Lumbar instability as an etiology of low back pain and its treatment by prolotherapy: A review.

BACKGROUND: Low back pain is a significant spinal disorder that affects much of the population at some point during their lives. OBJECTIVE: While proper diagnosis is key, diagnosing the underlying cause of low back pain may often be unclear. METHOD: In this review article, we discuss lumbar instability as an etiology of low back pain and its treatment by prolotherapy. RESULTS: Spinal ligaments may be an underlying culprit in the development of lumbar instability with resultant low back pain and associated disorders. CONCLUSION: In these cases, adequate treatment consisting of non-biologic prolotherapy or cellular prolotherapy, including platelet rich plasma (PRP), can be beneficial in restoring spinal stability and resolving chronic low back pain.

Influence of Pilates Method on Nonspecific Lumbar Pain

Low back pain is defined as pain located between the lower rib cage and the gluteal folds, and its etiology is multifactorial, considerably affecting quality of life. The aim of this literature review was to analyze the influence of the Pilates method on the symptoms of patients with nonspecific low back pain, which is considered a promising treatment for this type of pathology. A narrative review of the literature was carried out using the PubMed, Pedro, Scopus and Scielo databases. To perform the search, Pilates AND Low back nonspecific AND Pain were used as keywords. Articles published in the last 5 years, randomized clinical trials that verified the influence of the Pilates method in adult individuals with unspecified low back pain and full text in English were included. Of the 77 articles identified, 7 articlesmet the inclusion criteria, 7 analyzed the primary outcomes of pain intensity and disability, 5 articles compared Pilates with other rehabilitation techniques and 2 studies compared the effectiveness of Pilates solo with Pilates apparatus. It was concluded that all the techniques that were compared with Pilates are effective, being difficult to affirm the superiority of Pilates over them in relation to the reduction of pain and disability and improvement of quality of life. However, the Pilates method has shown good results in pain perception and intensity, functional capacity, fear of movement and the idea that movement can worsen your condition, muscle strength, range of motion and flexibility.

Intracranial Hypertension and Intra-abdominal Pressure. Is it Worth Measuring?

Patients with refractory intracranial hypertension who have already undergone all the measures recommended by the current guidelines can benefit from having their intraabdominal pressure monitored since its increase generates hemodynamic repercussions and secondary elevation of intracranial pressure. In this context, a bibliographic research was performed on PubMed with the terms intra-abdominal pressure, abdominal compartment syndrome, intracranial pressure, intracranial hypertension. Altogether, 146 articles were observed, 87 of which were from the year 2000, and only 15 articles were considered relevant to the topic. These studies indicate that patients with refractory intracranial hypertension can benefit fromthe measurement of intraabdominal pressure, since there is evidence that an increase in this pressure leads to organic dysfunctions with an indirect impact on cerebral venous return and, consequently, an increase in intracranial pressure. In thosewho underwent decompression laparotomy, direct effectswere observed in reducing intracranial hypertension and survival.

A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain.

OBJECTIVE: The aim of this study was to systematically review dextrose (d-glucose) prolotherapy efficacy in the treatment of chronic musculoskeletal pain. DATA SOURCES: Electronic databases PubMed, Healthline, OmniMedicalSearch, Medscape, and EMBASE were searched from 1990 to January 2016. STUDY SELECTION: Prospectively designed studies that used dextrose as the sole active prolotherapy constituent were selected. DATA EXTRACTION: Two independent reviewers rated studies for quality of evidence using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs, for level of evidence using a modified Sackett scale, and for clinically relevant pain score difference using minimal clinically important change criteria. Study population, methods, and results data were extracted and tabulated. DATA SYNTHESIS: Fourteen RCTs, 1 case-control study, and 18 case series studies met the inclusion criteria and were evaluated. Pain conditions were clustered into tendinopathies, osteoarthritis (OA), spinal/pelvic, and myofascial pain. The RCTs were high-quality Level 1 evidence (Physiotherapy Evidence Database ≥8) and found dextrose injection superior to controls in Osgood-Schlatter disease, lateral epicondylitis of the elbow, traumatic rotator cuff injury, knee OA, finger OA, and myofascial pain; in biomechanical but not subjective measures in temporal mandibular joint; and comparable in a short-term RCT but superior in a long-term RCT in low back pain. Many observational studies were of high quality and reported consistent positive evidence in multiple studies of tendinopathies, knee OA, sacroiliac pain, and iliac crest pain that received RCT confirmation in separate studies. Eighteen studies combined patient self-rating (subjective) with psychometric, imaging, and/or biomechanical (objective) outcome measurement and found both positive subjective and objective outcomes in 16 studies and positive objective but not subjective outcomes in two studies. All 15 studies solely using subjective or psychometric measures reported positive findings. CONCLUSION: Use of dextrose prolotherapy is supported for treatment of tendinopathies, knee and finger joint OA, and spinal/pelvic pain due to ligament dysfunction. Efficacy in acute pain, as first-line therapy, and in myofascial pain cannot be determined from the literature.