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PubMed1999

Brucella spondylitis: an important treatable cause of low backache.

OBJECTIVES: This study was undertaken to see if brucella spondylitis existed as a cause of backache in Mumbai and to identify the clinical setting in patients of backache where brucella serology is indicated. METHODS: In 18 months (June 1996-Dec. 1997) we performed tube agglutination test (TAT) for Brucella melitensis and abortus on 72 patients of low backache from Orthopaedics Department of a teritary health centre. All 72 patients satisfied the inclusion and exclusion criteria designed to exclude radiologically detectable congenital or degenerative cause of backache. RESULTS: Six out of 72 patients were seropositive for brucellosis. All six patients had either history of animal contact or ingestion of raw milk or milk product (cheese or paneer). The lumbosacral backache was severe, radiating to the legs and straight leg raising test was significantly positive, they had marked tenderness on spinous process of lower lumbar vertebrae. Changes of brucella spondylitis were present on plain radiogram of lumbosacral spine in three patients. Four patients had abnormalities on bone scintigraphy. CONCLUSION: Low backache of brucella spondylitis closely simulates pain of prolapsed intervertebral disc. Serologic testing for brucellosis is an important step in management of such patients, especially when history of animal contact or raw milk or milk product ingestion is present, as the disease can be eminantly treated with antibiotics.

Adolescent↗

PubMed2002

Epidural analgesia and backache: a randomized controlled comparison with intramuscular meperidine for analgesia during labour.

BACKGROUND: Concern has been expressed that epidural analgesia for labour may be associated with a higher incidence of backache. METHODS: A prospective randomized trial investigating the effect of epidural analgesia on the outcome of labour in nulliparae, mothers were randomized to receive either epidural analgesia or meperidine. A questionnaire on postnatal symptoms was sent to them 6 months after delivery. RESULTS: In all, 611 mothers were studied; 310 were randomly allocated to receive i.m. meperidine up to 300 mg and 301 to receive epidural bupivacaine. The response rate to our questionnaire was 83%. Intention-to-treat analysis showed similar prevalence rates of postpartum backache in the epidural (48%) and meperidine groups (50%), with an observed difference (epidural-meperidine) of -2% (95% CI, -11 to +6%). After excluding mothers with backache before delivery, there were also similar incidence rates of postpartum backache in the epidural (29%) and meperidine groups (28%), observed difference 1% (95% CI, -8 to +10%). CONCLUSIONS: Epidural analgesia in labour was not associated with an increase in the prevalence or incidence of backache.

Analgesia, Epidural↗

PubMed1977

Backache in pregnancy.

Replies to a questionnaire showed that, amongst 180 women delivered in The London Hospital, 48% experienced backache during pregnancy; in one third of these it was severe. The prevalence of back pain increased with both increasing age and increasing parity, and it was difficult to separate the relative contributions of these two factors. No evidence was found of an association between backache during pregnancy and height, weight, 'obesity index', weight gain, or baby's weight. Analysis of aggravating and relieving factors indicates some differences between backache in the pregnant and 'mechanical' back pain in the non-pregnant. Slightly less backache was reported amongst patients attending antenatal physiotherapy classes but the figures do not provide clear evidence of any protective effect of this attendance.

Back Pain↗

PubMed1989

Night backache in pregnancy. Hypothetical pathophysiological mechanisms.

One hundred women responded to a questionnaire dealing with night backache during pregnancy. All the women were in the second half of their pregnancy. Sixty seven per cent of the women reported discomfort and/or backache during the night. We hypothesize that hypervolemia combined with obstruction of the inferior vena cava, caused by the enlarging uterus, is the underlying pathomechanism leading to night backache. Patients with inadequate venous collateral circulation may develop excessive pressure within the venous system, the vertebral bodies and overdistension of venous channels distal to the occluded zone. These changes may lead to hypoxemia, metabolic disturbances, irritation of unmyelinated nerves and result in night backache.

Back Pain↗

PubMed2004

Headache and backache after lumbar puncture in children and adolescents: a prospective study.

OBJECTIVE: After lumbar puncture, many adults develop headaches or backaches. Postpuncture complaints are believed to be rare in children and adolescents, but their exact incidence is unclear because there is a paucity of data derived from general pediatric patients. In a prospective study of general pediatric and neuropediatric patients, we investigated the frequency of postlumbar puncture headaches or backaches and factors that might influence their occurrence. METHODS: Conducted over 12 months, the prospective study included 112 patients aged 2 to 16 years. We evaluated them for factors that might influence the rate of postpuncture complaints: age, gender, use of local anesthesia, cannula gauge, bevel orientation, number of puncture attempts, volume of cerebrospinal fluid (CSF) aspirated, and cell count in CSF. RESULTS: Twenty-seven percent of the patients experienced headaches (positional headache in 9%), and 40% developed backache. Frequency of complaints increased in relation to patients' age. In older children, girls reported complaints more frequently than did boys. Patients with higher cell counts in CSF had more frequent headaches than did patients without pleocytosis. Cannula gauge or bevel orientation did not influence outcome. CONCLUSION: The frequency of positional and nonpositional headaches after lumbar puncture is lower in children than in adults. Backaches contribute significantly to postpuncture morbidity. With puberty, the incidences of postpuncture complaints increase, and girls start to become more prone to develop postpuncture headaches. Recommendations regarding cannula gauge or bevel orientation that derive from studies in adults are not confirmed for children.

Adolescent↗

PubMedDate not supplied

Comparison of Sprotte and Quincke needles with respect to post dural puncture headache and backache.

OBJECTIVE: The objective of this study was to compare 24-gauge Sprotte and 25-gauge Quincke needles with respect to post dural puncture headache and backache. METHODS: Three hundred ASA Physical Status I or II patients scheduled for minor orthopedic or urologic operations under spinal anesthesia were chosen for this randomized, prospective study at a university hospital and a city hospital. Anesthetic technique, intravenous fluids, and postoperative pain therapy were standardized. Patients were randomly divided into three equal groups. Spinal anesthesia was performed with either a 24-gauge Sprotte needle or a 25-gauge Quincke needle with the cutting bevel parallel or perpendicular to the dural fibers. RESULTS: Anesthesia could not be performed in three cases with the Sprotte needle and in one case with the Quincke needle. The most common complications were post dural puncture backache (18.0%), post dural puncture headache (8.2%), and non-postural headache (6.7%). No major complications occurred. The Quincke needle with bevel perpendicular to the dural fibers caused a 17.9% incidence of post dural puncture headache. The Quincke with bevel parallel to the dural fibers and the Sprotte needles caused similar post dural puncture headache rates (4.5% and 2.4%, respectively). Other factors associated with post dural puncture headache were young age, early ambulation, and sedation during spinal anesthesia. There were no significant differences between needles in the incidence of post dural puncture backache. CONCLUSION: Our data indicate that Quincke needles should not be used with the needle bevel inserted perpendicular to the dural fibers. The Sprotte needle does not solve the problem of post dural puncture headache and backache.

Adult↗

PubMedDate not supplied

Backache prevalence among groups with long and normal working day.

OBJECTIVES: to describe the prevalence of backache among groups with long and normal working day. DESIGN: A cross sectional study of prevalence of backache among groups with long and normal working day. MATERIAL AND METHOD: Among the 19 wards of Kirtipur municipality, ward no. 11 was selected as a random cluster. 64 households of different socioeconomic status were selected at random. Total of 64 individuals from these households were selected in the study. CONCLUSION: The backache was found to be 62.5% prevalent. 75.8% of individuals in long working day category were found to be suffering from backache whereas 48.4% in normal working day group were suffering from it.

Back Pain↗

PubMedDate not supplied

[Prevention and conservative treatment of backache related to intervertebral disc disease].

Despite epidemic character of backache in the developed countries, proper treatment is still facing a lot of difficulties and disbelief. Backache are considered incurable disease disabling normal life and work by both numerous patients and physicians. Proper information on causes and sequelae of backache, prophylaxis, ergonomics of work and ways of decreasing complaints should be valuable. Conservative treatment, based on the Backache Exercise School doctrine, is very effective, saving unnecessary suffering and tragedies, and saving costs of disability.

Adult↗

PubMed2004

Headache, stomachache, backache, and morning fatigue among adolescent girls in the United States: associations with behavioral, sociodemographic, and environmental factors.

BACKGROUND: Data on the prevalence and co-occurrence of multiple somatic symptoms among US adolescent females as they are influenced by sociodemographic, behavioral, and environmental factors is limited. OBJECTIVES: To describe the health status of adolescent US females measured by the prevalence, frequency, and co-occurrence of headache, stomachache, backache, and morning fatigue and to investigate associations between selected risk and protective factors. DESIGN, SETTING, AND PARTICIPANTS: School-based, cross-sectional, nationally representative survey of adolescents in the 6th through 10th grades in the US. Data collected between 1997 and 1998. MAIN OUTCOME MEASURES: Prevalence of headache, stomachache, backache, and morning fatigue. RESULTS: Among US adolescent girls, 29.1% experience headaches, 20.7% report stomachaches, 23.6% experience back pain, and 30.6% report morning fatigue at the rate of more than once a week. Co-occurrence of somatic complaints is common. Among girls who experienced headaches more than once a week, 3.2 million (53.3%) also reported stomach pain more than once a week and 4.1 million (74.3%) reported morning fatigue more than once a week. Heavy alcohol use, high caffeine intake, and smoking cigarettes every day were strongly associated with all symptoms, while parent and teacher support served as protective factors. CONCLUSIONS: Somatic complaints of headache, stomachache, backache, and morning fatigue are common among US adolescent girls and co-occur often. Effective clinical treatment of this population requires comprehensive assessment of all female adolescents presenting with seemingly isolated somatic complaints.

Abdominal Pain↗

PubMed1998

[Incidence and predisposing factors of persistent backache after lumbar catheter epidural anesthesia in a non-obstetrical settingø].

OBJECTIVE: To determine the incidence of long term backache after lumbar epidural anesthesia with catheter (EPA) in the non-obstetrical setting. DESIGN: Prospective 1-year follow-up study. PATIENTS: All patients scheduled for elective arthroscopical surgery of the knee performed under EPA (n = 195). INTERVENTIONS: A first questionnaire was sent to each patient three months after the operation. To chose patients reporting persistent backache after three months, a second questionnaire was sent one year after the operation. MEASUREMENTS: Back pain before, within 5 days and at the time of the inquiry, i.e., three months and one year after EPA as well as patient satisfaction with the regional anesthetic. Statistic: contingency tables with Fisher's exact test (for categorical variables) and an unpaired t-Test (for continuous variables), p < 0.01 after adjustment for multiple testing (Bonferroni's method). MAIN RESULTS: Response rate was 67%. Before EPA 23 patients (17.5%) complained of back pain. The short term incidence of back pain (i.e, within 5 days after EPA) was 24 out of 131 patients (18.3%) and not associated with pre-epidural back pain (p = 0.036, n.s.). 15 out of 131 patients (11.5%) reported persistent back pain after three months, 13 of them had complained of back pain before EPA (p < 0.0001). Thus, the incidence of new back pain 3 months after EPA was only 1.5%. 7 of the 15 patients returned the second questionnaire: 6 reported still persistent back pain, and all had complained of back pain before EPA. Age, height, weight, sex, duration of anesthesia and operation were not associated with long term back pain. Despite persistent back pain after three months 10 out of 15 patients would opt again for EPA. CONCLUSION: The incidence of long term backache after EPA in the non-obstetrical setting is 11.5% and almost exclusively associated with pre-existing back pain. Biometrical factors seem to play no role. In patients with pre-existing back pain satisfaction with the anesthetic procedure might be improved by improving informed consent.

Anesthesia, Epidural↗

PubMed2001

Backache in gynaecologists.

The objectives of the study were to assess the overall prevalence of backache in gynaecologists and determine its impact on work, and to identify possible occupational risk factors. The sample comprised gynaecologists, both active and retired, listed as members of the Ulster Obstetrical and Gynaecological Society, who were asked to complete and return a postal questionnaire. The response rate was 94% (107/114). The prevalence of backache, which included pain arising in the thoracic and lumbosacral regions, was 72%. Fifty-three per cent of those with back pain blamed it on working in obstetrics and gynaecology. Overall, 32% of gynaecologists required a change of their work practice, 20% had taken time off work and 8% had required surgery. We conclude that significant morbidity results from backache in gynaecologists. This has economic implications and requires further assessment to improve prevention, with emphasis on individual training and ergonomic evaluation of work-related postures.

Adult↗

PubMed1994

Backache and work incapacity in Japan.

No one is spared a regional backache. Some episodes will compromise function to the extent of work incapacity. Throughout the industrialized world, workers' compensation insurance programs provide recourse for the segment of people whose incapacitating backache is held to have arisen out of and in the course of employment. Most programs have evolved from the Prussian paradigm introduced a century ago. That evolution represents country specific, de facto experiments in health policy. In the case of Japan, the Prussian paradigm was imposed on a very distinctive tradition at the end of World War II. Therein lies one of the more dramatic experiments of health policy. This essay attempts to document the process that resulted. To gain such insight, relevant physicians and bureaucrats in Japan were interviewed and government documents reviewed. This information was supplemented by nonsystematic culling of relevant reflections of scholars also pursuing the heuristic method but with different, usually nonclinical, tempering. It is clear that Japan has evolved an approach to the worker with an incapacitating backache that favors options other than recourse in workers' compensation for redress.

Back Pain↗

PubMed1985

Vertebral and paravertebral sepsis in diabetes: an easily missed cause of backache.

Vertebral osteomyelitis and epidural abscess are uncommon causes of backache but may have a prediliction for patients with diabetes. We report four cases seen in a diabetic unit over 2 years to emphasize the importance of making a diagnosis as early as possible. We suggest that when a diabetic patient complains of backache the erythrocyte sedimentation rate should be measured since this is the best clue that backache is due to something other than a mechanical derangement.

Abscess↗

PubMedDate not supplied

[Backache in adept teen-agers in occupations producing spinal strain--morbidity, predisposition].

In total 1,149 pupils of the III class of the mechanical, metallurgical, building, power engineering and chemical vocational schools were examined. Backache was diagnosed in 50 cases while the same ailment in parents or siblings were diagnosed in 148 cases, i.e. 17.2%. Percentage of persons with congenital spine disorders (low intervertebral disc, narrow spinal channel, segmentation disorders spondylolysis, and asymmetry of intervertebral joints) was estimated as 30%. Such disorders predispose to backache. A risk of backache in the group under study was estimated however as 50% of pupils preparing for professions producing significant overload to the spine. Possibilities and difficulties of the proper classifications of candidates to such vocations are discussed.

Adolescent↗

PubMed1991

Medical assessment after injury--problems encountered: IV. Backache.

Most of us have had backache at some time in our lives and it may be very difficult to sort out the complaint of backache after an injury. However a systematic approach together with an assessment of the injured person's reaction to his injuries will generally help. A working structured approach is given together with special tests where exaggeration is suspected. Reference is made to the percentage assessment of backache following injury. Finally it is stressed that "Prophylaxis is the best treatment" especially in an industrial setting.

Back Pain↗

PubMed1999

Backache: a rare diagnosis and unusual complication.

We report an adolescent girl who presented with an acute exacerbation of a chronic backache of 6 months duration. She complained of dribbling micturition, constipation, and an irresistible urge to strain for 72 h. In the waiting area of the local hospital she developed sudden, severe chest pain with progressive swelling of the upper torso. This proved to be the mode of presentation of a haematocolpos due to an imperforate hymen with the unusual complication of mediastinal emphysema. Imperforate hymen is a rare diagnosis, but should be considered when dealing with an adolescent girl with lower abdominal symptoms or backache.

Adolescent↗

PubMed1993

Factors influencing backache following epidural analgesia in labour.

262 obstetric patients received epidural analgesia during labour or for delivery. 6-8 weeks post partum they received a postal questionnaire. No association was found between backache and maternal age, height, weight, parity or mode of delivery, operator or difficulty with epidural insertion. However, in women who had had epidural analgesia, post-partum backache was associated with shorter labours. Difficult epidural insertions were more common in short women.

Journal Article↗

PubMedDate not supplied

Validity of the new Backache Index (BAI) in patients with low back pain.

BACKGROUND CONTEXT: The Backache Index (BAI) is applied to patients with low back pain (LBP) in order to help therapists, doctors, and surgeons perform physical examinations easily. It is carried out within a short space of time (<2 min) without using inclinometric instruments. PURPOSE: To explore the reliability, validity, and responsiveness of this new Backache Index in patients with LBP, which can fulfil the existing need for a reliable routine examination in the clinical environment. STUDY DESIGN/SETTING: Patients with LBP filled in disability questionnaires; pain rating scales and physical impairment tests were completed in function of construct validity and correlation studies. A subgroup was evaluated for interobserver and test-retest reliability, and a second group was reassessed after two active treatment sessions to verify the responsiveness compared with other examined variables. PATIENT SAMPLE: In total, 75 patients with subacute LBP (3-12 weeks) participated in a randomized controlled study. OUTCOME MEASURES: The validity of the BAI was explored through a correlation with the standard Oswestry LBP Disability Index (ODI), the McGill LBP Questionnaire Index (MPQ), and the Visual Analogue Scale (VAS). METHODS: The BAI consisted of a scoring system that includes pain factors and stiffness estimation at the end of a series of five different lumbar movements of a patient standing in an erect position. RESULTS: The correlations between the separate outcomes and the BAI ranged from 0.61 to 0.76 (p<.001). The interobserver reliability between two experienced observers for the five outcome scores was good (intraclass correlation coefficient [ICC]>0.86) and even perfect for the BAI (ICC=0.96). A BAI change of one unit is able to exclude a measurement error. A significantly good correlation (p<.001) was found between the BAI at baseline, the ODI (R=0.62), and the total degree of pain rating index (MPQ-PRI-T) (R=0.57), a moderate correlation with the total number of chosen adjectives from the whole list of adjectives (MPQ-NWC-T) (R=0.48), and the VAS (R=0.47), but a lower correlation was found with the MPQ-Quality of life index (R=0.43). The effect size and discriminative ability of the measures were explored after two treatment sessions of deep transverse friction myotherapy by means of study of the receiver operating characteristics curve (ROC) and the greatest area under the curve (AUC). The greatest level of distinction was found for the MPQ-PRI-T and the BAI (AUC>0.93), followed by the ODI (AUC=0.92). A lower level of distinction was found for the MPQ-NWC-T and the VAS (AUC>0.82). CONCLUSIONS: The BAI appears to be a reliable and valid assessment of overall restricted spinal movements in case of LBP and discriminates between successful and unsuccessful treatment outcome.

Adult↗