Trending Clinical Topic: Exercises for Spine Pain

Ryan Syrek


January 13, 2023

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Causes of spine, back, and neck pain can range from trauma to degenerative processes related to normal aging. No matter the cause, the effect of this pain can be distracting at best and substantially hinder quality of life at worst. Recent studies seeking to assess various treatments for this serious concern resulted in this week's top trending clinical topic. Promising results from the SPINE CARE randomized controlled trial showed that two different conservative interventions, followed for 6-8 weeks, resulted in marked improvement (see Infographic).

In the trial, 2971 adults (60% women; mean age, 51 years) with back or neck pain lasting less than 12 weeks were randomly assigned to usual care (no intervention; n = 992) or to the ICE (n = 829) or IPT (n = 1150) intervention. The ICE model stratifies patients on the basis of the risk for progression to chronic pain and addresses biopsychosocial contributors to pain. Patients at low risk received one physical therapy (PT) visit and one coaching call; patients at higher risk received three PT visits, three coaching calls, and one teleconsultation. IPT was delivered in eight weekly sessions focusing on postural realignment. It also emphasized self-efficacy and self-management, including daily exercises to improve postural control, coordination, and muscle balance.

Results at 3 months showed that both the ICE and IPT groups improved significantly more in Oswestry Disability Index (ODI) scores than the usual-care group. ODI scores with ICE went from 31.2 to 15.4. With IPT, scores went from 29.3 to 15.4. Usual care resulted in a decline from 28.9 to 19.5. At 3 months, the absolute difference in ODI score vs usual care was -5.8 for ICE (95% CI, -7.7 to -3.9; P < .001) and -4.3 for IPT (95% CI, -5.9 to -2.6; P < .001).

When it comes to traditional Chinese therapies for chronic spine and neck pain, two may be better than just one, according to a new study. In a randomized controlled study, tuina therapy plus yijinjing exercise was more effective than tuina therapy alone for pain, functional recovery, and anxiety. Tuina consists of soft tissue manipulation (eg, pressing, pushing, kneading) coupled with spinal manipulation. Yijinjing puts emphasis on the coordination of posture, meditation, and breathing.

The study included 102 participants (mean age, 36 years) with nonspecific, chronic neck pain lasting at least 3 months. Half of the patients received tuina therapy alone, and half received tuina combined with yijinjing. Compared with tuina alone, the combination was associated with a significantly lower visual analogue scale (VAS) score after 8 weeks, which met the primary endpoint. The median VAS score at baseline was 7 in both groups. At week 8, the tuina group had a 4.1-point mean reduction in VAS score compared with a 5.4-point reduction in the combined-therapy group (mean difference, 1.2 points; P < .001). After 8 weeks, patients in the combined-therapy group had a greater reduction in disability and tissue hardness, and better active range of motion, than patients in the tuina-only group. The greater impact of the combined therapy on pain intensity persisted at 12 weeks.

In less encouraging news, a recent study found that use of spinal cord stimulation (SCS) was not associated with reduced opioid use or nonpharmacologic pain intervention at 2 years compared with conventional medical management (CMM). However, it was associated with higher costs and increased complications. In the retrospective study, researchers compared over 7500 matched patients who had received either SCS or CMM. They found that, during the first 12 months, those treated with SCS had higher odds of long-term opioid use but fewer corticosteroid injections, radiofrequency ablations, and spinal surgeries. During the second year, no significant difference between the groups was noted.

During the 2-year study, 17.9% of patients treated with SCS experienced related complications (eg, breakdown, displacement, other mechanical complications, infection). Device revisions and/or removal occurred in 22.1% of patients; of these removals, one tenth of cases were not associated with a complication. The authors explain that this suggests "a lack of effectiveness." Total costs of care in the first year were $39,000 higher with SCS than with CMM and were similar in the second year.

When it comes to medications, a comprehensive literature review from last summer suggests that some are safer than others for treating spine-related pain in older patients. Investigators reviewed 138 double-blind, placebo-controlled trials. Among their key findings and recommendations: Acetaminophen has a favorable safety profile for spine-related pain whereas nonsteroidal anti-inflammatory drugs (NSAIDs) have greater efficacy.

Other key findings include that nerve pain medications gabapentin and pregabalin have some demonstrated benefit for neck and back nerve pain (eg, sciatica) in older adults, despite possibly causing some dizziness or difficulty walking. Researchers advise using these agents in lower doses with smaller dose adjustments. They also caution that the muscle relaxants carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, and orphenadrine should be avoided in older adults because of their association with risk for sedation and falls.

From news about various exercise and traditional Chinese interventions to findings related to spinal cord stimulation and commonly used medications, treatments for spine pain have been the focus of much recent investigation. As the US population in particular continues to "gray" and degenerative spinal conditions take effect, this information probably will remain sought after, as it was this past week.

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