BackgroundCentral sensitization (CS), characterized by amplified nociceptive processing within the central nervous system, is considered a key mechanism in chronic nonspecific low back pain (CNLBP). Although manual therapy (MT) is widely used in musculoskeletal rehabilitation, its effectiveness in patients with confirmed CS remains unclear. This study evaluated the effects of MT on CS, pain, disability, and quality of life in individuals with CNLBP.MethodsForty participants with physician-diagnosed CNLBP and CS (CSI ≥40) were randomly assigned to either an MT group (n = 20) or a conventional physiotherapy group (CT, n = 20). Both interventions were administered over a 4-week period. Outcomes included the Central Sensitization Inventory (CSI), Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and SF-36 Health Survey. Pre- and post-treatment scores were compared within and between groups.ResultsBoth groups demonstrated significant post-treatment improvements. In the MT group, significant improvements were observed in VAS, CSI, and ODI scores (all p < 0.001). In the CT group, significant improvements were also observed in VAS (p < 0.001), CSI (p = 0.044), and ODI (p = 0.009). Between-group analyses demonstrated significantly greater improvements in the MT group for CSI (p < 0.001), VAS (p = 0.045), and ODI (p = 0.010). Significant improvements across all SF-36 domains were observed in the MT group, whereas the CT group improved only in role limitations. Between-group comparisons showed greater improvements in physical function and general health perception in the MT group.ConclusionBoth interventions improved outcomes in patients with CNLBP and CS; however, adding MT to CT produced greater improvements in CS, pain, disability, and quality of life than CT alone.

Results suggest that psychosocial treatments for chronic pain work via several mechanisms, and that they often do so to similar degrees and in similar ways. Extant research, however, has focused on individual and/or independent effects of mechanisms on outcomes. Whether successful outcomes are also partly because of sequential and meaningful relationships among and between mechanisms-mechanism-to-mechanism effects-has not been examined. Secondary analyses were conducted of an RCT that compared cognitive therapy, mindfulness-based stress reduction, and behavior therapy to treatment as usual in a sample (N = 521) of people with chronic low back pain. Results of hierarchical linear modeling revealed that (1) Treatment Condition × Mechanism interactions predicting changes in other mechanisms were nonsignificant; (2) lagged prior session mechanism changes predicted next session changes in another mechanism; (3) lagged relationships between pain catastrophizing and pain self-efficacy were reciprocal, whereas links between lagged pain catastrophizing and mindfulness changes and lagged pain catastrophizing changes and behavioral activation changes were unidirectional; and (4) individual differences in the strengths of mechanism-to-mechanism relationships predicted pre- to post-treatment changes in outcomes. Results reveal heretofore hidden therapeutic processes that cognitive therapy, mindfulness-based stress reduction, and behavior therapy may share. Namely, that mechanism-to-mechanism lagged effects do indeed emerge beyond mechanism-to-outcome effects. Findings show not only that mechanisms may change in definable sequences relative to each other but that individual differences in the strengths of mechanism-to-mechanism relationships may themselves be predictive of outcomes.

Chronic non-specific low back pain (CNLBP) is a common condition associated with persistent pain, functional limitation, reduced quality of life, and substantial healthcare and socioeconomic burden. Mindfulness-based cognitive therapy (MBCT) has been increasingly used in chronic pain management and may provide a promising therapeutic approach for CNLBP. The emergence of virtual reality (VR) further provides an immersive, standardized, and accessible platform for delivering MBCT. This study aims to evaluate the effects and safety of a CNLBP-specific VR-integrated MBCT intervention in patients with CNLBP.

Intramural hematoma (IMH) is a variant of acute aortic syndrome (AAS) with a highly variable and potentially life-threatening course. Although uncomplicated type B IMH is generally managed conservatively, early disease progression may occur despite optimal medical therapy. Thoracic endovascular aortic repair (TEVAR) represents a safe and effective treatment option in complicated cases, particularly when timely intervention is achieved.

Although lumbopelvic disorders are common during pregnancy, evidence regarding their impact on health-related quality of life (HRQoL) remains limited. This study therefore aimed to assess the associations between urinary incontinence, fecal incontinence, constipation, sexual dysfunction, low back pain, and HRQoL during pregnancy. Analysis of covariance (ANCOVA) models and multivariate linear regression analyses were used to examine the associations between these conditions and HRQoL among 375 pregnant women in Nicaragua. Pregnant women with these disorders had significantly poorer HRQoL than those without them. The physical component score was associated with urinary incontinence (β =  -0.22, 95 percent CI: -0.42 to -0.01), constipation (β =  -0.43, 95 percent CI: -0.64 to -0.21), sexual dysfunction (β =  -0.13, 95 percent CI: -0.24 to -0.02) and low back pain (β =  -0.75, 95 percent CI: -1.07 to -0.44). The mental component score was associated with constipation (β =  -0.41, 95 percent CI: -0.61 to -0.21 and sexual dysfunction (β =  -0.13, 95 percent CI: -0.23 to -0.02). In conclusion, this study suggests that urinary incontinence, constipation, sexual dysfunction, and low back pain may be associated with poor physical well-being during pregnancy. Constipation and sexual dysfunction may also be associated with poor mental HRQoL.

BackgroundSpinal teratomas are exceedingly rare germ cell tumors, accounting for .1%-.5% of all spinal cord tumors, with adult-onset tumors being even more uncommon. Mature teratomas consist of differentiated tissues derived from the 3 embryonic germ layers and may contain a wide variety of adult-type tissue components. Prostatic glandular tissue has been documented in only a very limited number of spinal teratoma specimens, whereas bulbourethral gland tissue has never been reported in this setting.Patient PresentationWe report a 60-year-old male patient who presented with a 7-month history of low back and right lower limb pain, which progressively worsened, along with urinary incontinence for over 3 months. Lumbar magnetic resonance imaging (MRI) revealed an irregular intraspinal space-occupying lesion at the L1 level, measuring approximately 15.0 mm × 16.6 mm × 29.4 mm, which appeared slightly hyperintense on T1-weighted imaging, heterogeneous on T2-weighted imaging, and demonstrated heterogeneous enhancement on contrast administration. The patient underwent microsurgical gross total resection of the tumor. Postoperative pathological examination showed that the tumor was composed of mature tissues derived from all 3 germ layers. Endodermal derivatives included morphologically well-formed prostatic acinar structures (positive for PSA and P504S on immunohistochemistry; the preserved basal cell layer was confirmed by 34βE12 and p63 positivity, supporting a benign prostatic origin) and bulbourethral (Cowper) gland structures (clustered mucinous acini lined by cuboidal to columnar epithelium, mucin histochemistry not performed). Mesodermal derivatives included smooth muscle bundles as well as focal thin-walled vascular spaces and scattered clusters of cells morphologically resembling adrenal zona reticularis cells (polygonal cells with abundant eosinophilic or vacuolated cytoplasm containing scant, finely granular brownish-yellow pigment consistent with lipofuscin; immunohistochemical confirmation was not available, as these cell clusters were not present on deeper sections). Ectodermal derivatives consisted of glial tissue and nerve bundles. The pathological diagnosis was mature teratoma. Postoperatively, the patient's symptoms improved markedly.ConclusionsTo our knowledge, this is the first report of bulbourethral gland differentiation in a spinal teratoma. Other rare findings in this specimen included prostatic glands, focal vascular spaces, and cell clusters resembling adrenal cortical cells. These findings further expand the known histological spectrum of spinal teratomas and suggest that during development and migration, germ cells possess the potential to differentiate into urogenital sinus derivatives and may also give rise to other mesoderm-derived lineages. Complete surgical resection remains the mainstay of treatment, and long-term imaging follow-up is essential for monitoring recurrence.