Daniel Belavy Profile picture
May 13, 2022 13 tweets 8 min read Read on X
What causes back pain?🤔
Specifically: how much do nervous system, spine tissue and psychosocial contribute to #backpain?

#systematicreview with multivariate #metaanalysis in European J Pain @EFIC_org

doi.org/10.1002/ejp.18…

Led by @ScottTags 🙏collaborators

Thread
👇 Image
Low #backpain is leading cause of disability worldwide… 90-95% of cases are considered 'non-specific'

Many factors can contribute

Image 👇from doi.org/10.2147/jpr.s1… @chadcookpt

But which ones and how much? Image
Individual meta-analyses + factors associated with back pain
➡️ pain processing doi.org/10.1097/j.pain…
➡️ disc degeneration doi.org/10.3174/ajnr.A…
➡️ muscle atrophy doi.org/10.2522/ptj.20…
➡️ depression / distress doi.org/10.1093/fampra…

But is one more important than other?
Methods:
#systematicreview multivariate #metaanalysis
 studies comparing non-specific #backpain to pain-free
 studies MUST have at least two of three domains (Table👇)
 Newcastle-Ottawa scale for risk of bias
 random-effects pairwise and multivariate meta-analyses Image
Results
> 4000 studies screened
52 studies included
33 in quantitative synthesis

4 (12%) studies examined spinal imaging
33 (100%) psychosocial factors
30 (91%) nervous system biomarkers

>2000 participants in primary meta-analyses Image
Results:
✅Psychosocial factors had largest effect size
✅Larger than spine tissue or central nervous system biomarkers Image
Results:
✅chronic pain: nervous system, psychosocial and spinal imaging were different compared to pain-free control
✅acute pain: only psychosocial state was compromised. Spinal imaging biomarkers could not be assessed due to the lack of studies Image
Results:

✅looking at all the different kinds of biomarkers lumped in under (for example) nervous system, lead to similar results Image
What do the findings mean?

Spinal imaging, psychosocial and nervous system biomarkers contribute to non-specific low #backpain

Psychosocial factors "may" contribute more to non-specific back pain (note, we talk only about "effect sizes")
Paths forward in the future… some key aspects:

➡️ Only one (!) study to date that assessed all three domains. This = big evidence gap

➡️ The ‘non-specific’ label should be reconsidered as research finds specific and treatable multidimensional labels underpinning the condition Image
Limitations include:

(a) Only cross-sectional studies available (causality)

(b) Only four studies assessed the role of the spinal imaging along with psychosocial/nervous system biomarkers.. need more studies for this

(c) The lack of consistent reporting of brain regions
Key next steps:

🚀Larger scale study examining multiple domains

🚀Then, consideration of multidimensional sub-groups and their potential clinical significance

Maybe, one day, we can do away with the label non-specific for back pain 🙂
Interested in the research group @hsgesundheit in musculoskeletal health research in #Germany?

More details here and link to team website
👇👇👇👇👇

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More from @belavyprof

Apr 20, 2021
Is #exercise before or after hip joint replacement better than usual care or minimal treatment?

#Metaanalysis in @JAMANetworkOpen @JAMA_current
dx.doi.org/10.1001/jamane…

Led by Tobias, Jochen and Max from @PhysioMeScience

🙏for #collaboration!

Thread
👇👇👇👇
#osteoarthritis is one of the leading causes of #pain, #disability and healthcare resource usage worldwide.

Total hip replacements (THA below) done per year are expected to grow to ~600k per year by 2030
doi.org/10.2106/jbjs.1…
Some guidelines (both from 2020) recommend exercises with hip replacement

@NICEComms nice.org.uk/guidance/ng157
-pre-op advice only
-post-op inpatient ex ✅, outpatient self-directed exercise only

Dutch doi.org/10.1002/msc.14…
-pre-op ex ✅for specific patients
-post-op ✅
Read 15 tweets
Apr 9, 2021
Can #exercise “strengthen” the intervertebral disc?

A brief history of research from 2013 to 2020:

Review: dx.doi.org/10.1007/s40279…
Cross-section: dx.doi.org/10.1038/srep45…
RCT: dx.doi.org/10.1007/s00586…

🙏 collaborators

Thread 👇 👇 👇 👇
#backpain
First, we did a review of the literature (narrative, not a #systematicreview. This was back in my pre-systematic review days!) dx.doi.org/10.1007/s40279… in @SportsMedicineJ

🙏 @DieenJaap, Kirsten Albracht, Prof. Brüggemann, Dr. Vergroesen
It has been well established that exercise and loading can impact IVD height. E.g. doi.org/10.1097/000076… doi.org/10.1249/mss.0b…

So, exercise and movement protocols can at least ‘influence’ the IVD
Read 20 tweets

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