The Effect of Pain Relief on Daily Physical Activity: In-Home Objective Physical Activity Assessment in Chronic Low Back Pain Patients after Paravertebral Spinal Block

Abstract

This study evaluates the effect of paravertebral spinal injection (PSI), utilizing both subjective and objective assessments in chronic low back pain (LBP) associated with facet joint arthrosis over a one-month duration. Subjective questionnaires included the visual analogue scale (VAS) for pain, the Oswestry Disability Index, the Health Survey SF-12, and the short Falls Efficacy Scale International (FES-I). Objective assessments included in-clinic gait and Timed Up and Go (TUG) tests using wearable sensors, as well as 48 h daily physical activity (DPA) monitored using a chest-worn triaxial accelerometer. Subjective and objective measures were performed prior to treatment, immediately after the treatment, and one month after the treatment. Eight LBP patients were recruited for this study (mean age = 54 ± 13 years, body mass index = 31.41 ± 6.52 kg/m2, 50% males). Results show significant decrease in pain (~55%, p < 0.05) and disability (Oswestry scores, ~21%, p < 0.05). In-clinic gait and TUG were also significantly improved (~16% and ~18% faster walking and shorter TUG, p < 0.05); however, DPA, including the percentage of physical activities (walking and standing) and the number of steps, showed no significant change after PSI (p > 0.25; effect size ≤ 0.44). We hypothesize that DPA may continue to be truncated to an extent by conditioned fear-avoidance, a psychological state that may prevent increase in daily physical activity to avoid pain.

Measuring objective physical activity in people with chronic low back pain using accelerometers: a scoping review

“…More specifically, there was no significant reduction in steps per day and time spent in sedentary activities, no significant increase in light to moderate physical activity, no significant decrease in time spent daily sitting and standing, and only significant increase in time spent lying. (34) There was no significant difference in objective physical activity variables (sitting time, standing time, walking time, maximum walking duration, lying time, total steps, walking duration variability, episode cadence average) of participants with CLBP (n = 8) between baseline measurements and immediately after a paravertebral spinal block and at 1 month of follow-up after a paravertebral spinal block. (41) There was no significant difference in an objective physical activity variable (mean step count) of participants with CLBP wearing Fitbit (n = 9) or pedometer (n = 8) between baseline measurements and immediately after a 6-week physical activity and lifestyle program designed to promote self-management of back pain and at 1 month of follow-up.…”

“…This was the case for an education session combined with graded exposure sessions (37, 64), a workplace intervention based on physical activity (57) and messages encouraging or discouraging activity sent on a phone application over 2 weeks (38). Interventions that did not show significant effects on objective physical activity variables included a physical activity program supported by coaching and the use of an activity tracker (27,51,65), a physical therapy session (31), a paravertebral spinal block (34), a program based on selfmanagement of low back pain (41), a Nordic walking program (42), a cognitive functional therapy program (50), a 6-week exercise program combined with an education program (54), and an individualized program based on quality of life improvement (60).…”

Sensor-based Characterization of Daily Walking: A New Paradigm in Pre-frailty/Frailty Assessment

“…Healthcare research in wearable devices has been constantly growing in various areas like remote patient monitoring and healthcare (66)(67)(68)(69)(70), wearable sensor-based systems for health monitoring (71)(72)(73)(74), and ambient-assisted living tools for older adults (75). For the older adults requiring continuous health monitoring, sensor-based wearables and remote monitoring will help eliminate the hassle of periodic commute to diagnostic centers, reduce the amount of recurring admissions to the hospital, and facilitate more efficient clinical visits with objective results (76).…”

Incorporation of “Artificial Intelligence” for Objective Pain Assessment: A Comprehensive Review

“…A recent study compared postoperative analgesia by traditional management versus the application of the newly introduced “analgesia quality index” (AQI) through the application of AI-patient controlled analgesia (AI-PCA) and showed that the AQI decreased the incidence of moderate-to-severe pain, improved the quality of analgesia, and may provide guidance for optimum postoperative pain management [ 93 ]. However, the monitoring of physical activity may be affected by many factors, such as personal mood, weather conditions, and other psychosocial factors [ 94 , 95 ].…”