Search Results (665)

Background/Objective: Kinesiophobia is a major fear-avoidance concept in chronic low back pain (CLBP); however, its independent contribution to pain, disability, and health-related quality of life (HRQoL) beyond sociodemographic and clinical variables remains unclear. This study aimed to evaluate the associations between kinesiophobia and patient-reported outcomes in adults with chronic low back pain regarding (i) pain intensity, (ii) functional disability, and (iii) HRQoL. Methods: This cross-sectional study included 298 participants with CLBP (average age 38.7 ± 13.2 years; 58.0% female). Kinesiophobia was evaluated using the Tampa Scale of Kinesiophobia (range, 17–68). Outcomes were pain intensity (Numerical Pain Rating Scale; 0–10), functional disability (Roland–Morris Disability Questionnaire; 0–24), and HRQoL (RAND-36; 0–100). Two multivariable linear regression models were used per outcome. Model 1 was adjusted for sex and age, and Model 2 was additionally adjusted for BMI, marital status, education, employment, smoking status, and chronic disease. Hierarchical regression analysis evaluated the incremental variance explained by kinesiophobia (ΔR²) when entered after all covariates. Effects were reported per 10-point increase in Tampa score, with 95% confidence intervals (CI). Results: In the fully adjusted models, higher kinesiophobia was associated with greater pain intensity (B = +1.17 points per 10 Tampa; 95% CI 0.55–1.79, p < 0.001), greater disability (B = +3.24 points; 95% CI 2.05–4.43; p < 0.001), and lower HRQoL (B = −7.98 points; 95% CI −11.1–−4.81; p < 0.001). Hierarchical regression analyses showed that kinesiophobia explained additional variance in pain (ΔR² = 0.11), disability (0.12), and HRQoL (0.11), all p < 0.001. Conclusions: In adults with CLBP, kinesiophobia was associated with greater pain intensity, functional disability, and lower HRQoL, accounting for 11–12% of variance in each outcome beyond demographic and clinical covariates. These findings support routine assessment of kinesiophobia and justify longitudinal and interventional studies to determine temporal relationships and treatment effects. Full article

Background: Chronic low back pain (CLBP) is a leading cause of disability worldwide, with exercise endorsed as first-line treatment and non-steroidal anti-inflammatory drugs (NSAIDs) among the most used pharmacologic options. These interventions are frequently combined in clinical practice, yet their synergistic effects remain unclear. To evaluate whether NSAID use modifies the association between physical activity (PA) and CLBP using nationally representative data from NHANES 2009–2010. Methods: We analyzed 988 adults aged ≥20 years with complete data on chronic low back pain, physical activity, medication use, and modeled covariates. Results: Among participants not using NSAIDs, moderate recreational physical activity was associated with lower odds of CLBP (adjusted OR = 0.47, 95% CI 0.25–0.91; p = 0.029). Active transport showed a similar direction but was not statistically significant (OR = 0.38, 95% CI 0.13–1.12; p = 0.074). In interaction models, active transport x aspirin was associated with higher odds of CLBP (OR = 2.24, 95% CI 1.02–4.90; p = 0.044), and moderate recreational PA x any NSAID use was also associated with higher odds of CLBP (OR = 2.26, 95% CI 1.01–5.06; p = 0.047). Subgroup analyses were exploratory and heterogeneous, including a significant potential protective interaction (OR ≈ 0.19, 95% CI 0.06–0.69; p = 0.015). Conclusions: In a nationally representative sample, NSAID use appeared to modify the association between physical activity and chronic low back pain. These findings are exploratory and hypothesis-generating. Therefore, longitudinal studies are needed to clarify the temporal and causal relationships and the potential influence of NSAIDs. Full article

Background/Objectives: Disc herniation, also termed herniated nucleus pulposus (HNP), is a common spinal disorder affecting approximately 10% of the global population, associated with pain, neurological complications, and diminished quality of life. Despite its global burden, regional variations in public awareness and sociodemographic determinants remain inadequately characterized, particularly in Middle Eastern populations. This study aimed to assess the prevalence, public awareness, and sociodemographic determinants of HNP among adults in Saudi Arabia at a nationwide level. Methods: An analytical cross-sectional study was conducted from December 2024 to July 2025. Using a convenience sampling approach via social media platforms, an online questionnaire was distributed nationwide across Saudi Arabia. Data from 1112 participants were analyzed using descriptive statistics and multiple logistic regression. The questionnaire comprised two sections: sociodemographic characteristics and knowledge and awareness of HNP. Results: The prevalence of disc herniation was 8.9%, consistent with global estimates. Overall awareness was relatively high at 67.6%, though knowledge of specific risk factors varied considerably. Most participants recognized obesity (88.0%), poor sitting posture (85.8%), history of lower back trauma (86.2%), and work requiring physical effort (88.8%) as risk factors, while fewer acknowledged smoking (46.4%), diabetes (51.2%), sleeping on a soft bed (36.9%), and increased height (35.9%). Multiple logistic regression, adjusted for all sociodemographic, lifestyle, and health-related covariates, identified significant independent predictors of HNP including marital status (married OR = 2.90), current smoking (OR = 2.91), hyperlipidemia (OR = 1.86), family history (OR = 8.95), and prior knowledge of the condition (OR = 2.28). Knowledge of HNP was significantly associated with university education (OR = 1.70), higher income levels (OR = 2.23 for ≥15,000 SAR; OR = 2.07 for 5000–9999 SAR), and family history (OR = 4.70), while those in low and medium workload jobs demonstrated lower knowledge. Conclusions: Although overall public awareness of HNP is relatively high in Saudi Arabia, substantial gaps persist in knowledge of modifiable risk factors, particularly smoking and diabetes mellitus. Targeted smoking cessation campaigns, diabetes awareness programs, and ergonomic education initiatives delivered through primary healthcare centers, workplaces, and schools are recommended. Full article

Background: Prolonged standing can lead to musculoskeletal disorders, especially in the lower extremities, when appropriate footwear is not used. The aim of this study is to investigate the relationship between footwear styles, foot problems, and pain characteristics related to lower extremities in individuals with prolonged standing. Methods: A descriptive, cross-sectional study design was employed, using a random sample of individuals with prolonged standing (n = 159). Participants were asked questions about their footwear choices. They were asked to mark the lower extremity pain localization on the McGill Pain Map. In addition, foot deformities were evaluated by physical examination. Results: The findings revealed that most females (n = 88) and males (n = 71) preferred flat/sports footwear styles in both summer and winter. There was no significant difference between footwear styles and foot pain duration, intensity, and localization in both genders (p > 0.05). However, a statistically significant difference was observed among males between their summer footwear styles and pain related to lower extremities (low back pain and knee pain), and among females between their summer footwear styles and foot problems (bone deformities, skin pathologies and soft tissue issues) (p < 0.05). Conclusions: The results of this study show that the preferred footwear style was associated with lower extremity pain and foot problems, which emphasized the importance of footwear selection and footwear evaluation in the musculoskeletal evaluation of the lower extremities. Full article

Agriculture is a hazardous industry, and working in livestock production has been linked to musculoskeletal disorders (MSDs). However, limited research has examined work-related risk factors contributing to MSDs among livestock workers especially in small and family-owned operations, like most of the companies located in the Friuli-Venezia Giulia (FVG) region of Italy. This cross-sectional study conducted in July 2024 investigates self-reported musculoskeletal pain and discomfort and occupational exposures among dairy and swine farmworkers (N = 50; mean age = 37 years) in FVG. We assessed musculoskeletal exposures, self-reported pain and discomfort, and the use of preventive techniques to maintain musculoskeletal health. Participants reported a high prevalence (80%) of musculoskeletal pain and discomfort, particularly among those working in family operations. While lower back and knee pain were most common, work-related exposures were most strongly associated with pain in the lower back and neck. These findings highlight the need to address occupational health risks related to MSDs in livestock operations, including possible prevention and intervention strategies. This may be especially important for small and family-owned farms where preventive and ergonomic interventions may yield substantial benefits. Full article

Pain and working memory interact bidirectionally, yet most paradigms treat pain as an extraneous distractor rather than task-relevant content. This study investigated whether thermal sensations can be encoded and updated in working memory in an n-back paradigm. Nineteen healthy adults completed visual (location) and thermal (temperature) single n-back tasks, cross-modal conditions with task-irrelevant distractors, and a dual n-back task across three load levels (1-, 2-, 3-back). Results showed that thermal cues consistently yielded lower accuracy and longer response times (RTs) compared to visual cues (p < 0.001, q < 0.001). While task-irrelevant thermal input tended to prolong RTs in the visual task under low load (p = 0.033, q = 0.099), task-irrelevant visual input showed a trend-level improvement in thermal-task accuracy under high load (3-back; p = 0.020, q = 0.060), consistent with a potential cross-modal effect. Qualitative data indicated that participants strategically transcoded thermal sensations into word or numerical labels to support maintenance. These findings demonstrate that pain can be operationalized as mnemonic content, though its processing incurs significant executive costs due to transcoding demands and resource competition. By shifting focus from “pain-as-interference” to “pain-as-content”, this paradigm offers a principled approach for the mechanistic study of nociceptive working memory updating and provides a foundation for quantifying cognitive interference in clinical pain populations. Full article

Background/Objectives: Sciatica can adversely affect mental well-being; however, evidence regarding its psychological impact among Saudi women remains scarce, particularly concerning differential effects across specific mental health domains. This study examined the prevalence of sciatica and its associations with depression, anxiety, and stress among adult Saudi women. Methods: A cross-sectional online survey was conducted from February to March 2024 among Saudi women aged ≥18 years. Participants (n = 706) completed the Arabic Depression, Anxiety, and Stress Scale (DASS-21) and provided sociodemographic and health information. Sciatica status was based on self-report. Multivariable linear regression analyses identified independent predictors of each mental health domain. Results: Sciatica prevalence was 11.0% among 706 participants (mean age 29 ± 11 years; mean BMI 24 ± 6.5 kg/m²). Sciatica was the strongest independent predictor of stress (β = 6.87, 95% CI: 4.57–9.17, p < 0.001). No significant associations were observed with depression (β = 1.80, p = 0.183) or anxiety (β = 0.45, p = 0.481). Additional stress predictors included lower-back pain, diabetes, lower–middle income, and daily phone use >8 h, while bachelor-level education was protective. Arthritis independently predicted anxiety (β = 1.52, p = 0.008). Conclusions: In this convenience sample of Saudi women, sciatica was significantly associated with higher stress symptom scores, while associations with depression and anxiety did not reach statistical significance. The observed pattern suggests that stress screening and management should be considered within biopsychosocial care for sciatica patients, pending confirmation in prospective studies. Full article

Background: Low back pain (LBP) is a leading cause of disability, particularly in young adults. Decreased trunk endurance and altered movement patterns have been associated with lumbar symptoms and functional limitations; however, their concurrent relationships in active populations with minimal disability remain insufficiently characterized. This study was designed as an exploratory cross-sectional analytical study. Methods: The sample comprised 71 physically active university students (mean age, ~23 years; 79% men). Trunk endurance was assessed using the McGill isometric tests, and selected movement-pattern measures were obtained from four Functional Movement Screen (FMS) tasks focused on lumbopelvic control. The total FMS score was calculated, asymmetries were recorded in the Inline Lunge and Rotary Stability tasks, and lumbar-related disability was measured using the Oswestry Disability Index (ODI). Associations were analyzed using correlations and adjusted linear regression, and asymmetry-based comparisons were evaluated using non-parametric tests. Results: The average ODI was very low (approximately 4%), suggesting a floor effect. Greater trunk endurance was associated with lower ODI values, whereas the association between total FMS and ODI was weak and did not reach statistical significance in the adjusted model. Inline Lunge asymmetry was associated with higher ODI values, but this finding should be interpreted cautiously because of the very small subgroup size. Conclusions: In this physically active young adult sample, trunk endurance and selected movement-pattern measures provided complementary descriptive information on lumbar-related function; however, the observed associations were modest and should be interpreted cautiously. Full article

Introduction: With age and injury, the infiltration of fat in the paraspinal muscles can cause degeneration, disorganizing the structural integrity of the connective tissue and causing lower back pain (LBP). Human umbilical cord tissue allografts (UCTAs) have a collagen-rich matrix with various extracellular matrix (ECM) components that can replace damaged connective tissue. The objective of this paper is to analyze the preliminary findings from an observational repository on UCTAs for the supplementation of degenerated tissue in thoracic and lumbar paraspinal muscles refractory to standard conservative methods through patient-reported scales. Materials and Methods: A total of 117 patients from an observational repository were identified with paraspinal muscle degeneration. Patients received one to three applications of UCTAs; outcomes were tracked using the Numeric Pain Rating Scale (NPRS), the Western Ontario and McMaster University Arthritis Index (WOMAC), and the Quality-of-Life Scale (QOLS). Results: All groups showed positive improvement in the NPRS and WOMAC scales. Multi-application groups revealed statistically significant differences in the analyses. No adverse events or complications were reported. Discussion: Limitations included a lack of a control group, non-standardized application protocol, and the increase in recall and response bias due to using patient-reported measures. Conclusions: This pilot investigation presents the preliminary effectiveness necessary in hypothesis generation for continued research through randomized controlled trials to validate efficacy, establish optimal dosage protocols, and compare UCTAs to other conservative interventions. Full article

Introduction: Low back pain (LBP) is the leading cause of disability worldwide, with substantial variation in prevalence across regions. It is associated with a wide range of biophysical, psychological, social, and lifestyle factors, as well as comorbid conditions. Given its high impact, identifying population-level correlations of LBP is essential for informing prevention strategies. This study aimed to assess demographic, socioeconomic, lifestyle, and health-related factors associated with LBP in Hungary. Methods: A repeated cross-sectional analysis was conducted using secondary data from three waves of the European Health Interview Survey (EHIS) carried out in Hungary in 2009, 2014, and 2019. Results: The prevalence of LBP increased over the study period. Female sex, higher educational attainment, normal body mass index, non-smoking status, abstaining from alcohol, and good self-perceived health were associated with lower odds of LBP. In contrast, older age (≥65 years), unfavorable financial status, residence in socioeconomically disadvantaged regions, use of over-the-counter medications, and several chronic conditions were associated with higher odds. Conclusions: Reducing the impact of low back pain requires its integration into comprehensive public health frameworks that combine chronic disease management with consideration of socioeconomic inequalities at the population level. Full article

Lumbosacral and thoracolumbar kinematics are key risk factors for lifting-related low back pain, yet their measurement is typically restricted to motion capture laboratories. Inertial measurement units (IMUs) offer the potential to quantify spine kinematics in more naturalistic settings, but the validity of IMU-based processing pipelines relative to optical motion capture (OMC) remains unclear. Nine healthy participants performed stoop, squat, free, and asymmetric lifting tasks while IMU and OMC data were simultaneously collected to evaluate the concurrent validity of two IMU pipelines: the proprietary MVN Analyze pipeline and an OpenSense pipeline using a validated OpenSim biomechanical model for lifting. Joint angles from both pipelines were compared against OMC-derived joint angles calculated using the same validated OpenSim model with one-way repeated-measures statistical parametric mapping (SPM) (α = 0.05), Bland–Altman analysis with Limits of Agreement (LoA) and 95% Confidence Intervals (CIs), and Concordance Correlation Coefficients (CCCs) with 95% CIs. Xsens MVN Analyze consistently overestimated flexion-extension at both spinal levels across all lift types (lumbosacral: RMSE ≤ 9.8°, bias ≤ −14.5°, LoA ≤ ±10°; thoracolumbar: RMSE ≤ 5.4°, bias ≤ −8.3°, LoA ≤ ±5°), with SPM confirming significant differences during the lifting and lowering phases of all lifting cycles. In contrast, processing Xsens data with OpenSense using the same biomechanical model as the OMC data yielded excellent agreement with OMC (RMSE ≤ 2.9°, bias ≤ 3°, LoA ≤ ±10°). CCC was poor to moderate, specifically in lateral bending and axial rotation planes, likely reflecting limited between-participant ROM variability. These results suggest that discrepancies are driven primarily by biomechanical model differences rather than sensor or sensor fusion limitations. Ultimately, when paired with an appropriate biomechanical model, XSens sensors show promise for practical field-based assessment of lifting biomechanics, potentially requiring only sensors at the chest and pelvis. Full article

Current scientific reports on pain pharmacotherapy focus on the side effects of opioid medications related to dysregulation of the oxidative–antioxidant balance and immunomodulation. Initial observations concerned the use of opioids in the treatment of acute postoperative and cancer pain. Little is known about oxidative stress modulation in multi-modal opioid-based analgesia for chronic non-cancer pain. The aim of this study was to describe oxidative stress using plasma total antioxidant capacity (TAC) and total oxidative capacity (TOC), to assess whether these metrics are dependent on pain intensity and the scheme of analgesia. The study group consisted of patients with chronic low back pain, who were divided under the following treatments: multi-modal opioid-based therapy (n = 42), monotherapy with opioids (n = 28), and the control group (n = 11). A significantly lower TAC was observed in the study group compared to the monotherapy and control groups (220 µmol/L vs. 295 µmol/L, p = 0.02 vs. 399 µmol/L, p = 0.01). TOC was significantly lower in the polytherapy group compared to the monotherapy group (594 µmol/L vs. 723 µmol/L, p = 0.0002). A significantly lower TAC was observed in the typical analgesia scheme compared to the adjuvant analgesia model (260 µmol/L vs. 339 µmol/L, p = 0.01). The TAC in the severe pain classification was significantly lower than in the moderate group (p = 0.03). Multi-modal therapy with opioids significantly reduced oxidative activity compared to monotherapy but did not improve antioxidant capacity. Opioid-based pain therapy combined with adjuvant analgesics produced better antioxidant properties, and the antioxidant capacity was lower in severe pain scores. Full article

Intervertebral disc degeneration is the most recognized cause of low back pain, characterized by the decline in tissue structure and mechanics. Image-based mechanical parameters (e.g., strain, stiffness) may provide an ideal assessment of disc function that is lost with degeneration, but unfortunately, these remain underdeveloped. Moreover, it is unknown whether strain or stiffness of the disc may be predicted by MRI relaxometry (e.g., T₁ or T₂), an increasingly accepted quantitative measure of disc structure. In this study, we quantified T₁ and T₂ relaxation times and compared to in-plane strains measured with displacement-encoded MRI within human cadaveric discs under physiological levels of compression and bending. Using a novel inverse approach, we then estimated shear modulus in orthogonal image planes and regionally compared these values to relaxation times and 2D strains. Intratissue strain depended on the loading mode, and shear modulus in the nucleus pulposus was typically an order of magnitude lower than the annulus fibrosus. Relative shear moduli estimated from strain data derived under compression generally did not correspond with those from bending experiments. Only one anatomical region showed a significant correlation between relative shear modulus and relaxometry (T₁ vs. µ_rel, coronal plane under bending). Together, these results suggest that future inverse analyses may be improved by incorporating multiple loading conditions into the same model and that image-based elastography and relaxometry should be viewed as complementary measures of disc structure and function to assess degeneration in future studies. Full article

Background/Objectives: Poor bone quality is strongly associated with adverse surgical events. Although dual-energy X-ray absorptiometry (DXA) remains the gold standard for bone mineral density (BMD) assessment, logistical barriers may limit its preoperative application. The Endplate Bone Quality (EBQ) score is an MRI-derived metric quantifying subchondral bone quality at the vertebral endplate with demonstrated predictive value for cage subsidence following lumbar interbody fusion. However, EBQ has been measured exclusively at the operative level in surgical cohorts. This study aimed to assess level-specific EBQ scores across the entire lumbar spine and compare distributions across age, sex and osteoporosis subgroups. Methods: A single-institution retrospective review of T1-weighted lumbar MRI studies from patients evaluated for lower back pain from 2020 to 2025 was performed. EBQ was independently scored by two blinded raters at each disc space from L1–L2 to L5–S1 using 3 mm endplate ROIs normalized to a CSF ROI at L3. Interrater reliability was assessed via ICC, Pearson correlation, and RMSE. Patients were stratified by age (≤60 vs. >60 years), sex, and osteoporosis status, and subgroup comparisons were performed for overall and level-specific EBQ score. Results: A total of 96 patients with an average age of 61.0 ± 9.42 years were included in this study. The majority of patients included were female (87.5%), and 18.8% had been diagnosed with osteoporosis. EBQ scores demonstrated a progressive caudal increase across all subgroups from L2–L3 to L5–S1. Overall interrater reliability was acceptable (ICC = 0.76), with level-specific ICCs ranging from 0.70 to 0.83. No significant differences were observed between age or sex subgroups. Osteoporotic patients demonstrated significantly higher EBQ at L1–L2, L2–L3, and overall (all p < 0.05), with no significant differences at L3–L4 through L5–S1. Conclusions: This study provides normative, level-specific EBQ reference data throughout all levels of the lumbar spine. The increase in EBQ scores seen among caudal levels and reduced osteoporotic discriminatory power support the importance of level-specific context when interpreting EBQ thresholds. These findings may support future studies evaluating threshold development for EBQ. Full article

Despite the high prevalence of low back pain (LBP), evidence supporting the clinical effects of repetitive peripheral magnetic stimulation (rPMS) remains limited. A combined double-coil and handheld rPMS approach may enhance the therapeutic potential of this technology. This observational case series analyzed prospectively collected routine clinical data from 37 patients treated with a combined protocol of static double-coil lumbar rPMS and dynamic handheld lower-limb rPMS. Pain intensity, disability, and quality of life were assessed at baseline, post-treatment, and 1-month follow-up. Statistical analyses were complemented by an evaluation of clinical relevance using established minimal clinically important difference (MCID) thresholds. Significant improvements were observed across all outcomes. Pain decreased by 62.5% post-treatment and by 87.5% at follow-up, while disability was reduced by 86.8% and 92.1%, respectively. Quality of life scores approximately doubled. High MCID responder rates and consistent within-group changes were observed; however, given the single-arm design without a control group, these findings should be interpreted as exploratory and hypothesis-generating rather than confirmatory evidence of treatment effectiveness. This combined rPMS approach was feasible and well tolerated in routine clinical practice and was associated with clinically meaningful within-group improvements in pain, function, and quality of life. Further controlled studies are warranted. Full article