The Effect of Traction Forces in People With Obesity Suffering From Chronic Low Back Pain

The Effect of Traction Forces on Changes in Biochemical Markers of Degeneration and Functional Parameters of the Spine in People With Obesity Suffering From Chronic Low Back Pain

The purpose of the research study is to assess the impact of traction forces on changes in systemic markers concentrations of spinal structure damage in people with obesity. The research group will include 40 subjects aged 35-60 with simple obesity (BMI ≥ 30 kg / m2) and chronic lumbar spine pain syndrome.

The control group will consist of 20 subjects with normal body weight suffering from the same pain, at a similar age to the patients in the study group. Persons will be qualified for examination by a specialist in internal medicine and a physiotherapist.

To assess the degree of structural damage within the intervertebral disc and adjacent anatomical structures, patients will undergo magnetic resonance imaging of the lumbosacral spine (MRI 1.5T, standard in 3 projections). Patients will undergo traction therapy under the supervision of a physiotherapist. The application of traction forces on the traction table (ST6567P-SEERSMEDICAL) will last 30 minutes a day for 4 weeks (continuous traction mode with a maximum strength of 30% of the patient's body weight).

Twice, before and after therapy, the following will be assessed: (1) body composition (by DXA method), (2) other anthropometric indicators, (3) functional parameters of the spine: mobility (electrogoniometer), muscle bioelectric signal amplitude (electromyograph), soft tissue biophysical parameters (myotonometer), (4) pain threshold and intensity in the lumbar region (using an algometer and validated questionnaires), (5) disability caused by pain in the spine (Oswestry questionnaire), (6) blood biochemical indicators selected on the basis of the latest research on biomarkers of spinal damage (for this purpose, 25ml venous blood will be taken from the subjects).

Blood levels of interleukin-17, interleukin-4, interleukin-2 (IL-2), interleukin-10 (IL-10), differentiating growth factor 15 (GDF-15), leptin, adipsin, chemokine CCL5 (RANTES), stem cell growth factor β (SCGF-β), vascular endothelial growth factor (VEGF), neuropeptide Y, and chondroitin sulfate CS846 will be determined in the blood of the subjects. It is planned to assess the relationship of the studied biomarkers with the degree of disk degeneration, obesity, lean and fat body mass, pain intensity, and functional indicators of the spine. Patients will be asked to stop taking anti-inflammatory drugs during therapy and at least 24 hours prior to blood sampling.

Study Overview

• Status: Active, not recruiting
• Conditions: Obesity; Low Back Pain
• Intervention / Treatment: Device: lumbar traction therapy

Detailed Description

People suffering from obesity are particularly vulnerable to mechanical compression of the intervertebral discs, and as a result their degeneration, hernia and pressure on the nerve roots, which together cause inflammation and pain in the damaged area. This is a significant public health problem due to the 100% incidence of pain syndrome among people with obesity. The use of traction forces has beneficial effects on degenerated intervertebral discs, but there are no studies assessing the effectiveness of the traction method in relation to a group of obese people with back pain syndrome.

Beneficial biochemical changes in the blood, alleviation of pain, improvement of functional parameters of the spine are expected after application of traction forces to the patients in the mechanism of decompression of the destroyed and being in chronic inflammation intervertebral discs. Identification of biomarkers enabling to monitor the effects of therapies in patients with chronic back pain can become a contribution to change standards in the diagnosis of back pain and reorientation in its treatment to real causes.

• Study Type: Interventional
• Enrollment (Actual): 49
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Poland
  • Poznań, Poland, 61-871
    • Poznan University of Physical Education

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 35 years to 60 years (Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Written consent to participate in the study,
2. Age: 35 - 60 years,
3. Obesity (BMI ≥ 30 kg / m2) or normal weight (BMI 18,5-29,9 kg/m2),
4. Stable body weight in the last month ± 2 kg,
5. Chronic low back pain.

Exclusion Criteria:

1. Secondary form of obesity;
2. Serious neurological defects (including large muscle losses, sensory disturbances in a large area of the lower limb, occurrence of cauda equina syndrome);
3. Surgery, post-accident mechanical injuries, history of spine fractures;
4. History of rheumatic disease (RA, ankylosing spondylitis, systemic lupus);
5. Osteoporosis;
6. Pain located in a location other than the spine which is more severe than the low back pain;
7. Poorly controlled type 2 diabetes;
8. Poorly controlled hypertension (mean systolic blood pressure> 140mmHg and / or average diastolic blood pressure> 90mmHg) during the last month and / or the necessity of modification of pharmacological treatment;
9. Lipid disorders requiring the introduction of pharmacological treatment in the last 3 months before observation or during observation;
10. Acute coronary event, unstable angina, stroke or transient cerebral ischemia in the last 6 months;
11. Features of heart failure in physical examination and / or additional tests (chest X-ray, echocardiography);
12. Clinically significant arrhythmias, conduction disorders, pacemaker implantation;
13. Fainting in an interview,
14. Chronic kidney disease with creatinine clearance <60mL / min / 1.73m2;
15. Clinically significant liver dysfunction (transaminases exceeding 3 times the normal range);
16. Acute or chronic, clinically apparent inflammatory process of the respiratory tract, inflammatory processes of the genitourinary system, inflammatory process in the head and neck;
17. Acute infection in the last month;
18. Cancer;
19. Alcohol abuse, drug addiction;
20. Pregnancy;
21. Uncontrolled mental illness that may falsify test results;
22. Other conditions which may pose any risk to the patient during the observation.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Patients With Obesity; 40 subjects aged 35-60 with simple obesity (BMI ≥ 30 kg / m2) and chronic low back pain.	Device: lumbar traction therapy; The application of traction forces on the traction table (ST6567P-SEERSMEDICAL) will last 30 minutes a day for 4 weeks (continuous traction mode with a maximum strength of 30% of the patient's body weight).; Other Names: lumbar traction
Active Comparator: Normal-Weight Patients; 20 subjects aged 35-60 with normal body weight (BMI ≤ 24.9 and ≥ 18.5 kg/m2) suffering from chronic low back pain.	Device: lumbar traction therapy; The application of traction forces on the traction table (ST6567P-SEERSMEDICAL) will last 30 minutes a day for 4 weeks (continuous traction mode with a maximum strength of 30% of the patient's body weight).; Other Names: lumbar traction

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Interleukin-2, interleukin-4, interleukin-10, interleukin-17, RANTES, differentiating growth factor 15 (GDF-15) [pg/ml]	ELISA	pre-intervention
Interleukin-2, interleukin-4, interleukin-10, interleukin-17, RANTES, differentiating growth factor 15 (GDF-15) [pg/ml]	ELISA	48 hours after the intervention
Stem cell growth factor β [ng/ml]	ELISA	pre-intervention
Stem cell growth factor β [ng/ml]	ELISA	48 hours after the intervention
Leptin [ng/ml]	ELISA	pre-intervention
Leptin [ng/ml]	ELISA	48 hours after the intervention
Adipsin [pg/ml]	ELISA	pre-intervention
Adipsin [pg/ml]	ELISA	48 hours after the intervention
Neuropeptide Y [pg/ml]	ELISA	pre-intervention
Neuropeptide Y [pg/ml]	ELISA	48 hours after the intervention
Vascular Endothelial Growth Factor [pg/ml]	ELISA	pre-intervention
Vascular Endothelial Growth Factor [pg/ml]	ELISA	48 hours after the intervention
Chondroitin sulfate CS846 [ng/mL]	ELISA	pre-intervention
Chondroitin sulfate CS846 [ng/mL]	ELISA	48 hours after the intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
State of tension of erector spinae muscles [Hz]	Natural oscillation frequency [Hz], characterizing Tone or Tension will be assessed with myotonometer device.	pre-intervention
State of tension of erector spinae muscles [Hz]	Natural oscillation frequency [Hz], characterizing Tone or Tension will be assessed with myotonometer device.	48 hours after the intervention
Disability caused by pain in the spine	Oswestry questionnaire. When completing the questionnaire, the subject answers questions concerning: pain intensity, independence, lifting objects, walking, sitting, standing, sleeping, social life, sexual activity and traveling. The answers to the questions help to classify how limited the functioning of the patient is while performing certain activities. Responses are graded from 0 to 5. The overall score is given on a 0-50 point scale, where the higher the score, the greater the disability.	pre-intervention
Disability caused by pain in the spine	Oswestry questionnaire. When completing the questionnaire, the subject answers questions concerning: pain intensity, independence, lifting objects, walking, sitting, standing, sleeping, social life, sexual activity and traveling. The answers to the questions help to classify how limited the functioning of the patient is while performing certain activities. Responses are graded from 0 to 5. The overall score is given on a 0-50 point scale, where the higher the score, the greater the disability.	48 hours after the intervention
Magnetic resonance imaging of the lumbosacral spine	MRI 1.5T	pre-intervention
Total body fat content [%]	dual energy X-ray absorptiometry (DXA)	pre-intervention
Total body fat content [%]	dual energy X-ray absorptiometry (DXA)	48 hours after the intervention
Lean body mass [kg]	dual energy X-ray absorptiometry (DXA)	pre-intervention
Lean body mass [kg]	dual energy X-ray absorptiometry (DXA)	48 hours after the intervention
Mobility of the spine	electrogoniometer	pre-intervention
Mobility of the spine	electrogoniometer	48 hours after the intervention
Muscle bioelectric signal amplitude	electromyograph	pre-intervention
Muscle bioelectric signal amplitude	electromyograph	48 hours after the intervention
Dynamic stiffness of erector spinae muscles [N/m]	Biomechanical properties will be assessed with myotonometer device.	pre-intervention
Logarithmic decrement of natural oscillation, characterizing elasticity of erector spinae muscles	Biomechanical properties will be assessed with myotonometer device.	pre-intervention
Dynamic stiffness of erector spinae muscles [N/m]	Biomechanical properties will be assessed with myotonometer device.	48 hours after the intervention
Logarithmic decrement of natural oscillation, characterizing elasticity of erector spinae muscles	Biomechanical properties will be assessed with myotonometer device.	48 hours after the intervention
Pain threshold	algometer	pre-intervention
Pain threshold	algometer	48 hours after the intervention
Pain intensity: questionnaire	visual analogue scale (VAS) pain intensity questionare (reporting a score on a 10-point scale, the minimum (0) means no pain and the maximum (10) means a worst pain imaginable	pre-intervention
Pain intensity: questionnaire	visual analogue scale (VAS) pain intensity questionare (reporting a score on a 10-point scale, the minimum (0) means no pain and the maximum (10) means a worst pain imaginable	48 hours after the intervention

Collaborators and Investigators

• Sponsor: Poznan University of Physical Education
• Investigators: Principal Investigator: Marzena Ratajczak, PhD, Poznan University of Physical Education; Study Chair: Małgorzata Waszak, PhD, Poznan University of Physical Education

Publications and helpful links

General Publications

• Chow DHK, Yuen EMK, Xiao L, Leung MCP. Mechanical effects of traction on lumbar intervertebral discs: A magnetic resonance imaging study. Musculoskelet Sci Pract. 2017 Jun;29:78-83. doi: 10.1016/j.msksp.2017.03.007. Epub 2017 Mar 20.
• Omarker K, Myers RR. Pathogenesis of sciatic pain: role of herniated nucleus pulposus and deformation of spinal nerve root and dorsal root ganglion. Pain. 1998 Nov;78(2):99-105. doi: 10.1016/S0304-3959(98)00119-5.
• Maciaszek J, Skrypnik D, Ratajczak M, Stemplewski R, Osiński W, Bogdański P, Mądry E, Walkowiak J, Karolkiewicz J. Two aerobic exercise programs in management of back pain among middle-aged obese women: A randomized controlled study. Human Movement. 2016; 17(2): 72-79.
• Weber KT, Satoh S, Alipui DO, Virojanapa J, Levine M, Sison C, Quraishi S, Bloom O, Chahine NO. Exploratory study for identifying systemic biomarkers that correlate with pain response in patients with intervertebral disc disorders. Immunol Res. 2015 Dec;63(1-3):170-80. doi: 10.1007/s12026-015-8709-2.
• Tarabeih N, Shalata A, Trofimov S, Kalinkovich A, Livshits G. Growth and differentiation factor 15 is a biomarker for low back pain-associated disability. Cytokine. 2019 May;117:8-14. doi: 10.1016/j.cyto.2019.01.011. Epub 2019 Feb 15.
• Sowa GA, Perera S, Bechara B, Agarwal V, Boardman J, Huang W, Camacho-Soto A, Vo N, Kang J, Weiner D. Associations between serum biomarkers and pain and pain-related function in older adults with low back pain: a pilot study. J Am Geriatr Soc. 2014 Nov;62(11):2047-55. doi: 10.1111/jgs.13102. Epub 2014 Nov 3.

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2020
• Primary Completion (Actual): December 31, 2022
• Study Completion (Estimated): December 30, 2024

Study Registration Dates

• First Submitted: July 6, 2020
• First Submitted That Met QC Criteria: August 7, 2020
• First Posted (Actual): August 10, 2020

Study Record Updates

• Last Update Posted (Actual): January 23, 2024
• Last Update Submitted That Met QC Criteria: January 22, 2024
• Last Verified: October 1, 2023

More Information

Terms related to this study

• Keywords: lumbar traction; inflammation; biomarkers of low back pain; disk degeneration; traction therapy
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Overnutrition; Nutrition Disorders; Overweight; Body Weight; Obesity; Back Pain; Low Back Pain
• Other Study ID Numbers: PoznanUPhyEd no. 3

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No