INTRODUCTION: Low back pain (LBP) is often exacerbated by movement and, during functional movements, people with LBP tend to inherently modify their posture and movement patterns to avoid aggravating their pain further. Therefore, analysis of spinal movement in people with LBP is necessary and may lead to the identification of movement-based clusters for optimal treatment. PURPOSE: The overall purpose of this study was to investigate how movement patterns in people with chronic LBP relate to their subjective level of pain-related disability. First, we determined which spinal movements best discriminate between people with chronic LBP and asymptomatic controls; second, we ascertained whether the level of movement dysfunction in people with chronic LBP correlates with the Oswestry Disability Index (ODI). METHODS: 44 volunteers (26 with current chronic LBP, 15 asymptomatic controls) participated in this study. An OPAL (APDM Wearable Technology) inertial measurement unit (IMU) sensor was attached to the skin over the spinal region of L3-L4, which allowed for transmission of motion data from the lumbar spine. Participants were instructed to perform a series of eleven uniplanar and functional multiplanar spinal movements at a comfortable pace. The median peak angular velocity values from the lumbar spine (measured by the gyroscope component of the IMU) were extracted from MATLAB and Python, and all statistical analyses were subsequently performed in RStudio. RESULTS: From a mixed-direction stepwise regression based on the minimization of the Aikake Information Criterion (AIC), a binomial logistic regression model containing kinematic data from Flexion, Extension-Twist, Axial Rotation, and Sit-to-Stand tasks was selected as the best model to predict chronic LBP status (McFadden’s pseudo-R-squared: 0.310). Moreover, compared to sagittal uniplanar tasks, functional multiplanar movements were better at predicting LBP status (AICmulti-uni = −3.2). Lastly, we found no association between the kinematic data from the movements that best predicted LBP status and ODI scores (p-value = 0.405). CONCLUSION: In this study, we found no correlation between self-reported disability and kinematic median peak angular velocity data from Flexion, Extension-Twist, Axial Rotation, and Sit-to-Stand tasks. Therefore, other factors that may modulate physical function, such as psychosocial factors, should be investigated.

The purpose of this study was to investigate the effectiveness of Kinesio-Taping (KT) in golf-induced chronic low-back pain management. The golfing population continues to grow each year, and the risks of golf-induced chronic low back pain (CLBP) remain high. The Kinesio-taping technique is a non-invasive treatment intervention utilized in sports injury rehabilitation and prevention. Due to the lack of research on KT in golf-related injuries, this study addresses the injury mechanism of golf-induced CLBP and the proposed physiological mechanism and therapeutic effects on the musculoskeletal system of KT. This study is a comprehensive review of the golf swing, prevalence and risk factors of golf induced CLBP, treatment modalities for non-specific low back pain, and the use of KT in sports medicine and healthcare settings. The target population of this study includes active adults and older adults who are at risk or currently experiencing CLBP and those who may golf professionally or recreationally. The literature search (February- October 2022) was performed using multiple databases, including UCF Libraries, PubMed, GoogleScholar, SagePub, ScienceDirect, and Ebscohost. Keywords employed by this research include "low back*" "golf*" or "golf swing*" "Kinesio-tape*" or "Kinesio-taping*" and "pain*" or "injury*". Search results were carefully screened, and relevant literature was selected for this study. A total of 78 scientific studies were included in this review. This literature review found insufficient empirical evidence to support the application of KT in golf-induced low back pain management. Although the subjects' contextual effects should not be overlooked, the reasoning behind how KT physiologically affects target injury sites remains unclear. Further research is suggested to examine the effectiveness of KT in treating golf induced CLBP.

Chronic pain sufferers are frequently misunderstood and stigmatised. The aim of this investigation was to provide a description of the lifewor1d of people with chronic low back pain, using the phenomenological method. Themes which emerged were that the persistent nature of chronic pain makes it particularly difficult to endure, arousing a profound fear of the future. It causes a disruption in the relationship between the person and the body, in which the person is forced to function within the constraints of pain. Sufferers are unable to fulfil social roles as expected and are forced to revise their goals and activities. The distress of their experience is mediated by the ability to make sense of their condition, finding meaning in the pain itself. The study highlights the value of the phenomenological method in health psychology. Recommendations are made which may be of benefit to people with chronic pain and their families. / Psychology / M. Sc. (Psychology)

Apesar de ser reconhecidamente gerada por causas multifatoriais, as investigações a respeito da dor lombar crônica (DLC) são em sua maioria unidirecionais, dificultando uma visão mais ampla desse quadro. A proposta desse estudo foi investigar a DLC a partir de uma abordagem multidisciplinar, analisando parâmetros biomecânicos, morfológicos e inflamatórios. O experimento 1 objetivou a caracterização de portadores de DLC; e o Experimento 2, a influência de dois protocolos de treinamento de força na DLC, um de baixa intensidade e baixo volume (TB) e outro de alta intensidade e alto volume (TA). Em ambos os experimentos foram analisados intensidade de dor e nível de incapacidade funcional (escala analógica de dor e Índice Oswestry), Força de Reação de Solo (FRS - plataformas de força AMTI BP600900 - 2000), cinemática de membros inferiores (centrais inerciais - Noraxon) e atividade muscular do reto abdominal, oblíquos externos, multífidos lombares, glúteo médio, vasto lateral e bíceps femoral (TeleMyoDTS), durante a marcha e o sentar e levantar, citocinas inflamatórias por Multiplex em amostras de sangue e área de secção transversa (AST) dos multífidos lombares por imagem de ultrassom. No experimento 1, o grupo de portadores de DLC (n=35) em comparação ao grupo controle (n=20) apresentou maior inflamação sistêmica evidenciada por concentrações elevadas de Eotaxina e MCP-1, menor AST de multífidos lombares (8.11±0.98 vs 9.942±1.05cm²), maior e antecipado primeiro pico da FRS durante a marcha (1.19±0.11 vs 1.09±0.09 PC; 0.16±0.032 vs 0.18±0.031s), menor flexão de quadril (99.47±12.3 vs 107.44±8.46º) e menor atividade de multífidos lombares (41.08±16.15 vs 52.25±12.97 RMS) no sentar e levantar. Os resultados mostraram que os portadores de DLC apresentaram alterações biomecânicas relacionadas ao controle de carga mecânica, inflamação sistêmica aumentada e menor AST de multífidos, apontando para um ambiente catabólico associado a prejuízos nas funções do aparelho locomotor. No experimento 2, embora o grupo TA (n=13) tenha apresentado maior decréscimo no score do Índice Oswestry em relação ao grupo TB (n=13), (24.31±7.89 TA pré vs 9.69±6.97 TA pós; 25.15±9.05 TB pré vs 19.73±13.35 TB pós), ambos apresentaram resultados muito semelhantes nos parâmetros analisados após intervenção: as citocinas inflamatórias foram moduladas numa direção anti-inflamatória, a AST dos multífidos lombares aumentou 15,63% e o primeiro pico da FRS diminuiu na marcha (1.21±0.03 TA pré vs 1.19±0.03 TA pós, 1.15±0.07 TB pré vs 1.09±0.07 PC TB pós), a atividade de reto abdominal diminuiu na fase de balanço da marcha (41.38±12.9 TA pré vs 24.87±12.9 TA pós; 38.86±14.13 TB pré vs 32.5±14.13 RMS TB pós) e os multífidos lombares apresentaram atividade aumentada no sentar e levantar (27.25±2.36 TA pré vs 37.59±2.36 TA pós; 30.16±2.75 TB pré vs 30.72±2.75 RMS TB pós). Assim, independentemente de intensidade e volume estudados, o treinamento de força não apenas reduziu a percepção de dor e a inflamação sistêmica, como também afetou posistivamente parâmetros biomecânicos indicativos de desempenho e controle de carga / Although it is known that CLBP have a multifactorial etiology, the investigations about it are mostly specific to each investigation area, making difficult to understand this complex condition. The purpose of the present study was to investigate CLBP from a multidisciplinary approach, analyzing biomechanical, morphological and inflammatory parameters in two different experiments: one aiming to characterize the CLBP patients and the second to compare the influence of two strength training protocols, one of low intensity and low volume (LIT) and one of high intensity and high volume (HIT). In both experiments, pain intensity and level of functional disability were analyzed (by analogue scale of pain and Oswestry Index), Ground Reaction Forces (GRF - AMTI BP600900 - 2000 force plate), kinematics of lower limbs (Inertial Sensors by Noraxon) and electromyography of the rectus abdominis, external oblique, lumbar multifidus, medial gluteus, vastus lateralis and biceps femoris muscles (TelemyoDTS) during gait and sit-to-stand, inflammatory cytokines by Multiplex in blood samples and cross-sectional area (CSA) of the lumbar multifidus by ultrasound imaging. In the experiment 1, the CLBP group (n = 35) compared to the group of asymptomatic subjects (n = 20) presented higher systemic inflammation evidenced by high concentrations of Eotaxin and MCP-1, lower CSA of lumbar multifidus (8.11±0.98 vs 9.942±1.05cm²), higher and anticipated first peak of GRF during gait (1.19±0.11 vs 1.09±0.09 PC; 0.16±0.032 vs 0.18±0.031s), lower hip flexion (99.47±12.3 vs 107.44±8.46º) and lower activity of lumbar multifidus (41.08±16.15 vs 52.25±12.97 RMS) in sit-to-stand. These results showed that CLBP patients presented biomechanical changes related to mechanical load control, higher systemic inflammation and smaller lumbar multifidus CSA, pointing to a catabolic environment with deficit in body functionality. In the experiment 2, although the high intensity group (HIT; n = 13) presented a greater decrease in the Oswestry Index score than the low intensity group (LIT; n = 13), both presented very similar results after intervention from analyzed parameters: the inflammatory biomarkers were modulated in in an anti-inflammatory sense, the CSA of the lumbar multifidus increased 15,63%, and the GFR first peak decreased during gait (1.21±0.03 HIT pre vs 1.19±0.03 HIT pos, 1.15±0.07 LIT pre vs 1.09±0.07 BW LIT pos), rectus abdominis activity decreased in the balance phase of the gait (41.38±12.9 HIT pre vs 24.87±12.9 HIT pos; 38.86±14.13 LIT pre vs 32.5±14.13 RMS TB pós) and the lumbar multifidus presented increased activity in sit-to-santand (27.25±2.36 HIT pre vs 37.59±2.36 HIT pos; 30.16±2.75 LIT pre vs 30.72±2.75 RMS LIT pos). Thus, independently of intensity and volume analyzed, the strength training not only reduced chronic pain perception of CLBP patients, as improved biomechanical parameters related to load control, modulated inflammatory biomarkers and influenced in lumbar multifidus hypertophy

La lombalgie constitue une affection fréquente de la population adulte des pays industrialisés. Les médias parlent souvent de « mal de dos, mal du siècle ». Les études épidémiologiques révèlent en effet que la majorité des individus souffriront un jour du dos. La lombalgie présente généralement une évolution naturelle favorable. Les répercussions socio-économiques majeures associées aux douleurs lombaires, et qui conduisent certains à employer le terme de « fléau socioéconomique », résultent des lombalgies persistant plus de 3 mois (lombalgies chroniques) qui affectent pourtant moins de 10% des lombalgiques mais dont le traitement constitue un défi considérable pour le monde médical et la société. Ces observations ont motivé notre recherche relative à lévaluation et la revalidation de la lombalgie chronique. En effet, malgré une littérature scientifique abondante, ce sujet reste méconnu et parfois même controversé. Après avoir précisé létat de la question (chapitre II), notre contribution personnelle (chapitre III) concerne lévaluation et la rééducation musculaire du lombalgique chronique. Notre contribution comporte trois parties : La PREMIERE PARTIE déterminera les tests les plus adaptés pour évaluer les muscles extenseurs du tronc de lombalgiques chroniques. A cette fin, nous avons appliqué la procédure suivante : Etape 1 : revue de la littérature, analyse critique et sélection des évaluations disponibles. Etape 2 : analyse comparative des tests sélectionnés sur des sujets sains afin dapprécier leur faisabilité et leur reproductibilité. Etape 3 : étude de la reproductibilité des tests sélectionnés sur des patients lombalgiques chroniques. Etape 4 : évaluation de la sollicitation cardio-vasculaire des épreuves. Etape 5 : validation des épreuves en examinant la sollicitation musculaire. La SECONDE PARTIE appréciera lampleur du déconditionnement physique du sujet lombalgique chronique tout en précisant son caractère global ou local. Cette étude compare, chez des sujets lombalgiques et sains appariés, les performances des extenseurs du tronc mais également dautres muscles du tronc et des membres inférieurs ainsi que du système cardio-respiratoire. La TROISIEME PARTIE examinera lefficacité lefficacité de la nouvelle prise en charge multidisciplinaire (octobre 2004) proposée par le service de Médecine Physique du CHU de Liège aux patients lombalgiques chroniques. Lors de la discussion générale (chapitre IV), nous établirons des recommandations relatives à lévaluation et au traitement des lombalgiques chroniques.

Tyrimo problema: lėtinio nugaros juosmeninės dalies skausmo pasikartojimo tikimybė labai didelė, todėl svarbu ištirti ir įvertinti pratimų išliekamąjį poveikį gydant nugaros skausmą. Kol apatiniai stuburo segmentai yra nestabilūs, jokie pratimai, mažinantys nugaros juosmeninės dalies skausmą, nebus efektyvūs. Stuburą stabilizuojančių pratimų dozavimas, jų atlikimo trukmė ir išliekamasis poveikis vis dar kelia diskusijų ir reikalauja išsamesnių tyrimų. Tyrimo hipotezė: 12 savaičių 24 procedūrų stuburą stabilizuojančių pratimų programos išliekamasis poveikis yra nepakankamas, siekiant ilgalaikio gydomojo efekto 40–60 metų amžiaus moterims, kamuojamoms lėtinio nugaros juosmeninės dalies skausmo. Tyrimo tikslas: įvertinti 12 savaičių 24 procedūrų stuburą stabilizuojančių pratimų programos išliekamąjį poveikį 40–60 metų amžiaus moterims, kamuojamoms lėtinio nugaros juosmeninės dalies skausmo. Tyrimo uždaviniai: ištirti liemens lenkiamųjų ir tiesiamųjų raumenų izometrinę jėgą ir ištvermę prieš ir po stuburą stabilizuojančių pratimų programos bei praėjus 4 ir 8 savaitėms po jos; nustatyti tiriamųjų nugaros juosmeninės dalies skausmo lygį ir įvertinti funkcinę būklę prieš ir po stuburą stabilizuojančių pratimų programos bei praėjus 4 ir 8 savaitėms po jos; įvertinti liemens lenkiamųjų ir tiesiamųjų raumenų jėgos ir ištvermės pokyčio įtaką nugaros juosmeninės dalies skausmo intensyvumui bei funkcinei būklei. Tyrimo metodai: Biodex System 3 Pro izokinetinis dinamometras, pilvo ir... [toliau žr. visą tekstą] / The problem of the research: the probability that chronic low back pain will reoccur is very high. For this reason, it is important to examine and evaluate the lastingness of the effect of the exercises while treating back pain. To reduce low back pain spine stabilizing exercises are applied. Dosage of exercises, duration of their performance and lastingness of the effect are still generating discussions and require a more detailed research. The hypothesis of the research: lastingness of twelve-week, 24 procedures, spine stabilizing exercises programme is not sufficient for 40-60 year old women with chronic low back pain while seeking a long lasting healing effect. The aim of the research: to evaluate lastingness of twelve-week, 24 procedures, spine stabilizing exercises programme effect on 40-60 year old women with chronic low back pain. The objectives of the research: to examine isometric force and endurance of back bending and straightening muscles before and after spine stabilizing exercises programme as well as 4 and 8 weeks after it; to determine subjects’ level of low back pain and functional state before and after spine stabilizing exercises programme as well as 4 and 8 weeks after it; to determine the effect of change in strength and endurance of waist bending and straightening muscles on low back pain intensity and functional state. Methods applied in the research: Biodex System 3 Pro isokinetic dynamometer, tests on abdomen and back muscles endurance, Oswestry... [to full text]

Bakgrund: Ländryggen består av fem kotor som är omgiven av en avancerad ligamentapparat samt muskler som ska stabilisera denna instabila konstruktion av leder. Ländryggens främsta funktioner är att vara viktbärande och stötdämpande samt att skydda ryggmärgskanalen och nervrötterna. Orsaker till ländryggssmärta är svaga muskler, senor, ligament, degenerativa förändringar, artros etc. Det är 80% av alla personer som har haft eller kommer att ha ont i ryggen, av dessa utvecklar 20% kroniska besvär. Kronisk smärta är det om personen har haft besvär mer än tre månader. Det finns olika sätt att behandla ländryggssmärta, både med manuella behandlingsformer och träning, det är inte känt vilken behandlingsform som är den mest effektiva. Förutom individerna som drabbas, drabbas också samhället av kronisk ländryggssmärta, 2009 var sjukförsäkringskostnaderna 4144 miljoner kronor. Syfte: Syftet med denna systematiska litteraturstudie var att sammanställa resultat av interventionsstudier och undersöka om manuella terapiformer har ett mervärde vid behandling av personer i arbetsför ålder med kronisk ländryggsmärta. Metod: En litteratursökning genomfördes i de medicinska databaserna PubMed, CINAHL och PEDro. Sökningen resulterade i åtta inkluderade studier som motsvarade inklusions- och exklusionskriterierna. Samtliga studier granskades via SBU:s granskningsmall för randomiserade studier. Resultat: Vid granskning av studierna avseende smärta visade fyra signifikanta resultat till förmån för interventionsgruppen, två var av medelhögt bevisvärde och två av svagt bevisvärde. Vid granskning av studierna avseende funktion var det fyra som visade signifikanta resultat till förmån för interventionsgruppen, en studie erhöll högt bevisvärde och en annan med medelhögt bevisvärde. Vid granskning av studierna avseende livskvalitet var det två studier som visade signifikanta resultat till förmån för interventionsgruppen, båda erhöll medelhögt bevisvärde. Konklusion: Det finns indikationer på att manuella behandlingsformer kan ha ett mervärde vid behandling av individer med kronisk ländryggssmärta i arbetsför ålder. Ytterligare forskning inom ämnet efterfrågas. / Background: The lumbar spine consist of five vertebrae surrounded by an advanced ligament device and muscles that will stabilize this unstable construction of joints. The lumbar spines main functions are to be weight-bearing and shock absorption, and protection of the spinal cord and the nerve roots. Causes of low back pain are weak muscles, tendons, ligaments, degenerative changes, osteoarthritis etc. There is 80% of all people who have had or will have low back pain, of which 20% of these will develop chronic problems. Chronic pain is if the person has had pain for more than three months. There are different ways of treating low back pain, both with manual therapies and exercise, it is not known which treatment is the most efficient. In addition to the affected individuals, the society also suffers from chronic low back pain. In 2009, health insurance costs were SEK 4144 million. Purpose: The purpose of this systematic literature study was to compile the results of intervention studies and to investigate whether manual therapies have added value in the treatment in people of working age with chronic lumbar pain. Method: A search for literature was made in the medical databases PubMed, CINAHL and PEDro. The search resulted in eight included articles that corresponded to the inclusion and exclusion criterias. All articles were examined through the SBU template for randomized studies. Results: In examination the studies on pain, four of the included articles showed significant differences in favor of the intervention group, two were of moderate level of evidence and two were of weak level of evidence. In examination the studies on function, four of the included articles showed significant differences in favor of the intervention group, one study received high level of evidence and another with moderate level of evidence. In examination the studies on quality of life, two of the included articles showed significant differences in favor of the intervention group, both receiving moderate level of evidence. Conclusion: There are indications that manual treatments may have added value in the treatment of individuals with chronic low back pain in working age. Further research on the subject is requested.

Chronic pain sufferers are frequently misunderstood and stigmatised. The aim of this investigation was to provide a description of the lifewor1d of people with chronic low back pain, using the phenomenological method. Themes which emerged were that the persistent nature of chronic pain makes it particularly difficult to endure, arousing a profound fear of the future. It causes a disruption in the relationship between the person and the body, in which the person is forced to function within the constraints of pain. Sufferers are unable to fulfil social roles as expected and are forced to revise their goals and activities. The distress of their experience is mediated by the ability to make sense of their condition, finding meaning in the pain itself. The study highlights the value of the phenomenological method in health psychology. Recommendations are made which may be of benefit to people with chronic pain and their families. / Psychology / M. Sc. (Psychology)

Apesar de ser reconhecidamente gerada por causas multifatoriais, as investigações a respeito da dor lombar crônica (DLC) são em sua maioria unidirecionais, dificultando uma visão mais ampla desse quadro. A proposta desse estudo foi investigar a DLC a partir de uma abordagem multidisciplinar, analisando parâmetros biomecânicos, morfológicos e inflamatórios. O experimento 1 objetivou a caracterização de portadores de DLC; e o Experimento 2, a influência de dois protocolos de treinamento de força na DLC, um de baixa intensidade e baixo volume (TB) e outro de alta intensidade e alto volume (TA). Em ambos os experimentos foram analisados intensidade de dor e nível de incapacidade funcional (escala analógica de dor e Índice Oswestry), Força de Reação de Solo (FRS - plataformas de força AMTI BP600900 - 2000), cinemática de membros inferiores (centrais inerciais - Noraxon) e atividade muscular do reto abdominal, oblíquos externos, multífidos lombares, glúteo médio, vasto lateral e bíceps femoral (TeleMyoDTS), durante a marcha e o sentar e levantar, citocinas inflamatórias por Multiplex em amostras de sangue e área de secção transversa (AST) dos multífidos lombares por imagem de ultrassom. No experimento 1, o grupo de portadores de DLC (n=35) em comparação ao grupo controle (n=20) apresentou maior inflamação sistêmica evidenciada por concentrações elevadas de Eotaxina e MCP-1, menor AST de multífidos lombares (8.11±0.98 vs 9.942±1.05cm²), maior e antecipado primeiro pico da FRS durante a marcha (1.19±0.11 vs 1.09±0.09 PC; 0.16±0.032 vs 0.18±0.031s), menor flexão de quadril (99.47±12.3 vs 107.44±8.46º) e menor atividade de multífidos lombares (41.08±16.15 vs 52.25±12.97 RMS) no sentar e levantar. Os resultados mostraram que os portadores de DLC apresentaram alterações biomecânicas relacionadas ao controle de carga mecânica, inflamação sistêmica aumentada e menor AST de multífidos, apontando para um ambiente catabólico associado a prejuízos nas funções do aparelho locomotor. No experimento 2, embora o grupo TA (n=13) tenha apresentado maior decréscimo no score do Índice Oswestry em relação ao grupo TB (n=13), (24.31±7.89 TA pré vs 9.69±6.97 TA pós; 25.15±9.05 TB pré vs 19.73±13.35 TB pós), ambos apresentaram resultados muito semelhantes nos parâmetros analisados após intervenção: as citocinas inflamatórias foram moduladas numa direção anti-inflamatória, a AST dos multífidos lombares aumentou 15,63% e o primeiro pico da FRS diminuiu na marcha (1.21±0.03 TA pré vs 1.19±0.03 TA pós, 1.15±0.07 TB pré vs 1.09±0.07 PC TB pós), a atividade de reto abdominal diminuiu na fase de balanço da marcha (41.38±12.9 TA pré vs 24.87±12.9 TA pós; 38.86±14.13 TB pré vs 32.5±14.13 RMS TB pós) e os multífidos lombares apresentaram atividade aumentada no sentar e levantar (27.25±2.36 TA pré vs 37.59±2.36 TA pós; 30.16±2.75 TB pré vs 30.72±2.75 RMS TB pós). Assim, independentemente de intensidade e volume estudados, o treinamento de força não apenas reduziu a percepção de dor e a inflamação sistêmica, como também afetou posistivamente parâmetros biomecânicos indicativos de desempenho e controle de carga / Although it is known that CLBP have a multifactorial etiology, the investigations about it are mostly specific to each investigation area, making difficult to understand this complex condition. The purpose of the present study was to investigate CLBP from a multidisciplinary approach, analyzing biomechanical, morphological and inflammatory parameters in two different experiments: one aiming to characterize the CLBP patients and the second to compare the influence of two strength training protocols, one of low intensity and low volume (LIT) and one of high intensity and high volume (HIT). In both experiments, pain intensity and level of functional disability were analyzed (by analogue scale of pain and Oswestry Index), Ground Reaction Forces (GRF - AMTI BP600900 - 2000 force plate), kinematics of lower limbs (Inertial Sensors by Noraxon) and electromyography of the rectus abdominis, external oblique, lumbar multifidus, medial gluteus, vastus lateralis and biceps femoris muscles (TelemyoDTS) during gait and sit-to-stand, inflammatory cytokines by Multiplex in blood samples and cross-sectional area (CSA) of the lumbar multifidus by ultrasound imaging. In the experiment 1, the CLBP group (n = 35) compared to the group of asymptomatic subjects (n = 20) presented higher systemic inflammation evidenced by high concentrations of Eotaxin and MCP-1, lower CSA of lumbar multifidus (8.11±0.98 vs 9.942±1.05cm²), higher and anticipated first peak of GRF during gait (1.19±0.11 vs 1.09±0.09 PC; 0.16±0.032 vs 0.18±0.031s), lower hip flexion (99.47±12.3 vs 107.44±8.46º) and lower activity of lumbar multifidus (41.08±16.15 vs 52.25±12.97 RMS) in sit-to-stand. These results showed that CLBP patients presented biomechanical changes related to mechanical load control, higher systemic inflammation and smaller lumbar multifidus CSA, pointing to a catabolic environment with deficit in body functionality. In the experiment 2, although the high intensity group (HIT; n = 13) presented a greater decrease in the Oswestry Index score than the low intensity group (LIT; n = 13), both presented very similar results after intervention from analyzed parameters: the inflammatory biomarkers were modulated in in an anti-inflammatory sense, the CSA of the lumbar multifidus increased 15,63%, and the GFR first peak decreased during gait (1.21±0.03 HIT pre vs 1.19±0.03 HIT pos, 1.15±0.07 LIT pre vs 1.09±0.07 BW LIT pos), rectus abdominis activity decreased in the balance phase of the gait (41.38±12.9 HIT pre vs 24.87±12.9 HIT pos; 38.86±14.13 LIT pre vs 32.5±14.13 RMS TB pós) and the lumbar multifidus presented increased activity in sit-to-santand (27.25±2.36 HIT pre vs 37.59±2.36 HIT pos; 30.16±2.75 LIT pre vs 30.72±2.75 RMS LIT pos). Thus, independently of intensity and volume analyzed, the strength training not only reduced chronic pain perception of CLBP patients, as improved biomechanical parameters related to load control, modulated inflammatory biomarkers and influenced in lumbar multifidus hypertophy

Background: The buprenorphine transdermal system (BTDS) is approved in the US for the management of chronic pain. Due to its high affinity for mu-opioid receptors with a slow dissociation profile, buprenorphine may potentially displace or prevent the binding of competing mu-opioid-receptor agonists, including immediate-release (IR) opioids, in a dose-dependent manner. Health care professionals may assume that the use of IR opioids for supplemental analgesia during BTDS therapy is not acceptable. Materials and methods: This post hoc analysis evaluated the use of IR opioids as supplemental analgesia during the management of moderate-severe chronic pain with BTDS at 52 US sites (BUP3015S, NCT01125917). Patients were categorized into IR-opioid and no-IR-opioid groups. At each visit of the extension phase, adverse events, concomitant medications, and information from the Brief Pain Inventory (BPI) were recorded. Results: The most common supplemental IR opioids prescribed during BTDS treatment (n=354) were hydrocodone-acetaminophen and oxycodone-acetaminophen. The mean daily dose of IR opioids (morphine equivalents) for supplemental analgesia was 22 mg. At baseline, BPI pain intensity and BPI - interference scores were higher for patients in the IR-opioid group. In both treatment groups, scores improved by week 4, and then were maintained throughout 6 months of the open-label extension trial. The incidence of treatment-emergent adverse events was similar in both groups. Conclusion: Patients who were prescribed IR opioids reported lower scores for BPI pain intensity and pain interference to levels similar to patients receiving BTDS without IR opioids, without increasing the rate or severity of treatment-emergent adverse events. Patients prescribed concomitant use of IR opioids with BTDS had greater treatment persistence. The results of this post hoc analysis provide support for the concomitant use of IR opioids for supplemental analgesia during the management of moderate-severe chronic pain with BTDS.