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PubMedDate not supplied

[Physical impairments and comorbidities in a sample of members of a pension fund of blue-collar workers suffering from severe low back pain].

AIM: Idiopathic (unspecific) low back pain is the most common rheumatological complaint. Results of international studies give evidence that in about 80 % of the cases a specific diagnosis is not possible, thus creating an unsatisfactory situation for the orthopaedist. We feel that it is necessary to keep the discussion on the rate of specific causes for low back pain open. METHODS: In the context of a research project on the need for rehabilitation, 335 subjects suffering from severe low back pain were subjected to a physical (orthopaedic-neurological) examination. Also, a questionnaire was distributed assessing psychological status, work situation, comorbid conditions, risk factors, and demography. RESULTS: In more than half of the subjects, clues for a specific cause for the back pain were found; in more than one third of the cases there were one or more neurological signs. CONCLUSION: The data presented demonstrate that specific causes for low back pain might be more common than generally assumed. This leads us to the conclusion that there is a need for more clinically-oriented, population-based (epidemiological) research on possible pathologic causes of low back pain and comorbid conditions.

Adult↗
PubMed2005

Relationship between low-back pain, muscle spasm and pressure pain thresholds in patients with lumbar disc herniation.

It is not known whether or not muscle spasm of the back muscles presented in patients with sciatic scoliosis caused by lumbar disc herniation produces muscle pain and/or tenderness. Pressure pain thresholds (PPTs) of the lower back and low-back pain were examined in 52 patients (13 of 52 presenting sciatic scoliosis) with lumbar disc herniation who complained of radicular pain and in 15 normal subjects. PPTs were measured at five points bilaterally using an electronic pressure algometer. Low-back pain was evaluated using visual analogue scale (VAS) ratings. All patients complained of radicular leg pain and were divided into the following three groups according to the presence of and the region of low-back pain: no low-back pain group, low-back pain with no laterality group, and low-back pain dominantly on the herniation side group; the VAS rating on the side ipsilateral to the herniation side was higher than that on the contralateral side. In the normal subjects, there were no statistically significant differences between sides in mean PPTs at all sites examined. PPTs were not lower in the spasmodic side (concave side) than the convex side in patients with sciatic scoliosis. PPTs on the herniation side were significantly lower than those on the contralateral side in patients with low-back pain dominantly on the herniation side. Furthermore, the areas of low PPTs were beyond the innervation area of dorsal ramus of L5 and S1 nerve root. It was considered that not only the peripheral mechanisms but also the hyper excitability of the central nervous system might contribute in lowering PPTs of the lower back on the herniation side.

Adult↗
PubMed2006

Repeat assessment improves the prediction of prognosis in patients with low back pain in primary care.

Low back pain is considered to fluctuate over time, and related prognostic factors may behave similarly, therefore classification of prognosis may be affected by timing of assessment. We aimed to investigate the implications of timing of assessment of prognosis in low back pain. In a prospective cohort of primary care low back pain consulters aged 30-59 years, 359 returned questionnaires at baseline, one-month and one-year. The stability of selected prognostic indicators between baseline and one-month later was assessed, and relative risks for their association with outcome (individually and in combination) were calculated. Reported absence of most outcome indicators was stable between baseline and one-month. However, among people reporting presence of indicators at baseline, only around half still reported them a month later. There were no important differences between the prognostic strength of indicators measured at baseline or one-month. People reporting presence of indicators at either point had significantly higher risk of poor outcome than people not reporting the indicator at all. Presence of the indicators at both time points was associated with even higher risk; people with persistent high pain intensity had 15 times the risk of a poor outcome (relative risk 15.1; 95% confidence interval 6.7-33.8) compared with people not reporting high pain at either point. Combining information on prognostic indicators from two time points provides better classification of low back pain patients' eventual outcome than a single measurement alone. This increased accuracy in predicting prognosis is relevant to both clinical and research practice.

Adult↗
PubMed2006

Chronic low back pain: progress in therapy.

Low back pain is a common complaint in the primary care setting. Although most patients with acute low back pain will improve with conservative treatment, back pain often recurs, and a subset of patients will progress to chronic and sometimes disabling symptoms. A variety of treatments have been used for chronic low back pain; the best evidence supports intensive rehabilitation programs that include tailored exercise therapy in conjunction with cognitive behavioral interventions and education. The benefit of medications, including nonsteroidal anti-inflammatory drugs, analgesics, and possibly antidepressants or muscle relaxants, must be weighed against potential adverse effects. There is insufficient evidence regarding the effectiveness of many of the available therapies for chronic low back pain, and well-designed, randomized controlled trials are needed to clarify the role of these treatments.

Analgesics↗
PubMed2004

The effectiveness of ergonomic interventions on return-to-work after low back pain; a prospective two year cohort study in six countries on low back pain patients sicklisted for 3-4 months.

AIMS: To study occurrence and effectiveness of ergonomic interventions on return-to-work applied for workers with low back pain (LBP). METHODS: A multinational cohort of 1631 workers fully sicklisted 3-4 months due to LBP (ICD-9 codes 721, 722, 724) was recruited from sickness benefit claimants databases in Denmark, Germany, Israel, Sweden, the Netherlands, and the United States. Medical, ergonomic, and other interventions, working status, and return-to-work were measured using questionnaires and interviews at three months, one and two years after the start of sickleave. Main outcome measure was time to return-to-work. Cox's proportional hazards model was used to calculate hazard ratios regarding the time to return-to-work, adjusted for prognostic factors. RESULTS: Ergonomic interventions varied considerably in occurrence between the national cohorts: 23.4% (mean) of the participants reported adaptation of the workplace, ranging from 15.0% to 30.5%. Adaptation of job tasks and adaptation of working hours was applied for 44.8% (range 41.0-59.2%) and 46.0% (range 19.9-62.9%) of the participants, respectively. Adaptation of the workplace was effective on return-to-work rate with an adjusted hazard ratio (HR) of 1.47 (95% CI 1.25 to 1.72; p < 0.0001). Adaptation of job tasks and adaptation of working hours were effective on return-to-work after a period of more than 200 days of sickleave with an adjusted HR of 1.78 (95% CI 1.42 to 2.23; p < 0.0001) and 1.41 (95% CI 1.13 to 1.76; p = 0.002), respectively. CONCLUSIONS: Results suggest that ergonomic interventions are effective on return-to-work of workers long term sicklisted due to LBP.

Absenteeism↗
PubMed2006

[Central pain processing in chronic low back pain. Evidence for reduced pain inhibition].

INTRODUCTION: A study of patients with low back pain (LBP) had revealed altered central pain processing. At an equal pain level LBP patients had considerably more neuronal activation in the somatosensory cortices than controls. In a new analysis of this dataset, we further investigated the differences in central pain processing between LBP patients and controls, looking for possible pathogenic mechanisms. METHODS: Central pain processing was studied by functional magnetic resonance imaging (fMRI), using equally painful pressure stimuli in a block paradigm. In this study, we reanalyzed the fMRI data to statistically compare pain-elicited neuronal activation of both groups. RESULTS: Equally painful pressure stimulation resulted in a significantly lower increase of regional cerebral blood flow (rCBF) in the periaqueductal gray (PAG) of the LBP patients. The analysis further revealed a significantly higher increase of rCBF in LBP than in HC in the primary and secondary somatosensory cortex and the lateral orbitofrontal cortex (LOFK), elicited by these same stimuli. CONCLUSIONS: These findings support a dysfunction of the inhibitory systems controlled by the PAG as a possible pathogenic mechanism in chronic low back pain.

Adult↗
PubMed1996

Sensory detection and pain thresholds in spinal cord injury patients with and without dysesthetic pain, and in chronic low back pain patients.

In an effort to understand the mechanisms involved in dysesthetic pain syndrome (DPS) in spinal cord injury (SCI) patients, four groups of 13 subjects each--SCI subjects with DPS, SCI subjects without pain, chronic low back pain subjects, and control subjects--were examined for sensory detection and pain thresholds at forearm, neck, and rostral trunk areas. Results indicated that the SCI pain group had significantly lower pain thresholds at all skin sites, compared to the SCI no-pain and chronic low back pain groups, and at the rostral trunk skin site, compared to the control group. The SCI pain group also showed a lower sensory detection threshold at the rostral trunk skin site than did the SCI no-pain group. Equally important, the SCI no-pain group had detection and pain thresholds significantly higher than those of the control group. The results suggest fundamental differences in somatosensory processing when DPS is or is not a consequence of SCI.

Adult↗
PubMed1997

Transdermal fentanyl as treatment for chronic low back pain.

Management of chronic low back pain often includes oral opioid use. The effectiveness of therapy is dependent upon compliance, which in turn is dependent upon response, side effects, access, and convenience. Our hypothesis was that a transdermal fentanyl system would provide more effective pain management than oral opioids. Fifty patients with chronic low back pain were examined. After litration to levels corresponding to current oral opioid use, each patient was maintained on transdermal fentanyl for one month. Oral opioid therapy was then resumed. Their experience was assessed with the a visual analogue scale for pain intensity, a numerical pain score, the Oswestry disability questionnaire, the pain disability index, and the Verran Snyder-Halpern sleep scale. Significant improvement in pain relief and disability was found with transdermal fentanyl compared with oral opioids. Mild opioid side effects were common, but easily controlled. Use of transdermal fentanyl is an effective alternative to oral opioids for managing chronic low back pain.

Administration, Cutaneous↗
PubMed1989

Descriptive epidemiology and public health aspects of low back pain.

The prevalence of low back syndrome and its consequences in terms of disability, handicap, and need for medical care were studied as part of "the Mini-Finland Health Survey". A sample of 8000 persons representative of the Finnish population aged 30 or over was invited for examination, and 7217 (90%) participated. At interview 75% of the participants reported that they had experienced at least one episode of low back pain. Six or more episodes were reported by half of the population, and about 20% had suffered from pain during the previous month. On the basis of a standardised clinical examination, a physician diagnosed low back syndrome in 17.5% of men and 16.3% of women. The prevalence was highest in those aged 55-64 years. The use of health services was frequent among those suffering from low back pain. Nevertheless, their need for care was commonly unmet. Some disability was found in almost 60% of the subjects with low back pain, although severe functional limitations were rare. It was estimated that of the work disability the reduced capacity for everyday duties apart from work, and the reduced capacity for leisure time activities, in the population 18%, 16%, and 17%, respectively, were attributable to the low back syndrome. Thus low back syndrome has a strong impact on individuals and on society as a whole.

Adult↗
PubMed1996

Distinguish the specific from non-specific low back pain.

The diagnosis of low back pain is common and non-specific. While many theories exist concerning the etiology of low back pain, most attribute the condition to degenerative conditions of the spine with superimposed chemical and inflammatory factors. Acute low back pain is generally self-limited if treated in a supportive fashion. Certain factors such as constitutional symptoms and rest or night pain may implicate a more serious condition and possibly warrant early investigation. Chronic conditions generally relate to "segmental instability" or discogenic causes. Diagnosis and treatment of these conditions are controversial.

Acute Disease↗
PubMedDate not supplied

Treating acute low back pain with continuous low-level heat wrap therapy and/or exercise: a randomized controlled trial.

BACKGROUND CONTEXT: Restorative exercise and palliative modalities are frequently used together for the treatment of acute low back pain. However, little is known about the effects of combining these treatments. PURPOSE: To evaluate the efficacy of combining continuous low-level heat wrap therapy with directional preference-based exercise on the functional ability of patients with acute low back pain. STUDY DESIGN/SETTING: A randomized controlled trial was conducted at three outpatient medical facilities. PATIENT SAMPLE: One hundred individuals (age 31.2+/-10.6 years) with low back pain of less than 3 months duration. OUTCOME MEASURES: The primary outcome measure was functional ability assessed by the Multidimensional Task Ability Profile questionnaire. Secondary outcomes were disability assessed by the Roland-Morris Disability Questionnaire and pain relief assessed by a 6-point verbal rating scale. METHODS: Participants were randomized to one of four groups: Heat wrap therapy alone (heat wrap, n=25); directional preference-based exercise alone (exercise, n=25); combination of heat wrap therapy and exercise (heat+exercise, n=24); or control (booklet, n=26). Treatment was administered for five consecutive days and included four visits to the study center over 1 week. RESULTS: At 2 days after the conclusion of treatment (Day 7), functional improvement for heat+exercise was 84%, 95%, and 175% greater than heat wrap, exercise, and booklet, respectively (p<.05). Seventy-two percent of the subjects in the heat+exercise group demonstrated a return to pre-injury function compared with 20%, 20%, and 19% for heat wrap, exercise, and booklet, respectively (p<.05). Disability reduction for heat+exercise was 93%, 139%, and 400% greater than heat wrap, exercise, and booklet, respectively (p<.05). Pain relief for heat+exercise was 70% and 143% greater than exercise and booklet, respectively (p<.05). CONCLUSIONS: Combining continuous low-level heat wrap therapy with directional preference-based exercise during the treatment of acute low back pain significantly improves functional outcomes compared with either intervention alone or control. Either intervention alone tends to be more effective than control.

Activities of Daily Living↗
PubMed1984

Value of consensual ratings in differentiating organic and functional low back pain.

Evaluated 40 low back pain patients by a multidisciplinary team (orthopedic surgeons, nursing staff and a medical psychologist) to identify the behavioral characteristics associated with functional and organic determinants of pain. Significant relationships were found between orthopedists' clinical judgments and higher scores on MMPI scales F, HS, and MA, between nurses' ratings and higher scores on MMPI scales D, PA, PT, and SI, and on the Zung Depression Scale and STAI Trait-Anxiety scale. Physicians and nurses consensually agreed on 27 cases. Behavioral observations of the orthopedists and the nursing staff revealed contrasting patterns of behavior for those patients classified as organic or functional. The power of the consensual rating method and its usefulness in clinical appraisals were discussed.

Adult↗
PubMed1988

The occurrence of maladaptive health-related behaviors and teacher-rated conduct problems in children of chronic low back pain patients.

Chronic low back pain (CLBP) is often associated with a complex of behaviors in the patient which cause interference in adaptive functioning of both the patient and the patient's family. This study examined a group of children of CLBP patients, a control group of children of diabetic patients, and a general control group of children. The study supported the hypothesis that, as a group, children of CLBP patients would exhibit a higher frequency of behaviors hypothesized to be learned through observation of and interaction with a CLBP parent than would children in either of the control groups. Significant differences between the pain group and the control groups on each of the nine teacher-reported and child self-report measures were observed. Implications and limitations of the study are discussed.

Back Pain↗
PubMed1983

EMG biofeedback used to reduce standing levels of paraspinal muscle tension in chronic low back pain.

Twenty chronic low back pain (LBP) patients with relatively high standing paraspinal EMG levels (greater than 5 microV) were randomly assigned to 2 groups. One group (N = 10) received EMG biofeedback training to reduce standing paraspinal EMG levels, the other group (N = 10) served as a waiting list control group. Changes in perceived pain (duration X intensity) and paraspinal EMG in standing position were measured at a 3 week pretreatment baseline, during the 3 week treatment period, and at a 3 week post-treatment baseline. Compared to patients in the waiting list control group, those who received EMG biofeedback showed a significant decrease in standing paraspinal EMG from pretreatment to post-treatment baseline. However, no significant differences in reported pain were found during these periods. It is concluded that reduction of standing paraspinal EMG does not lead to reduction in pain.

Adult↗
PubMed1998

SPET and three-phase planar bone scintigraphy in adult patients with chronic low back pain.

Among adults, low back pain (LBP) persisting for more than 3 months is a common complaint. A variety of imaging modalities including bone scintigraphy have been recommended as appropriate for the investigation of chronic LBP, even when there is no reason to suspect that the pain is due to tumour, infection or inflammatory arthritis. In this chronic LBP population, the diagnostic benefit of bone SPET, together with planar flow study, blood pool and delayed three-phase imaging, was assessed, Altogether, 2108 consecutive adult patients were entered into the chronic LBP bone scintigraphy database. Retrospective exclusion of patients with a history of tumour, infection or inflammatory arthritis reduced the population to 1390, of whom 916 underwent a lumbosacral spine flow study and blood pool imaging in addition to planar and SPET bone scintigraphy. The diagnostic benefit of these imaging studies was tabulated and compared. In addition, a retrospective chart review of the patients with renal and other soft tissue abnormalities identified by a flow study and blood pool imaging was undertaken with a view to documenting any changes in treatment planning over the 6 months following the nuclear medicine studies. Of the lumbosacral spine abnormalities, 44.1% were seen equally well on planar and SPET images, 24.0% better on SPET, 31.4% only seen on SPET, and 0.4% only seen on planar imaging. The distribution of abnormalities identified on SPET images in the lumbar spine was divided between vertebral bodies (36.1%), lamina or pedicles (which included frequent sites of increased uptake in the articular facets and pars interarticularis) (53.8%), spinous processes (8.7%) and transverse processes (1.3%). For the flow study and blood pool imaging, there was a 16.7% rate of positive studies. However, there were no documented changes in treatment planning because of these positive findings. In conclusion, when used to examine adult patients with chronic LBP, SPET detects significantly more scintigraphic abnormalities than planar imaging. The addition of a flow study and blood pool imaging as part of these LBP examinations results in a significant benefit. However, the clinical utility of such flow study and blood pool imaging studies cannot be confirmed.

Adult↗
PubMed2004

Exploring the experiences of partners who live with a chronic low back pain sufferer.

Chronic low back pain (CLBP) is a condition that causes individuals considerable distress. It also presents a significant challenge to the health service and is often viewed by clinicians as frustrating to manage. The purpose of the present paper is to explore the experiences of individuals in the immediate social sphere of those suffering from CLBP and their role in care-giving for their partner. An approach was taken using two qualitative research methods to gather data: journals and focus groups. Findings from the journals and the focus groups revealed issues for partners of CLBP sufferers in relation to living with their partners' pain, perceptions of healthcare and the dominance of illness over social contacts. Key themes revealed the complex emotions experienced by respondents, and underlined the need for their role as care givers and partners to be acknowledged by healthcare professionals. The data also highlighted respondents' desire to have greater involvement in their partners' healthcare, which includes provision of relevant information and involvement with therapeutic interventions. The findings emphasise the need for healthcare professionals to include and acknowledge partners and others in the immediate social sphere of patients in the management of chronic conditions.

Back Pain↗