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PubMedDate not supplied

Somatization symptoms in chronic low back pain patients.

Chronic low back pain (CLBP) patients often are described as "somatizers", who report multiple somatic complaints beyond back pain itself, but the nature and clinical significance of this observation is poorly understood. To clarify the characteristics, correlates and severity of somatization in CLBP, we rigorously assessed somatization symptoms in a sample of patients not selected for psychiatric or pain clinic referral. Male CLBP patients (N = 97), attending a primary care orthopaedic clinic, and matched healthy controls (N = 49), were assessed using the Diagnostic Interview Schedule III-A (DIS), Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HRSD), McGill Pain Questionnaire (MPQ), Sickness Impact Profile (SIP), and the Pain and Impairment Relationship Scale (PAIRS). Although none of the subjects met strict DSM-III criteria for a lifetime diagnosis of Somatization Disorder, 25.8% of CLBP patients reported a lifetime history of 12 or more somatic symptoms, as compared to only 4.1% of controls. In the less symptomatic ranges, patients still generally reported more symptoms than controls, with 51.5% of patients vs. 8.2% of controls reporting 7-11 symptoms, and 22.7% vs. 87.8% of controls reporting 0-6 symptoms (p < .001). Major depression and alcohol dependence were significantly associated with increased severity of somatization (p < .05). Lower mood and increased impairment, but not pain intensity, were related to greater number of somatic complaints. Symptoms of somatization are prevalent, but not universal, in CLBP and the pattern of these symptoms is reminiscent of the "spectrum of severity" reported in other medical populations. Recognizing this spectrum of somatization may lead to better patient-treatment matching and improved clinical outcomes.

Adaptation, Psychological↗
PubMed2000

A randomized trial of a cognitive-behavioral program for enhancing back pain self care in a primary care setting.

Back pain is a significant health care problem that has been managed unsatisfactorily in primary care settings. Providers typically address medical issues but do not adequately address patient concerns or functional limitations related to back pain. We evaluated a brief intervention for primary care back pain patients designed to provide accurate information about back pain, instill attitudes favorable towards self care, reduce fears and worries, assist patients in developing personalized action plans to manage their back pain, and improve functional outcomes. Patients enrolled in a large health maintenance organization were invited to participate in an educational program to improve back pain self care skills 6-8 weeks after a primary care back pain visit. Patients (n=226) were randomly assigned to a Self Care intervention or to Usual Care, and were assessed at baseline, 3-, 6-, and 12-months. The intervention involved a two-session Self Care group and an individual meeting and telephone conversation with the group leader, a psychologist experienced in chronic pain management. The intervention was supplemented by educational materials (book and videos) supporting active management of back pain. The control group received usual care supplemented by a book on back pain care. Participants assigned to the Self Care intervention showed significantly greater reductions in back-related worry and fear-avoidance beliefs than the control group. Modest, but statistically significant, effects on pain ratings and interference with activities were also observed.

Adult↗
PubMed1995

Pain drawing in the evaluation of low back pain.

Pain drawings were obtained from three groups of patients: 51 with lumbar disc herniation; 55 with lumbar stenosis, and 42 with benign low back pain. On grid assessment, patients with disc herniation and stenosis who complained of radiating pain or intermittent claudication had a significantly larger number of grids for the extremities than those with benign low back pain. In studies of the relation between the characteristics of the pain drawing and the outcome of treatment, most patients with 19 grids or less, or a score of 3 points or less, had a satisfactory outcome. Those with more grids or a higher score tended to be unsatisfactory. Pain drawing permits differentiation of the three patterns of pain and is useful for predicting the outcome of treatment.

Activities of Daily Living↗
PubMedDate not supplied

Psychological correlates of pain behavior in patients with chronic low back pain.

Pain behaviors that are excessive for the degree of known physical disease are common in patients with chronic low back pain and are frequently assumed to arise from a comorbid depressive illness. Although some studies have confirmed an association between depression and excessive pain behavior, methodologic problems (such as the use of depression ratings that also recorded symptoms attributable to physical disease) make interpretation of this finding difficult. We recruited 54 consecutive patients with chronic (>6 months) low back pain from a hospital clinic. Subjects completed self-rated assessments of anxiety and depression (Hospital Anxiety and Depression Scale) designed to be minimally affected by physical symptoms, along with assessments of disability (ODQ), pain (visual analogue scale), pain behavior (Waddell checklist), and physical impairment. Seventeen subjects (31%) exhibited excessive pain behavior. Overall, they were no more depressed or anxious than the remainder, although men with excessive pain behavior showed a trend toward being more depressed. Patients with excessive pain behavior were more disabled (self-rated and observer-rated), reported greater pain, and were more likely to be female and to have pain of shorter duration. Pain behavior did not correlate with anxiety or depression, but correlated with measures of disability and pain intensity. Factor analysis revealed that physical disability, pain intensity, and pain behavior loaded heavily on the first factor. Anxiety and depression loaded together on a separate factor. We conclude that pain behaviors were not related to anxiety or depression in our group, although gender differences between groups could have contributed to our negative findings. Pain behaviors may influence other physical measures. Further studies are required to investigate the relation between depression and pain behavior while controlling for gender differences.

Adult↗
PubMed1987

Description of pain and the relationship with psychological factors in patients with low back pain.

Description of pain and the relationship with psychological factors was studied in 82 patients with low back pain. Both description of pain and psychological factors were found to have high loadings on one dimension, without being identical variables. A relationship was found between psychological factors and the duration of back pain but not to a degree to which the back pain is found to be explained somatically. The description of pain bore no relationship to the duration of back pain nor to the degree to which back pain can be somatically explained.

Adult↗
PubMed2005

[Low back pain disability assessment tools].

OBJECTIVES: To identify and compare low back pain functional assessment tools and to determine their characteristics and the selection criteria for their use. MATERIALS AND METHOD: We systematically searched Medline with the key words: low back pain, scale validity, questionnaire, assessment, outcome, and functional evaluation and with some data from the "Guide des Outils de Mesure et d'Evaluation en Médecine Physique et de Réadaptation", which allowed us to complete the search on specific tools including the Roland Disability Questionnaire, Dallas Pain Questionnaire, Quebec Back Pain Questionnaire, and Oswestry Back Pain Questionnaire. We restricted our analysis to studies about the psychometric properties of functional tools. RESULTS: We identified 19 scales or questionnaires, 9 specifically for low back pain and with a concept of functional incapacity. Four tools are recognised as having good psychometric properties and are widely used with linguistic adaptations in different countries. We also identified 10 generic tools proposed to assess outcome in low back pain, which are more conceptually linked to perceived health status, quality of life, and pain assessment. CONCLUSION: A "gold standard" to evaluate disability in low back pain does not exist, but only 4 tools (the Dallas Pain Questionnaire, Roland Disability Questionnaire, Quebec Back Pain Disability Scale and Oswestry Low Back Pain Disability Questionnaire) demonstrated strong qualities (content and construct validity, feasibility, linguistic adaptation and international use).

Disability Evaluation↗
PubMed2006

Parenteral corticosteroids for Emergency Department patients with non-radicular low back pain.

Although not recommended for low back pain, the efficacy of systemic corticosteroids has never been evaluated in a general low back pain population. To test the efficacy of systemic corticosteroids for Emergency Department (ED) patients with low back pain, a randomized, double-blind, placebo-controlled trial of long-acting methylprednisolone was conducted with follow-up assessment 1 month after ED discharge. Patients with non-traumatic low back pain were included if their straight leg raise test was negative. The primary outcome was a comparison of the change in a numerical rating scale (NRS) 1 month after discharge. Of 87 subjects randomized, 86 were successfully followed to the 1-month endpoint. The change in NRS between discharge and 1 month differed between the two groups by 0.6 (95% confidence interval -1.0 to 2.2), a clinically and statistically insignificant difference. Disability, medication use, and healthcare resources utilized were comparable in both groups. Corticosteroids do not seem to benefit patients with acute non-radicular low back pain.

Adult↗
PubMed2001

Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group.

STUDY DESIGN: A systematic review of randomized controlled trials. SUMMARY OF BACKGROUND DATA: The treatment of chronic low back pain is not primarily focused on removing an underlying organic disease but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioral interventions are commonly used in the treatment of chronic (disabling) low back pain. OBJECTIVES: To determine whether behavioral therapy is more effective than reference treatments for chronic nonspecific low back pain and which type of behavioral treatment is most effective. METHODS: The authors searched the Medline and PsychLit databases and the Cochrane Controlled Trials Register up to April 1999, and Embase up to September 1999. Also screened were references of identified randomized trials and relevant systematic reviews. Methodologic quality assessment and data extraction were performed independently by two reviewers. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioral outcomes, overall improvement, back pain-specific and generic functional status, return to work, and pain intensity) using the random effects model. RESULTS: Only six (25%) studies were high quality. There is strong evidence (level 1) that behavioral treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% confidence interval [CI] 0.25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI: -0.04, 0.74) and behavioral outcomes (pooled effect size 0.40; 95% CI: 0.10, 0.70) of patients with chronic low back pain when compared with waiting-list controls or no treatment. There is moderate evidence (level 2) that a addition of behavioral component to a usual treatment program for chronic low backpain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% CI: -0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI:-0.30, 0.36), and behavioral outcomes (pooled effect size 0.19; 95% CI: -0.08, 0.45). CONCLUSIONS: Behavioral treatment seems to be an effective treatment for patients with chronic low back pain,but it is still unknown what type of patients benefit most from what type of behavioral treatment.

Chronic Disease↗
PubMed2000

Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group.

STUDY DESIGN: A systematic review of randomized controlled trials. SUMMARY OF BACKGROUND DATA: The treatment of chronic low back pain is not primarily focused on removing an underlying organic disease but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioral interventions are commonly used in the treatment of chronic (disabling) low back pain. OBJECTIVES: To determine whether behavioral therapy is more effective than reference treatments for chronic nonspecific low back pain and which type of behavioral treatment is most effective. METHODS: The authors searched the Medline and PsychLit databases and the Cochrane Controlled Trials Register up to April 1999, and Embase up to September 1999. Also screened were references of identified randomized trials and relevant systematic reviews. Methodologic quality assessment and data extraction were performed independently by two reviewers. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioral outcomes, overall improvement, back pain-specific and generic functional status, return to work, and pain intensity) using the random effects model. RESULTS: Only six (25%) studies were high quality. There is strong evidence (level 1) that behavioral treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% confidence interval [CI] 0. 25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI: 0.04, 0.74) and behavioral outcomes (pooled effect size 0.40; 95% CI: 0.10, 0.70) of patients with chronic low back pain when compared with waiting-list controls or no treatment. There is moderate evidence (level 2) that a addition of behavioral component to a usual treatment program for chronic low backpain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% CI: 0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI: 0.30,0.36), and behavioral outcomes (pooled effect size 0.19; 95% CI: 0.08, 0.45). CONCLUSIONS: Behavioral treatment seems to be an effective treatment for patients with chronic low back pain,but it is still unknown what type of patients benefit most from what type of behavioral treatment.

Analgesics↗
PubMed2003

Stressful psychosocial work environment increases risk for back pain among retail material handlers.

BACKGROUND: Back pain is a major source of lost work time. Occupational physical activity only accounts for a fraction of low back pain; therefore, there is growing interest in investigating other possible causes of back pain including the psychosocial work environment. METHODS: Material handlers (N = 6,311) in 160 newly opened stores were interviewed at study entry and approximately 6 months later. Factor analysis was used to reduce the 37 psychosocial questionnaire items to seven distinct factors. RESULTS: After adjusting for history of back problems and work-related lifting, risk of back pain was moderately increased among employees who reported high job intensity demands (odds ratio (OR) = 1.8), job dissatisfaction (OR = 1.7), and high job scheduling demands (OR = 1.6). CONCLUSIONS: Modification of the psychosocial work environment for material handlers in large retail stores may help reduce back pain among employees.

Adult↗
PubMed2004

Onset of pain relief with rofecoxib in chronic low back pain: results of two four-week, randomized, placebo-controlled trials.

OBJECTIVE: We recently reported the efficacy of rofecoxib in two randomized controlled trials in chronic low back pain (CLBP). The objectives of this report are to present data regarding the onset of efficacy of rofecoxib from these trials and propose methods for reporting onset. RESEARCH DESIGN AND METHODS: Patients were aged 18-75, with non-radicular CLBP for >or= 3 months. Patients were randomized to rofecoxib 25mg, 50 mg, or placebo once daily for 4 weeks. Assessments included Low Back Pain and Bothersomeness scales every morning and Relief from Starting Pain after the first dose at 0.5, 1, 2, 3, 4 h, bedtime, and next morning. Onset of meaningful relief was measured by Time to Confirmed 50% Reduction in Pain and Time to Confirmed 'Slightly' or 'Not At All' Bothersome Pain. Onset of perceptible pain relief was measured by Time to At Least 'A Little' Confirmed Pain Relief. RESULTS: 690 patients entered. Significantly more patients treated with rofecoxib had compared with 1/3 receiving placebo. Median meaningful relief compared to placebo: 60.4, 58.4, and 34.7% for rofecoxib 25mg, 50 mg, and placebo (p< 0.001). Median time to meaningful relief for rofecoxib was 2 days, 1 day sooner than placebo. Rofecoxib was superior to placebo by bedtime after the first dose. CONCLUSIONS: Approximately 2/3 of patients achieved meaningful pain relief with rofecoxib time to onset of meaningful relief was about 2 days, but superior relief over placebo was seen by bedtime after the first dose. Onset of perceptible pain relief was within 2 h. We propose that measures of onset of analgesic effect include the proportion of patients who achieve meaningful pain relief and in this subgroup, the time-to-onset of confirmed meaningful reduction in pain intensity, time-to-onset of confirmed pain relief, and time to first separation from placebo in the proportion of patients who achieve meaningful pain relief.

Adolescent↗
PubMed1994

Studying the natural history of back pain.

Improved information on the natural history of back pain is needed to enable doctors and their patients to understand the likely course of back pain and to evaluate whether alternative interventions are preferred over self care or watchful waiting. The course of back pain is highly variable, occurring in transient, recurrent, and chronic phases. Recent longitudinal studies suggest that back pain is typically a recurrent condition and that chronic phases of back pain occur more often than previously believed. New methods of studying the course of back pain, standardized definitions of phases in the natural history of back pain, and improved outcomes data are needed to better understand the short-term and long-term course of back pain.

Back Pain↗
PubMed1981

Evaluation of low back pain and assessment of lumbar corsets with and without back supports.

A method is described for evaluating the progress of patients with back pain. Various symptoms were scored on analogue scales and spinal motion was measured by various techniques. These data were integrated to make subjective and objective indices respectively. Reasonable reproducibility of the measurements was obtained. This technique was used to elucidate the role of the lumbar support in surgical corsets in relief of back pain. Sufferers from back pain were randomly allocated to corsets with and without lumbar supports. There was significant improvement in those with a support compared with those without. On the other hand objective changes measured with the corset removed did not differ between the 2 groups. This study indicates that the spinal support in a lumbosacral corset makes a significant contribution towards the relief of symptoms.

Adult↗
PubMed1992

Assessment of outcome in patients with low-back pain.

The Low-Back Outcome Score has been devised as a new and accurate rating system for patients with low-back pain. Thirteen factors, such as pain, employment, sporting ability, rest required, and activities of daily living, were included; subjective opinion was excluded. Pain and active pursuits were weighted. Presentation of the score as a questionnaire, excluding examination findings, eliminated both interobserver variation and observer variation with time. The score was applied retrospectively in a follow-up study of conservatively treated patients and was found to be more comprehensive and more discriminating than the Oswestry Disability Score, the Waddell Disability Rating, or the Waddell Physical Impairment Rating. The Low-Back Outcome Score is recommended for further evaluation in future prospective studies in low-back pain.

Back Pain↗
PubMed2000

Behavioural treatment for chronic low back pain.

BACKGROUND: The treatment of chronic low back pain is not primarily focused on removing an underlying organic pathology, but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioural interventions are commonly used in the treatment of chronic (disabling) low back pain. OBJECTIVES: The objective of this systematic review was to determine if behavioural therapy is more effective than reference treatments for chronic non-specific low back pain, and which type of behavioural treatment is most effective. SEARCH STRATEGY: We searched the Medline, PsycLit databases, and the Cochrane Controlled Trials Register up to April 1999, Embase up to September 1999. We also screened references of identified randomised trials and relevant systematic reviews. SELECTION CRITERIA: Only randomised trials on any type of behavioural treatment for non-specific chronic low back pain were included. DATA COLLECTION AND ANALYSIS: Methodological quality assessment and data extraction was done by two reviewers independently. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioural outcomes, overall improvement, back pain specific and generic functional status, return to work, and pain intensity) using the random effects model. MAIN RESULTS: Only 6 studies (25%) were high quality. There is strong evidence (level 1) that behavioural treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% CI 0.25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI -0.04, 0.74) and behavioural outcomes (pooled effect size 0.40; 95% CI 0.10, 0.70) of chronic low back pain patients when compared to waiting list controls or no treatment. There is moderate evidence (level 2) that an additional behavioural component to a usual treatment program for chronic low back pain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% CI - 0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI - 0.30, 0. 36) and behavioural outcomes (pooled effect size 0.19; 95% CI - 0.08, 0.45). REVIEWER'S CONCLUSIONS: Behavioural treatment seems to be an effective treatment for chronic low back pain patients, but it is still unknown what type of patients benefit most from what type of behavioural treatment.

Behavior Therapy↗
PubMed1999

Phantom limb, residual limb, and back pain after lower extremity amputations.

This study describes the sensations and pain reported by persons with unilateral lower extremity amputations. Participants (n = 92) were recruited from two hospitals to complete the Prosthesis Evaluation Questionnaire which included questions about amputation related sensations and pain. Using a visual analog scale, participants reported the frequency, intensity, and bothersomeness of phantom limb, residual limb, and back pain and nonpainful phantom limb sensations. A survey of medication use for each category of sensations also was included. Statistical analyses revealed that nonpainful phantom limb sensations were common and more frequent than phantom limb pain. Residual limb pain and back pain were also common after amputation. Back pain surprisingly was rated as more bothersome than phantom limb pain or residual limb pain. Back pain was significantly more common in persons with above knee amputations. These results support the importance of looking at pain as a multidimensional rather than a unidimensional construct. They also suggest that back pain after lower extremity amputation may be an overlooked but very important pain problem warranting additional clinical attention and study.

Adult↗
PubMed1998

Lumbar supports and education for the prevention of low back pain in industry: a randomized controlled trial.

CONTEXT: Low back pain is a frequent and costly health problem. Prevention of low back pain is important both for the individual patient and from an economic perspective. OBJECTIVE: To assess the efficacy of lumbar supports and education in the prevention of low back pain in industry. DESIGN: A randomized controlled trial with a factorial design. SETTING: The cargo department of an airline company in the Netherlands. PARTICIPANTS: A total of 312 workers were randomized, of whom 282 were available for the 6-month follow-up. INTERVENTIONS: Subjects were randomly assigned to 4 groups: (1) education (lifting instructions) and lumbar support, (2) education, (3) lumbar support, and (4) no intervention. Education consisted of 3 group sessions on lifting techniques with a total duration of 5 hours. Lumbar supports were recommended to be used during working hours for 6 months. MAIN OUTCOME MEASURES: Low back pain incidence and sick leave because of back pain during the 6-month intervention period. RESULTS: Compliance with wearing the lumbar support at least half the time was 43%. In the 282 subjects for whom data were available, no statistically significant differences in back pain incidence (48 [36%] of 134 with lumbar support vs 51 [34%] of 148 without, P=.81) or in sick leave because of low back pain (mean, 0.4 days per month with lumbar support vs 0.4 days without, P=.52) were found among the intervention groups. In a subgroup of subjects with low back pain at baseline, lumbar supports reduced the number of days with low back pain per month (median, 1.2 vs 6.5 days per month; P=.03). CONCLUSIONS: Overall, lumbar supports or education did not lead to a reduction in low back pain incidence or sick leave. The results of the subgroup analysis need to be confirmed by future research. Based on our results, the use of education or lumbar supports cannot be recommended in the prevention of low back pain in industry.

Absenteeism↗
PubMed2003

Factors associated with back pain symptoms in pregnancy and the persistence of pain 2 years after pregnancy.

BACKGROUND: Factors associated with back pain symptoms in pregnancy and the persistence of pain 2 years after pregnancy. AIMS: To determine the prevalence of back pain during pregnancy and to delineate the factors associated with the development and persistence of such symptoms 2 years after delivery. MATERIALS AND METHODS: Prospective observational cohort. Consecutive patients in a low-risk obstetric population with singleton pregnancies were surveyed for back pain symptoms during pregnancy in the early postpartum period by a structured questionnaire. Data from this survey were then correlated with the details of labor and pregnancy outcome, as well as epidemiological, occupation and work data. A follow-up questionnaire survey was administered 24 months after delivery to the group who reported back pain symptoms in the first survey. The absence/presence of persistent symptoms at 24 months was correlated with the characteristics of their pregnancy, as well as their daily life activities at the time of the survey. RESULTS: A total 326 patients with complete data were recruited. Two hundred and fifty (76.6%) reported one or more significant episodes of back pain during their pregnancy. Significantly more patients with presence of pain in pregnancy had history of previous back pain episodes when not pregnant (48% vs. 19.7%, p < 0.001), as well as during previous pregnancies (66% vs. 40%, p < 0.025), or in the postpartum period (40% vs. 6.6%, p < 0.001). There was no significant difference between those with or without pain in their pregnancy outcome. Complete data on 189 of the 250 study patients (75.6%) were available for analysis at 24 months after delivery. The incidence of persistent back pain symptoms was 21.1% (n = 40). Those with persistent pain were older, had significantly earlier onset of pain symptoms in the index pregnancy compared with those without pain at 24 months, and they also had their worse symptoms at an earlier gestation during the index pregnancy. Moreover, those with persistent pain had a higher weight gain at 24 months compared with their preindex pregnancy weight (6.8 kg, SD3.0) compared with those without further pain (4.0 kg, SD2.8) (p < 0.01), as well as less weight loss compared with their early postpartum weight (8.1 kg, SD4.8 vs. 1.1.5 kg, SD5.6) (p < 0.01). CONCLUSION: The main factors associated with development of back pain were previous episodes of back pain while non-pregnant or pregnant. The occurrence of back pain during pregnancy did not affect the pregnancy outcome. The main risk factors associated with persistent back pain at 24 months appeared to be the onset of severe pain at an early gestation in the index pregnancy, as well as the inability to reduce weight to their pre-pregnant level.

Adult↗