Frequency-domain measures showed a significant increase in LF (p = 0.030) and HF (p = 0.014), and a decrease in LF/HF ratio (p = 0.046). A significant decrease was found in minimum HR values (p = 0.001) and average HR (p = 0.001). Moreover, maximal HR decreased its value from 116.7 ± 26.1 to 113.7 ± 40.8 after intervention. In addition, subjective pain perception (VAS scores) was significantly lower (p = 0.001) in the post-session assessment. Conclusions: Physiotherapy treatment produced an increase in parasympathetic nervous system activation and a decrease in subjective pain perception in non-specific subacute LBP patients.Introduction: Physiotherapy treatment is a common intervention for low back pain (LBP) patients. These interventions have been related to physiological effects in the central nervous system. Thus, the aim of this study was to analyze the effect of physiotherapy treatment in patients with LBP in the autonomic nervous system activation and subjective pain perception of patients. Methods: A total of 30 male subjects diagnosed with non-specific subacute LBP received a 50 min session consisting of (a) a manual therapy based on joint mobilization and soft tissues techniques in the lumbo-pelvic area, (b) a stretching program, and (c) motor control exercises of the core muscles. The autonomic modification of participants was assessed prior to and after the physiotherapy treatment. Results: Heart rate variability (HRV) analysis reported a significant increase in average RR ( Through the past decades, noninvasive treatments in the management of chronic low back pain has been a topic of research ,2. AmongChanges in the activity of the autonomic nervous system after the application of certain physiotherapy techniques have been reported by some authors, especially invasive techniques such as percutaneous needle electrolysis and acupuncture ,17,18,19The clinical interest of sympathetic (SNS) and parasympathetic nervous system (PNS) activity in this context relies on the role they play in the regulation of pain states, especially chronic pain. Tracy et al. performed a metanalysis in this topic, concluding that a decrease in parasympathetic activation is commonly found in chronic pain patients . A commoThe aim of this study was to analyze the effect of a physiotherapy treatment in patients with LBP in the autonomous nervous system activation and subjective pain perception of patients. The initial hypothesis was that the physiotherapy treatment would decrease the sympathetic autonomous activation and pain perception of patients.The present study was a prospective clinical trial developed from September to December 2020, following the Template for Intervention Description and Replication (TIDieR) guidelines .In this study, 30 volunteer male patients  diagnosed with non-specific subacute LBP by a medical doctor were included. The recruitment was carried out by a medical doctor with more than 25 years of experience. The inclusion criteria were as follows: ≥18 years old, LBP , and a current episode of 2–12 weeks with the presence of back pain symptoms. Exclusion criteria were: fractures, inflammatory arthropathies, spine disturbances, metabolic diseases, any disc condition, other LBP interventions or treatments, and other physical or mental disturbances reported in the clinical exam .t-test with Jpower tool (Jamovi software), with a power of 0.80, α error of 0.05, and an effect size of 0.5, resulting in a total sample of 30 subjects.The sample size for the present study was calculated by employing a one-sample The whole procedure was performed following the Declaration of Helsinki  and approved by the Ethics Committee of the European University of Madrid (Spain) (CIPI/18/074). Before starting the study, all participants were informed about the process to be carried out and gave their voluntary written informed consent.All the patients went through 1 physiotherapy session consisting in a manual therapy intervention based on joint mobilization and soft tissues techniques in the lumbo-pelvic area ; stretchThe autonomic modification of participants was assessed prior to and after the physiotherapy treatment. For this aim, participants were laying in a supine position for 5 min for HRV measurement in a stretcher placed in a room with controlled temperature, following previous research protocols .The autonomic activation of the participants was analyzed by HRV measure using Polar V800 equipment , following previously reported research protocols . This evTime-domain : Based on the assessment of the intervals between normal heartbeats. During the statistical analysis, generally all the QRS  complexes, the duration between consecutive QRS complexes , or the instantaneous heart rates during continuous electrocardiogram (ECG) recordings are determined . We recoFrequency-domain/spectral measures : This analysis provides information on how the power is distributed as a function of frequency. This provides us with smoother spectral components that can be distinguished as independent from preselected frequency bands and easy postprocessing of the spectrum with an automatic calculation of low- and high-frequency power components and an easy identification of the central frequency of each component, as well as accurate estimation even on a small number of samples . HF and Finally, the minimum, maximal, and average heart rate were also measured.To assess the subjective pain perception, we employed a visual analogue scale (VAS) of 10 mm (from 0 no pain to 10 maximum pain) at baseline and immediately after the session .t-test for related samples. The level of significance for all the comparisons was set at p ≤ 0.05, and the effect size of results was calculated with the Cohen’s D. In addition, Pearson correlation analysis was employed to test the relation between VAS and HRV variables.Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0 . The Kolmogorov–Smirnov test was used to test the normality and homogeneity of the sample in each variable. To analyze the modification of studied variables after the physiotherapy treatment, we conducted an independent Data are presented as mean ± SD. RR abbreviation corresponds to the interval between successive “R” points (peaks), root mean square of successive differences (RMSSD) corresponds to the square root of the mean of the squares of the successive differences between adjacent beat to beat intervals, LRMSSD stands for the logarithm of the square root of the mean value of the sum of squared differences of all successive R-R intervals, SDNN stands for the standard deviation of all normal RR intervals, RMSSD corresponds to the square root of the mean of the sum of the squared differences between adjacent normal R-R intervals, PNN50 stands for the percentage of differences between adjacent normal R-R intervals more than 50 ms, LF stands for low frequency, and HF stands for high frequency.p = 0.001), RMSSD (p = 0.008), LRMSSD (p = 0.001), SDNN (p = 0.005), and PNN50 (p = 0.024) after the treatment. These data from time-domain parameters indicated a higher post-session parasympathetic activation. Concerning frequency-domain measures, the data showed a significant increase in LF (p = 0.030) and HF (p = 0.014), and a decrease in LF/HF ratio (p = 0.046)  .p = 0.001) and average HR (p = 0.001) was observed, which indicated a preponderancy of PNS activation. Moreover, maximal HR decreased its value from 116.7 ± 26.1 to 113.7 ± 40.8 after intervention (p = 0.001) in the post-session assessment.On the contrary, a significant decrease in minimum HR values (rvention . In addiA negative, significant correlation was found between RMSSD, LRMSSD, SDNN, PNN50, total power, LF and HF, and VAS scores , indicatThe aim of this study was to analyze the effect of a physiotherapy session in patients with non-specific subacute low back pain in terms of autonomous nervous system activation and subjective pain perception. The initial hypothesis was confirmed since after the physiotherapy session, the parameters of sympathetic autonomous activation and pain perception of the subjects decreased.Analyzing the autonomic activation modifications after the intervention, we found how there was a direct impact on sympathetic–vagal balance. The increase in the time-domain parameters highlighted the increase in parasympathetic activation. Regarding the frequency domain, we found a general increase in autonomic activation with a significant higher total power, which was reflected in a significant increase of HF and LF variables . SpecifiConcerning the sensibility of the measures, all the HRV parameters evaluated in this study showed a high sensibility to monitor autonomic modifications. This results differed partially with another previous studies, since depending on the context and population evaluated, different sensibility of HRV variables were found ,46,47,48In this study, a statistically significant inverse correlation was found between RMSSD, LRMSSD, SDNN, PNN50, total power, LF and HF, and subjective pain perception. According to these results, parasympathetic activation seems to have an impact in decreasing pain perception mechanisms. Previous research highlighted that patients with chronic pain reported disturbances in sympathetic–parasympathetic balance, showing a decreased high frequency HRV, probably due to excessive SNS activation . In partPrevious studies found how physiotherapy soft tissues techniques produce an increase in the parasympathetic activation ,21,22. GPNS activation produced by physiotherapy treatment could be clinically relevant in certain populations with high levels of SNS activation. The effects of stress through autonomic system analysis have been studied in several groups of subjects. A recent systematic review from Bustamante et al.  focused Future research lines could explore the combination of physiotherapy treatment with other interventions that have been proved as useful for increasing PNS activation, such as physical activity programs , psycholSeveral limitations can be reported for the present study. For example, the sample was composed entirely by men. This should be taken into account in order to not extrapolate the results to the entire population. In this line, future research is needed that includes both genders. In addition, the evaluation of the HRV only in the short term must also be taken into consideration. Future research is needed with a mid- and long-time follow-up. Finally, another study limitation for the present work was that only one HRV measure was recorded.The results of the present research highlighted the validity of HRV portable system to monitor modifications in the autonomic nervous system of patients. This system could be easily implemented in clinics as a method to control the evolution and efficiency of treatment in this populations.A physiotherapy session including joint mobilization, soft tissue techniques, a stretching program, and motor control exercises of the core muscles produces an increase in parasympathetic nervous system activation and a decrease in subjective pain perception in non-specific subacute LBP patients.


Kidney surgery involves placing the kidney in the iliac fossa of the lower abdomen on the right or left side. Studies have found that most kidney patients experience moderate to severe pain after surgery. The stress response caused by postoperative pain, especially visceral pain, not only aggravates the patient's pain and irritability and aggravates the original complications but may also harm the early recovery of renal function and affect the survival of the kidney. Therefore, adequate postoperative analgesia for renal patients is essential. This paper combines ultrasound-guided laparoscopic technology to improve the postoperative analgesia effect of renal surgery and compares the data with experimental research methods. Through experimental research, it can be seen that the method proposed in this article has a certain effect, and ultrasound-guided laparoscopic technology can be used in follow-up clinical research to improve the analgesic effect of renal surgery. Postoperative pain is dominated by acute pain. Appropriate therapy of postoperative acute pain may not only increase patients' happiness with physicians, but it can also have a significant impact on their prognosis. On the other hand, poorly managed postoperative acute pain may lead to chronic pain, obstructing the recovery of postoperative respiratory, circulatory, and other organ functions and complicating perioperative care . The mecThoracic paravertebral nerve block is traditionally performed using anatomical landmarks, and a resistance loss or pressure monitoring placement approach is utilized to evaluate whether the puncture needle is in the correct location. This treatment has a limited success rate and is prone to significant consequences, such as nerve and blood vessel injury. In recent years, as ultrasound technology has advanced, the use of ultrasound to perform nerve blocks has become a hot topic in clinical practice. Compared to other imaging methods, ultrasound offers the benefits of no X-ray exposure, lightweight, rapidity, and precision . The useThe best therapy for stomach discomfort is radical renal gastric medication combined with laparoscopic surgery. It may greatly minimize trauma, discomfort in life, and treatment time when compared to open kidney extraction surgery and laparoscopic renal root treatment time, which appear during surgical kidney extraction. The patient will continue to experience agony. Multiple intravenous analgesia pumps  are already employed in clinical practice to reduce pain and discomfort; however, widespread opioid usage will result in side effects such as vomiting and respiratory hypoxia . TransveIn addition to being important for specific health background, characteristics and dignity of acid-base balance and hemoglobin level, it also has the filtration and removal of original drugs and toxins. As a result, the patient's paralysis and paralysis become weaker, and the risk of poisoning-related adverse reactions will also increase, which will cause damage to the recovery of renal function. Furthermore, there are several therapeutic reasons why viewers may or may not return to the show. A major element in a difficult pregnancy is the presence of pain. In order to reduce pain, it is extremely possible that it will create unpleasant pain, which will have a negative impact on patients' quality of life, medical expenditures, and the rate at which patients' postoperative analgesia returns to normal. Effective side effect analgesia after renal surgery is dependent on preonset circumstances of uremia patients and physiological effects of medications on the damaged renal function of patients. It has not yet entirely recovered, and hypoglycemia, among other factors, might jeopardise the return of functions and restrict therapeutic analgesia alternatives. This article combines ultrasound-guided laparoscopy to study the postoperative analgesia effect of renal surgery, which provides a theoretical reference for subsequent renal postoperative analgesia.Laparoscopy has steadily grown and replaced a number of conventional surgical approaches, giving new assistance for a variety of conditions, thanks to extensive promotion of the idea of minimally invasive surgery. Retroperitoneal laparoscopic radical nephrectomy has become a popular surgical treatment for patients with kidney cancer because of its benefits such as little trauma, good operative vision, and speedy patient recovery . After aInadequate postoperative analgesia may cause postoperative stress, trouble with early activities, lack of sleep, and other issues, all of which can degrade the quality of recovery. Furthermore, one of the key variables in the development of chronic pain is significant postoperative pain. It is clear that active and effective postoperative analgesia has significant therapeutic implications. Traditional analgesia is primarily based on opioid analgesics, but it is prone to adverse reactions such as postoperative nausea and vomiting, urinary retention, intestinal obstruction, and respiratory depression, all of which result in patients' spending more time in the hospital and taking longer to recover. To get the optimum analgesic effect, multimodal analgesia (MMA) combines the use of a range of analgesic medicines and treatments with various mechanisms of action. It is the most effective analgesic technique for reducing adverse drug or procedure responses .ICAPR defines pain as “an unpleasant sensation and emotional experience associated to existing or prospective tissue injury.” Inflammatory and neuropathic pain are clinically classified as two distinct types of pain based on the source of the pain. This complicates pain therapy because of the many processes of pain, which causes it to show in distinct clinical conditions in different ways. The body's stress reaction is triggered by postoperative pain, which manifests itself swiftly and strongly. Mental and bodily symptoms accompany the condition at the same time. Postoperative complications and patient dissatisfaction might result if it is not addressed quickly and effectively. Induce postoperative chronic pain and adequate postoperative analgesia may help patients recover after surgery . IncisioThe ultrasound probe was inserted laterally on the anterior abdomen's abdominal wall, where the three muscle layers may be easily recognised. Following the identification of the transversus abdominis plane, the probe was moved laterally and posteriorly and put on the iliac. The midaxillary line above the crest is at the same level as the crest itself. It is put in the ultrasound probe's front plane. Ultrasound imaging enables the operator to observe clearly how the puncture needle enters the transverse abdominis plane via distinct muscles. Squirting some saline into the puncture site will show where the needle tip is, and the local anesthetic will spread as a result. The hypoechoic zone is plainly apparent as well. Anatomical abnormalities, particularly in obese people, may cause a false impression of breakthrough in the traditional route, according to literature . As in o2. ③ ASA classification is I-II. ④ The patient has no severe visual or hearing impairment and can read text. Exclusion criteria are as follows: ① patients with severe heart, liver, lung, and renal insufficiency and need to be admitted to the ICU for continued treatment after surgery; ② patients with abnormal coagulation function; ③ patients with a history of allergy to anesthetics; ④ patients with a history of long-term drinking, chronic pain, or long-term use of psychotropic drugs; ⑤ patients with scars, infections, or tumors at the puncture site; ⑥ patients with a history of malignant high fever or family history; ⑦ patients who cannot cooperate with follow-up or have poor compliance; and ⑧ pregnant and lactating women. Rejection criteria are as follows: cases that have been included in the group but meet one of the following conditions should be rejected: ① patients who are misdiagnosed, ② patients who meet the exclusion criteria, ③ patients who seriously violate the test protocol and affect the observation of the study, ④ important data is lost or cannot be obtained, ⑤ the investigator decides that continuing the study is not good for the patient's health, and ⑥ the subject can withdraw for any reason.Case selection criteria are as follows: ① The age of the patient is 18-75 years old. ② 18 < BMI < 28 kg/mRandomization grouping method. The study used the SPSSl3.0 statistical software to generate random numbers. Then, the patients were randomly divided into ropivacaine block combined with general anesthesia group (group A), ropivacaine+morphine block combined with general anesthesia group (group B), and placebo control group (group C) according to the ratio of 1 : 1 : 1. All three groups of patients received the same protocol of PCIA after operation [peration .All patients were fasted with water for 8 hours before the operation, and no preoperative medication was given. After entering the operating room, the patient was routinely established a peripheral venous channel, infused with a compound sodium chloride solution, and instilled and supplemented with fasting water at a rate of 8 mL/kg/h for the loss of body fluids. The patient was connected to a multifunctional ECG monitor to monitor heart rate (legs), noninvasive blood pressure (BP), electrocardiogram (ECG), and pulse oxygen saturation (Sp02). The patient underwent radial artery puncture and catheterization under local anesthesia with 1% lidocaine. At the same time, it is necessary to monitor continuous invasive arterial pressure and connect to Vigileo continuous cardiac output monitor for hemodynamic monitoring. Before general anesthesia induction, the three groups of patients were put under general anesthesia, and paraspinal space puncture on the afflicted side was conducted under ultrasound supervision. Before the nerve block, the patient was given oxygen and placed in a side-lying posture with the operative side up, the head bowed, and the knee bowed to completely expose the puncture site. We first determine the thoracic spinous process (T9 and T11 double puncture points) at the puncture site and use a desktop color Doppler ultrasound diagnostic apparatus with a high-frequency probe frequency (6.10 MHz). The probe is coated with ultrasonic couplant. A longitudinal section scanning approach is used to establish the location of the vertebral body, and then, a cross-sectional scanning method (the long axis of the ultrasonic probe is 2.0-2.5 cm apart) is used in order to clarify the puncture site (the long axis of the ultrasound probe is perpendicular to the spine). It is at this point in time that the ultrasound picture reveals the skin and paraspinal muscles, as well as transverse process, superior ligament of costotransverse process, and pleura. We used Aner Iodine to sterilise a 15 cm radius around the puncture site and 1 percent lidocaine for regional anesthetic after that. With the use of the ultrasonic in-plane puncture technique, a 10 cm long 22G lumbar puncture needle was used to pierce thoracic paravertebral space and puncture the intertransverse ligament beyond lamina lateral edge, and the needle was entered along the lateral edge of lamina. The whole puncture procedure should attempt to demonstrate the needle tip's path. The drug may be given gently when the needle tip is in the correct location, and no blood or cerebrospinal fluid is drawn. In group A, 30 ml of 0.5 percent ropivacaine was administered via two puncture locations. 30 cc of 0.5 percent ropivacaine+1 mg morphine was injected into group B. A total of 30 meters of physiological saline was injected into group C. Each portion contains 15 ml of medication, with a total of 30 ml of medicine for each group of two puncture spots. Under ultrasound, a weak echo group formed by the increase of the liquid medicine on the outside of the pleura can be seen, and the pleura can be seen to depress the lung tissue forward. 15-20 min after injection, it is necessary to confirm the level of anesthesia and determine the blocking effect .μg/kg, and rocuronium 0.6 mg/kg for induction of anesthesia. After the patient's eyelash reflex disappeared, the patient received oxygen-assisted breathing with a mask, followed by tracheal intubation 3-5 minutes later, and an anesthesia machine was connected to perform mechanical ventilation. During the operation, we adjust the tidal volume (VT) as needed to be 8-10 ml/kg, the inspiratory − expiratory ratio (I/E) = 1 : 2, the respiratory rate is 10-16 times/min, and the ETC02 is maintained at about 35.45 mm Hg During the operation, the patient was inhaled with a mixture of sevoflurane (2.3%)+02/air (1 : 1) (sevoflurane 1.O.1.3 MAC). Remifentanil was injected intravenously at 0.06~0.199/kg/min to maintain the depth of anesthesia, and rocuronium was given intermittently as needed to maintain muscle relaxation. If the mean arterial pressure falls below 20% of the preoperative basic value during the surgery, the patient will be given an intravenous injection of ephedrine 6 rag/time to boost the blood pressure. If the patient's heart rate is fewer than 50 beats per minute, an intravenous dose of atropine 0.3 mg/time will be administered. After the procedure, the patient was given 4-8 mg of morphine and 6 mg of tropisetron, as well as stopping breathing sevoflurane and pumping remifentanil. The oxygen flow was increased to 6-10 L/rain, and the patient was given 4-8 mg of morphine and 6 mg of tropisetron. After the operation, the patient was connected to an intravenous self-controlled analgesic pump. After the spontaneous breathing recovered, the patients were given atropine 0.02 mg/kg and neostigmine 0.04 mg/kg to antagonize the residual effects of muscle relaxants. After VT > 6 mJ/kg, the patient was pulled out of the tracheal tube. Nerve blocking drug configuration: group A is 0.75% ropivacaine 75 mg+normal saline, and it is 15 ml in total; group B is 0.75% ropivacaine 75 mg+morphine 1 mg+physiological saline, and it is 15 ml in total; group C is 15 mL of normal saline. The three groups of intravenous self-control analgesic pumps all use the same formula: 50 mg morphine + 12 mg tropisetron injection + 0.9%normal saline, totaling 150 ml. The injection volume of PCn is 3 ml, which contains 1 ml of morphine, and the lock interval is 15 min. There is no background infusion volume, and it can be infused for 24 to 48 hours.Patients were given intravenous injections of propofol 1.5-2.5 mg/kg, fentanyl 2-4 Analgesic use. We recorded the total intraoperative use of remifentanil and the cumulative use of morphine at l h, 6 h, 12 h, 24 h, and 48 h after surgery.Insufficient analgesia, blood vessel damage, pneumothorax, general spinal anesthesia, local anesthetic poisoning, and nerve injury were all reported in the three groups, as well as postoperative nausea, vomiting, chills, hypotension, respiratory depression, skin itching, skin rash, and other adverse reactions.P < 0.001). The cumulative amount of morphine in group A is higher than that in group B, especially at 12 h, 24 h, and 48 h after surgery (P < 0.001), as shown in Tables 2Compared with group C, the cumulative amount of morphine at 1 h, 6 h, 12 h, 24 h, and 48 h after operation is significantly reduced in group A and group B  following energy conversion. After being relayed through the spinal cord, brainstem, and diencephalon, the appropriate sensory afferent route (noxious afferent pathway) enters the central nervous system and reaches the limbic system and cerebral cortex. After then, the integration of all levels of central centers produces the pain experience and pain response.Electrical stimulation of a certain intensity (high frequency and low intensity) may be used to stimulate thick myelinated axons. The main idea of “transcutaneous electrical stimulation analgesia” is that it produces analgesia by limiting the inflow of tiny fibers in the same segment (TENS). The key cytological reason for their hyperalgesic behavior, according to current research, is the excitability alterations of primary sensory neurons produced by acute or chronic nerve damage, as well as the remodeling of synaptic connections between neurons in the spinal dorsal horn. In this study, ultrasound imaging technology was used to perform paravertebral nerve block on the affected side of patients undergoing elective retroperitoneal laparoscopic renal surgery. This article uses the SPSS13.0 statistical software to generate random numbers to randomly divide the subjects into three groups: ropivacaine block combined with general anesthesia group (group A), ropivacaine+morphine block combined with general anesthesia group (group B), and placebo control group (group C) . All thr


Background: Rotator cuff tears are common causes of functional shoulder instability and often lead to arthroscopic rotator cuff repair. A well-programmed rehabilitation leads to successful tendon healing, positive functional recovery and subjective well-being (SWB). Objective: To evaluate the changes in shoulder functioning and SWB pre-, post-outpatient rehabilitation and after one-month follow-up. Materials and Methods: A total of 44 patients were assessed three times: at the beginning (six weeks’ post-surgery), at the end of outpatient rehabilitation (2–3 weeks) and one month after rehabilitation. The outcome measures were the Disabilities of the Arm, Shoulder and Hand score (DASH), active range of motion (ROM), manual muscle testing (MMT), hand dynamometry (HD) and pain level by a Visual Analogue Scale (VAS). SWB was assessed by Rosenberg self-esteem scale (RSES), Positive and Negative Affect Schedule (PANAS) and the Lithuanian Psychological Well-Being Scale (LPWBS). Results are presented as a difference between periods. Results: Affected shoulder motor function  significantly improved in three periods (p < 0.05); however, major recovery was observed in the follow-up period. VAS scores meaningfully decreased over all stages and negatively correlated with motor function recovery (p < 0.05). DASH rates exhibited significant retrieval in all phases, especially in follow-up. SWB results demonstrated the larger effects of self-evaluation in follow-up, improved daily functions and psychological wellness, then negative emotions significantly decreased (p < 0.05). Conclusions: The experienced pain and psychosocial factors significantly influence functional recovery of the shoulder during rehabilitation. The improvement in motor function, ability and pain relief during rehabilitation increases level of SWB, psychological wellness and positive emotional affect in long-term context. More than 1.7 billion people, nearly 25% of the world’s population, are affected by a musculoskeletal condition . In as mRC pathology can result in weakness, shoulder instability and limitation of daily activities (work and sports). Symptomatic disease affects between 4–32% of the patient population with RC tears. Although patient’s age, activity level, size of the tear and smoking status influence the decision of management, and the frequently preferred method of initial treatment is non-surgical. However, if this management is unsuccessful, surgical repair has been shown to relieve pain and improve function in >90% of patients . People Potter et al. state that patients with shoulder and RC pathology who exhibit greater levels of psychological distress report inferior preoperative self-assessments of pain and function . Mild toAllowing healing of the repaired RC tendon while minimising stiffness and muscle atrophy are the primary goals of postsurgical rehabilitation. Both protective and accelerated rehabilitation protocols must be utilised based on individual patient risk for developing postoperative hand muscle stiffness . Arm position during immobilisation (four to five weeks after surgery) is also of importance during the early healing phase of tendon repair ,16. ContWe raise the hypothesis that an outpatient rehabilitation program can be more effective in reducing pain and improving primary recovery of shoulder motor function , but arm functionality in daily life and SWB significantly improves more long-term and depends on patient responsibility and achieved rehabilitation outcomes.The objectives of the study are to clarify the period during which the highest recovery in different areas of shoulder motor function has been observed and how much this impairment affects SWB.According to strict inclusion criteria, a small number of patients that underwent rehabilitation in our outpatient unit in a prospective cohort clinical trial were involved . Patients underwent arthroscopic RC repair and after 5–6 weeks began participation in a 2 weeks’ duration conventional outpatient rehabilitation . Long-term data collection was completed at the scheduled follow-up one-month after rehabilitation.Inclusion criteria identified patients who (1) were ≥ 40 years old and scheduled for a shoulder arthroscopy for a primary symptom of shoulder pain secondary to a reparable full-thickness RC tear, (2) underwent surgical intervention for the first time, (3) started an outpatient rehabilitation program six to seven weeks after surgery and (4) attended follow-up one month (30–35 days) after rehabilitation. Exclusion criterion included: (1) young patients (<39 years old), (2) RC tear retraction and repeated shoulder arthroscopy, and (3) outpatient rehabilitation started more than seven weeks after surgery.Five patients (8%) did not complete the outpatient rehabilitation program and 11 patients (25%) did not return for scheduled follow-up after one month due to it being their second assessment completed, due to worsening health . In total, 44 of 65 patients (67%) completed the study and were included in the analysis of final data. Patients who did not return for follow-up after one month were also contacted by phone, mail or email and asked to complete questionnaires to improve the follow-up rate. The assessment data was collected, scored and entered into a database by a study coordinator.The average age ± standard deviation (SD) of 44 patients who participated in all three stages of the study was 57.4 ± 2.8 years, with 28 men (63.64%) and 16 women (36.36%). The main sociodemographic characteristics of participants are presented in The main outcome measures used for evaluation of hand motor function recovery after RC tears were the following: Disabilities of the Arm, Shoulder and Hand score (DASH), which is a comprehensive self-administered questionnaire about the symptoms and functioning of the entire upper extremity ; manual p < 0.05) was used to test for data normality. The results for the three periods were compared in the following order: the I with the II period, and then the II with the III period. Normally distributed data were compared utilizing the parametric statistical method, i.e., paired two-sample t-test (p < 0.05). Not normally distributed data (p < 0.05) were compared employing a non-parametric statistical method, i.e., the Wilcoxon signed rank test (p < 0.05). The normally distributed data are represented as mean ± SD, while the non-normally distributed data are represented by median . The Cohen’s value d was calculated to evaluate effect size: d = 0.01—very small effect size, d = 0.20—small effect size, d = 0.50—medium effect, size, d = 0.80—large effect size, d = 1.20—very large effect size, d = 2.00—huge effect size [p < 0.05. All the analyses were carried out using MatlabR2019b software .The Lilliefors normality test (ect size . With rep < 0.05). A significant decrease over all periods indicating that pain decreased with the use of rehabilitation measures and their long-term effects were observed in the follow-up outcomes, resulting in the eventual decrease of pain. However, it can be observed that in the follow-up period, the pain experienced by patients was on average four points lower, compared to pre-period.VAS psychometric response scores for the subjective states of intensity, severity and nature of experienced pain  were sigThe estimates of pain experienced by most patients in the post-stage decreased significantly compared to pre-stage, but several (11%) patients remained with pain estimates that continued to be high (reported > five points), with even the highest reported patient pain in the follow-up period not exceeding five points.p < 0.05) differed in the three periods with effect size d = 1.93 for pre- and post-stage; d = 2.1 for post-stage/follow-up outcomes and, for follow-up/healthy hand, d = 1.42 (The distribution of subjects according to affected hand side showed that the affected right hand prevailed in 35 (79.5%) subjects and the affected left hand in nine (20.45%) subjects. Affected hand grip strength significantly  and joint mobility (active goniometry) in the three periods are presented in p = 0.01) and elbow flexion . Furthermore, increasing ROM showed better correlations to pain in II and III periods, which indicated effective complex rehabilitation measures that reduced pain and increased arm motor function.Our study showed that a patient’s shoulder and elbow muscle, hand grip strength and hand ROM significantly improved over all three periods; however, a significantly decrease in pain was also observed. The significant reduction in pain negatively correlated with hand grip strength (HD)  response. Outcome effect from I to II period demonstrated very high and significant effect size in the first half of the questionnaire. However, the period from II to III showed smaller various effect sizes, in comparison to the previous term. The scores on both tests ranged from 0 (no disability) to 100 (most severe disability). Lower scores indicated a lower level of disability. At I period, the average DASH total score was 105.27 ± 9.31 points, at II period, 68.45 ± 8.50 points and finally, at III period, the average score was 72.68 ± 6.73 points. A statistical difference was found between all DASH questions in the periods, except for 21 between periods II and III and 22 between periods I and II  questionnaire, a comprehensive self-report questionnaire in which patients can rate difficulty and interference in daily life to perform certain upper extremity activities on a five-point Likert scale, meaningful changes in the answers in three periods were revealed. However, the study results show different recovery of an individual ability to complete tasks, for which the patient can select an appropriate number corresponding to his/her severity/function level. I and II .Patients self-reported the disabilities of the upper extremity following the DASH 1–21 activities  and reduction in pain, thus increasing the level of positive affect and decreasing negative affect .p < 0.05). Self-esteem by the RSES from I to II period increased by the small effect size ) and the meaningful changes were observed from II to III period  *), which indicate an increasing higher global self-esteem level. Psychological wellness increased significantly from I to II period , but a large effect was significantly lower than for II/III period  *). Life satisfaction score for I/II period displayed small changes (from 135.38 ± 15.06 to 137.03 ± 14.75), in comparison to II/III  *). The PANAS showed similar tendency of outcomes variation: the size of negative emotions significantly decreased more in post-/follow-up ) * and for post-/follow-up, values dropped to 13.06 ± 2.77 * (d = 1.20 (large effect) *, p < 0.05). Subsequently, positive emotions significantly increased in post-/follow-up ) and for post-/follow-up period, values increased to 37.78 ± 5.05 * (d = −0.72 (medium effect) *, p < 0.05). Daily function scores varied the same way as negative emotions  for pre-/post- and to 35.36 ± 14.90 *  * for post-/follow-up).Overall results demonstrated that the subjective variables of symptoms and function have the most robust associations with SWB following RC tears. The larger effects of self-evaluation were indicated for the post- and follow-up periods. The results of patients’ self-esteem by measured Rosenberg self-esteem scale (RSES) and Lithuanian Psychological Well-Being Scale (LBWS) scores revealed significantly different results only in the follow-up outcomes (p < 0.05). Pain became the key factor for our further study, as we correlated it with the almost all obtained parameters and indicated the most sensitive. The use of rehabilitation measures and their long-term effects were mostly observed only in the follow-up outcomes. Furthermore, in follow-up period, the pain experienced by patients was lower compared to the pre-period, and it also affected the recovery of movements, strength and hand functionality. The higher level of experienced pain in pre- and post-rehabilitation period could be influenced by the fact, that more our patients had a massive damage of m.supraspinatus (45.45%) and combined muscle (m.supraspinatus and m.infraspinatus) (26.54%). Affected hand grip strength significantly (p < 0.05) differed in three periods; however, we observed that dominant (right) and non-dominant (left) hand grip strength recovery did not differ meaningfully. The largest recovery in the global shoulder evaluations  was also observed in the follow-up period, and compared to the strength of a healthy hand, strength did not recover and did not reach the average of a healthy hand. Furthermore, an increase of ROM shows a better correlation to pain relief in II and III periods, which confirms that integrated rehabilitation measures are effective in reducing pain and restoring arm motor function. The overall success and effective recovery of motor function depends on the rehabilitation treatment protocol, which is characterised by the requirement of some supervised physical therapy, often requiring 12 weeks or more, focusing on supine exercises with gradual progression to upright [To ensure that the rehabilitation measures are effective, the outcomes after arthroscopic RC repair should be evaluated over time. What determines the effectiveness of rehabilitation? It is quite clear that both the complexity of the surgical intervention ,6,8,18 a upright . To obta upright .According to the self-report questionnaire DASH, in which patients can rate difficulty and interference in daily life to perform certain upper extremity activities, this study’s results showed different recoveries of individual abilities to complete tasks . At the Patient SWB following RC tears has been associated with pain, dysfunction, functional difficulty and outcome after RC surgery ,24. In oThis study found that the experienced pain and psychosocial factors after RC tears do significantly influence the level of disability and functional recovery of shoulder. Patient expectations and outcomes significantly increased during the rehabilitation program, with decreasing experienced pain, and patients had higher positive emotional effect and significant shoulder motor function recovery. However, shoulder functioning and the ability to perform daily living activities in the long-term period reached the highest recovery, although the positive emotional effect did not change significantly. The follow-ups after one month showed that a home exercise program must be continued consistently, as an intensive three- to four-week rehabilitation program is not sufficient to significantly improve shoulder function and functioning in ADLs and reduce the psychosocial confounders of patients. Most importantly, improvement in motor function and the ability to perform ADLs are sensitive to pain level. Pain relief directly positively affects a high level of SWB, psychological wellness, and positive emotional affect after RC tears.


Introduction: this study aimed to investigate the long-term clinical efficacy and satisfaction degree of integrative Korean medicine (KM) treatment for patients with failed back surgery syndrome (FBSS). Methods: we performed a follow-up questionnaire survey and retrospective analysis of medical records for patients with FBSS who underwent inpatient treatment for ≥ 1 week. The primary evaluation indices were numeric rating scale (NRS) scores for low back pain (LBP) and leg pain at admission and discharge. Sub-evaluation indices included the Oswestry Disability Index (ODI) and EuroQol 5-dimension (EQ-5D) score. The follow-up questionnaire survey obtained information regarding previous surgeries; reasons for satisfaction/dissatisfaction with surgical and KM treatment; and current status. Results: compared with at admission, there was a significant post-treatment decrease in the NRS scores for LBP and leg pain, as well as the ODI score. Further, there was a significant post-treatment increase in the EQ-5D score. Regarding the patients’ global impression of change for KM treatment administered during admission and at the follow-up questionnaire survey, 101 (95.3%) patients selected “minimally improved” or better. Conclusion: integrative KM treatment could effectively reduce pain, as well as improve function and health-related quality of life, in patients with FBSS. The increase was most marked in the oldest age groups with a 2.8-fold increase in procedures for those aged ≥ 60 years in England [Approximately 15–20% of all adults experience low back pain (LBP) annually; moreover, 50–80% of adults experience at least one LBP episode over their lifetime . Surgica England .Although there have been advances in surgical techniques and equipment, some patients still present with postoperative persistent pain or discomfort, with the prevalence of failed spinal surgery, generally ranging from 10% to 40% . AccordiPatients with FBSS present with a high pain level and low health-related quality of life (HRQoL) resulting from the failure to control existing pain. Patients presenting secondary neuropathic pain due to FBSS experience a greater pain level, a decrease in HRQoL, and functional impairment compared with patients presenting other chronic pain disorders, including complex regional pain syndrome (CRPS), rheumatoid arthritis, osteoarthritis, and fibromyalgia . MoreoveA multi-disciplinary approach is considered as the most effective treatment for patients with FBSS; further, there is a need for involvement of physicians, psychologists, physical therapists, and other affiliated healthcare professionals to improve the treatment outcomes of patients with FBSS . HoweverThis multi-center, long-term follow-up observational study investigated patients with FBSS who underwent at least one spinal surgery for symptom improvement followed by inpatient treatment for persistent pain or post-alleviation pain recurrence. We retrospectively reviewed the medical records of patients with FBSS who visited one of four regional network KM hospitals  between January 2015 and December 2019; moreover, a follow-up questionnaire survey was conducted. The KM hospitals that served as study centers are spine speciality hospitals, as recognized by the Minister of Health and Welfare. Although the primary treatment modality in these hospitals is KM treatment, they pursue an integrative treatment model involving conventional medicine and Oriental medicine based on modern medical diagnostic technology ,15. The (1) Patients with a history of low back surgery admitted with a chief complaint of persistent pain/discomfort or recurrent pain/discomfort. (2) Patients who underwent inpatient treatment at our hospital for ≥1 week. (3) Patients aged 19–70 years. (4) Patients who voluntarily provided informed consent for study participation.(1) Patients diagnosed with severe specific disorders that could cause LBP and leg pain . (2) Patients with progressive neurological deficits or severe concurrent neurologic symptoms. (3) Patients with non-spinal causes and/or soft tissue problems . (4) Patients with other chronic diseases that could affect the interpretation of the treatment effect/outcome . (5) Patients taking corticosteroids, immunosuppressant drugs, psychiatric medicines, or other drugs considered as inappropriate during the inpatient treatment period. (6) Patients previously admitted to our hospital within the past six months. (7) Patients unfit for study participation due to other reasons as determined by the researcher . (8) Patients who did not consent to study participation.Date and mode of onset .Intervention(s) received between onset and admission .Current disease history and information regarding spinal surgery .Comorbidities .Social history .Radiological findings (L-spine T2-weighted MRI or CT scans).Demographic characteristics of interest included age and sex. We collected the following medical information from the electronic medical records (EMRs):Details regarding prescriptions in the EMR were extracted to investigate the number of patients who received different KM treatment types prescribed by a KM doctor, as well as the average number of each treatment. For herbal treatment, one dose was counted as one treatment; however, for all other treatments, one treatment was counted each time it was performed/administered.A follow-up questionnaire survey was conducted to obtain information regarding low back surgery and KM treatment; reason(s) for satisfaction/dissatisfaction with each treatment; and current status. This questionnaire survey was performed via telephone interviews and online Google questionnaires. Questionnaire items included surgery history before inpatient KM treatment; postoperative pain recurrence; improvement level from and satisfaction degree with KM treatment; surgery history after inpatient KM treatment; current treatment; and evaluation of current symptoms , Oswestry Disability Index (ODI), and EuroQol 5-dimension (EQ-5D-5L)). In the satisfaction survey, the subjective satisfaction degree of patients was scored on a 1–10 point scale. Additionally, reasons for satisfaction/dissatisfaction with each treatment were investigated based on multiple-choice items. The choices included the extent and speed of post-treatment pain reduction; functional recovery; treatment ease; recurrence frequency; sequelae; cost burden; and availability of treatment information.Numeric Rating Scale (NRS) The NRS subjectively measures the pain level on a 0–10 scale, with 0 representing no pain and 10 representing the worst pain imaginable. The visual analogue scale is also widely used; however, the NRS is relatively easier to use since it does not require good vision or motor function. NRS scores for LBP and leg pain at admission and discharge were collected from the EMRs. In the follow-up questionnaire survey, NRS scores were collected at five different time points: onset, after surgery, before admission to the KM hospital, after discharge from the KM hospital, and at present.Oswestry Disability Index (ODI) The ODI is a 10-item questionnaire for assessing the LBP-induced disability degree. Each item is divided into six stages with 0–5 points being assigned to each item. The score is positively correlated with the severity of disability. We used a previously validated Korean version of the ODI questionnaire . ODI sco5-Level EuroQol 5-Dimension (EQ-5D-5L) The EQ-5D-5L was developed to assess the HRQoL and is widely used across healthcare fields. It is comprised of five dimensions regarding current health status . Moreover, each dimension is assessed through five levels . The weight for HRQoL was calculated by applying an estimated weight model for Koreans . EQ-5D-5http://www.e-irb.com/index.jsp, accessed on 29 September 2020). Based on our study objectives, the EMRs were analyzed to obtain data from patients who had provided consent at our hospital. Since our questionnaire survey targeted patients who had been discharged, as well as covered an extensive survey area, it was conducted via telephone interviews or online Google questionnaires. The patients were informed regarding the source of contact information and use of personal information. For patients who provided consent, the survey was conducted; otherwise, the use of information was stopped and all personal information was destroyed.This study was approved by the Institutional Review Board (IRB) of Jaseng Hospital of Korean Medicine  while categorical variables were presented as frequency and percentage. Subsequently, differences in baseline characteristics between patients who completed the follow-up questionnaire and those who did not were assessed using the independent t-test and chi-squared test.The NRS, ODI, and EQ-5D scores at admission, discharge, and follow-up were presented as mean ± SD. The decrease over time was tested using a linear mixed model. Each time point in the model was considered as a categorical variable and included as a fixed effect with the baseline value of each outcome. The subject was included as a random effect. The results were presented with a 95% confidence interval (CI).n) and percentage (%). Subsequently, we used a multivariate logistic regression model to analyze whether MCID was achieved. The model included the following variables: age, sex, onset, onset mode, surgery type, surgery on L4/5 disc level, disc herniation, stenosis, spondylolisthesis, hypertension, diabetes, smoking, alcohol, NRS scores for arms and legs, and ODI and EQ-5D scores at admission. The results were presented as odds ratio (OR) and 95% CI. The goodness of fit was given as area under the curve (AUC).Regarding the minimal clinically important difference (MCID) for patients with FBSS, an NRS score of 2.25 for LBP , NRS scop value < 0.05. Statistical analyses were performed using R Studio .Statistical significance was set at a We included 254 patients who experienced recurrent LBP or leg pain after back surgery with subsequent admission to one of four regional network KM hospitals in this study. Among them, we excluded 20 patients with missing data regarding pain at admission or not meeting the enrolment criteria. Consequently, 234 patients were included in the analysis set. For MCID analysis, 231 patients were included after excluding two and one patient(s) due to missing data regarding the reason for onset and drinking status at admission. Further, 106 patients completed the follow-up questionnaire survey via telephone or internet .n = 219, 93.6%) followed by discectomy . Regarding the operated disc level, L4–5 was most common . Regarding the lumbar MRI or CT findings, herniation of the nucleus pulposus (HNP) was most common , followed by spinal stenosis   female patients. The mean duration of hospital stay was 28.1 ± 17.1 days. Regarding the surgery type, laminectomy was most common  . There w, 28.6%) .p < 0.001). In the follow-up questionnaire survey, the mean NRS score at onset, after surgery, before admission to KM hospital, after discharge from KM hospital, and present time were 8.54 ± 1.45, 4.35 ± 2.75, 7.00 ± 1.67, 3.53 ± 2.03, and 3.54 ± 2.49, respectively . The NRS score for leg pain decreased by 1.88 points . These findings were indicative of a significant improvement in pain A (p < 0.ectively B.p < 0.001). Further, there was a significant improvement in the HRQoL indicated by an increase in the EQ-5D score by 0.20 points (at admission (0.54 ± 0.22), at discharge (0.74 ± 0.13); 95% CI: 0.17–0.24; p < 0.001; Moreover, we observed a significant functional improvement indicated by a decrease in the ODI score by 17.35 points (at admission (50.55 ± 16.53), at discharge (33.19 ± 15.93); 95% CI: 15.09–19.62) and 23.50 points (at admission (50.55 ± 16.53), at questionnaire survey (27.39 ± 16.97); The number of patients who had achieved MCID 1 and 2 in the NRS score for LBP at discharge was 96 (41.6%) and 109 (47.2%), respectively. Further, the number of patients who had achieved an MCID in the ODI and EQ-5D score at discharge was 146 (63.2%) and 101 (43.7%), respectively. Moreover, the number of patients who achieved an MCID in the ODI and EQ-5D scores at follow-up was 79 (74.5%) and 45 (42.5%), respectively.Patients with FBSS with higher NRS scores for LBP at admission had a higher OR for achieving MCID (ORs for achieving MCID 1 and 2 were 1.45 (95% CI: 1.10–1.90) and 3.43 (95% CI: 2.26–5.22), respectively). There was an OR of 2.51 (95% CI: 1.07–5.90) for achieving an MCID in the EQ-5D calculated based on responses provided in the follow-up questionnaire survey regarding the NRS score for LBP at admission. There was an OR of 1.06 (95% CI: 1.03–1.09) for achieving an MCID in the ODI score at admission. There were ORs of 1.16 (95% CI: 1.07–1.27) and 0.85 (95% CI: 0.75–0.96) for achieving an MCID in the ODI and EQ-5D MCID scores, respectively, at the follow-up questionnaire survey. There were ORs of 0.82 (95% CI: 0.77–0.87) and 0.78 (95% CI: 0.69–0.88) for achieving MCID in the EQ-5D score at discharge and the follow-up questionnaire survey, respectively.Regarding the surgery type, the OR for achieving MCID in the ODI score at discharge in patients who underwent laminectomy was 3.20 (95% CI: 1.02–10.06). The OR for achieving MCID 2 in the NRS score for LBP at discharge in patients who underwent spinal fusion was 3.13 (95% CI: 1.03–9.51). Furthermore, the OR for achieving MCID 1 in the NRS score for LBP at discharge in patients who underwent discectomy was 2.03 (95% CI: 1.07–3.85). Regarding the medical classification based on lumbar MRI or CT findings, the OR for achieving MCID 1 and 2 in the NRS score for LBP at discharge in patients with HNP was 2.29 (95% CI: 1.18–4.47) and 2.97 (95% CI: 1.38–6.39), respectively. There were ORs of 0.29 (95% CI: 0.08–0.99) and 0.04 (95% CI: 0.00–0.37) for achieving an MCID in the ODI and EQ-5D scores, respectively, at discharge in patients with spondylolisthesis. With respect to smoking, the ORs for achieving MCID 1 and 2 in the NRS score at discharge were 0.27 (95% CI: 0.11–0.69) and 0.15 (95% CI: 0.05–0.46), respectively .Regarding the inpatient treatment, the patients received the following integrative KM treatments at our hospital: herbal medicine, acupuncture, pharmacopuncture, Chuna manual therapy, and Korean physical therapy . Integrative KM treatments mainly comprised of those used for lumbar disc herniation and stenosis ,28. All n = 23, 21.7%) and < 1 week  being the most common responses. There were 17 (16.0%) patients who experienced persistent pain immediately after the initial surgery, with the median duration to recurrence being 12 (1–48) months and ≥ 1 year– < 3 years  being the most common responses. Regarding the reasons for surgery, “no other choice due to extreme pain”  and “expectation of significant pain reduction”  were the most common responses. Regarding the reason for satisfaction with spinal surgery, “significant pain reduction”  and “fast pain reduction”  were the most common responses. Contrastingly, regarding the reasons for dissatisfaction with spinal surgery, “no pain reduction”  was the most common response, followed by “sequela” and “frequent pain recurrence” . Further, postoperative pain recurrence was observed mostly at the “same level” (62.3%) or “contiguous level” (29.2%). Additionally, 40 (37.7%) patients with FBSS were recommended for reoperation; among them, 16 (40.0%) patients underwent reoperation before being admitted to the KM hospital  weeks, with ≥ 2 years , followed by Chuna manual therapy  and acupuncture . The most common reasons for satisfaction with KM treatment were “significant pain reduction”  and “functional recovery” . The most common reason for dissatisfaction with KM treatment was “cost burden” . Further, 13 (12.3%) patients underwent reoperation after inpatient KM treatment  for KM treatment, 101 (95.3%) patients chose “minimally improved” or better. The mean score for the satisfaction degree with KM treatment was 7.97 ± 1.98 points. Most patients with FBSS were satisfied with pharmacopuncture  with LBP showing a greater improvement than the MCID. Further, 41.6% of the patients showed ≥50% decrease in the NRS score, which was slightly lower than that reported by previous studies [There was a significant decrease in the NRS scores for LBP and leg pain at admission and discharge  after s studies , 0.174 [ studies ).Analysis of data obtained at admission and discharge from patients with FBSS revealed that the mean changes in the NRS scores for LBP, ODI, and EQ-5D scores, but not the NRS score for leg pain, were higher than the MCID. Analysis regarding MCID achievement revealed that patients with relatively severe FBSS who had high ODI and NRS scores for LBP or low EQ-5D scores who received integrative KM treatment showed a higher OR for achieving the MCID in each indicator. Patients with higher NRS scores for LBP at admission showed greater MCID achievement in the HRQoL at follow-up. Patients with relatively severe pain are thought to achieve greater improvement, which results in better results for current HRQoL.Regarding lumbar MRI or CT findings, patients with FBSS with HNP showed a higher OR of achieving MCID in the NRS score for LBP. This is because integrative KM treatment in patients with lumbar disc herniation has a long-term effect on disc resorption , as wellContrastingly, patients with FBSS with spondylolisthesis showed a low OR for achieving MCID in terms of functional impairment and HRQoL. Generally, conservative treatment for spondylolisthesis in adults with progressing degeneration is not as effective as surgical treatment ,39, whicItems in the follow-up questionnaire survey included information regarding surgical treatment, satisfaction/dissatisfaction with surgical treatment, and satisfaction/dissatisfaction with KM treatment, which could not be easily identified from the data collected from the EMR. The questionnaire survey indicated that the most common reason for choosing surgical treatment was “significant pain reduction”, which was the same reason for satisfaction. Surgical treatment reduced acute pain; however, there was a high likelihood of residual pain or pain recurrence. Consequently, the patients were dissatisfied with their physical condition after surgical treatment. However, patients with previous failure using generic conservative treatments, including drug therapy or physical therapy, recognized that only a few treatment options remained after surgical treatment. Therefore, they considered reoperation to resolve their symptoms. Integrative KM treatment provides an alternative for broadening the treatment options for such patients with FBSS.Although PGIC for KM treatment was measured after a long post-discharge period, most responses were positive with no response indicating a negative change. The reasons for satisfaction with KM treatment included significant pain reduction and functional recovery. Among the KM treatment modalities, pharmacopuncture showed the highest satisfaction degree (64.2%), followed by Chuna manual therapy (37.7%), and acupuncture (32.1%), which were the most commonly administered treatment modalities within three months after the questionnaire survey. These findings indicated that most patients receiving inpatient KM treatment and answered to the follow-up survey had a high satisfaction degree with and positive impression of KM treatment. However, the response rate to the survey was less than 50%, the interpretation need to be done carefully.Pharmacopuncture, which showed the highest satisfaction degree, involves a combination of conventional acupuncture and herbal medicine to sustain their mechanical and chemical effects through optimal acupoint access . CurrentThis study combined a retrospective analysis of EMR and long-term follow-up questionnaire survey. Given the limitations resulting from this study design, the study could not be conducted under a controlled environment, and there was no control group for comparison. In the questionnaire survey, the question regarding the intraoperative status relied on the patient’s long-term memory; therefore, recall inaccuracy cannot be dismissed. Moreover, we included patients with a history of at least one back surgery; therefore, there was some uncertainty regarding distinction between pain experience and tension/pain resulting from overuse, as well as other chronic LBP disorders, including myofascial pain syndrome, fibromyalgia, and CRPS. In this study, the response rate to the follow-up survey was less than 50%, so we need to interpret the efficacy of integrative KM treatment with caution. Finally, the applied integrative KM treatment combines multiple treatment modalities; therefore, it is difficult to differentiate among the individual effects of each treatment modality.Despite these limitations, this study is significant since it analyzed the long-term effects of integrative KM treatment for FBSS thorough a follow-up survey. A previous study explored the same research topic using 707 patients with FBSS ; howeverOur findings are favorable since they demonstrate the therapeutic effect and satisfaction degree with integrative KM treatment in patients with FBSS in South Korea. Therefore, integrative KM treatment could be an alternative treatment option for patients with FBSS, who currently have limited treatment options. The multi-dimensional effectiveness of integrative KM treatment in patients with FBSS was tested using proven tools for pain, functional impairment, and HRQoL, with the findings demonstrating long-term maintenance of the treatment effects. However, there is a need for more evidence regarding integrative KM treatment for patients with FBSS and additional validation through well-designed RCTs with appropriate samples.Integrative KM treatment could reduce persistent or recurrent pain, as well as improve functional impairment and HRQoL in patients with FBSS. Therefore, integrative KM treatment could be considered an effective conservative treatment modality for managing patients with FBSS.


The association of psychological factors with postoperative pain has been well documented. The incorporation of psychoeducational intervention into a standard analgesia protocol seems to be an attractive approach for the management of acute postoperative pain. Our study aimed to evaluate the impact of psychoeducational intervention on acute postoperative pain in pulmonary nodule (PN) patients treated with thoracoscopic surgery.In this study, 76 PN patients treated with thoracoscopic surgery and intravenous patient-controlled analgesia (IV-PCA) plus psychoeducational evaluation and intervention were selected as the psychoeducational intervention group (PG). Another 76 PN patients receiving IV-PCA without psychoeducational intervention after thoracoscopic surgery, treated as the control group (CG), were identified from the hospital database and matched pairwise with PG patients according to age, sex, preoperative body mass index (BMI), opioid medications used for IV-PCA and the educational attainment of patients.P < 0.001). Total opioid consumption for acute postoperative pain in the PG was 52.1 mg of morphine equivalent, which was significantly lower than that (67.8 mg) in the CG (P = 0.038). PG patients had a significantly lower incidence of rescue analgesia than CG patients . Nausea/vomiting was the most common side effect of opioid medications, recorded for 3 (3.9%) PG patients and 10 (13.2%) CG patients (P = 0.042). In addition, no significant difference was observed between PG and CG patients in terms of grade 2 or higher postoperative complications .The most common psychological disorders were anxiety and interpersonal sensitivity, which were recorded from 82.9% (63/76) and 63.2% (48/76) of PG patients. The numerical rating scale (NRS) pain scores of the PG patients were significantly lower than those of the CG patients at 2 and 24 h after surgery (Psychoeducational intervention for PN patients treated with thoracoscopic surgery resulted in reduced acute postoperative pain, less opioid consumption and fewer opioid-related side effects. Pulmonary nodules (PNs) are increasingly detected with extensive use of chest computed tomography (CT) scans . The staThe association of psychological factors with postoperative pain and surgical recovery has been well documented , 10, 11.In this matched-pair study, 152 PN patients who underwent thoracoscopic surgery and IV-PCA with or without psychoeducational intervention were retrospectively analysed. The aim of this work was to evaluate the impact of psychoeducational intervention on acute postoperative pain, opioid consumption, side effects of opioid medications and postoperative complications for PN patients treated by thoracoscopic surgery.Inclusion criteria: age 18 years or older; clinical diagnosis of PN with high probability of malignancy; treatment with single-port thoracoscopic wedge resection surgery; postoperative analgesia with IV-PCA; American Society of Anaesthesiologists physical status (ASA-PS) grade 1 or 2; no pain 72 h prior to the surgery.Exclusion criteria: incomplete medical documentation; multiport thoracoscopic surgery that might increase postoperative pain; intraoperative conversion to an open approach; presence of anxiety disorders or other significant alterations of cognitive impairment or mental status or visual and auditory deficits; history of antitumour therapy, psychopharmacological drug use, or chronic opioid use for any reason; concomitant malignant disease; considerable cardiopulmonary morbidity; hypohepatia or renal insufficiency.Seventy-six eligible patients with PN who underwent IV-PCA plus psychoeducational intervention after thoracoscopic surgery at the Affiliated Hospital of Jiangnan University between June 2018 and November 2019 were selected as the psychoeducational intervention group (PG). All PG patients provided written informed consent prior to IV-PCA and psychoeducational intervention. Another 76 PN patients receiving IV-PCA without psychoeducational intervention, included as the control group (CG), were identified from the electronic hospital database and matched pairwise with the PG according to age, sex, preoperative body mass index (BMI), opioid medications used for IV-PCA and the educational attainment of patients. Patient characteristics at baseline in both groups are detailed in Table All patients in both groups received general anaesthesia according to the following protocols. Briefly, intravenous administration of 1–3 mg of midazolam, 1.5–2.5 mg/kg propofol, 4 μg/kg fentanyl and 0.6 mg/kg rocuronium was performed for induction anaesthesia. Inhalation of sevoflurane (1.0%) and continuous infusion of remifentanil (4–18 μg/kg·h), propofol (2–5 mg/kg·h) and rocuronium (0.3 mg/kg·h) were performed for the maintenance of anaesthesia. The bispectral index (BIS) was used to guide the dose of anaesthetic for all patients. Other drugs affecting analgesia intraoperatively, such as magnesium, clonidine, paracetamol, and piritramide, were not administered to any patient.All patients received IV-PCA for postoperative pain management. An opioid agent  was administered at a total volume of 100 ml. The analgesic was infused basally at a rate of 2 ml/h with a bolus dose of 5 ml and a 2 ml bolus with 15-min lockout. Most patients used the total amount of IV-PCA within the first 2 postoperative days (PODs), and additional opioid analgesics  were prescribed by the anaesthesiologists or surgeons upon patient request. Intercostal block and infiltration with local anaesthetics of the surgical wound were not performed for all patients.Patients in the control group received general education support, including leaflets and behavioural instructions, regarding appropriate ways they could adhere to medical advice to support their recovery.In addition to general educational support, PG patients received psychological evaluations and interventions before surgery. First, the psychological symptoms of the PG patients were assessed with the symptom checklist-90 (SCL-90) questionnaire. In the SCL-90 inventory, 90 items are scored on a five-point scale to reflect the psychological symptom patterns of the patient. The items refer to the assessment of 10 indices, one each for somatization, obsessive-compulsive tendencies, depression, anxiety, phobia, interpersonal sensitivity, hostility, paranoid ideations, psychotic states, and other symptoms. Patients with any index scored above 1 were identified as having psychological disorders, and individualized psychological interventions were administered accordingly. Interventions included encouragement, verbal suggestion, relaxation training, guided imagery and audio or video recordings according to the patient’s individual situation. To ensure the outcome of the interventions, the procedure was performed by two trained nurses with 5 and 7 years of professional experience.The following data were collected for this study: acute postoperative pain scores during the first 3 PODs, opioid consumption for acute pain after surgery, the incidence of rescue analgesia, side effects of the opioid medications, and Grade 2 or higher postoperative complications.A numeric rating scale  was used to evaluate acute pain after surgery, which was measured at 2, 24, 48, and 72 h after surgery by registered nurses. The amount of opioid medication used for acute pain during the first 3 PODs, the incidence of rescue analgesia, and opioid-related side effects were collected by the anaesthesiologists. Opioid consumption was converted to morphine equivalents (mg) using a standard conversion ratio. Postoperative complications were assessed and recorded by the surgeons using the Clavien–Dindo grading system, in which Grade 2 or higher complications were defined as requiring pharmacological or surgical treatment and/or presentation with life-threatening complications or death.P value < 0.05 was accepted as statistically significant.The Pearson chi-squared test was used to compare categorical variables. Differences in continuous variables between the PG and CG groups were assessed using Student’s t test. All statistical analyses were performed using SPSS software, version 2.0.0 . A The psychological disorders of PG patients measured with SCL-90 (scored above 1) before surgery are listed in Table P < 0.001).Table P = 0.038). The results also demonstrated that PG patients had a significantly lower incidence of rescue analgesia than CG patients .As detailed in Table P = 0.042). In addition, dizziness was observed in 4 (5.3%) patients in the intervention group and 5 (6.6%) patients in the group that did not receive psychoeducational intervention, and the difference was not statistically significant (P = 0.731). We also found that the incorporation of psychoeducational intervention in our cohort showed significantly reduced total opioid-related adverse events compared with the CG .The opioid-related side effects recorded in the two groups are listed in Table P = 0.240), although there was a trend of reduction for atelectasis, recorded in 1 (1.3%) PG patient and 4 (5.3%) CG patients (P = 0.172).As shown in Table Postoperative pain management is an important component of patient care. In this study, the combined analgesia modality of IV-PCA plus psychoeducational intervention was retrospectively evaluated for patients with pulmonary nodules treated by thoracoscopic surgery. The results showed that the combined analgesia resulted in reduced acute postoperative pain, less opioid consumption and fewer opioid-related side effects than IV-PCA alone.The perception and severity of postoperative pain are influenced by various biological and psychosocial factors , 16. It P = 0.038) and fewer opioid-related side effects  than CG patients. These results, together with the pain relief data mentioned above, further indicate that IV-PCA plus psychoeducational intervention might be a promising method for the management of acute postoperative pain in patients with PN after thoracoscopic surgery.Opioids are the most commonly used analgesics during the postoperative period , 20. HowP = 0.240). Given the relatively small sample size and the selection bias in the patient population, further prospective studies are needed to verify these results.Notably, although the relationship between postoperative complications and pain intensity has been reported in several studies , 22, 23,This study has some limitations. The main limitation arose from the retrospective nature of the data, which were obtained through past records. Another drawback was the potential bias introduced by patient selection. Furthermore, the psychological symptoms of PG patients were not reassessed after psychoeducational intervention, so the outcomes of the intervention, whether it was truly beneficial or not, could not be analysed in the present study. Additionally, only intravenous analgesia was used, involving administration of three different opioids . Finally, observation bias, also known as the Hawthorne effect, which concerns research participation, the consequent awareness of being studied, and possible impact on behaviour, is a disadvantage of this study.Psychoeducational intervention for PN patients treated by thoracoscopic surgery resulted in reduced acute postoperative pain, less opioid consumption and fewer opioid-related side effects. Further clinical trials are needed to confirm these findings.


The use of lidocaine (lignocaine) and ketamine infusion in the inpatient treatment of patients with headache disorders is supported by small case series. We undertook a retrospective cohort study in order to assess the efficacy, duration and safety of lidocaine and ketamine infusions.Patients admitted between 01/01/2018 and 31/07/2021 were identified by ICD code and electronic prescription. Efficacy of infusion was determined by reduction in visual analog score (VAS), and patient demographics were collected from review of the hospital electronic medical record.Through the study period, 83 infusions  were initiated for a headache disorder . In migraine, lidocaine infusion achieved a ≥50% reduction in pain in 51.1% over a mean 6.2 days (SD 2.4). Ketamine infusion was associated with a ≥50% reduction in pain in 34.4% over a mean 5.1 days (SD 1.5). Side effects were observed in 32 and 42.4% respectively. Infusion for medication overuse headache (MOH) led to successful withdrawal of analgesia in 61.1% of lidocaine, and 41.7% of ketamine infusions.Lidocaine and ketamine infusions are an efficacious inpatient treatment for headache disorders, however associated with prolonged length-of-stay and possible side-effects. Within Australia, headache was the 20th most common diagnosis for patients subsequently admitted to hospital for the period 2016–2017  pain score, which was determined by analysis of recorded pain score in the medical record at the commencement and cessation of infusion (or admission and discharge). Demographic data, medical history, length of stay, infusion, complication and re-presentation were all recorded from the EMR. The number of previously failed preventative medications for migraine were recorded where available from treating specialist correspondence and hospital clinic letters (data available in 47/77 migraine patients). Headache diagnoses were made according to the International Classification of Headache Disorders (ICHD-3).T-tests used to test the null hypothesis. Two-sided p-values <0.05 were considered statistically significant. All analyses were performed in SPSS v27.0. This study received approval from the local human research ethics committee (HREC 327/20).A variance and regression analysis were undertaken to assess adjusted outcomes in the cohort, and raw outcome data was also reported. Between 01 January 2018 and 31 July 2021 eighty-three patients were admitted to hospital for the treatment of a headache disorder and required an intravenous infusion of either lidocaine or ketamine. The prescription and management of intravenous infusions at the hospital is standardized and managed by local protocols. Through the study period, fifty patients received lidocaine infusions at a rate of 2 mg/min. A total of 33 patients received ketamine infusions, which are started at 7 mg/h, and up-titrated according to protocol (see attachment 2) and as tolerated to a maximum dose to 24 mg/h.A total of 77 patients received an infusion for migraine , three for new daily persistent headache (NDPH) , two patients received lidocaine infusions for SUNCT and one received a lidocaine infusion for cluster headache. The demographics of the cohort are presented in The overall rate of any adverse effect of intravenous infusion was 32% in the lidocaine cohort, and 42.4% in the ketamine cohort. The majority of adverse events reported were minor, and not unexpected with the medication, such as paraesthesia with ketamine infusion and dizziness with lidocaine, however more significant adverse effects were noted requiring cessation of infusion. A complete list of adverse events is summarized in A total of 77 patients received infusions for migraine  over the study period. Of the cohort, 68.9% were semi-electively admitted to the hospital for the purposes of the infusion, while the remainder received an infusion after presenting through the emergency department and an escalation of other therapies. Medication overuse in this cohort was present in 39%, and 33.8% of patients presented in status migrainosus. The mean maximum tolerated dose of ketamine was 16.3 mg/h (SD 6.5 mg). The demographics of the migraine cohort are summarized in In patients who received a lidocaine infusion, the proportion who achieved a 50% or greater reduction in pain was 51.1% (23/45), achieved after a mean of 4.5 (SD 0.5 days), while 31.1% (14/45) achieved pain freedom over a mean infusion duration of 6.2 days (SD 2.4 days). The 30-day re-admission rate was 6.7% (3/45). In the ketamine infusion cohort, the proportion of patients who achieved a 50% or greater reduction in pain was 34.4% (11/32), achieved after a mean of 3.4 days (SD 0.5 days) while 15.6% (5/32) achieved pain freedom over a mean of 5.1 days (SD 1.5). The 30-day re-admission rate was 3.1% (1/32).p = 0.035). The estimated marginal mean percentage reduction following co-variate analysis was 62% in the lidocaine group (95% CI 45–79%), and 33.4% in the ketamine group (95% CI 14.4–52.4%).In the migraine cohort, the mean percentage reduction in VAS pain score with lidocaine infusion was 53% (SD 39.3), and 31.6% (SD 41.3) for ketamine infusion . In 47 oWithin the migraine cohort 26 patients were reported to suffer from status migrainosus. Within this group, the 16 patients received a lidocaine infusion, 43.8% (7/16) of whom had a ≥50% reduction in pain, while 25% (4/16) achieved pain freedom over a mean 6.6-day (SD 2.7) infusion. The 30-day re-admission rate was 12.5% (2/16). A total of 10 patients received a ketamine infusion, with a ≥50% reduction in pain rate of 20% (2/10) and pain freedom in 10% (1/10), over a mean 5.9 day (SD 1.2). There were no re-admissions within 30 days.Within the migraine cohort, 30 patients were documented to suffer from medication overuse headache (MOH). Of patients who received a lidocaine infusion, 27.8% (5/18) overused triptans, 5.5% (1/18) overused NSAIDs and 72.2% (13/18) overused opiates. Within the ketamine cohort, 16.7% (2/12) overused triptans, 16.7% (2/12) overused NSAIDS and 66.7% overused opiates. Within the MOH cohort, lidocaine infusion achieved a ≥50% reduction in pain in 50% (9/18) of patients, and pain freedom in 22.2% (4/18). The offending was successfully withdrawn in 61.1% (11/18), and the mean duration of infusion was 6.1 days (SD 2.3). Ketamine infusion achieved a ≥50% reduction in pain in 25% (3/12), and pain freedom in 25% (3/25). Medication overuse was successfully addressed in 41.7% (5/12) patients, over a mean duration of 5.3 days (SD 1.3).Three patients received infusions  for a new daily persistent headache (NDPH). Both patients who received lidocaine infusion  achieved a ≥50% reduction in pain, while neither had pain freedom. The patient who received a ketamine infusion electively did not achieve a ≥50% reduction in pain. No patients were re-admitted within 30 days.Within the study period, three patients received a lidocaine infusion for a trigeminal autonomic cephalalgia (TAC), two patients diagnosed with SUNCT  and one with cluster headache (via emergency). All patients who received a lidocaine infusion for a TAC achieved both a ≥50% reduction in pain and pain freedom. One patient with SUNCT re-presented within 30 days.This study provides further evidence for the use of intravenous lidocaine and ketamine in the treatment of headache disorders. The efficacy of intravenous lidocaine in achieving pain freedom at discharge in status migrainosus in this cohort 25%) is similar to the 20% reported previously in a child and adolescent cohort % is simi. In treaThe efficacy of ketamine infusions has been reported previously by Lauritsen et al. In this case series, the authors utilized a VAS < 3 as an outcome measure rather than pain freedom, which accounted for at least a ≥50% reduction from the reported initial VAS. The authors reported 6/6 patients achieved this outcome. In comparison in our cohort, the ≥50% reduction rate in migraine was significantly less (34.4%) .The reported rate of adverse-effects of intravenous lidocaine in the literature varies between 0 and 100% . ConversThe mechanism by which intravenous lidocaine has anti-nociceptive effect in headache is uncertain. It has an inhibitory effect on voltage-gated sodium channels, and the active metabolite of lidocaine, monoethylglycine (MEG) inhibits the glycine transporter GlyT1 . In pre-Consideration of the preventative medication that a patient has responded to may provide insight into the tolerability of the infusion. Propranolol and verapamil, which may cause bradycardia, may be poorly tolerated with lidocaine. Ketamine undergoes N-demethylation in the liver under the influence of CYP3A4 , while lThe strengths of this study include the size of the cohort, which is the largest infusion study in the literature that the authors are aware of. In addition, outcome data was available for every case, and each case was reviewed by a specialist neurologist. The major limitation of this study is the retrospective design. Data such as the presence of complications of migraine such as status migrainosus or MOH relied upon the accuracy of documentation at the time, and as such are most liable to under-reporting in this study. Data detailing all trialed alternate therapies, timing of treatment failure, and duration of symptoms prior to commencement of infusion was not available. Similarly, data following discharge was not available, and as such duration of effect, MOH withdrawal or pain freedom is not known. Finally, the choice of intravenous infusion for individual patient was made by the treating neurologist at the time, and therefore is subject to patient factors, as well as individual prescribing habits and biases.This cohort study provides further evidence for the efficacy of intravenous lidocaine and ketamine in the inpatient treatment of headache disorders. Our study suggests that lidocaine infusions are associated with a higher mean reduction in pain score compared to ketamine, however further prospective study is required to confirm this observation. The overall adverse effects of both infusions in this cohort was high. Further prospective, controlled studies are required to guide treatment decisions in the inpatient treatment of migraine and headache disorders.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Alfred Health Human Research Ethics Committee. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.JR and EH developed the concept of the project. JR, KT, HH, and SC contributed to data extraction. JR was responsible for the primary writing of the manuscript. All authors contributed substantially to data analysis, editing, and approval of the final manuscript.JR has received payment for educational presentations from Viatris. RS has served on advisory boards for Novartis, Teva, Eli Lilly, Allergan, Lundbeck and has received payment for educational presentations from Allergan, Teva, Eli Lilly and Novartis. MM serves on the advisory board for Allergan, Novartis, Eli Lilly, Autonomic Technologies Inc. and TEVA and has received payment for the development of educational presentations from Allergan, electroCore, Eli Lilly, Novartis and TEVA. EH has served on advisory boards for Sanofi-Genzyme, Novartis, Teva, Eli Lilly, Allergan, Lundbeck, been involved in clinical trials sponsored by Novartis, Teva, Xalud, Cerecin, and has received payment for educational presentations from Allergan, Teva, Eli Lilly and Novartis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


However, there was no significant difference in trunk endurance between two groups (p > 0.05). This study found that core stability exercise was effective in reducing pain and enhancing balance in patients with LBP, and demonstrated that the application of additional Kinesio taping further increased these effects. Therefore, we recommend that core exercise combined with Kinesio taping may be used to improve the pain and postural balance of patients with LBP in clinics.The aim of this study was to evaluate the effect of core stability exercise combined with Kinesio taping on pain, endurance, and balance in patients with lower back pain (LBP). 46 patients with LBP were recruited and randomly allocated into the core stability exercise with taping (CSET) group and the core stability exercise (CSE) group. All participants performed core stability exercises for 40 min/day, 5 times/week for 8 weeks, and additional Kinesio taping was applied to the lower backs in the CSET group. The primary outcome measure was the pain intensity using the visual analog scale, and secondary outcome measures were trunk endurance and balance using the Biering-Sorensen test and force plate, respectively. After the intervention, the CSET group showed significant improvements in pain and postural balance compared to the CSE group ( Deep-trunk musculature including the multifidus, transverse abdominis (trA), and internal oblique muscles are the primary stabilizers of the lumbar spine and trunk during movement and are known as postural control muscles . In patiCore stability exercise aims to restore and strengthen trunk stability and functional movement by retraining the co-activation of the muscles in the abdomen, back, pelvis, and chest  ThereforThe taping method has been used to manage and treat symptoms of musculoskeletal injuries without side effects in hospitals, and it has recently been used as a treatment option to manage and prevent symptoms caused by LBP, shoulder joint injury, and various sports injuries . AlthougTherefore, this study aimed to suggest an effective therapeutic intervention method for LBP patients by investigating the effects of core stability exercise combined with Kinesio taping on pain, endurance, and balance.Forty-six patients with LBP were recruited from J Hospital in South Korea. All participants included in the study experienced LBP for ≥3 months, were aged between 18 and 65 years, had a visual analog scale (VAS) score of ≥3, could maintain their standing posture independently for ≥30 s, and could understand and follow the researcher’s instructions . The folIn this study, 46 patients fulfilling the inclusion criteria were selected and randomly assigned into the core stability exercise with taping (CSET) group and the core stability exercise (CSE) group. To perform random allocation, each subject, without information about the study, picked a number from a sealed envelope.Both groups performed core stability exercises for 40 min a day, 5 times a week for 8 weeks. This study used a single-blinded method to increase the reliability of the evaluation. Training and measurements were performed by different physical therapists with over 5 years of clinical experience. Informed consent was voluntarily obtained from all patients before participation in this study, which was approved by the Institutional Review Board (IRB) of Gachon University (IRB no. 1044396-202007-HR-140-01).Core stability exercises were performed in the order of independent isometric contraction of the trA and multifidus, co-contraction and functional tasks of deep body commuters, functional tasks with loads, and functional tasks with unstable surfaces. At the beginning of training, starting with isometric contraction of the core muscles with low intensity, the intensity was gradually increased until the functional task was performed, and four phases were performed for 10 sessions each. In Phase 1, independent isometric contractions of trA and multifidus were performed, and in Phase 2, co-contraction of deep trunk muscles was performed. In Phase 3, the exercise of Phase 2 was performed with external load applied to the wrist and ankle, and in Phase 4 functional tasks on unstable surfaces were included. Five minutes each of warm-up and cool-down were performed before and after the exercises, respectively. All functional movements were performed in the neutral position of the lumbar spine  Supplem.Taping was applied additionally in the CSET group. For taping, an elastic Kinesio tape with a 5 cm width was used, and the tape was changed once every 3 days. Two I-shaped strips were cut by measuring the length from PSIS to T12 in trunk flexion. In the upright sitting position, the bases of the strips were placed on both sides of the PSIS, and the strips were attached without tension on both erector spinae muscles, with the trunk flexed as much as possible. Another 3 I-shaped strips were attached to the lower lumbar in the form of an asterisk. The central part where the strips overlap was attached without tension, and the rest part was attached by applying the maximum tension  Figure .Pain, endurance, and balance were measured before the intervention and 1 day after the last intervention. The VAS was used to measure pain intensity. The score ranges from 0 to 100, and it was measured in units of length up to the location where the patient indicated the level of pain. VAS is known to have a high sensitivity to measure pain and is proportional to the pain experienced by the patient. This is the most widely used measurement method, exhibiting good reliability for chronic as well as acute pain .The Biering-Sorensen test was used to measure the endurance of the trunk musculature. This method showed high test-retest reliability with an intra-class correlation coefficient of 0.88 in the evaluation of the isometric trunk muscle endurance . For theA force plate  was used to measure the postural sway. Participants were asked to stand in a comfortable position with their arms at the side and stare at a point of 15-cm diameter placed 3 m away. The total sway length was measured for 30 s. The average value was obtained after each measurement was repeated thrice [t-test and chi-square test were used for continuous variables and categorical variables, respectively, to compare the baseline characteristics of the participants of the CSET and CSE groups. The paired t-test was used to compare changes in the baseline values within each group, and the independent t-test was used to compare the before and after changes between the groups. The level of statistical significance was set at 0.05. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS version 21.0).Normality of variables was assessed using the Shapiro-Wilk test. The independent The general and medical characteristics of all participants in the CSET and CSE groups were homogenous .p < 0.05). The improvement in the VAS score of the CSET group  was more significant than that of the CSE group  (The VAS score significantly decreased in the CSET and CSE groups after the intervention (1 score) .p < 0.05); however, there was no significant difference between the groups (Trunk endurance significantly increased in the CSET and CSE groups after intervention (e groups .p < 0.05), but the decrease in postural sway in the CSET group was more significant. The changeable amount before and after training was −35.72 ± 15.88 and −24.46 ± 17.35 cm, respectively (After training, the CSET and CSE groups showed a significant decrease in postural sway (ectively .We confirmed the effect of core stability exercise and additional Kinesio taping on pain in patients with low back pain. As a result of the present study, both groups showed significant pain improvement after intervention, and in particular the application of Kinesio taping further increased the effect of therapeutic exercise . AccordiLBP Patients may have decreased levels of muscular endurance in the trunk region due to various causes, such as increased metabolic levels due to prolonged muscle contraction or spasms , decreasThis study also measured the changes in postural sway after training. The results revealed that the CSET group showed significant improvement as compared to the CSE group. This could be attributed to the improvement in proprioception. Studies have reported that LBP patients have decreased proprioceptive sensation and poor balance ability ,30. TapiThis study investigated the effects of core stability exercise combined with taping on pain, endurance, and postural sway in patients with LBP. The results revealed a significant improvement in pain and postural sway in both two groups. However, these results cannot be generalized because the sample size was small in this study, and the actual proprioception was not measured. Therefore, future studies are necessary to confirm the effects of taping combined with various treatments on the proprioception of the trunk and the activity and cross-sectional area of the trunk musculature.Our results support the study reporting that CSE is effective for pain management in patients with LBP, and also prove that the additional application of taping to therapeutic exercise can further improve pain and balance ability in patients with LBP. Through this, we propose that taping could be used in combination with therapeutic exercise to improve the pain and balance ability of patients with LBP in clinics and sports centers.