilates in managing CNLBP. This study aimed to assess the effects of 8 × 8 Pilates Matwork core exercises on pain and functioning in middle-aged adult women with CNLBP, through a flexion relaxation phenomenon (FRP) analysis. Methods: We included middle adult women (n = 21) with diagnosis of CNLBP and a Numeric Rating Scale (NRS) > 4. The experimental group underwent a treatment of eight Pilates Matwork sessions, biweekly for 4 weeks, lasting about 40 min. The control group underwent standardized exercises used for managing CNLBP. Outcome measures included NRS, Oswestry Disability Index (ODI), Quebec Back Pain Disability Scale (QBPDS), and the FRP ratio via surface electromyography during trunk maximum flexion. We evaluated the participants at the baseline (T0), at the end of the 4-week treatment (T1), and at 4 weeks after the end of the treatment, at 8 weeks from the baseline (T2). Results: In this pilot RCT, 21 middle-aged adult women affected by CNLBP were randomly allocated with a ratio of 1:1 in the Pilates group, and in parallel in the control group. The experimental group showed a significant improvement in ODI and QBPDS scores compared to the control group, maintained at follow-up for ODI, along with an NRS reduction at T2. About FRP, Pilates has proven to be comparable to conventional treatment, showing no significant difference in FRR at T1 and T2. Only the experimental group exceeded the 9.5 cutoff at T2, as a protective predictive index for CNLBP. Conclusions: This pilot RCT provided preliminary evidence that Pilates might be an effective rehabilitation method, enhancing functioning and pain management in middle-aged adult women affected by CNLBP. The FRP study proves to be efficient in translating clinical assessments into rehabilitation assessment measures. Full article

A butterfly vertebra is an uncommon but clinically and radiologically significant pathology. The etiological factor of this pathology is a congenital defect in the formation of the vertebral body during embryogenesis, resulting in a cleft within the vertebral body that, in an X-ray, resembles the shape of a butterfly. Butterfly vertebrae are most often found in the thoracic and lumbar spine and more rarely in the sacral region. The clinical manifestations of this condition do not differ from the symptoms of other diseases, and it may also be asymptomatic. Only the recognition of its characteristic radiologic signs allows for accurate and timely diagnosis, as well as differentiation from other pathological processes such as fractures, metastases, and inflammation. In these cases, magnetic resonance imaging is the first-choice method. An important aspect in recognizing this pathology is its correlation with other congenital syndromes, even in cases of a single vertebral defect. We present 2 cases with an isolated S1 butterfly vertebra. The first is a 47-year-old male who presented to the hospital with complaints of chronic pain in the lower back and sacral region, more pronounced on the right side. The second is of a 39-year-old male who also presented to the hospital with chronic pain. All diagnostic modalities for this pathology have been used to demonstrate high-quality pictures, including X-ray, computed tomography (CT), and magnetic resonance imaging (MRI). Full article

Background and Objectives: Chronic low back pain (CLBP) is associated with altered neuromuscular control. Dynamic Neuromuscular Stabilization (DNS) targets core–limb coordination; however, its specific impact on lower-limb electromyographic (EMG) activity during gait remains unclear. Materials and Methods: Fifty-five young adults with non-specific CLBP (pain ≥ 3 months with no identifiable specific pathology) completed the trial (overall mean age 23.7 ± 1.3 years). Participants were randomized to an 8-week DNS program or a control. Pre-/Post-intervention surface EMG during gait and clinical outcomes (VAS, ODI) were assessed. Results: Compared with control, DNS showed lower adjusted Post-test VAS (3.08 ± 0.25 vs. 6.13 ± 0.24; ηp² = 0.596) and ODI (15.73 ± 1.55% vs. 34.36 ± 1.52%; ηp² = 0.579). Directionally, DNS was associated with phase-specific EMG modulation: tibialis anterior during mid-stance was lower (ηp² = 0.137), rectus femoris during push-off was lower (ηp² = 0.119), biceps femoris during push-off was lower (ηp² = 0.168), and vastus medialis at heel-strike was higher (ηp² = 0.077) relative to control. Other muscle–phase pairs showed no adjusted between-group differences. Conclusions: An 8-week DNS program was associated with clinically meaningful reductions in pain and disability and with phase-specific changes in lower-limb EMG during gait. These findings support DNS as a promising rehabilitation option for young adults with CLBP; confirmation in larger trials with active comparators is warranted. Full article

Background: The hemoglobin–albumin–lymphocyte–platelet (HALP) score integrates the immunonutritional and inflammatory status. We evaluated whether baseline HALP predicts the 3-month response after lumbar medial branch radiofrequency ablation (RFA), defined as a Visual Analogue Scale (VAS) reduction of ≥50% and an Oswestry Disability Index (ODI) reduction of ≥40%, and identified a Youden-optimal cut-off. The discrimination and calibration of multivariable models were also assessed. Methods: This single-center retrospective cohort (N = 120) included rigorously selected patients (≥50% pain relief after two comparative medial branch blocks) undergoing standardized RFA. Multivariable logistic regression was adjusted for age, sex, Body Mass Index (BMI), smoking status, paraspinal tenderness, and baseline scores. We quantified the Area Under the Receiver Operating Characteristic Curve (AUC), Hosmer–Lemeshow (HL) goodness-of-fit, Brier score, and calibration slope; optimism was corrected using a 500-bootstrap method. Results: Responses occurred in 64.2% (VAS) and 65.8% (ODI) of participants. HALP independently predicted ODI (OR = 1.06, 95% CI 1.02–1.09; p < 0.001) and VAS (OR = 1.05, 95% CI 1.02–1.08; p = 0.001). As a single predictor, HALP showed fair discrimination (AUC 0.717 [VAS], 0.731 [ODI]). The Youden cut-off of 39.8 yielded high sensitivity (~0.87) with modest specificity (~0.58–0.61). Multivariable AUCs were 0.744 (VAS) and 0.774 (ODI), optimism-corrected to 0.680 and 0.720; calibration was acceptable (HL p > 0.05; slopes ≈ 0.74–0.78; Brier 0.188/0.179). Conclusions: HALP is a simple, low-cost adjunct that independently predicts short-term pain and functional outcomes after lumbar medial branch RFA. Incorporation into post-block triage may refine selection, especially for functional improvement, pending prospective external validation and recalibration of the cut-off. Full article

Background/Objectives: Lumbosacral transitional vertebra (LSTV) is a common anatomical variant, but its identification on plain radiographs is often inconsistent. This inconsistency can lead to clinical complications such as chronic low back pain, misinterpretation of spinal parameters, and an increased risk of wrong-level surgery. This study aimed to develop and validate a deep learning-based artificial intelligence (AI) model for the automated detection of LSTV on plain lumbar radiographs. Methods: This retrospective observational study included a total of 3116 standing lumbar lateral radiographs. The presence or absence of lumbosacral transitional vertebra (LSTV) was definitively established using whole-spine imaging, CT, or MRI. Multiple deep learning architectures, including DINOv2, CLIP (ViT-B/32), and ResNet-50, were initially evaluated for binary classification of LSTV. Among these, the ResNet-50 model with partial fine-tuning achieved the best test performance and was subsequently selected for fivefold cross-validation using the training set. Model performance was assessed using accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUROC), and interpretability was evaluated using gradient-weighted class activation mapping (Grad-CAM). Results: On the independent test set of 313 radiographs, the final model demonstrated robust diagnostic performance. It achieved an accuracy of 76.4%, a sensitivity of 85.1%, a specificity of 61.9%, and an AUC of 0.84. The model correctly identified 166 out of 195 LSTV cases and 73 out of 118 normal cases. Conclusions: This AI-based system offers a highly accurate and reliable method for the automated detection of LSTV on plain radiographs. It shows strong potential as a clinical decision-support tool to reduce diagnostic errors, improve pre-operative planning, and enhance patient safety. Full article

Low back pain (LBP) is a highly prevalent musculoskeletal problem and a leading cause of disability worldwide. From a pathophysiological perspective, the contribution of inflammation to LBP is being increasingly recognized. In this literature review, we aim to provide an overview of the role of inflammation as a mediator of LBP while summarizing clinical studies investigating the potential role of anti-inflammatory treatments in the management of LBP. Although often controversial, the available evidence suggests an important role of inflammation in the pathogenesis of LBP, which can be further translated into novel therapeutic targets. Both anti-tumor necrosis factor (anti-TNF) and anti-nerve growth factor (anti-NGF) agents hold the potential of blocking inflammation and pain pathways in patients with chronic LBP. TNF inhibitors have been tested mostly in small trials with mixed results, and their long-term efficacy remains to be proven. Anti-NGF agents have demonstrated stronger and consistent efficacy in randomized controlled trials, but safety concerns compromise their widespread use. The potential role of other anti-inflammatory molecules is currently under investigation. Presently, the routine use of TNF or NGF inhibitors is not supported in radiculopathy or chronic LBP. However, novel anti-inflammatory therapies introduced in the rheumatology field appear to be promising for specific subsets of patients suffering from chronic, refractory LBP, with a complementary role as therapeutic tools, after the unsuccessful outcome of the conservative approach. Full article

Background: Lumbar facet joint degeneration is a common source of chronic low back pain. Radiofrequency (RF) ablation is widely used, whereas cryoablation (CA) remains less extensively investigated. Evidence directly comparing the long-term outcomes of these two modalities is scarce, particularly beyond 12 months. Methods: This single-center retrospective cohort study analyzed patients with lumbar facet joint degeneration who underwent RF (n = 97) or CA (n = 83). Clinical data were retrieved from institutional records. Pain intensity (VAS), functional outcomes (ODI and RMDQ), and quality-of-life measures (EQ-5D and SF-36) were assessed at baseline and at 1, 3, 6, 12, 18, and 24 months. The primary outcome was change in ODI; secondary outcomes included VAS, RMDQ, quality of life, and complications. Clinically meaningful improvement was defined according to Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds. Results: Both RF and CA significantly improved pain and function compared with baseline. RF demonstrated superior reductions in ODI and VAS at 12 and 18 months (p < 0.05); however, by 24 months, treatment effects had diminished, and no significant differences remained (p > 0.05). Quality-of-life improvements plateaued after 18 months in both groups. Minor complications occurred in 9.3% of RF cases and 6.0% of CA cases; no major adverse events were observed. Conclusions: RF provided earlier and more pronounced benefits in pain and function up to 18 months, whereas both RF and CA showed reduced but comparable effectiveness at 24 months. These findings support RF as a preferred interventional option for robust short- to mid-term outcomes, with CA serving as a safe long-term alternative. However, the single-center retrospective design and potential observer bias limit generalizability. Future multicenter prospective studies are warranted. Full article