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[National Research Program. Part B: Chronicity of backache].

The main goal of part B of the National Research Program No 26 is to investigate the process leading to chronic low back pain. Starting from epidemiological facts the main risk factors are described from a systemic viewpoint. The rapid increase of disabling low back pain in the past decades makes it clear that factors outside the spine have to be made responsible for this process. There are changes in life-style and interpersonal relations, as well as in society and the health-care system. From these factors means of prevention are derived. Besides psychological factors general fitness and the training condition of the back muscles play an important role in effective prevention.

Back Pain↗

[Analysis of the cost of illness in backache].

BACKGROUND: Back pain has become quite a health problem in today's modern industrial society. Even though an excellent network of doctors and efficient treatments is available and most of the patients need only a few treatments, back pain is a common cause of illness and inability to work. This amounts to a considerable reduction in quality of life for those affected, additionally this also leads to a high economic burden for the national economy and the solidarity of the insured. COST ANALYSIS: The total costs caused by back pain come up to about 34 billion DM per year according to the present study. Ten billion DM of these amount to direct costs, which are divided into costs for physician visits (including diagnostic procedures) at about 35%, hospital, treatment at about 22%, rehabilitation at about 21%, physical therapy at about 17% and medication at about 5%. Regarding total costs, which are composed of around 70% indirect costs, the direct costs relativize immensly. CONCLUSION: Savings through restrictive prescriptions for medications therefore have no great impact on total costs. Only a more efficient therapy, which reduces sick days, number of recurrences and development of chronic illness as well as a more effective prevention, is able to limit the costs of back pain in the long-run. Therefore, more research on a broader base may result in a significant benefit in this area.

Adult↗

[A psychological therapy methods in chronic non-radicular backache].

The presence of psychological co-morbidity and difficulties in coping with chronic low-back pain are indications for the application of psychological therapy procedures. In the treatment of patients with chronic pain, the aim of therapy as well as the technique of the traditionally employed psychotherapeutic procedures need to be modified. What is of immediate importance is to promote an active pattern of coping with pain and discourage pain-related inactivity and reduce feelings of helplessness and hopelessness. To achieve this, it is necessary to combine various psychological treatment modalities (relaxation techniques and behavioural or psychodynamic therapy) with exercise programs as in physiotherapy or sports medicine. In the choice of the appropriate psychotherapeutic modalities, it is important to take into consideration the extent of chronicity of pain, the patient's subjective understanding of the illness, a possible wish of the patient for early retirement, previous experience with chronic pain and the extent to which the patient has been psychologically traumatised (especially in his childhood and youth). Relatives should be integrated in the planning and possibly also in carrying out of the treatment. Symptom-specific group therapy might motivate patients to undergo treatment and to change their habitual ways of life. A multimodal treatment approach incorporating orthopaedic, sports medicine, physiotherapeutic, psychological and socio-therapeutic procedures have proved to be more effective in the treatment of chronic pain than one employing monocausal treatment modalities.

Adaptation, Psychological↗

"Occupational backache" - surface electromyography demonstrates the advantage of an ergonomic versus a standard microscope workstation.

Musculoskeletal symptoms such as low back pain, neck pain, and tension headache are reported by up to 80% of professional personnel involved in daily microscope work. Yet, in striking contrast to the high prevalence of complaints, there is a general unawareness of this issue both in those suffering, and those ordering and designing microscopes. We intend to call attention to this underestimated work-related health hazard and to demonstrate a potential means of prevention. We obtained repeated surface electromyographic (EMG) recordings from the most strained neck, upper limb, and back muscles in 12 healthy volunteers while they were operating a near-to-ergonomic prototype workstation and a conventional microscope, respectively. Mean EMG activity was reduced in all recorded muscles when operating the ergonomic workstation compared to the standard microscope. This improvement became more distinct with sustained work, and was most pronounced in those muscles displaying the highest degree of activity while using the standard microscope. We demonstrate the usefulness of surface EMG recordings to show the advantage of an ergonomically tailored and individually adjustable microscope workstation over a standard microscope. The former allows the operator to maintain a more physiological posture, and may thus prevent the development of cumulative musculoskeletal disorders during prolonged microscope-related work.

Adult↗

Treatment of backache with spinal injections of local anesthetics, spinal and systemic steroids. A review.

Low back pain and sciatica have been treated with peridural local anesthetics for over 80 years and with epidural and subarachnoid steroid injections for a quarter of a century. This review surveyed the literature concerning the evolution, pathophysiology, complications and results of this type of therapy. The volume injected and the method used vary with different physicians and no standard has been established. Good results from this treatment which vary from 20 to 95% decrease on long-term follow up. Statistical significance is absent if compared with other forms of therapy. It is the authors' opinion that the rationale for the use of spinal local analgesics or steroids or intramuscular steroids has not been scientifically proven. Complications with the use of subarachnoid steroids are sufficiently serious that this form of therapy should be condemned. In this age of accountability it is imperative that therapies with questionable benefits should be critically evaluated.

Adrenal Cortex Hormones↗