Buprenorphine transdermal patches (TPs) are used for the management of both acute and chronic pain of varied aetiologies. They offer a convenient and sustained method of drug delivery with a good safety profile. Though nausea and/or vomiting have been reported with buprenorphine TP, intractable vomiting (without spontaneous resolution) has never been reported before. We report a 45-year-old female who presented with acute exacerbation of chronic low back pain with radiculopathy of bilateral lower limbs. We offered her conservative management initially. Buprenorphine TP (10 mcg/hour) was applied along with the prescription of a few oral medications. However, the subsequent day, she visited our clinic again with complaints of 6-7 episodes of vomiting with persistent nausea over the past 24 hours. Buprenorphine TP-induced vomiting was suspected. The patch was removed promptly, and rescue antiemetics were administered. Monitoring of patients on opioids, even with TPs, is warranted.

Low back pain (LBP) is a leading cause of disability worldwide, with intervertebral disc degeneration (IDD) as a major contributor. IDD is strongly associated with aging and is characterized by cellular senescence, extracellular matrix degradation, and chronic low-grade inflammation, all of which impair disc homeostasis. Current treatments often provide limited or transient relief, prompting interest in non-invasive, biologically active approaches such as pulsed electromagnetic fields (PEMFs). This systematic review evaluates the evidence on PEMF therapy for IDD, including in vitro, in vivo, and clinical studies, and summarizes mechanisms of action, efficacy, and limitations.

We present the case of a 43-year-old male with progressive thoracic spine pain and bilateral intercostal referral who was ultimately diagnosed with spondylodiscitis. Despite red flag features such as night pain, functional decline, and significant unintentional weight loss, the patient lacked traditional risk factors for spinal infection. He had previously received acupuncture for lumbar radiculopathy, which had since resolved. Magnetic resonance imaging revealed vertebral body involvement and disc space destruction at the T8-T9 level, consistent with spondylodiscitis. The patient underwent surgical decompression, washout, and fusion, followed by a course of intravenous and oral antibiotics. He achieved full symptomatic resolution at follow-up. This case underscores the importance of early imaging and diagnostic suspicion in patients with spinal pain and red flags, even in the absence of conventional risk factors, and highlights the potential infectious risks of acupuncture performed outside clinical settings.

The author reflects on experiences over a half-century of engagement in chiropractic education. Both positive and negative aspects of the profession's evolution are highlighted, including such areas as clinical education, diversity within chiropractic education, the importance of research, and the importance of gaining public trust through evidence-based practices. The paper concludes with a repeated call to action for the profession to be a major player in the solution to the global challenge of low back pain, which can be supported by integration with the healthcare-system-at-large as a trusted and valued team member.

Sacroiliac joint (SIJ) disease is a common source of low back and buttock pain and is often linked to prior lumbar fusion, pregnancy, trauma, or repetitive loading. Because conservative measures such as injections and radiofrequency can be short-lived, interest has shifted toward minimally invasive SIJ fusion.

This systematic review with network meta-analysis aimed to identify the most effective intervention incorporating a substantial physical activity component in individuals with comorbid depressive symptoms and nonspecific chronic low back pain (LBP). A search of six databases (PubMed/Medline, PsycINFO, Web of Science Core Collection, EMBASE, CINAHL, CENTRAL) was conducted up to July 30, 2025. Randomised controlled trials on participants > 15 years with comorbid clinically relevant depressive symptoms (e.g., Beck Depression Inventory (BDI)-II > 13) and chronic (> 12 weeks) LBP were included. Interventions involved ≥ 33% active movement and lasted ≥ 2 weeks. Outcome-wise risk of bias (RoB) for the self-reported outcomes was assessed using the Cochrane RoB 2 tool. Primary outcomes were (i) changes in depressive symptoms (mandatory) and (ii) pain intensity, disability and quality of life, with each study required to include at least one of three additional outcomes. We calculated frequentist-based network meta-analysis. Of 2138 studies, five studies (N = 834, 50.1% female, mean age: 52.8 years) with eight treatments were included. Overall RoB ranged from low to some concerns. Yoga with education was most effective at mid-term follow-up (intervention duration closest to 12 weeks, k = 9), showing improvements in pain (SMD=-1.05 [95%CI=-1.38 to -0.72]) and clinically relevant improvements in depressive symptoms (SMD=-1.48 [95%CI=-1.81 to -1.14]), all vs. usual care. Antidepressant therapy with pain self-management (e.g., physical activity, relaxation, breathing) moderately affected depressive symptoms (SMD=-0.56 [95%CI=-0.60 to -0.53]) and pain (SMD=-0.53 [95%CI=-0.56 to -0.49]). At long-term follow-up, antidepressant therapy with pain self-management, and online- and mobile-based therapy showed superiority over usual care. The overall certainty of evidence across outcomes was low to very low. With very low certainty evidence, yoga combined with education yielded the most favourable effects across outcomes. However, these findings should be interpreted with caution and require adequately powered future trials. While other approaches showed small to moderate effects, their clinical relevance remains uncertain.PROSPERO 2024 ID: CRD42024523604.