Nonspecific Low Back Pain

Chiarotto, Alessandro; Koes, Bart W.

doi:10.1056/nejmcp2032396

Cited by 110 publications

(101 citation statements)

References 52 publications

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“…IDD has become the principal contributor to the LBP, which heavily affects the life quality of patients and brings a huge economic burden to the society [2,5]. Stem cell therapy has been considered as a promising therapeutic option for IDD, however, the involved underlying mechanisms remain unclear to date [33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

“…Low back pain (LBP) has become a very common health concern in the modern society, which generates a social and economic burden to human beings [1][2][3]. It is estimated that approximately 80% of population experience the LBP at least once in their lifetimes [4].…”

Section: Introductionmentioning

confidence: 99%

“…It is estimated that approximately 80% of population experience the LBP at least once in their lifetimes [ 4 ]. Intervertebral disc degeneration (IDD) is the principal contributor to the LBP [ 2 , 5 ]. IDD is an inflammatory-catabolic process triggered by a series of pathogenic factors, including gene susceptibility, increased mechanical stress, abnormal immunity, metabolic disorders, and oxidative stress [ 3 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…IDD is an inflammatory-catabolic process triggered by a series of pathogenic factors, including gene susceptibility, increased mechanical stress, abnormal immunity, metabolic disorders, and oxidative stress [ 3 , 6 , 7 ]. The standard treatments for LBP caused by IDD include the bed rest, administration of nonsteroid anti-inflammatory drugs and analgesics, discectomy, and lumbar interbody fusion [ 2 , 5 ]. However, the existing treatments can only relieve the clinical symptoms instead of reversing the degeneration process.…”

Section: Introductionmentioning

confidence: 99%

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Mesenchymal Stem Cells May Alleviate the Intervertebral Disc Degeneration by Reducing the Oxidative Stress in Nucleus Pulposus Cells

Zhao

Xiang

Cheng

et al. 2022

Stem Cells International

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Background. Stem cell therapy is a promising therapeutic modality for intervertebral disc degeneration (IDD). Oxidative stress is a vital contributor to the IDD; however, the definite role of oxidative stress in stem cell therapy for IDD remains obscure. The aim of this study was to determine the vital role of oxidative stress-related differentially expressed genes (OSRDEGs) in degenerative NPCs cocultured with mesenchymal stem cells (MSCs). Methods. A series of bioinformatic methods were used to calculate the oxidative stress score and autophagy score, identify the OSRDEGs, conduct the function enrichment analysis and protein-protein interaction (PPI) analysis, build the relevant competing endogenous RNA (ceRNA) regulatory networks, and explore the potential association between oxidative stress and autophagy in degenerative NPCs cocultured with MSCs. Results. There was a significantly different oxidative stress score between NPC/MSC samples and NPC samples ( p < 0.05 ). Forty-one OSRDEGs were selected for the function enrichment and PPI analyses. Ten hub OSRDEGs were obtained according to the PPI score, including JUN, CAT, PTGS2, TLR4, FOS, APOE, EDN1, TXNRD1, LRRK2, and KLF2. The ceRNA regulatory network, which contained 17 DElncRNAs, 240 miRNAs, and 10 hub OSRDEGs, was constructed. Moreover, a significant relationship between the oxidative stress score and autophagy score was observed ( p < 0.05 ), and 125 significantly related gene pairs were obtained ( r > 0.90 , p < 0.05 ). Conclusion. Stem cell therapy might repair the degenerative IVD via reducing the oxidative stress through the ceRNA regulatory work and restoration of autophagy in degenerative NPCs. This research could provide new insights into the mechanism research of stem cell therapy for IDD and potential therapeutic targets in the IDD treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mesenchymal Stem Cells May Alleviate the Intervertebral Disc Degeneration by Reducing the Oxidative Stress in Nucleus Pulposus Cells

Zhao

Xiang

Cheng

et al. 2022

Stem Cells International

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“…Lumbar disc herniation (LDH) is one of the most common spinal pathologies, which can be associated with debilitating pain1 and neurological dysfunction 2. A herniated disc is diagnosed when the nucleus pulposus extends beyond the normal barrier of the annulus fibrosus 3.…”

Section: Introductionmentioning

confidence: 99%

Does motor control training improve pain and function in adults with symptomatic lumbar disc herniation? A systematic review and meta-analysis of 861 subjects in 16 trials

et al. 2022

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ObjectiveTo evaluate the effectiveness of motor control training (MCT) compared with other physical therapist-led interventions, minimal/no intervention or surgery in patients with symptomatic lumbar disc herniation (LDH).DesignSystematic review and meta-analysis.Data sourcesEight databases and the ClinicalTrials.gov were searched from inception to April 2021.Eligibility criteriaWe included clinical trial studies with concurrent comparison groups which examined the effectiveness of MCT in patients with symptomatic LDH. Primary outcomes were pain intensity and functional status which were expressed as mean difference (MD) and standardised mean difference (SMD), respectively.ResultsWe screened 6695 articles, of which 16 clinical trials (861 participants) were eligible. Fourteen studies were judged to have high risk of bias and two studies had some risk of bias. In patients who did not undergo surgery, MCT resulted in clinically meaningful pain reduction compared with other physical therapist-led interventions (ie, transcutaneous electrical nerve stimulation (TENS)) at short-term (MD –28.85, –40.04 to −17.66, n=69, studies=2). However, the robustness of the finding was poor. For functional status, a large and statistically significant treatment effect was found in favour of MCT compared with traditional/classic general exercises at long-term (SMD −0.83 to –1.35 to −0.31, n=63, studies=1) and other physical therapist-led interventions (ie, TENS) at short-term (SMD −1.43 to –2.41 to −0.46, n=69, studies=2). No studies compared MCT with surgery. In patients who had undergone surgery, large SMDs were seen. In favour of MCT compared with traditional/classic general exercises (SMD −0.95 to –1.32 to −0.58, n=124, studies=3), other physical therapist-led interventions (ie, conventional treatments; SMD −2.30 to –2.96 to −1.64, n=60, studies=1), and minimal intervention (SMD −1.34 to –1.87 to −0.81, n=68, studies=2) for functional improvement at short-term. The overall certainty of evidence was very low to low.ConclusionAt short-term, MCT improved pain and function compared with TENS in patients with symptomatic LDH who did not have surgery. MCT improved function compared with traditional/classic general exercises at long-term in patients who had undergone surgery. However, the results should be interpreted with caution because of the high risk of bias in the majority of studies.PROSPERO registration numberCRD42016038166.

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Does pain medication influence outcomes in elderly people seeking care for back pain? BACE cohort study

Zhu

Chiarotto

Enthoven³

et al. 2023

European Journal of Pain

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Background: Back pain is common among older adults resulting in the high societal and economic burden of persistent pain and disability. Pain medications are frequently prescribed for back pain, especially among older patients, but the efficacy of analgesics on back pain in this patient population remains under debate. In the present study, we investigated the outcomes (i.e. pain intensity and disability) of pain medication use in older people with back pain participating in a prospective cohort study.Methods: A total of 669 patients aged >55 years consulting a general practitioner for a new episode of back complaints were included in this study. The association between pain medication use and outcomes (pain intensity and disability) was assessed at 3-month follow-up.Results: Pain medication users were observed to experience more pain and disability at baseline compared with non-users. At 3-month follow-up, patients from all subgroups (e.g. pain medication users versus non-users) improved over time. Yet medication users had higher pain intensity and poorer disability scores compared with non-users. Patients who de-escalated or stopped pain medication had lower pain and disability than non-users. When comparing different types of medications (i.e. paracetamol, non-steroidal anti-inflammatory drugs, opioids), none of the groups showed better scores regarding pain and disability in users compared with non-users. Opioid users displayed the highest levels of pain and disability. Conclusions:In the present study, although patients who de-escalated or stopped analgesics had less pain and disability, pain medication overall does not result in better outcomes in older people with back pain.Significance: Older patients taking pain medication did not report better outcomes than the ones who did not, except for those who de-escalated or stopped pain medication. Caution should be taken in prescribing pain medication for older patients with back pain in primary care.

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Nonspecific Low Back Pain

Abstract: This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist.The article ends with the authors' clinical recommendations.

Cited by 110 publications

References 52 publications

Mesenchymal Stem Cells May Alleviate the Intervertebral Disc Degeneration by Reducing the Oxidative Stress in Nucleus Pulposus Cells

Mesenchymal Stem Cells May Alleviate the Intervertebral Disc Degeneration by Reducing the Oxidative Stress in Nucleus Pulposus Cells

Does motor control training improve pain and function in adults with symptomatic lumbar disc herniation? A systematic review and meta-analysis of 861 subjects in 16 trials

Does pain medication influence outcomes in elderly people seeking care for back pain? BACE cohort study

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