OPPORTUNITIES FOR MANAGING CHRONIC LOW BACK PAIN BY INCORPORATING DIFFERENT PHYSICAL MODALITIES INTO REHABILITATION PROGRAMS

Abstract

Low back pain is a common reason for patients to suffer and see a doctor. A large number of people have experienced at least once pain in the lumbar spine. Often acute pain becomes chronic when no anatomical or functional cause can be identified and it begins to be defined as non-specific. This can lead to inappropriate treatment and rehabilitation. Various therapeutic approaches, including physical factors, could be incorporated into low back pain management programs, although there are no uniform recommendations regarding physiotherapy at present. The aim of the report is to study the effects of physical modalities application in chronic non-specific low back pain and to evaluate to what extent they can be effective non-pharmacological treatment strategy. Materials and methods: a review of available scientific databases (Pubmed, Google Scholar, Science Direct, PEDro and Cyrillic publications) was performed, with literature sources regarding the possible causes of chronic nonspecific low back pain, diagnostic and therapeutic means, including pharmacological and physiotherapeutic. The search was conducted using keywords such as: low back pain, chronic low back pain, nonspecific low back pain, global treatment guidelines, non-pharmacological treatment of low back pain, therapeutic exercises, electrotherapy, therapeutic ultrasound, shock wave therapy, laser therapy, magnetic fields. Results: The review included articles reporting recommendations for the treatment of low back pain, clinical trials, randomized clinical trials, meta-analyses, and scientific reviews on the topic. Evidence was found demonstrating the high prevalence of chronic and non-specific low back pain and the associated difficulties in its diagnosis and treatment. Nevertheless, the guidelines reach a certain consensus regarding pharmacological treatment. On the other hand, non-pharmacological treatment is still under discussion. Emphasis is placed on cognitive behavioral therapy and exercise. Recommendations regarding the use of therapeutic exercise have varying levels of credibility. Currently, there is still no consensus on the usefulness of one or another type of therapeutic exercise program. Patient education and application of manual therapy techniques would also likely have certain therapeutic benefits added to routine care. Treatment with physical modalities has been quite controversial (from negative recommendations about the lack of effect of this treatment to reports reporting positive results). Although there is agreement among most authors that the prolonged use of analgesics and/or non-steroidal medications can lead to a number of complications and adverse side effects. Of the physical modalities, analgesic electro procedures (TENS, interferential current), therapeutic ultrasound and shock wave therapy, low and high intensity laser therapy as well as magnetotherapy are preferred. There is scientific evidence found, that physical modalities treatment could reduce pain, improve range of motion in the low back and daily functional activity.

Conclusion: Low back pain, especially when there is no clear morphological cause, complicates the process of diagnosis and targeted therapy. Often, it is a cause that can become chronic, requiring prolonged use of medication. Non-pharmacological therapies such as patient education, cognitive behavioral therapy and exercise are recommended, although there is no precise recommendation regarding type, duration and frequency. The use of physical modalities and electrotherapy is subject to further research, but there is already evidence to support the positive outcome of their use in terms of pain reduction, improvement in functional activity and reduction in use of medication, suggesting that research should continue.