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At least 433 records · Page 24Linked to original sources
PubMed1999

Determinants of WOMAC function, pain and stiffness scores: evidence for the role of low back pain, symptom counts, fatigue and depression in osteoarthritis, rheumatoid arthritis and fibromyalgia.

OBJECTIVES: The Western Ontario MacMaster (WOMAC) is a validated instrument designed specifically for the assessment of lower extremity pain and function in osteoarthritis (OA) of the knee or hip. In the clinic, however, we have noted that OA patients frequently have other musculoskeletal and non-musculoskeletal problems that might contribute to the total level of pain and functional abnormality that is measured by the WOMAC. In this report, we investigated back pain and non-articular factors that might explain WOMAC scores in patients with OA, rheumatoid arthritis (RA) and fibromyalgia (FM) in order to understand the specificity of this instrument. METHODS: RA, OA and FM patients participating in long-term outcomes studies completed the WOMAC and were assessed for low back pain, fatigue, depression and rheumatic disease symptoms by mailed questionnaires. RESULTS: Regardless of diagnosis, WOMAC functional and pain scores were very much higher (abnormal) among those complaining of back pain. On average, WOMAC scores for back pain (+) patients exceeded those of back pain (-) patients by approximately 65%,, and 52% of OA patients reported back pain. In regression analyses, study symptom variables explained 42, 44 and 38% of the variance in WOMAC function, pain and stiffness scores, respectively. In the subset of OA patients, radiographic scores added little to the explained variance. The strongest predictor of WOMAC abnormality in bivariate and multivariate analyses was the fatigue score, with correlations of 0.58, 0.60 and 0.53 with WOMAC function, pain and stiffness, respectively. The WOMAC performed well in RA and FM, and correlated strongly with the Health Assessment Questionnaire (HAQ) disability scale and a visual analogue scale (VAS) pain scale. CONCLUSION: The WOMAC captures more than just knee or hip pain and dysfunction, and is clearly influenced by the presence of fatigue, symptom counts, depression and low back pain. WOMAC scores also appear to reflect psychological and constitutional status. These observations suggest the need for care in interpreting WOMAC scores as just a measure of function, pain or stiffness, and indicate the considerable importance of psychological factors in rheumatic disease and rheumatic disease assessments.

Adult↗
PubMed1997

Linking symptom-specific physiological reactivity to pain severity in chronic low back pain patients: a test of mediation and moderation models.

Symptom-specific reactivity to stress (lower paraspinal muscle reactivity) among chronic low back pain (CLBP) patients may exacerbate chronic pain. It was hypothesized that among CLBP patients (N = 107) only stress-induced lower paraspinal reactivity, and not reactivity in other indexes, would predict pain severity (PS), and that lower paraspinal reactivity would mediate or moderate links between depression and PS. Electromyogram readings from lower paraspinal and trapezius muscles, systolic and diastolic blood pressures, and heart rate were collected during mental arithmetic (MA) and an anger recall interview. The moderator hypothesis was supported: Only lower paraspinal reactivity during MA was related significantly to PS, but only among patients with high levels of depression. Thus, a profile of lower paraspinal hyperreactivity plus depressed affect may aggravate CLBP.

Adult↗
PubMed1991

Labor pain: effect of maternal position on front and back pain.

The purpose of this study was to determine whether women in labor report less pain when they are in a vertical (sitting or standing) position than in a horizontal (side-lying or supine) position. Pain scores were obtained from 60 women in early labor (dilation 2-5 cm) who alternated between the two positions. The results show that about 35% of women feel less front pain and 50% feel less back pain when they are in a vertical position than in a horizontal position. The decrease in continuous back pain (83%) was particularly impressive, but the front and back pains associated with contractions were significantly diminished as well. These results, taken together with those of earlier studies, indicate that many women in early labor have less pain and are generally more comfortable in a vertical than in a horizontal position. Since early labor comprises a substantial proportion of the entire process of labor and delivery, any simple procedure which alleviates pain without danger to mother or child, such as shifting from a horizontal to a vertical position, should be promoted and employed.

Adolescent↗
PubMed2005

Predictive validity of the Chronic Pain Coping Inventory in subacute low back pain.

The Chronic Pain Coping Inventory (CPCI) was developed to assess eight behavioral coping strategies hypothesized to be important for pain adaptation. But the predictive validity of the CPCI has yet to be tested in a longitudinal study. Here, 321 workers on sick leave after a work accident affecting the low back pain (LBP) region completed the CPCI during the subacute stage (T1) of LBP as well as the Catastrophizing scale of the Coping Strategies Questionnaire (CSQ). Disability, pain intensity and depressive mood were assessed simultaneously as well as 6 months later (T2). Work status was also determined at follow-up. Hierarchical regression analyses revealed that the CPCI (Guarding scale) predicted T1 disability and T2 disability (Relaxation scale), but T1 disability was the best predictor of T2 disability. For T1 pain intensity, the CSQ's Catastrophizing dimension was the best predictor and the CPCI Guarding scale added a small contribution. T1 pain intensity was the best predictor of T2 pain intensity. Catastrophizing and Guarding were the most strongly associated with depressive mood at T1 but at T2, only depressive mood at T1 predicted this same variable. Results indicated also that the Guarding and Catastrophizing scales were able to predict future work status. The present study clearly reveals the usefulness of Guarding from the CPCI and Catastrophizing from the CSQ, when predicting different outcomes of adjustment to low back pain.

Activities of Daily Living↗
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↗
PubMed1991

A comparison of two-point discrimination threshold of tactual, non-painful stimuli between chronic low back pain patients and controls.

Differences in pain sensitivity between chronic pain patients and healthy controls have been reported. Seltzer and Seltzer extended this line of research in studying the sensitivity to non-painful stimuli. They reported that the 2-point discrimination threshold of chronic pain patients was higher than that of control subjects. However, the study of Seltzer and Seltzer suffered from several methodological shortcomings. Therefore, in the present study we tried to replicate the findings in a group of chronic low back pain patients using a design that was believed to be methodologically stronger. Replication failed: no evidence was found for the hypothesis that chronic pain patients are less sensitive to non-painful stimuli. Further studies on various defined types of acute and chronic pain patients are required.

Adult↗
PubMed1982

Comparison of three measures for detecting psychological disturbance in patients with low back pain.

The MMPI Low Back Scale, the 'Conversion V' MMPI profile and the Back Pain Classification Scale were compared for accuracy in detecting psychological disturbance in a sample of 91 patients with low back pain. These patients were classified as to the presence or absence of organic findings and psychological disturbance on the basis of objective and independent evaluations. Hit rates or 37.4%, 64.5% and 78.0% were produced by the 3 measures, respectively. The Back Pain Classification Scale was the most accurate measure, and the only scale to exceed base rate. The implications of these findings for clinical practice are discussed.

Adolescent↗
PubMed1986

Evaluation and management of the patient with acute back pain.

Patients with low back pain are among the largest group of health care consumers today. During an episode of acute back pain the patient may be hospitalized for diagnostic workup and medical management, processes to which occupational therapists can contribute. The occupational therapist's evaluation includes assessment of the patient's activities of daily living and understanding of back protection and pain behaviors. The therapist involves the patient in managing his or her back problem by teaching problem-solving skills and identifying appropriate life-style changes. Instruction is provided in proper body mechanics, anatomy of the spine, work simplification, relaxation, and adaptive methods of performing daily activities. Given the short hospitalization period, outpatient follow-up may be provided to facilitate the application of information learned in the hospital to home and work settings. The goal of occupational therapy is to help the patient with low back pain return to a productive life-style.

Activities of Daily Living↗
PubMed2002

Epidemiology of back pain in the athlete.

Back pain and injuries are common complaints of athletes. The nature of the sport involved with the specific stresses that it places on the athlete's spine may play a role in the injuries incurred. These injuries may limit an athlete's function and hinder performance; however, the majority of these insults are self-limiting and respond well to conservative measures. Based on the epidemiologic data, it appears that possibly the single most important step in reducing the back pain experienced by athletes would involve the performance of a structured back-strengthening program. Such a plan might reduce the most common diagnostic entities encountered by the athlete with back pain.

Adolescent↗
PubMed1990

Mechanically induced pelvic pain and organic dysfunction in a patient without low back pain.

Previous reports have identified mechanical disorders of the lumbar spine as a cause of pelvic pain and organic dysfunction (PPOD) in patients with low back pain. Less common however, are reports of mechanically induced pelvic pain and organic dysfunction in patients without accompanying low back pain. This report details the examination findings and treatment response of a patient with pelvic pain, organic dysfunction and clinical evidence of lower sacral nerve root compression (LSNRC) in whom low back pain was not an accompanying finding. Despite the absence of low back pain however, clinical evaluation revealed the characteristic findings of mechanically induced pelvic pain and organic dysfunction secondary to lower sacral nerve root irritation or compression as a result of a mechanical disorder of the low back. As in long standing cases of mechanically induced pelvic pain and organic dysfunction in which low back pain is present, this case also exhibited severe and widespread involvement of the pelvic organs. In spite of numerous failed attempts at treatment directed at the symptomatic component of the patients disorder, complete resolution of symptoms was achieved by manipulative treatment directed at the mechanical disorder of the lumbar spine.

Adult↗
PubMed2002

[Mechanism of intractable low back pain and neural blockade].

Low back pain is one of the most prevalent complaints in clinical medicine. Sensations from the axial skeleton and the surrounding tissues are only vaguely somatotopic and are non-specific in quality. The diagnosis of the mechanism or source of low back pain is therefore very challenging. The treatment of low back pain that recurs, persists or intensifies is also formidable, because there has been no evidence of various therapies for chronic back pain. From the prophylactic viewpoint of chronic pain, the most considerable matter is early elimination of severe pain under certain diagnosis. In this article, the mechanisms of passing into the chronic state, especially the development of neuropathic pain, and the utilities of diagnostic and therapeutic neural blockade for low back pain are discussed.

Humans↗
PubMed2004

Etiology of low back pain in athletes.

Low back pain and injury is a common affliction for patients involved in athletic endeavors. For this reason, the health care professional should be cognizant of age-related and sports-specific considerations when evaluating athletes with low back complaints. An elevated index of suspicion with regard to specific etiologies of back pain proves invaluable in order to avoid the misdiagnosis of a more serious problem. Although a number of conditions exist that require more aggressive evaluation and treatment, the majority of low back pain in athletes is self-limiting. In this context, a treatment plan designed to increase low back and abdominal muscle strength, flexibility, and range of motion often proves beneficial not only in returning the athlete to competition, but also in preventing injury recurrence.

Athletic Injuries↗
PubMed2004

Interventions in chronic low back pain.

BACKGROUND: Chronic low back pain presents a major challenge for general practitioners and is a significant drain on community resources. Patients often feel frustrated by modern medicine's apparent failure to validate their symptoms with a specific diagnosis and management plan. OBJECTIVE: This article presents an evidence based guide to current interventions, including an algorithm for the interventional diagnostic workup of low back pain that has persisted beyond 3 months. DISCUSSION: Modern imaging techniques rarely determine the cause of pain. The GP must look for 'red flag' clues in the history. Management of low back pain includes NSAIDs, simple injections of plain local anaesthetic without adrenalin or cortisone, referral to a masseuse, cortisone, physiotherapist and/or a musculoskeletal pain physician. Specific management includes medial branch and sacroiliac joint blocks, and radiofrequency neurotomy. Patients with long term pain may be referred to a psychologist for cognitive behavioural therapy.

Algorithms↗
PubMed1996

Effects of working postures on low back pain.

The prevalence of back pain in a sample of 100 employees in a clothes factory was studied and predisposing factors especially working postures were analyzed. The employee's ages were 17-40 years (mean 28 years). Durations of employment were between 1 month to 21 years (mean 9.4 years). Working time per day was 8 h. The subjects included 18 males and 82 females. The prevalence of back pain was 38%. Working activities like lifting, pulling and pushing, bending and sitting were highly associated with low back pain. Standing and walking were also associated but with a lower prevalence.

Adolescent↗
PubMed2000

The relation between pain intensity, disability, and the episodic nature of chronic and recurrent low back pain.

STUDY DESIGN: An observational study on the course of chronic and recurrent low back pain and its relation to disability and medication use performed on the basis of daily diary recording. OBJECTIVES: To provide a description of daily pain reporting by individuals with self-reported chronic and recurrent low back pain, to study how the intensity and episodic nature of low back pain is related to disability and medication use, and to classify subjects according to Von Korff's categories of chronic low back pain. SUMMARY OF BACKGROUND DATA: The natural history of low back pain has been described, and some classification schemes have been proposed, but little has been reported on pain characteristics and their relation to self-report of disability. METHODS: Daily self-reports of pain intensity, social and work disability, and medication use were collected from 94 participants with self-reported chronic or recurrent low back pain over a 6-month period. A metric for describing the episodic nature of chronic low back pain was developed. RESULTS: A significant effect of pain intensity on disability was found. During an episode, participants had significantly greater disability and medication use. Work-related disability and medication use was significantly greater in the latter half of an episode. CONCLUSIONS: Pain intensity can affect disability, but the episodic nature of low back pain also affects the ability to function in both work and personal life. Intermittent increases in pain can markedly alter disability. Chronic low back pain should not be treated as a static phenomenon.

Activities of Daily Living↗
PubMed1992

Postpartum low-back pain.

To determine the prevalence of back pain and its development over the first postpartum period, 817 women who had been followed through pregnancy were studied a minimum of 12 months after delivery. More than 67% of the women experienced back pain directly after delivery, whereas 37% said they had back pain at the follow-up examination. Most of the women who had recovered became pain-free within 6 months. Factors that correlated to persistent postpartum back pain were the presence of back pain before pregnancy, the presence of back pain during pregnancy, physically heavy work, and multipregnancy. Of these four factors, physically heavy work was found to have the strongest association with persistent back pain at 12 months.

Absenteeism↗
PubMed1980

Emotional disturbance and chronic low back pain.

Treated chronic low back pain patients (N = 102) in a university hospital clinic. Ss were given the EPI, the Recent LIfe Changes Questionnaire, and the Locus of Control Scale in order to isolate the principal dimensions of emotional disturbance in such patients and to see whether derived dimensions were related to response to conservative treatment for back pain. Self-report ratings of current pain intensity were obtained approximately 1 year after the start of treatment. Factor analysis revealed five factors: Distrust and alienation, somatic concern, vulnerability, extraversion, and social desirability; these accounted for 71% of the total variance among patients. Patients with above-average pretreatment distrust and alienation scores more frequently failed to return the follow-up form than patients with below-average scores. Low scores on somatic concern were related to good outcome. Results suggest that patients in alienation and distrust may be prone to be poor compliers. Because only the somatic concern dimension predicted outcome, a single scale that measures this characteristic may be sufficient for effective identification of the potential good vs. poor responders to conservative treatment of low back pain.

Adult↗
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↗