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Myofascial pain syndrome of lower back — Clinical Guidelines

Overview

Myofascial pain syndrome of the lower back involves chronic pain and tenderness in muscles and connective tissues of the lumbar region, often without identifiable structural abnormalities. 12

Diagnosis

Clinical Presentation: Presence of trigger points and characteristic pain patterns. 12

Imaging: MRI useful for detecting degenerative changes in the lumbar spine, though not specific for myofascial pain 3.

Grading: No standardized grading system specifically for myofascial pain; often assessed clinically. 12

Management

First-Line Treatments:

- Physical Therapy: Including exercises targeting core stability and flexibility 7. - Trigger Point Injections: For localized pain relief 12.

Adjunctive Treatments:

- Cannabidiol: Evidence suggests limited efficacy; further studies required 1 5. - Vitamin D Supplementation: Particularly in postmenopausal women with high BMI 6. - Rehabilitation Programs: Intensive programs shown effective in occupational injury patients 7.

Special Populations

Postmenopausal Women: Vitamin D inadequacy combined with high BMI affects paraspinal muscle atrophy and pain intensity 6.

Elderly: Increased prevalence of degenerative changes in the lumbar spine; individualized treatment approaches recommended 3.

Key Recommendations

Utilize MRI for identifying degenerative changes in the lumbar spine, aiding in differential diagnosis 3 (Evidence: Moderate).

Implement physical therapy and core stability exercises as primary management strategies 7 (Evidence: Moderate).

Consider vitamin D supplementation in postmenopausal women with high BMI and lower back pain 6 (Evidence: Moderate).

Evaluate the potential role of cannabidiol cautiously, given current limited evidence 1 5 (Evidence: Weak).

Tailor rehabilitation programs to individual patient needs, especially in occupational injury contexts 7 (Evidence: Moderate).

References

1 Finsterer J. Assessing a potential therapeutic effect of cannabidiol for lower back pain, requires appropriately designed studies. Annals of agricultural and environmental medicine : AAEM 2024. link 2 Schönnagel L, Muellner M, Suwalski P, Zhu J, Guven AE, Caffard T et al.. Abdominal aortic calcification is independently associated with lumbar endplate degeneration. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2023. link 3 Näther P, Kersten JF, Kaden I, Irga K, Nienhaus A. Distribution Patterns of Degeneration of the Lumbar Spine in a Cohort of 200 Patients with an Indication for Lumbar MRI. International journal of environmental research and public health 2022. link 4 Hood C, Zamani R, Akrami M. Impact of heterotopic ossification following lumbar total disk replacement: a systematic review. BMC musculoskeletal disorders 2022. link 5 Senderovich H, Wagman H, Zhang D, Vinoraj D, Waicus S. The Effectiveness of Cannabis and Cannabis Derivatives in Treating Lower Back Pain in the Aged Population: A Systematic Review. Gerontology 2022. link 6 Chen H, Xu HW, Zhang SB, Yi YY, Wang SJ. Vitamin D inadequacy combined with high BMI affects paraspinal muscle atrophy and pain intensity in postmenopausal women. Climacteric : the journal of the International Menopause Society 2022. link 7 Kim JH, Hong YJ, Lee G. Efficacy of a Lower Back Intensive Rehabilitation Program in Occupational Injury Patients and Characteristics of Care: A Retrospective Cohort Study. Medical science monitor : international medical journal of experimental and clinical research 2022. link 8 Kim MG, Ahn YS. Associations between lower back pain and job types in South Korean male firefighters. International journal of occupational safety and ergonomics : JOSE 2021. link 9 Gao F, Liu S, Zhang X, Wang X, Zhang J. Automated Grading of Lumbar Disc Degeneration Using a Push-Pull Regularization Network Based on MRI. Journal of magnetic resonance imaging : JMRI 2021. link 10 Iriondo C, Pedoia V, Majumdar S. Lumbar intervertebral disc characterization through quantitative MRI analysis: An automatic voxel-based relaxometry approach. Magnetic resonance in medicine 2020. link 11 Liu ZC, Wang ZL, Huang CY, Fu ZJ, Liu Y, Wei ZC et al.. Duhuo Jisheng Decoction inhibits SDF-1-induced inflammation and matrix degradation in human degenerative nucleus pulposus cells in vitro through the CXCR4/NF-κB pathway. Acta pharmacologica Sinica 2018. link 12 Karppinen J, Arokoski J, Paananen M, Lausmaa M, Takala EP, Pohjolainen T. Individualized methods for the diagnosis and treatment of nonspecific lower back pain. Duodecim; laaketieteellinen aikakauskirja 2016. link 13 Ogurkowska M, Kawałek K. Pathological changes in the lumbar intervertebral discs among professional field hockey players. The Journal of sports medicine and physical fitness 2016. link 14 Endo Y, Miller TT, Saboeiro GR, Cooke PM. Lumbar discal cyst: Diagnostic discography followed by therapeutic computed tomography-guided aspiration and injection. Journal of radiology case reports 2014. link 15 Ghosh S, Chaudhary V. Supervised methods for detection and segmentation of tissues in clinical lumbar MRI. Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society 2014. link 16 Neman J, Hambrecht A, Cadry C, Goodarzi A, Youssefzadeh J, Chen MY et al.. Clinical efficacy of stem cell mediated osteogenesis and bioceramics for bone tissue engineering. Advances in experimental medicine and biology 2012. link 17 Glazier PS. Is the 'crunch factor' an important consideration in the aetiology of lumbar spine pathology in cricket fast bowlers?. Sports medicine (Auckland, N.Z.) 2010. link 18 Knight RJ, Birkinshaw R. An unusual cause of lower back pain: uterus didelphys and unilateral cervical atresia. International journal of clinical practice. Supplement 2005. link 19 Jackson KC. Pharmacotherapy in lower back pain. Drugs of today (Barcelona, Spain : 1998) 2004. link 20 Panagiotacopulos ND, Lee JS, Pope MH, Friesen K. Evaluation of EMG signals from rehabilitated patients with lower back pain using wavelets. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology 1998. link00013-3)

Myofascial pain syndrome of lower back