Diagnostic and therapeutic perspectives on low back pain in women with hypertension
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Aug 27, 2025
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Abstract
Low back pain (LBP) affects approximately 9–12% of the global population at any given time. Most cases are nonspecific, occurring without a clear anatomical cause, and are typically managed with conservative approaches such as physiotherapy and light activity. This case involved a woman with LBP due to lumbar spondyloarthrosis and herniated nucleus pulposus (HNP) accompanied by hypertension. Her history of elevated blood pressure and frequent heavy lifting were recognized as significant risk factors, potentially affecting organ perfusion. The management provided in this case was appropriate and comprehensive, combining pharmacotherapy, physiotherapy as supportive therapy to enhance functional recovery, and comorbidity management. This integrated approach demonstrated effective clinical outcomes in addressing both the musculoskeletal and cardiovascular aspects of the patient’s condition.
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How to Cite
Mayda, L., Kurniawati, H., Yasmin, S. and Fitriani, R. (2025) “Diagnostic and therapeutic perspectives on low back pain in women with hypertension”, Science Midwifery, 13(3), pp. 927-933. doi: 10.35335/midwifery.v13i3.2054.
References
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Christe, G., Nzamba, J., Desarzens, L., Leuba, A., Darlow, B., & Pichonnaz, C. (2021). Physiotherapists’ attitudes and beliefs about low back pain influence their clinical decisions and advice. Musculoskeletal Science and Practice, 53, 102382. https://doi.org/10.1016/j.msksp.2021.102382
Christofaki, M., & Papaioannou, A. (2014). Ondansetron: A review of pharmacokinetics and clinical experience in postoperative nausea and vomiting. Expert Opinion on Drug Metabolism & Toxicology, 10(3), 437–444. https://doi.org/10.1517/17425255.2014.882317
Deyo, R. A., & Weinstein, J. N. (2001). Low back pain. The New England Journal of Medicine, 344(5), 363–370. https://doi.org/10.1056/NEJM200102013440508
García-Moreno, J. M., Calvo-Muñoz, I., Gómez-Conesa, A., & López-López, J. A. (2022). Effectiveness of physiotherapy interventions for back care and the prevention of non-specific low back pain in children and adolescents: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 23(1), 314. https://doi.org/10.1186/s12891-022-05270-4
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Harris, J. S., Weiss, M. S., Haas, N. S., Hegmann, K. T., Holland, J. P., Kistner, F., Ott, U., Hegmann, K. B., & Thiese, M. S. (2017). Methodology for ACOEM’s Occupational Medicine Practice Guidelines-2017 Revision. Journal of Occupational and Environmental Medicine, 59(9), 913–919. https://doi.org/10.1097/JOM.0000000000001109
Hayden, J. A., van Tulder, M. W., Malmivaara, A., & Koes, B. W. (2005). Exercise therapy for treatment of non-specific low back pain. The Cochrane Database of Systematic Reviews, 2005(3), CD000335. https://doi.org/10.1002/14651858.CD000335.pub2
Jacobs, W. C. H., van Tulder, M., Arts, M., Rubinstein, S. M., van Middelkoop, M., Ostelo, R., Verhagen, A., Koes, B., & Peul, W. C. (2011). Surgery versus conservative management of sciatica due to a lumbar herniated disc: A systematic review. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 20(4), 513–522. https://doi.org/10.1007/s00586-010-1603-7
Koes, B. W., van Tulder, M. W., & Thomas, S. (2006). Diagnosis and treatment of low back pain. BMJ (Clinical Research Ed.), 332(7555), 1430–1434. https://doi.org/10.1136/bmj.332.7555.1430
Lubis, I. (2015). Epidemiologi Nyeri Punggung Bawah. Kelompok Studi Nyeri Perhimpunan Dokter Spesialis Saraf Indonesia.
Mescouto, K., Olson, R. E., Hodges, P. W., Costa, N., Patton, M. A., Evans, K., Walsh, K., Lonergan, K., & Setchell, J. (2022). Physiotherapists Both Reproduce and Resist Biomedical Dominance when Working With People With Low Back Pain: A Qualitative Study Towards New Praxis. Qualitative Health Research, 32(6), 902–915. https://doi.org/10.1177/10497323221084358
Modic, M. T., & Ross, J. S. (2007). Lumbar degenerative disk disease. Radiology, 245(1), 43–61. https://doi.org/10.1148/radiol.2451051706
Moore, R. A., Derry, S., Aldington, D., & Wiffen, P. J. (2015). Single dose oral analgesics for acute postoperative pain in adults—An overview of Cochrane reviews. The Cochrane Database of Systematic Reviews, 2015(9), CD008659. https://doi.org/10.1002/14651858.CD008659.pub3
Ogbeivor, C., & Elsabbagh, L. (2021). Management approach combining prognostic screening and targeted treatment for patients with low back pain compared with standard physiotherapy: A systematic review & meta-analysis. Musculoskeletal Care, 19(4), 436–456. https://doi.org/10.1002/msc.1541
Pappas, P. G., Kauffman, C. A., Andes, D. R., Clancy, C. J., Marr, K. A., Ostrosky-Zeichner, L., Reboli, A. C., Schuster, M. G., Vazquez, J. A., Walsh, T. J., Zaoutis, T. E., & Sobel, J. D. (2016). Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 62(4), e1-50. https://doi.org/10.1093/cid/civ933
Peloso, P. M., Fortin, L., Beaulieu, A., Kamin, M., Rosenthal, N., & Protocol TRP-CAN-1 Study Group. (2004). Analgesic efficacy and safety of tramadol/ acetaminophen combination tablets (Ultracet) in treatment of chronic low back pain: A multicenter, outpatient, randomized, double blind, placebo controlled trial. The Journal of Rheumatology, 31(12), 2454–2463.
Pinzon, R. (2012). Profil Klinis Pasien Nyeri Punggung Bawah Akibat Hernia Nukleus Pulposus. Cermin Dunia Kedokteran, 39(10).
Splittgerber, R. (2024). Snell’s Clinical Neuroanatomy (9th ed.). https://shop.lww.com/Snell-s-Clinical-Neuroanatomy/p/9781975195946?srsltid=AfmBOooIasYFYakZ_M8plvchPx-hf1PYvGD2YJ7CILB2z9zOdTn4_4T5
Sun, Y., Lai, M.-S., & Lu, C.-J. (2005). Effectiveness of vitamin B12 on diabetic neuropathy: Systematic review of clinical controlled trials. Acta Neurologica Taiwanica, 14(2), 48–54.
Tampubolon, E. A., & Fransysca, H. (2021). Counseling on the Benefits of Pregnant Gymnastics Against Low Back Pain in Pregnant Women in Environment V, Medan Tuntungan District in 2021. Science Midwifery, 9(2), 517–520.
Van Zundert, J., Hartrick, C., Patijn, J., Huygen, F., Mekhail, N., & van Kleef, M. (2011). Evidence-based interventional pain medicine according to clinical diagnoses. Pain Practice: The Official Journal of World Institute of Pain, 11(5), 423–429. https://doi.org/10.1111/j.1533-2500.2011.00490.x
Wiffen, P. J., Derry, S., Bell, R. F., Rice, A. S., Tölle, T. R., Phillips, T., & Moore, R. A. (2017). Gabapentin for chronic neuropathic pain in adults. The Cochrane Database of Systematic Reviews, 6(6), CD007938. https://doi.org/10.1002/14651858.CD007938.pub4
Xiao, L., & Harrison, D. G. (2020). Inflammation in Hypertension. Canadian Journal of Cardiology, 36(5), 635–647. https://doi.org/10.1016/j.cjca.2020.01.013
Balagué, F., Mannion, A. F., Pellisé, F., & Cedraschi, C. (2012). Non-specific low back pain. Lancet (London, England), 379(9814), 482–491. https://doi.org/10.1016/S0140-6736(11)60610-7
Cholesterol Treatment Trialists’ (CTT) Collaboration, Fulcher, J., O’Connell, R., Voysey, M., Emberson, J., Blackwell, L., Mihaylova, B., Simes, J., Collins, R., Kirby, A., Colhoun, H., Braunwald, E., La Rosa, J., Pedersen, T. R., Tonkin, A., Davis, B., Sleight, P., Franzosi, M. G., Baigent, C., & Keech, A. (2015). Efficacy and safety of LDL-lowering therapy among men and women: Meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet (London, England), 385(9976), 1397–1405. https://doi.org/10.1016/S0140-6736(14)61368-4
Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., Owens, D. K., Clinical Efficacy Assessment Subcommittee of the American College of Physicians, American College of Physicians, & American Pain Society Low Back Pain Guidelines Panel. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478–491. https://doi.org/10.7326/0003-4819-147-7-200710020-00006
Christe, G., Nzamba, J., Desarzens, L., Leuba, A., Darlow, B., & Pichonnaz, C. (2021). Physiotherapists’ attitudes and beliefs about low back pain influence their clinical decisions and advice. Musculoskeletal Science and Practice, 53, 102382. https://doi.org/10.1016/j.msksp.2021.102382
Christofaki, M., & Papaioannou, A. (2014). Ondansetron: A review of pharmacokinetics and clinical experience in postoperative nausea and vomiting. Expert Opinion on Drug Metabolism & Toxicology, 10(3), 437–444. https://doi.org/10.1517/17425255.2014.882317
Deyo, R. A., & Weinstein, J. N. (2001). Low back pain. The New England Journal of Medicine, 344(5), 363–370. https://doi.org/10.1056/NEJM200102013440508
García-Moreno, J. M., Calvo-Muñoz, I., Gómez-Conesa, A., & López-López, J. A. (2022). Effectiveness of physiotherapy interventions for back care and the prevention of non-specific low back pain in children and adolescents: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 23(1), 314. https://doi.org/10.1186/s12891-022-05270-4
Haritsah, N. F., W, Y. H., & Basuki, N. (2024). The comparative effect of core stability exercise and aquatic exercise therapy on reducing pain in patients with low back pain. Science Midwifery, 12(4), 1432–1438. https://doi.org/10.35335/midwifery.v12i4.1682
Harris, J. S., Weiss, M. S., Haas, N. S., Hegmann, K. T., Holland, J. P., Kistner, F., Ott, U., Hegmann, K. B., & Thiese, M. S. (2017). Methodology for ACOEM’s Occupational Medicine Practice Guidelines-2017 Revision. Journal of Occupational and Environmental Medicine, 59(9), 913–919. https://doi.org/10.1097/JOM.0000000000001109
Hayden, J. A., van Tulder, M. W., Malmivaara, A., & Koes, B. W. (2005). Exercise therapy for treatment of non-specific low back pain. The Cochrane Database of Systematic Reviews, 2005(3), CD000335. https://doi.org/10.1002/14651858.CD000335.pub2
Jacobs, W. C. H., van Tulder, M., Arts, M., Rubinstein, S. M., van Middelkoop, M., Ostelo, R., Verhagen, A., Koes, B., & Peul, W. C. (2011). Surgery versus conservative management of sciatica due to a lumbar herniated disc: A systematic review. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 20(4), 513–522. https://doi.org/10.1007/s00586-010-1603-7
Koes, B. W., van Tulder, M. W., & Thomas, S. (2006). Diagnosis and treatment of low back pain. BMJ (Clinical Research Ed.), 332(7555), 1430–1434. https://doi.org/10.1136/bmj.332.7555.1430
Lubis, I. (2015). Epidemiologi Nyeri Punggung Bawah. Kelompok Studi Nyeri Perhimpunan Dokter Spesialis Saraf Indonesia.
Mescouto, K., Olson, R. E., Hodges, P. W., Costa, N., Patton, M. A., Evans, K., Walsh, K., Lonergan, K., & Setchell, J. (2022). Physiotherapists Both Reproduce and Resist Biomedical Dominance when Working With People With Low Back Pain: A Qualitative Study Towards New Praxis. Qualitative Health Research, 32(6), 902–915. https://doi.org/10.1177/10497323221084358
Modic, M. T., & Ross, J. S. (2007). Lumbar degenerative disk disease. Radiology, 245(1), 43–61. https://doi.org/10.1148/radiol.2451051706
Moore, R. A., Derry, S., Aldington, D., & Wiffen, P. J. (2015). Single dose oral analgesics for acute postoperative pain in adults—An overview of Cochrane reviews. The Cochrane Database of Systematic Reviews, 2015(9), CD008659. https://doi.org/10.1002/14651858.CD008659.pub3
Ogbeivor, C., & Elsabbagh, L. (2021). Management approach combining prognostic screening and targeted treatment for patients with low back pain compared with standard physiotherapy: A systematic review & meta-analysis. Musculoskeletal Care, 19(4), 436–456. https://doi.org/10.1002/msc.1541
Pappas, P. G., Kauffman, C. A., Andes, D. R., Clancy, C. J., Marr, K. A., Ostrosky-Zeichner, L., Reboli, A. C., Schuster, M. G., Vazquez, J. A., Walsh, T. J., Zaoutis, T. E., & Sobel, J. D. (2016). Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 62(4), e1-50. https://doi.org/10.1093/cid/civ933
Peloso, P. M., Fortin, L., Beaulieu, A., Kamin, M., Rosenthal, N., & Protocol TRP-CAN-1 Study Group. (2004). Analgesic efficacy and safety of tramadol/ acetaminophen combination tablets (Ultracet) in treatment of chronic low back pain: A multicenter, outpatient, randomized, double blind, placebo controlled trial. The Journal of Rheumatology, 31(12), 2454–2463.
Pinzon, R. (2012). Profil Klinis Pasien Nyeri Punggung Bawah Akibat Hernia Nukleus Pulposus. Cermin Dunia Kedokteran, 39(10).
Splittgerber, R. (2024). Snell’s Clinical Neuroanatomy (9th ed.). https://shop.lww.com/Snell-s-Clinical-Neuroanatomy/p/9781975195946?srsltid=AfmBOooIasYFYakZ_M8plvchPx-hf1PYvGD2YJ7CILB2z9zOdTn4_4T5
Sun, Y., Lai, M.-S., & Lu, C.-J. (2005). Effectiveness of vitamin B12 on diabetic neuropathy: Systematic review of clinical controlled trials. Acta Neurologica Taiwanica, 14(2), 48–54.
Tampubolon, E. A., & Fransysca, H. (2021). Counseling on the Benefits of Pregnant Gymnastics Against Low Back Pain in Pregnant Women in Environment V, Medan Tuntungan District in 2021. Science Midwifery, 9(2), 517–520.
Van Zundert, J., Hartrick, C., Patijn, J., Huygen, F., Mekhail, N., & van Kleef, M. (2011). Evidence-based interventional pain medicine according to clinical diagnoses. Pain Practice: The Official Journal of World Institute of Pain, 11(5), 423–429. https://doi.org/10.1111/j.1533-2500.2011.00490.x
Wiffen, P. J., Derry, S., Bell, R. F., Rice, A. S., Tölle, T. R., Phillips, T., & Moore, R. A. (2017). Gabapentin for chronic neuropathic pain in adults. The Cochrane Database of Systematic Reviews, 6(6), CD007938. https://doi.org/10.1002/14651858.CD007938.pub4
Xiao, L., & Harrison, D. G. (2020). Inflammation in Hypertension. Canadian Journal of Cardiology, 36(5), 635–647. https://doi.org/10.1016/j.cjca.2020.01.013