The Use of Virtual Reality in Back Pain Rehabilitation: A Systematic Review and Meta-Analysis.

This systematic review aimed to synthesize the existing evidence of extended reality (XR) on pain and motor function outcomes in patients with back pain. Following the Cochrane guidelines, relevant articles of any language were selected by 2 independent reviewers from CINAHL, Cochrane, Embase, Medline and Web of Knowledge databases. Of 2,050 unique citations, 24 articles were included in our review. These studies included a total of 900 back pain patients. Despite broader XR search, all interventions were virtual reality (VR) based and involved physical exercises (n = 17, 71%), hippotherapy (n = 4, 17%), motor imagery (n = 1, 4%), distraction (n = 1, 4%), and cognitive-behavior therapy (n = 1, 4%). Sixteen controlled studies were included in a meta-analysis which suggested that VR provides a significant improvement in terms of back pain intensity over control interventions (Mean Difference: -0.67; 95% CI: -1.12 to -0.23; I2 = 85%). Almost all included studies presented high risk of bias, highlighting the need to improve methodology in the examination of VR interventions. While the specific set of studies showed high heterogeneity across several methodological factors, a tentative conclusion could be drawn that VR was effective improving back pain intensity and tends to have a positive effect on improving other pain outcomes and motion function. PERSPECTIVE: Extended reality technologies have appeared as interesting nonpharmacological options for the treatment of back pain, with the potential to minimise the need for opioid medications. Our systematic review summarised existing applications of extended reality for back pain and proposed a few recommendations to direct further studies in the field.

Relative Effectiveness of Electroacupuncture and Biofeedback in the Treatment of Neck and Upper Back Myofascial Pain: A Randomized Clinical Trial.

OBJECTIVE: To determine the differences between clinical effects of electroacupuncture and biofeedback therapy in addition to conventional treatment in patients with cervical myofascial pain syndrome (MPS). DESIGN: Randomized clinical trial. SETTING: Physical medicine and rehabilitation clinic of a university hospital. PARTICIPANTS: Fifty patients (N=50) aged 25-55 years of both sexes with chronic neck pain diagnosed with MPS (characterized by trigger points within taut bands) were randomly assigned to 2 equal groups of 25 individuals. INTERVENTIONS: The patients in electroacupuncture group were treated with standard acupuncture and concomitant electrical stimulation; those in biofeedback group received visual electromyography biofeedback therapy for muscle activity and relaxation. Both groups received the intervention 2 times a week for a total of 6 sessions. Basic exercise training and medicines were administered for all the patients. MAIN OUTCOME MEASURES: Pain severity based on the visual analog scale (VAS), functional status using Neck Disability Index (NDI), cervical range of motion (ROM) using and inclinometer, and pressure pain threshold (PPT) using an algometer were evaluated before and at 3 and 12 weeks after the treatment. Primary outcome was defined as 20% reduction in the 3-month neck pain and dysfunction compared to baseline, assessed through the NDI. RESULTS: Fifty patients (39 women, 11 men) with a mean age (years) ± SD of 39.0±5.5 and neck pain duration (weeks) of 6.0±2.2 were analyzed. All parameters, except for PPT of the lower trapezius and paravertebral muscles were improved significantly in both groups, while baseline values were controlled. The primary outcome was achieved more significantly in the acupuncture group than in the biofeedback group: 20 (80.0%) vs 10 (40.0%); rate ratio=2 with 95% confidence interval (CI), 1.19-3.36; number needed to treat (NNT)=2.5 with 95% CI, 1.54-6.58. Advantages of acupuncture over biofeedback were observed according to values obtained from the NDI, VAS, extension and left lateral-bending ROM, and PPT on the left upper trapezius after the last session of intervention until 3 months (P<.05). CONCLUSIONS: Both electroacupuncture and biofeedback therapies were found to be effective in management of MPS when integrated with conventional treatment. However, intergroup differences showed priority of acupuncture in some parameters vs biofeedback. Thus, electroacupuncture seems to be a better complementary modality for treatment of MPS in the neck and upper back area.

Management of thoracic spine pain and dysfunction: A survey of clinical practice in the UK.

BACKGROUND: The thoracic spine (TS) is relatively under-researched compared to the neck and low back. As the challenge of managing spinal pain persists, understanding current physiotherapy clinical practice for TS pain and dysfunction is necessary to inform future research in this area. OBJECTIVE: To investigate physiotherapy practice for managing thoracic spine pain and dysfunction (TSPD) in the UK, with a secondary focus on examining differences across settings and expertise. DESIGN AND METHOD: A cross sectional e-survey informed by existing evidence was designed. Comprising closed and open questions, the survey is reported in line with Checklist for Reporting Results of Internet E-Surveys. Eligible participants were UK-trained physiotherapists managing patients with TSPD, recruited for 9 weeks up to 8/2/16. Data analysis included descriptive analyses (closed questions) and thematic analysis (open questions). RESULTS: From the 485 respondents, fulfilling the required sample size, key findings included. EXAMINATION: Active motion testing, palpation and postural assessment was 'always' undertaken by >89% of respondents. MANAGEMENT: Active (exercises) and passive (e.g. mobilisations) techniques were used by >85% of respondents, with ∼50% using manipulation, taping and acupuncture. Practice settings: Although broadly similar passive techniques were used more in private practice and sport. Expertise: Broadly similar patterns were seen for use of exercise across levels of expertise, although differences observed for electrotherapy and manipulation. CONCLUSION: Despite limited research exercise is widely used in all areas of practice and across all level of expertise. Further research is required to investigate exercise prescription for TSPD and implementation of evidence-based practice.

GLA:D® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence.

BACKGROUND: Clinical guidelines recommend that people with back pain be given information and education about their back pain, advice to remain active and at work, and exercises to improve mobility and physical activity. Guidelines, however, rarely describe how this is best delivered. The aim of this paper is to present the development, theories, and underlying evidence for 'GLA:D Back' - a group education and exercise program that translates guideline recommendations into a clinician-delivered program for the promotion of self-management in people with persistent/recurrent back pain. METHODS: GLA:D Back, which included a rationale and objectives for the program, theory and evidence for the interventions, and program materials, was developed using an iterative process. The content of patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements hypothesised to improve back pain beliefs and management skills. The program was tested on eight people with persistent back pain in a university clinic and 152 patients from nine primary care physiotherapy and chiropractic clinics. Following feedback from the clinicians and patients involved, the working version of the program was created. RESULTS: Educational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between the sum of demands and the individual's capacity. These were operationalised in PowerPoint presentations with supporting text to aid clinicians in delivering two one-hour patient education lectures. The exercise program included 16 supervised one-hour sessions over 8 weeks, each comprising a warm-up section and eight types of exercises for general flexibility and strengthening of six different muscle groups at four levels of difficulty. The aims of the exercises were to improve overall back fitness and, at the same time, encourage patients to explore variations in movement by incorporating education content into the exercise sessions. CONCLUSION: From current best evidence about prognostic factors in back pain and effective treatments for back pain, research and clinical experts developed a ready-to-use structured program - GLA:D® Back - to support self-management for people with persistent/recurrent back pain.

[Dissemination of Patient Education in the Rehabilitation of Chronic Back Pain - Cost Analysis of a Program Implementation]. / Dissemination eines Schulungsprogramms bei chronischem Rückenschmerz ­ Kostenanalyse der Programmimplementierung.

The aim of the project is a cost analysis of 2 different strategies "train-the-trainer-seminar" (ttt-seminar) and "implementation guideline" (ig) in the implementation of a standardised patient education program in the inpatient rehabilitation of patients with chronic back pain. The implementation strategies were assigned by chance to 10 rehabilitation clinics. Expenditure of time was evaluated by questionnaire. Additionally materials and travel expenses were calculated. The total implementation costs accounted 4 582 € for the ttt-seminar and were about one third (35%) higher than the costs for the ig-strategy. The higher total implementation costs can basically be attributed to higher personnel costs due to the time-consuming seminar. However, in the ig-strategy postprocessing costs were 23.5% higher than in the ttt-strategy.

Immediate effects of thoracic spinal mobilisation on erector spinae muscle activity and pain in patients with thoracic spine pain: a preliminary randomised controlled trial.

OBJECTIVES: To investigate the activity of the thoracic erector spinae muscles and perceived pain intensity immediately after central postero-anterior (PA) mobilisation of the thoracic spine. DESIGN: Randomised, placebo-controlled, experimental design. PARTICIPANTS AND INTERVENTIONS: Thirty-four participants with non-specific thoracic pain were randomised to the experimental group [grade III central PA mobilisation performed for 3minutes at the level of the seventh thoracic vertebra (T7)] or the placebo group (less than grade I central PA mobilisation performed for 3minutes at T7). MAIN OUTCOME MEASURES: Before and immediately after PA mobilisation, surface electromyography (EMG) was recorded from the thoracic erector spinae muscles as the participants performed 10° spine extension from a prone position for 10seconds. Each participant rated their pain intensity as an investigator performed grade III central PA over the most symptomatic thoracic segment, and the pressure pain threshold (PPT) was evaluated bilaterally over the erector spinae muscles. RESULTS: The EMG amplitude of thoracic erector spinae activity was reduced significantly after the intervention in the experimental group (P<0.05), but not in the placebo group. The difference between the groups was significant {pre-post change: placebo -14 [standard deviation (SD) 50]mV, experimental 28 (SD 48)mV; mean difference -42mV; 95% confidence interval of the difference -76 to 7; P<0.05} albeit small (Grissom=0.44). However, both groups showed a significant reduction in pain immediately after the intervention, and both groups showed a similar pre-post change in PPT. CONCLUSION: These preliminary findings indicate that grade III central mobilisation over the most symptomatic thoracic segment reduces thoracic erector spinae activity during extension of the trunk in people with non-specific thoracic spine pain. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN47601528.

Comparative Effectiveness of Conservative Interventions for Nonspecific Chronic Spinal Pain: Physical, Behavioral/Psychologically Informed, or Combined? A Systematic Review and Meta-Analysis.

UNLABELLED: Nonspecific chronic spinal pain (NSCSP) is highly disabling. Current conservative rehabilitation commonly includes physical and behavioral interventions, or a combination of these approaches. Physical interventions aim to enhance physical capacity by using methods such as exercise, manual therapy, and ergonomics. Behavioral/psychologically informed interventions aim to enhance behaviors, cognitions, or mood by using methods such as relaxation and cognitive behavioral therapy. Combined interventions aim to target physical and also behavioral/psychological factors contributing to patients' pain by using methods such as multidisciplinary pain management programs. Because it remains unclear whether any of these approaches are superior, this review aimed to assess the comparative effectiveness of physical, behavioral/psychologically informed, and combined interventions on pain and disability in patients with NSCSP. Ten electronic databases were searched for randomized controlled trials (RCTs) including participants reporting NSCSP. Studies were required to have an "active" conservative treatment control group for comparison. Studies were not eligible if the interventions were from the same domain (eg, if the study compared 2 physical interventions). Study quality was assessed used the Cochrane Back Review Group risk of bias criteria. The treatment effects of physical, behavioral/psychologically informed, and combined interventions were assessed using meta-analyses. Twenty-four studies were included. No clinically significant differences were found for pain and disability between physical, behavioral/psychologically informed, and combined interventions. The simple categorization of interventions into physical, behavioral/psychologically informed, and combined could be considered a limitation of this review, because these interventions may not be easily differentiated to allow accurate comparisons to be made. Further work should consider investigating whether tailoring rehabilitation to individual patients and their perceived risk of chronicity, as seen in recent RCTs for low back pain, can enhance outcomes in NSCSP. PERSPECTIVE: In this systematic review of RCTs in NSCSP, only small differences in pain or disability were observed between physical, behavioral/psychologically informed, and combined interventions.

Trunk Muscle Training Augmented With Neuromuscular Electrical Stimulation Appears to Improve Function in Older Adults With Chronic Low Back Pain: A Randomized Preliminary Trial.

OBJECTIVES: To assess the feasibility of a trial to evaluate a trunk muscle training program augmented with neuromuscular electrical stimulation (TMT+NMES) for the rehabilitation of older adults with chronic low back pain (LBP) and to preliminarily investigate whether TMT+NMES could improve physical function and pain compared with a passive control intervention. MATERIALS AND METHODS: We conducted a single-blind, randomized feasibility trial. Patients aged 60 to 85 years were allocated to TMT+NMES (n=31) or a passive control intervention (n=33), consisting of passive treatments, that is, heat, ultrasound, and massage. Outcomes assessed 3- and 6-month postrandomization included Timed Up and Go Test, gait speed, pain, and LBP-related functional limitation. RESULTS: Feasibility was established by acceptable adherence (≥80%) and attrition (<20%) rates for both interventions. Both groups had similar, clinically important reductions in pain of >2 points on a numeric pain rating scale during the course of the trial. But, only the TMT+NMES group had clinically important improvements in both performance-based and self-reported measures of function. In terms of the participants' global rating of functional improvement at 6 months, the TMT+NMES group improved by 73.9% and the passive control group improved by 56.7% compared with baseline. The between-group difference was 17.2% (95% confidence interval, 5.87-28.60) in favor of TMT+NMES. DISCUSSION: It seems that a larger randomized trial investigating the efficacy of TMT+NMES for the purpose of improving physical function in older adults with chronic LBP is warranted.

Spinal pain--good sleep matters: a secondary analysis of a randomized controlled trial.

PURPOSE: The estimated prevalence of poor sleep in patients with non-specific chronic low back pain is estimated to 64% in the adult population. The annual cost for musculoskeletal pain and reported poor sleep is estimated to be billions of dollars annually in the US. The aim of this cohort study with one-year follow-up was to explore the role of impaired sleep with daytime consequence on the prognosis of non-specific neck and/or back pain. METHODS: Secondary analysis of a randomized controlled trial, including 409 patients. RESULTS: Patients with good sleep at baseline were more likely to experience a minimal clinically important difference in pain [OR 2.03 (95% CI 1.22-3.38)] and disability [OR 1.85 (95% CI 1.04-3.30)] compared to patients with impaired sleep at one-year follow-up. CONCLUSION: Patients with non-specific neck and/or back pain and self-reported good sleep are more likely to experience a minimal clinically important difference in pain and disability compared to patients with impaired sleep with daytime consequence.

Clinical outcomes of early and later physical therapist services for older adults with back pain.

BACKGROUND CONTEXT: The timing of physical therapy (PT) services and its association with later function and pain are not clear, especially in older adults. PURPOSE: The purpose of this study was to compare clinical outcomes of patients receiving early or later PT services with those not receiving PT among older adults presenting to primary care for a new visit for back pain. STUDY DESIGN/SETTING: Prospective cohort study using the Back Pain Outcomes Using Longitudinal Data registry. PATIENT SAMPLE: A total of 3,705 adults 65 years and older with a new visit for back pain were included. OUTCOME MEASURES: The outcome measures were Roland-Morris Disability Questionnaire (RMDQ), Pain Numerical Rating Scales, and EuroQol-5D. METHODS: We studied two phases of PT utilization: early (0-28 days) and later (3-6 months). At baseline, we selected the participants with complete 12 months of patient-reported outcomes and electronic medical record data. Early PT was defined as initiating PT less than or equal to 28 days from the index visit for back pain. The no early PT group consisted of patients with no PT, no injections, no surgery, and no chiropractic within 28 days. We restricted the later phase analysis to patients with pain greater than 2 of 10 and an RMDQ score greater than 4 to create a subsample of patients with continuing clinically important back pain. We defined later PT as initiating PT between 3 and 6 months after the index visit. The no later PT group consisted of patients without any PT during this time. We used propensity score matching followed by multiple linear regression to estimate the mean difference in outcome. Sensitivity analysis examined clinically important change and dose of PT use among the early PT group. RESULTS: The early PT group had better functional status with an adjusted mean RMDQ of 1.1 points less than the no early PT group (95% confidence interval: -2.2, -0.1) and less back pain of -0.5 (-0.9, -0.1) at 12 months. There was no difference between early PT groups at 3 and 6 months. The odds of a 30% improvement in function or pain were not different between these matched groups at 12 months, but the early PT group had increased odds of a 50% improvement in function at 12 months (odds ratio: 1.58, 95% confidence interval: 1.04, 2.40). There was no difference between later groups at 12 months. Greater dose of PT use within the early PT group was associated with better functional status (p= .01). CONCLUSIONS: We found that among older adults presenting to their primary care providers for a new episode of back pain, early referral to PT resulted in no or minimal differences in pain, function, or health-related quality at 3, 6, or 12 months compared with a matched group that did not receive early PT. Secondary analysis show that patients initiating early PT may be somewhat more likely to experience 50% improvement in function at 12 months.

Application of Tensegrity Massage to Relive Complications After Mastectomy--Case Report.

PURPOSE: The case study was to determine the effectiveness of tensegrity massage in a patient after mastectomy. DESIGN: Tensegrity massage was performed in a 50-year-old woman after mastectomy. The purpose of the massage was to normalize the tension of musculo-ligamento-fascial system in the chest, shoulder girdle, and back. METHODS: The patient was subjected to a series of six massage sessions, 45 minutes each, twice a week. FINDINGS: The applied massage therapy contributed to the reduction of the postoperative scar tenderness and painfulness, to the relaxation of the muscular tone within the shoulder girdle, and to the improvement of the patient's general feeling. CONCLUSIONS: Tensegrity massage is an effective therapy in the elimination of pain and abnormal tissue tension induced by extensive scarring after mastectomy. CLINICAL RELEVANCE: The presented massage procedure had a positive effect immediately after the therapy and after 1-month follow-up.

[Multimodal pain therapy]. / Multimodale Schmerztherapie.

Chronic pain has both high prevalence and a significant economic impact in Germany. The most common chronic pain types are low back pain and headache. On the one hand, the management of chronic pain patients is incomplete, yet it is often overtreated in orthopaedic surgical settings with interventional procedures. The reason for this is the structure of outpatient management and the way it is paid for in Germany. Pain management of patients with private insurance cover is no better because of "doctor shopping". Medical guidelines could be of some help in improving the situation, but they are widely unknown, and have still to demonstrate whether they have any impact on GP treatment pathways. The "gold standard" multimodal pain therapy shows significant improvement in many studies compared to monomodal therapy regimes and interventional regimes, but is too rarely recommended by the patients' physicians, whether GPs or specialists. Because of the huge number of institutions nowadays that, for the sake of form, offer such multimodal therapies, these need to be differentiated in terms of their structural and process quality. A first step is the "k edoq" project. It is essential to improve knowledge of the principles of modern pain management. This includes better networking and communication between doctors, physiotherapists and psychologists, and at the grassroots level, providing the public with more detailed and better information.

Comparison of group motor control training versus individual training for people suffering from back pain.

This study investigated the effects of "motor-control training" (MCT) using the model of deficits in the activation of transversus abdominis (TrA) in people with recurrent back pain. The purpose of this investigation was to establish whether MCT - implemented within a new group intervention (experimental group) - is able to produce results similar to those of a conventional intervention applied individually (control group) to people suffering from back pain. Using the form of an experimental pre-post-test design, the study consisted of an experimental group (N = 18, mean age M = 45.2; SD = 18.4; 9 ♂, 9 ♀) and a comparison group (N = 13; age = 56.6; SD = 18.5; 6 ♂, 7 ♀). The training covered a period of six weeks, with two training sessions per week. The amount of training was the same in both groups. Aside from the same extent of training, the participants in the experimental group completed training content in the group interventions identical to that completed by the comparison group in the individual treatments. To clarify: The difference between the two groups was that the participants in the individual-therapy control group received individual feedback on their exercise performance and correction notes from the instructor. This degree of individual attention was not given within the group therapy. The selective activation of the M. transversus abdominis (TrA) was the main focus of the intervention, with the intent of improving its stabilising corset function, especially within the lumbar region, via increased tension of the thoracolumbar fascia. To record the progress of both groups, the anterolateral abdominal muscle recruitment of the M. transversus abdominis (TrA) was measured as a main influencing factor for anterolateral stabilisation of the spine. For measurements of muscle recruitment, rehabilitative ultrasound imaging (M-Turbo™ SonoSite(®) Erlangen in B-Mode) according to Whittaker (2007) was used. Furthermore, the relationship between pain relief and the development of muscle recruitment was evaluated. Finally, the possible pain relief and the improvement of daily routine disruptions were assessed via the visual analogous scale (VAS) and the Oswestry Disability Questionnaire (ODI) (Mannion et al., 2006a,b). Both forms of intervention produced significant improvements in abdominal muscle control and pain (p < 0.003; p < 0.007). However, according to Cohen (1988), the effect sizes could be classified as a low to medium effect advantage on the part of the individual treatment (d < 0.5). Nevertheless, there were no statistically significant differences between individual and group interventions for the measured parameters, indicating that the group interventions can be considered more efficient because more patients were helped at the same time with similar effort. This result provides new and valuable insights for doctors, sports medicine specialists and physiotherapists, as well as for the sponsors of prescribed treatments, and it confirms the usefulness of integrating the new form of intervention into existing multimodal back therapy training concepts.

Motor imagery in people with a history of back pain, current back pain, both, or neither.

INTRODUCTION: There is mounting evidence that cortical maps are disrupted in chronic limb pain and that these disruptions may contribute to the problem and be a viable target for treatment. Little is known as to whether this is also the case for the most common and costly chronic pain-back pain. OBJECTIVES: To investigate the effects of back pain characteristics on the performance of left/right trunk judgment tasks, a method of testing the integrity of cortical maps. METHODS: A total of 1008 volunteers completed an online left/right trunk judgment task in which they judged whether a model was rotated or laterally flexed to the left or right in a series of images. RESULTS: Participants who had back pain at the time of testing were less accurate than pain-free controls (P=0.027), as were participants who were pain free but had a history of back pain (P<0.01). However, these results were driven by an interaction such that those with current back pain and a history of back pain were less accurate (mean [95% CI]=76% [74%-78%]) than all other groups (>84% [83%-85%]). DISCUSSION: Trunk motor imagery performance is reduced in people with a history of back pain when they are in a current episode. This is consistent with disruption of cortical proprioceptive representation of the trunk in this group. On the basis of this result, we propose a conceptual model speculating a role of this measure in understanding the development of chronic back pain, a model that can be tested in future studies.

Effect of acharya technique upon back pain among industrial workers.

Back pain is a universal problem affecting people from all regions of the world. Since relief using modern systems of medicine is hardly forthcoming, the efficacy of indigenously developed Acharya Technique was assessed. Using purposive sampling, data was collected from 30 industrial workers from Erode (TN). It was found that while 36.7 percent participants had complete discomfort in back pain before resorting to Acharya Technique, after its administration, 40percent had only mild discomfort in back pain, thus showing the effectiveness of this technique. It is suggested to include Acharya Technique in continuing educational programmes on wider scale.

Long-term benefits of radon spa therapy in rheumatic diseases: results of the randomised, multi-centre IMuRa trial.

In chronic rheumatic diseases, recent treatment regimens comprise multimodal concepts including pharmacologic, physical/exercise, occupational and psychological therapies. Rehabilitation programmes are used for long-term management of disease. Spa therapy is often integrated in various middle and south European and Asian countries. Here, we investigated radon spa therapy as applied in health resorts compared to a control intervention in rheumatic out-patients. Randomised, blinded trial enroling 681 patients [mean age 58.3 (standard deviation 11.1); female 59.7%] in 7 health resorts in Germany and Austria with chronic back pain (n 1 = 437), osteoarthritis (OA) (n 2 = 230), rheumatoid arthritis (n 3 = 98), and/or ankylosing spondylitis (n 4 = 39); multiple nominations in 146 cases). Outcomes were pain (primary), quality of life, functional capacity, and medication measured before start, after end of treatment, and 3 times thereafter in 3 monthly intervals. Adverse events were documented. To analyse between-group differences, repeated-measures analysis of covariance was performed in metric endpoints and Fisher's exact test in rates. Two-sided significance level of 5% was chosen. Until end of follow-up, superiority of radon therapy was found regarding pain relief (p = 0.032) and analgesic drug consumption (p = 0.007), but not regarding quality of life. Functional capacity was assessed specific to the underlying indication. Significant benefits were found in radon-treated OA patients until 6-month follow-up (p = 0.05), but not until end of study (p = 0.096). Neither the back pain sub-population nor the two smaller patient populations with inflammatory indications benefited significantly in functional capacity. Results suggest beneficial analgesic effects of radon spa therapy in rheumatic diseases until 9 months post-intervention.

[The effectiveness of short courses of balneopeloidtherapy of dorsopathies based at the "Kliuchi Health Resort"].

Natural therapeutic factors are successfully used at the Klyuchi health resort for the rehabilitation of the patients presenting with dorsopathies. A total of 120 patients with this condition were examined for the evaluation of their algic and psychovegetative status before and after the balneopeloid therapeutic treatment in combination with transcranial electrostimulation of the brain. Serum serotonin levels were measured during the same periods. It was shown that balneopeloid therapy significantly reduced the intensity of pain, the degree of anxiety and depression, expression of vegetative disorders. Simultaneously, the quality of life of the patients markedly improved and blood serotonin level increased. It was shown that beneficial effect of shortened 14 day courses of balneopeloid therapyon the patients presenting with dorsopathies is similar to that of 21 day courses, but the cost effectiveness of the former is much higher.