Low Back Pain

The main purpose of this study is to test the safety and efficacy of study drug for the treatment of chronic low back pain (CLBP). This trial is part of the chronic pain master protocol H0P-MC-CPMP (NCT05986292), which is a protocol to accelerate the development of new treatments for chronic pain.

This study tests whether a virtually delivered integrated tai chi, qigong, and meditation program, added to usual care, improves chronic low back pain, disability, quality of life, and healthcare costs compared with usual care alone. Adults with chronic low back pain are randomized to begin the program immediately (Tai Chi Now) or after a six-month period (Tai Chi Later). Outcomes are collected by online survey over twelve months.

Low back pain is a common musculoskeletal complaint among athletes, and most cases are classified as non-specific low back pain, in which no clear anatomical or pathological source of pain can be identified. Recreational athletes, who exercise regularly for health and fitness rather than for competition, often have less structured training planning and technical supervision than professional athletes, which may increase their susceptibility to musculoskeletal complaints. Core stability has become an important consideration in the prevention and management of low back pain. The core region includes the abdominal muscles, paraspinal muscles, diaphragm, and pelvic floor muscles, and plays an important role in maintaining spinal stability. Reduced activation and endurance of these muscles may increase the load on the lumbar spine and contribute to the development of low back pain. This randomized trial compares two exercise approaches in recreational athletes with non-specific low back pain: a core endurance exercise program and a segmental stabilization exercise program targeting the transversus abdominis and lumbar multifidus. Participants are randomly assigned to one of the two programs, both delivered three days per week for six weeks under physiotherapist supervision. Pain and functional status, dynamic balance, and core muscle endurance are assessed before the program and at the end of the six-week program.

Aim This study aims to assess the effectiveness of an early intervention comprising individually tailored physiotherapy, including dialogue, education, and graded activity, following lumbar spinal fusion surgery. The effectiveness will be evaluated on patient-specific goals, physical activity, pain intensity, pain interference, fear of movement, and pain self-efficacy for patients after a lumbar spinal fusion.

The goal of this clinical trial is to learn if a health system intervention called "Stratified Targeted Engagement from Primary Care to Physical Therapy (STEPPT)" can improve how often doctors refer Hispanic patients with spine pain to physical therapy (referral rate) and how often patients attend physical therapy after being referred (adherence rate). The main questions this study aims to answer are 1) does STEPPT improve physical therapy referral and adherence rates compared to usual care for Hispanic patients with spine pain who seek care in a Federally Qualified Health Center (FQHC) serving low income communities, and 2) how consistently do FQHC providers and staff deliver STEPPT to patients who may benefit? STEPPT will train doctors and other health care providers to educate participants on the benefits of physical therapy for spine pain and participants will receive culturally tailored handouts and videos to teach them about their spine pain and what to expect in physical therapy. Patients will also receive personalized assistance to schedule their physical therapy appointment and address potential barriers for attending the appointment.

This study aims to evaluate the effectiveness of pain education and clinical hypnosis delivered via a mobile app compared to a guideline-informed factsheet for reducing pain and disability in people experiencing chronic low back pain attending general practice.

This study is a randomized controlled trial (RCT) investigating whether adding Acceptance and Commitment Therapy (ACT) to standard physiotherapy provides greater benefits for adults with chronic low back pain than physiotherapy alone. A total of 60 participants will be randomly allocated into two groups: ACT plus physiotherapy and physiotherapy alone. Both groups will receive a 8-weeks program with two sessions per week. The ACT component focuses on acceptance, psychological flexibility, mindfulness, cognitive defusion, values, and committed action. The main outcomes are pain catastrophizing, functional disability, perceived stress, and sleep quality, assessed using the PCS, ODI, PSS, and PSQI. The study aims to determine whether combining psychological and physical rehabilitation produces better outcomes than physiotherapy alone.

The study aims to evaluate the effectiveness of a structured patient education program in enhancing adherence to prescribed home exercise regimens in individuals with chronic low back pain, knee osteoarthritis, and shoulder pain.

Study to evaluate the effectiveness of time variant pulse (TVP)-SCS in patients with chronic pain using commercially approved Boston Scientific SCS Systems per local Instructions for use (IFU). In addition, to compile real-world clinical outcomes in subjects with chronic, intractable low back and/or leg pain.

This study aims to investigate the immediate effects of dual-task neuromuscular warm-up exercises on balance and proprioception in individuals with chronic nonspecific low back pain. Participants will be randomly assigned to either a dual-task neuromuscular warm-up exercise group or a neuromuscular warm-up exercise group. Both groups will also receive the same conventional physiotherapy program. Balance, proprioception, lumbar muscle properties, pressure pain threshold, and flexibility will be assessed before and after the intervention to determine whether adding cognitive tasks to neuromuscular warm-up exercises provides additional immediate benefits.

The purpose of this study in patients undergoing routine care epidural spinal cord stimulation (SCS) is to determine 1) whether SCS reduces arterial blood pressure (BP) in patients which chronic low back pain and hypertension, 2) whether higher baseline BP (i.e., hypertension) predicts reductions in pain following SCS, and finally 3) whether different SCS waveforms elicits stimulus-evoked compound action potentials (ECAPs) in spinal cord and at the cortex (electroencephalography, and magnetoenchphalography).

Low back dysfunction is one of the most common musculoskeletal disorders and is associated with pain, disability, and reduced quality of life. Artificial intelligence (AI) has emerged as a promising tool to support personalized rehabilitation by improving exercise prescription, monitoring adherence, and providing real-time feedback. This randomized controlled trial aims to compare the effectiveness of an AI-driven rehabilitation program with a traditional physical therapy program in patients with low back dysfunction. Primary outcomes include pain intensity, functional disability, and quality of life. The findings may provide evidence regarding the role of AI-assisted rehabilitation in improving clinical outcomes.

Rationale: Chronic Low Back Pain (CLBP) is often associated with "cortical reorganization," where the brain's map of the back becomes less precise. This phenomenon contributes to the persistence of pain and reduced body awareness. While traditional rehabilitation focuses on the physical structure of the spine, neurocognitive approaches use "perceptive surfaces" to provide specific tactile and proprioceptive feedback, aiming to "retrain" the brain's representation of the trunk. Objective and Hypothesis: The primary goal of this study is to investigate how the brain responds to stimulation from these perceptive surfaces in patients with CLBP compared to healthy individuals. The investigators hypothesize that using these surfaces will lead to immediate changes in functional brain connectivity, particularly in areas responsible for body awareness and pain processing (somatosensory and salience networks). Study Procedures: The study will involve 20 patients with chronic non-specific low back pain and 20 healthy volunteers. All participants will undergo a Functional Magnetic Resonance Imaging (fMRI) session. During the scan, participants will be placed on a specialized perceptive surface. Brain activity and connectivity will be measured at rest and during specific tactile stimulation. Additionally, advanced imaging techniques (SANDI model) will be used to look at the microscopic structure of brain cells (neurons). Clinical Impact: By comparing the two groups, the study aims to identify specific "brain signatures" of recovery. This could help clinical professionals understand if perceptive surfaces can effectively restore cortical maps, leading to better personalized rehabilitation strategies for chronic pain.

This is a single-case experimental design study enrolling individuals with chronic low back pain who will be receiving pain science education and virtual reality over 3 weeks.

Non-specific low back pain refers to pain in the lower back region that cannot be attributed to a specific identifiable pathology such as infection, tumor, osteoporosis, lumbar disc herniation, spinal stenosis or fracture. It is the most common type of low back pain, accounting for about 85-90% of cases. Non specific low back pain is posteriorly occurring that is located between lower rib margin and gluteal fold. It is exacerbated by sustained back postures, back movements or back muscle imbalances. The aim of study is to find out which technique whether Spray and stretch technique or strain Counter strain works better in reducing pain ,improving movement ,and decreasing disability caused by tight hamstring muscles in people with non specific low Back Pain.

The goal of this clinical trial is to find out whether adding a bone-marrow aspirate concentrate (BMAC) injection during surgery can improve recovery in adults undergoing lumbar microdiscectomy for a lumbar disc herniation. The main questions it aims to answer are: * Does the BMAC injection lead to better disc tissue health after surgery (as seen on MRI scans)? * Does the BMAC injection lead to greater improvement in pain and disability compared to surgery alone? Participants will be adults aged 18 and older who are scheduled for lumbar microdiscectomy surgery. Researchers will compare one group of participants receiving the standard-of-care surgery plus the BMAC injection with another group receiving the same surgery without the injection to see if the injection offers added benefit. Participants will: * Have surgery (microdiscectomy) with or without the injection. * Complete pain and disability questionnaires at several times over 2 years. * Undergo MRI scans at baseline and follow-up to assess disc structure and tissue health. * Provide samples of leftover disc or bone-marrow tissue (as applicable) from surgery for analysis.

Artificial intelligence (AI) symptom-checking tools, including large language models such as ChatGPT, are increasingly used by patients before they seek care. These tools may shape patients' beliefs about their diagnosis, how serious they think their condition is, and when they decide to seek treatment. It is not yet known how this pre-visit AI use affects the initial physical therapy encounter for spine-related problems. This prospective observational cohort study examines whether prior use of AI symptom-checking tools influences the first physical therapy evaluation in adults presenting with spine-related musculoskeletal complaints (neck, thoracic, or low back pain, with or without radicular symptoms). Consecutive patients attending an outpatient physical therapy clinic for a new evaluation are grouped as AI users or non-AI users based on whether they used such a tool for their current complaint in the previous 30 days. The primary outcome is shared decision-making, measured with the SDM-Q-9 immediately after the initial evaluation. Secondary outcomes include stage of presentation, agreement between the patient's expected diagnosis and the clinician's classification, baseline pain and disability, functional performance, and clinical outcomes at 2 and 6 weeks. The investigators hypothesize that prior AI use is associated with differences in shared decision-making and in how patients present for care.

Brief Summary The goal of this clinical trial is to learn if MUSIC CARE©, a music-based therapy tool, can improve the physical abilities of people with chronic low back pain (back pain that lasts more than 3 months). The main questions it aims to answer are: Does MUSIC CARE© help participants better perform their daily activities? Does MUSIC CARE© lower the fear of movement in participants? Does MUSIC CARE© help participants return to work? Why this study? Chronic low back pain is a leading cause of disability and absence from work. Physical rehabilitation is the recommended treatment. However, many participants develop a fear of movement. This fear slows down their recovery and limits the benefits of rehabilitation. MUSIC CARE© is a digital music tool. It uses specially designed music to help participants relax and feel less pain. Researchers believe that using MUSIC CARE© before rehabilitation sessions may help participants move more freely and recover better. How does the study work? Researchers will compare two groups of participants: Group 1: follows a standard rehabilitation program with MUSIC CARE© Group 2: follows a standard rehabilitation program without MUSIC CARE© This comparison will show whether MUSIC CARE© brings added benefits. Participants will: Take part in a rehabilitation program for 5 to 6 weeks Use MUSIC CARE© before each therapy session (Group 1 only). Complete questionnaires about their pain, fear of movement, and ability to perform daily activities. Be followed for 6 months after the program ends, including an assessment of their return to work. What could this study change? If results are positive, this study could confirm that MUSIC CARE© is a useful non-drug tool to support rehabilitation for people with chronic low back pain. It could help bring this approach into standard care programs, with no additional medication.

The purpose of this research study is to see how a mindfulness meditation-based intervention affects pain. Specifically, we are interested in understanding the pain-relieving brain mechanisms of mindfulness meditation-based therapy for patients with opioid-treated chronic low back pain.

As of 2020, 53 million Americans provide unpaid care to an individual with a disability. One commonly performed activity of daily living (ADL) provided by informal caregivers is assisted transfers, which requires moving an individual from one surface to another. Approximately 94% of informal caregivers who assist with ADLs to persons with adult-onset chronic physical disabilities affecting mobility reported musculoskeletal discomfort, with pain and discomfort made worse by performing caregiving activities. Although many informal caregivers assist with transfers, most have never received any formal training in proper manual lifting or mechanical lifting techniques. Improper transfer techniques can be detrimental to not only caregiver health but also to the persons they assist resulting in shoulder injury, bruising and pain from manual lift techniques, hip fractures from falls, and skin tears from shear force that occurs with sliding during transfers. Current standard of care provides limited in-person training of caregivers, as most of the rehabilitation process is client-focused. When training is provided clinicians have no means to objectively evaluate if proper techniques are being performed at discharge or when the caregiver and care recipient return home. For this reason, an outcome measure called the Caregiver Assisted Transfer Technique Instrument (CATT) was developed to provide a quick, objective way to evaluate proper technique of caregivers who provide transfer assistance to individuals with disabilities. The CATT evaluates the caregiver's performance on setup, quality of the task performance, and results. After a formal assessment through stakeholder review involving clinicians, informal caregivers, and individuals with physical disabilities who require transfer assistance, the CATT was expanded to include two versions; one that evaluates manual lift technique (CATT-M) and one that evaluates mechanical lift techniques (CATT-L). However, the CATT must undergo further testing with informal caregivers and the individuals they assist to determine if the CATT is a reliable, valid, and responsive tool for identifying skill deficits in caregivers performing assisted transfers. The purpose of this study is to establish the psychometric properties (reliability, validity, and responsiveness) of the CATT and to evaluate the effects of an individualized training session for participants who have transfer technique deficits as identified by the CATT. The long-term goal of this research is to develop the CATT so that it can be used as an objective indicator of transfer performance as well as guide training and educational interventions for informal caregivers to reduce the risk of musculoskeletal pain and injury associated with assisted transfers.

This study will evaluate a new treatment program for patients with ongoing or long-term low back pain who receive care at primary care physiotherapy units. Participants with subacute or chronic nonspecific low back pain will be randomly divided into three groups for comparison of their progress. The first group will receive an eight-week program of therapeutic exercise and health education, which will be delivered entirely online. The second group will receive the same exercise and education program in face-to-face sessions. The third group will receive standard physiotherapy care. The study will last eight weeks, and researchers will follow up with participants three months later. The project's main goal is to measure changes in participants' daily disability levels. The researchers will also examine other important factors, such as pain intensity, fear of movement, anxiety, depression, quality of life, and overall satisfaction with the care received. Measurements will be taken before the study begins, immediately after the eight-week program ends, and at the three-month follow-up. This trial aims to find more accessible, evidence-based ways to treat back pain, reduce hospital waiting lists, and improve patient well-being by combining digital and in-person care.

Core stability is the ability to control the position and movement of the trunk for optimal production, transfer, and control of forces in the upper and lower extremities during functional activities. Studies have shown that TrA activation is delayed in individuals with low back pain. The relationship between core stability and the lower extremity has been frequently studied in the literature, and according to Kibler's 'Kinetic Chain' theory, loss of proximal stability is known to lead to dysfunction in distal segments; however, the relationship between the upper extremity and core stability is still unclear. The aim of our study is to investigate the upper extremity reach capacity and scapular stability of individuals with low back pain in relation to TrA involvement and to compare them with healthy individuals without low back pain.

The aim of this research is to compare the effects of post-facilitation stretch and dry needling on hamstring flexibility, pain, lumbar range of motion, pelvic tilt, and functional status in patients with chronic low back pain. This randomized clinical trial will be conducted at Spine Care Physical Therapy and Rehabilitation Centre (SPRC), Peshawar. The sample size will be 36 participants, who will be randomly divided into two groups: 18 participants in the post-facilitation stretch group and 18 participants in the dry needling group. The study duration will be 3 weeks, with interventions applied three times per week. The sampling technique used will be non-probability purposive sampling, followed by random allocation using the sealed opaque envelope method. Participants aged 20-50 years diagnosed with chronic nonspecific low back pain and having hamstring tightness will be included. Outcome measures used in the study will be Active Knee Extension Test (goniometer) for hamstring flexibility, Numeric Pain Rating Scale (NPRS) for pain, goniometer for lumbar flexion and extension, pelvic inclinometer for pelvic tilt, and Modified Oswestry Disability Index (MODI) for functional disability.

This multi-center registry study aims to evaluate the safety and effectiveness of ultrasound-guided pharmacopuncture for patients diagnosed with spinal diseases. A total of 600 patients, aged 19 to under 70 years, will be enrolled across six Korean medicine hospitals. Eligible participants must have a pain Numeric Rating Scale (NRS) of 5 or higher for their most dominant spinal pain, which includes neck pain with upper extremity radiating pain, or low back pain with lower extremity radiating pain. As a non-interventional observational study, it will include patients who are already planned to receive ultrasound-guided pharmacopuncture as part of their routine clinical care. The primary outcome is the change in the most dominant spinal pain intensity measured by the NRS from baseline to 4 weeks. Secondary outcomes include functional disability evaluated using the Neck Disability Index (NDI) or Oswestry Disability Index (ODI), quality of life using the EQ-5D-5L, and patient satisfaction. Safety will be closely monitored by assessing all adverse events at every visit, evaluating their incidence, severity, and causality related to the procedure. Participants will be selected based on strict inclusion and exclusion criteria to ensure safety and consistency. Ethical standards including informed consent, data privacy, and ongoing safety monitoring will be rigorously upheld throughout the study.

Chronic Nonspecific Low Back Pain (NLBP) is a common condition that occurs without a specific underlying pathology, resulting in muscle tension, pain, and a decreased quality of life. Office workers are particularly at risk due to prolonged sitting, ergonomic errors, and low physical activity. While exercise therapy is a primary approach for management, low adherence rates often limit its effectiveness. Telerehabilitation (remote, technology-supported physiotherapy) stands out for its potential to increase access and support continuity of care. This study is a randomized controlled trial that will be conducted with 45 office workers aged 18-65 diagnosed with chronic NLBP. Participants will be randomly assigned to three parallel groups: traditional exercise (brochure-based), synchronous telerehabilitation (live sessions), and asynchronous telerehabilitation (pre-recorded videos). The intervention protocol will be implemented for 8 weeks. Evaluations will be performed before and after the 8-week period using the Visual Analog Scale (VAS) for pain intensity, Oswestry Disability Index (ODI) for functional disability, Short Form-36 (SF-36) for health-related quality of life, and a Patient Satisfaction Questionnaire. The aim of this study is to compare the effects of traditional, synchronous, and asynchronous telerehabilitation approaches on pain, disability, quality of life, and satisfaction to determine the most effective management model for office workers with chronic nonspecific low back pain.