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At least 289 records · Page 16Linked to original sources
PubMed1996

Randomized controlled trials in industrial low back pain relating to return to work. Part 2. Discogenic low back pain.

The purpose of this review was to determine the efficacy of treatments for discogenic low back pain (LBP) by examining all randomized controlled trials (RCTs) of discogenic LBP published in the English language literature between 1975 and 1993 with "return to work" (RTW) as the end point. From more than 4,000 LBP citations, nearly 600 articles were initially reviewed; 35 studies met our selection criteria. Twenty-two studies were discussed in Part 1 (Acute Interventions) or will be discussed in Part 3 (Chronic Interventions). In this review, of 13 RCTs assessing interventions for LBP with sciatica, 9 were appropriate for their focus on, and radiologic confirmation of, discogenic LBP. The treatments assessed included chemonucleolysis, surgical discectomy, and epidural steroid injection. A 26-point system to assess the quality of methodologic rigor was used for each article. Our literature survey found a need for additional studies comparing surgery, conservative care, epidural steroids, traction, and other approaches to determine their individual effects for RTW after discogenic disease.

Adrenal Cortex Hormones↗
PubMed1999

The effect of repeated epidural sympathetic nerve block on "failed back surgery syndrome" associated chronic low back pain.

STUDY OBJECTIVE: To assess the therapeutic benefits of repeated epidural local anesthetic administration on pain perception and straight leg raise (SLR) in patients suffering from chronic low back pain. DESIGN: Prospective, randomized, controlled, single-blind study protocol. PATIENTS: 50 ASA physical status I, II, and III patients at least 18 years of age, who had previously undergone spine surgery. INTERVENTIONS: All participants were admitted to hospital for the 5-day duration of the study. Following epidural catheterization, fluoroscopy was performed to verify correct placement of the epidural catheter. On the first study day, all patients received depomedrol 80 mg, in 10-ml 1% lidocaine, epidurally. Thereafter, patients were randomized into two equal groups. In Group Bupivacaine (B) 10-ml 0.125% bupivacaine was administered. In Group Saline (S), an equal volume of saline was administered. Epidural injections were performed twice daily (09H00 and 14H00) for 4 days. Sympathetic blockade was confirmed by the presence of peripheral vasodilatation. Sensory blockade was assessed using loss of pin prick and temperature sensation. SLR as well as patient-generated 100-mm visual analog score (VAS) for pain were performed prior to each injection, at 15 minutes after injection, and hourly for 2 hours thereafter. Similar parameters were measured 1 week, 1 month, and 3 months after discharge. MEASUREMENTS AND MAIN RESULTS: 46 patients completed the study. VAS for pain was marginally lower in Group B. However, statistical significance was not demonstrated. During the hospitalization period, the SLR in both study groups significantly (0.008) improved with time. However, no difference between the groups was demonstrated. In both groups, 1 week, 1 month, and 3 months after discharge, the SLR was comparable to prestudy recordings. In Group B, at 1 week, 1 month, and 3 months after discharge, patient-generated VAS for pain were significantly (p = 0.002) higher when compared to pain scores at the time of patient discharge.

Adult↗
PubMed2001

Localized low back pain and low back pain as part of widespread musculoskeletal pain: two different disorders? A cross-sectional population study.

In a cross-sectional postal questionnaire study we compared individuals with localized low back pain (LBP) with individuals with LBP as part of widespread musculoskeletal pain, according to demographic and lifestyle characteristics and functional ability. All the inhabitants in Ullensaker county born 1918-20, 1928-30, 1938-40, 1948-50, 1958-60 and 1968-70 were sent a questionnaire in 1994. The study population comprised 2,893 responders. LBP as part of widespread pain indicated reduced functional ability, and the groups differed in several demographic and lifestyle characteristics.

Activities of Daily Living↗
PubMed2001

Treatment of low back pain with a herbal or synthetic anti-rheumatic: a randomized controlled study. Willow bark extract for low back pain.

OBJECTIVES: To compare the effects of a proprietary extract of willow bark (Assalix) and a selective inhibitor (rofecoxib) of the enzyme cyclo-oxygenase-2 (COX-2). METHODS: An open, randomized, post-marketing study was carried out in an out-patients clinic on two groups of patients aged 18 to 80 yr presenting over a 6-month period with acute exacerbations of low back pain. Using computer-generated random list, 114 patients were allocated to receive a daily dose of herbal extract containing 240 mg of salicin [PAID (phyto-anti-inflammatory drug) group] and 114 were allocated to receive 12.5 mg of the synthetic COX-2 inhibitor rofecoxib [NSAID (non-steroidal anti-inflammatory drug) group]. The doses were chosen according to existing recommendations. All patients were free to use whatever additional conventional treatments were thought necessary. The outcome measures were a modified Arhus index, its pain component and the Total Pain Index. RESULTS: Groups were well matched. After 4 weeks of treatment, the Arhus index had improved by about 20%, its pain component by about 30% and the Total Pain Index by about 35%. The number of pain-free patients (visual analogue scale score <2) was about 20 in each group. About 60% of the patients in each group responded well to the treatment (as judged by an improvement of >/=30% in the Total Pain Index relative to its baseline). The improvement was also reflected reasonably well in the physicians' and patients' judgements of the effectiveness of treatment, which were largely concordant. Few patients of either group resorted to the additional conventional treatment options. The incidence of adverse events was similar in the two groups. Treatment with rofecoxib was about 40% more expensive than that with Assalix. CONCLUSION: There was no significant difference in effectiveness between the two treatments at the doses chosen. Treatment with Assalix was less expensive.

Adolescent↗
PubMedDate not supplied

An analysis of differential epidural spinal anesthesia and pentothal pain study in the differential diagnosis of back pain. Aids in avoiding unnecessary back surgery.

The selection of the proper patient for back surgery is of prime importance and is the topic of this report. An analysis of patients evaluated with differential epidural spinal anesthesia and the Pentothal pain study show these tests to be helpful in separating those patients with primarily organic pain who could benefit from surgery from those patients with primarily functional pain who should not be operated upon. These tests will help one determine whether a disability is related to the severity of pain, to the patient's emotional response to pain, or to a somatic manifestation of a gross emotional breakdown.

Affective Symptoms↗
PubMed2006

Clinical course and impact of fear-avoidance beliefs in low back pain: prospective cohort study of acute and chronic low back pain: II.

STUDY DESIGN: Prospective inception cohort study. OBJECTIVES: To compare the clinical course of fear-avoidance beliefs in acute and chronic low back pain (LBP) and investigate the contribution of fear-avoidance beliefs to predict pain and disability after 1 year. SUMMARY OF BACKGROUND DATA: Fear-avoidance beliefs are involved in disability development. There is little knowledge on the development of fear-avoidance beliefs among different LBP subgroups. METHODS: Patients with acute (n = 123) and chronic (n = 50) LBP completed a comprehensive assessment, including the Fear-Avoidance Beliefs Questionnaire (FABQ), and were followed at 3, 6, 9, and 12 months. RESULTS: At baseline, patients with chronic LBP had significantly higher FABQ-scores for work (FABQ-Work) than patients with acute LBP (P < 0.001), and this difference remained unchanged over 1 year (P > 0.21). At baseline, there was no statistical significant difference in FABQ-scores for physical activity (FABQ-PA) between the two groups (P = 0.57). FABQ-PA scores decreased significantly over the first 4 weeks among patients with acute LBP during follow-up and remained unchanged thereafter, whereas in the chronic sample the FABQ-PA scores were unchanged throughout the first year (time effect, P < 0.001; and interaction effect, P < 0.001). In the acute sample, FABQ-Work predicted pain (P < 0.05) and disability at 12 months (P = 0.01). In the chronic sample, FABQ-PA predicted disability at 12 months (P = 0.03). The associations between the FABQ and pain/disability disappeared with distress included in the models. CONCLUSION: Patients with chronic LBP had more fear-avoidance beliefs for work than patients with acute LBP. There were small changes in fear-avoidance beliefs during the year of follow-up, except for a rapid decrease during the first month in the FABQ-PA in the acute sample. Fear-avoidance beliefs predicted pain and disability at 12 months after adjusting for socio-demographic and pain variables. Distress was a stronger predictor than fear-avoidance beliefs.

Acute Disease↗
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↗
PubMed2004

Psychosocial factors at work in relation to low back pain and consequences of low back pain; a systematic, critical review of prospective cohort studies.

Relevant studies of low back pain (LBP) published between 1990 and 2002 were systematically retrieved via electronic databases and checking of reference lists. Forty papers fulfilled the inclusion criteria; 10 were of high quality. A wide variety of instruments had been used for collection of data on work related psychosocial factors, many of which had not undergone any form of validation. Moderate evidence was found for no association between LBP and perception of work, organisational aspects of work, and social support at work. There was insufficient evidence for a positive association between stress at work and LBP. No conclusions could be drawn regarding perception of work and consequences of LBP. There was strong evidence for no association between organisational aspects of work and moderate evidence for no association between social support at work and stress at work and consequences of LBP.

Cohort Studies↗
PubMed2004

[Marked similarity between the Dutch Institute for Health Care Improvement guideline 'Aspecific low back pain complaints' and the Dutch College of General Practitioners guideline 'Low back pain'].

The Dutch Institute for Healthcare Improvement's (CBO) guideline on the diagnosis and treatment of aspecific, acute and chronic, low back complaints corresponds in general to the Dutch College of General Practitioners' guideline with regard to the following topics: time-contingent treatment, restricted use of X-ray examination, and the options for non-medical treatment. A noteworthy exception in the CBO-guideline is the suggestion of manipulation of the spine as a possible treatment although there is no mention of proof of effectiveness.

Acute Disease↗
PubMed1989

Chronic low back pain and the failed low back syndrome.

Disorders associated with back pain usually have two components. One pertains to the spinal disorder and the other to symptoms and signs that result from compromise of individual nerve roots, the cauda equina, or, in some cases, the conus medullaris. In this article, those spinal structures capable of giving rise to pain, its approximate distribution, the nature of the discomfort and disturbance of spinal and neural function consequent upon disease of the vertebral column, and the evaluation and management of the individual patient will be considered.

Back Pain↗
PubMed1985

A model for conservative care of low back pain: back school, epidural blocks, mobilization.

Conservative care for low back pain can be an enjoyable and successful experience for the physician. It requires a bit more organization and assistance than other routine forms of orthopaedic practice. It begins with a systematic collection of historical and physical information. The most appropriate conservative treatment is selected specifically for the patient's diagnosis. The patient's participation is required in the conservative treatment, and he must be willing to take responsibility for his condition. Education and training are the mainstay of conservative treatment with the addition of injections, braces, mobilization, medication, or rest as temporary adjuncts.

Anti-Inflammatory Agents↗
PubMed1988

Acute low back pain: diagnosis and management of mechanical back pain.

Low back pain is the most common musculoskeletal complaint seen in an ambulatory care setting and affects 80 per cent of all persons at some time in their lives. It is the number one cause of activity restriction in people under 45. With the exception of progressive neuromotor compromise, the initial treatment of nearly all causes of LBP is conservative: the use of analgesics and/or anti-inflammatory agents, bed rest, and patient education.

Acute Disease↗
PubMed1994

Patterns in low back pain hospitalizations: implications for the treatment of low back pain in an era of health care reform.

OBJECTIVE: To examine patterns in both surgical and nonsurgical low back pain (LBP) hospitalizations through time and among geographic regions and to explore the practical implications of these patterns for health care reform. SETTING: For time trends, the U.S. (1979-1987); for geographic variations, major regions of the U.S. (1987). DATE SOURCE: The National Hospital Discharge Survey. RESULTS: Rates of both surgical and nonsurgical LBP hospitalization varied twofold among regions of the U.S., and average lengths of stay for these types of hospitalization varied considerably as well. The U.S. rate of LBP surgery increased sharply during the period covered by the study. Over the same time, the U.S. rate of nonsurgical LBP hospitalization declined, as did average lengths of stay for both types of LBP hospitalization. CONCLUSION: Wide variations in LBP hospitalization practices raise the issue of which practices are most appropriate. Outcomes research addresses this issue, as does research on patient preferences for certain types of treatment. As indicated by the increasing rate of LBP surgery, more research also needs to be done on changing physician practice style. If such research were to result in a reduction in LBP hospitalization, savings in health care costs would be considerable.

Back Pain↗
PubMed2006

Dinuclear iridium(III) complexes consisting of back-to-back tpy-(ph)n-tpy bridging ligands (n = 0, 1, or 2) and terminal cyclometallating tridentate N-C-N ligands.

Three dinuclear iridium(III) complexes consisting of a conjugated bis-tpy type bridging ligand and cyclometallating capping tridentate ligands of the 1,3-di-2-pyridylbenzene family have been prepared (tpy, 2,2',6',2' '-terpyridine). The two tpy units of the bridge are connected via their back-positions (4') either directly or with a p-phenylene or p-biphenylene spacer. The synthesis relies on the reaction between the dinuclear [Ir(dpb)Cl2]2 complex (dpb-H =1,3-dipyridyl-4,6-dimethylbenzene) and the corresponding bis-tpy ligand. Electrochemical measurements afford metal-centered oxidation and ligand-centered reduction potentials; from the oxidation steps, no evidence is obtained for a strong coupling between the two iridium(III) subunits of the dinuclear species. For all complexes, ground-state absorption data in the 380 nm to visible region show a trend which is consistent with the presence of charge-transfer (CT) transitions involving different degrees of electronic delocalization at the bridging ligands. (dpb)Ir(tpy-tpy)Ir(dpb)4+ exhibits an appreciable luminescence at room temperature (phi = 3.0 x 10(-3); tau = 3.3 ns), whereas no emission from the other binuclear complexes is detected. All binuclear complexes luminesce at 77 K, and a metal-to-ligand CT nature for (dpb)Ir(tpy-tpy)Ir(dpb)4+ is suggested, whereas a ligand-centered (LC) emission is proposed for (dpb)Ir(tpy-(ph)2-tpy)Ir(dpb)4+ on the basis of the comparison with the phosphorescence properties of the free bridging ligand, tpy-(ph)2-tpy. Transient absorbance experiments at room temperature afford the absorption spectra and lifetimes of the non-emissive excited states. For (dpb)Ir(tpy-ph-tpy)Ir(dpb)4+ and (dpb)Ir(tpy-(ph)2-tpy)Ir(dpb)4+, the spectra exhibit a broad profile peaking around 780 nm, quite intense in the case of (dpb)Ir(tpy-(ph)2-tpy)Ir(dpb)4+, and lifetimes of 160 and 440 ps, respectively.

Journal Article↗
PubMed2003

Getting back in the race. Retired healthcare executives are being lured back into the office as organizations look for experienced leaders to take the reins.

All the young whippersnappers better look out--the veterans are coming back to show how it's done. More and more as of late, executives who chucked the 80-hour workweek grind are coming out of retirement to take the helm at beleaguered healthcare systems. MedCath Corp. board Chairman Steve Puckett, at left, says experience counts for a lot when handing over such responsibility.

Aged↗