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PubMed1980

[Percutaneous electrocoagulation of posterior ramus of spinal nerves in pain relief treatment of spondylogenic low back pain (author's transl)].

The author presents his results on 70 patients under treatment of low back pain by means of electrocoagulation of the posterior ramus of spinal nerves. In many cases of disc hernia it was possible to attain good results that enabled us to abandon the operative procedure. The best results were achieved in cases of sciatalgic pains, which were diminished more considerably than the local lumbosacral ones. When conservative methods fail, and no absolute operative indications exist, coagulation may be helpful in pain relief.

Back Pain↗
PubMed2002

Effectiveness of a selected bedding system on quality of sleep, low back pain, shoulder pain, and spine stiffness.

OBJECTIVE: To determine whether clinical and statistically significant changes in back pain, shoulder pain, spine stiffness, and quality of sleep may be documented after use of a prescribed bedding system. DESIGN: Quasi-experimental field study of single group pretest-posttest design with subjects serving as their own controls. SETTING: Two chiropractic clinics and the Oklahoma State University Program of Health and Human Performance. SUBJECTS: Convenience sample of 22 subjects (women, n = 13; men, n = 9) between the ages of 25 and 75 years with documented disturbed sleep, shoulder pain, low back pain, and spine stiffness of a chronic nature. OUTCOME MEASURES: Pretest and posttest 28-day Visual Analog Scales for pain, spine stiffness, and quality of sleep. MAIN RESULTS: The experimental bedding system reduced back pain by 57.21% (P =.000001), reduced shoulder pain by 60.83% (P =.000005), reduced back stiffness by 59.12% (P =.000004), and improved quality of sleep by 60.73% (P =.000001). CONCLUSIONS: Results suggest that subjects obtain significant improvement in shoulder and back pain, back stiffness, and quality of sleep after 28 days of prescribed bedding system use as compared with 28 days of personal bedding use. Female subjects and those with lower body weight were more likely to significantly improve than heavier and more obese subjects.

Adult↗
PubMed1992

The effect of chymopapain on low back pain.

One hundred and fifteen patients underwent chymopapain treatment for acute disc protrusion between 1980 and 1988. Sixty-six patients who were treated with single-level injection were reviewed retrospectively with clinical follow-up from 2 to 10 years (mean, 4.6 years). All patients met modified McCulloch criteria (not all patients had leg pain greater than back pain). The presence of pre-existing chronic low back pain (LBP) was recorded in 33 patients and compared to their present low back symptomatology and functional limitations. Patients with pre-existing chronic LBP had a success rate of 52%, whereas patients meeting all the McCulloch criteria without chronic LBP had a success rate of 52%, whereas patients meeting all the McCulloch criteria without chronic LBP had a success rate of 85%. The overall effect of chemonucleolysis on LBP demonstrated no change in 18% and a mild increase in 45% of the patients (even though they had a successful outcome). The pre-existing disc space narrowing and the postoperative change of disc space height of 33 patients assessed on lateral roentgenograms showed no correlation to the clinical response. Temporal sequential computed tomography scan assessment of 56 patients following chemonucleolysis demonstrated little change of disc herniation in the first 3 months, with only a gradual and incomplete resolution in the ensuing 12 months.

Adult↗
PubMed1991

Interaction of height and mechanical loading of the spine in the development of low-back pain.

The relation of low-back pain to height and physical activity was examined among 2667 British men and women aged 20-59 years and selected from the general population. Information about occupational activities, height, and lifetime history of low-back pain was obtained from a postal questionnaire. The lifetime prevalence of low-back pain was 58.3%. After allowance for other occupational activities, the onset of low-back pain was strongly associated with heavy lifting at work (men: relative risk (RR) 2.0, 95% confidence interval (95% CI) 1.4-2.8; women: RR 2.2, 95% CI 1.3-3.5). For the men there was also an association with digging (RR 1.6, 95% CI 1.1-2.3). Risk of low-back pain increased with height among the men but not among the women. The risks associated with heavy lifting and digging were greater for the short than for the tall men. Thus the data provide no justification for excluding tall men from heavy manual tasks, despite their greater susceptibility to back problems.

Adult↗
PubMed1991

Low back pain in children.

Low back pain is a rare phenomenon in children. The etiology differs from the degenerative and diskogenic disease in adults and is almost never a manifestation of psychological disturbance. Low back pain in children is often the harbinger of serious underlying pathologic changes and should be evaluated by state-of-the-art neuroradiologic tests.

Adolescent↗
PubMed1999

The power of the visible: the meaning of diagnostic tests in chronic back pain.

This article explores the meaning of diagnostic tests for people with chronic back pain. Lower back pain is one of the most common health problems in the US. Five to ten percent of the patients who visit a primary care provider for back pain ultimately develop a chronic condition. We draw on interviews with chronic back pain patients in Atlanta, Dallas and Seattle to argue that testing constitutes an important element in the legitimation of pain for these patients. We discuss three aspects that make testing an area of concern for patients: a strong historical connection between visual images and the medicalization of the interior of the body, a set of cultural assumptions that make seeing into the body central to confirming and normalizing patients' symptoms, and the concreteness of diagnostic images themselves. Our interviews show that when physicians cannot locate the problem or express doubt about the possibility of a solution, patients feel that their pain is disconfirmed. Faced with the disjunction between the cultural model of the visible body and the private experience of pain, patients are alienated not only from individual physicians but from an important aspect of the symbolic world of medicine. This paper concludes by suggesting that a fluid, less localized understanding of pain could provide a greater sense of legitimacy for back pain patients.

Adult↗
PubMed2005

[Epidemiology of low back pain].

Epidemiology of low back pain, that is, the study of the incidence and prevalence of the pain is essential for detecting the degree of time and physical loss in a person or a society, and for making a project to minimize the loss. For carrying out the study, definition of low back pain is important to understand correctly the real state and comparing the variable data resulting from different studies.

Female↗
PubMed1997

Transdermal fentanyl as treatment for chronic low back pain.

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

Administration, Cutaneous↗
PubMed2005

Aetiology of low back pain in Mulago Hospital, Uganda.

BACKGROUND: Low back pain exists in epidemic proportions in the western world and is on the increase. Its cause is mostly nonspecific. Not much is known about it in the developing world because the data is scanty. This study was set out to investigate the possible causes of low back pain and prevalence. OBJECTIVE: To establish the likely causes of low back pain among patients seen in the out patient department, Mulago Hospital, Uganda. METHODS: 204 patients were enrolled out of 1033 general patients who were present to the out patient referral hospital orthopedic clinic. All the 204 were referred patients with low back pain as the chief complaint. They were subjected to a questionnaire, which included history taking, a physical examination and investigations. Data was entered using Epi info soft ware and analyzed using SPSS. RESULTS: The prevalence was 20%. The mean age was 47 years 10 months. The majority, 62.3% of patients had mechanical or simple back pain with no definable patho-anatomic causative factor (non-specific). 19.1% had nerve root compression due to prolapsed intervertebral discs. 17.2% had serious spinal pathology due to tuberculosis, brucellosis, fractures and degenerative changes. For 3 patients (1.5%) the cause was not determined. CONCLUSION: The findings indicate that low back pain of non-specific aetiology is the commonest cause of back pain. The precise aetiology of this large indefinite entity warrant further study.

Cross-Sectional Studies↗
PubMed2001

Capsicum pain plaster in chronic non-specific low back pain.

Topically applied capsaicin (CAS 404-86-4) induces the release of substance P, a neurotransmitter, from sensory C-fibres. In addition, there is a specific blockade of transport and de-novo synthesis of substance P. As a result, repeated applications of capsaicin bring about a long lasting desensitisation to pain (increase of pain threshold). The desensitising effect is fully reversible. The confirmed pharmacodynamic actions and a number of double-blind clinical studies indicate that local capsicum preparations are very suitable for the treatment of neuropathic pain or musculoskeletal disorders, with or without inflammatory components. In a double-blind, randomised parallel-group study a capsicum plaster was compared with a placebo for 3 weeks in 154 patients with non-specific back pain. Inclusion criteria were a history of back pain for a minimum period of 3 months and a degree of pain of 5 or more on an eleven grade visual analogue scale. The principal target variable consisted of the score of 3 combined pain scales. Secondary efficacy measures were tests of mobility, a disability index (in the context of Arhus low back rating scale) and global assessments by physicians and patients. For patients to be rated as responders their total pain score at the final examination after 3 weeks of treatment had to show a reduction by at least 30% of the baseline value. The study unequivocally achieved the target criterion with a rate of responders in the capsicum group of 60.8% against 42.1% in the placebo group (p = 0.0219). The sum of the 3 separate pain scales decreased more markedly in the capsicum group than in the placebo group (38.5% compared to 28.0%; p = 0.002). Relatively slight improvements of the impaired mobility and the functional status are explained by the characteristics of the disorder treated. The efficacy ratings by observers and patients was definitely in favour of capsicum. Adverse effects--mostly harmless and resolving spontaneously--were reported by 15 patients in the capsicum group and by 9 in the placebo group. The tolerance ratings by investigators and patients were superior to the placebo product. This, however, partly is due to the local pharmacological actions of the drug. As in comparably positive randomised studies with capsaicin cream in patients with osteoarthritis or fibromyalgia it was shown that a capsicum plaster preparation can also be used to advantage in chronic non-specific back pain.

Administration, Topical↗
PubMed2004

[Indications for epidural steroids in back pain and in radiculopathy].

Back pain is very frequent in western countries and it represents a very high social cost. The treatment is based on five modalities: medication, physiotherapy, invasive technics, rehabilitation programs and psycho-social approaches. Several treatments may be proposed simultaneously and introduced gradually. Steroid administration by epidural injection is frequently used in Belgium, even though no prospective randomised studies have shown a real benefit over the long term. The indications for epidural injection must be carefully chosen. These include subacute pain (less than six months) in the lower limbs despite a well observed medical treatment. Patients are invited to give informed consent; the technic must be performed in an appropriate environment by an experienced physician. The initial treatment of back pain is medical. This pathology is multifactorial and the relief of symptoms is often incomplete. The patient should be urged to feel responsible for and involved in his treatment.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Pain-related factors contributing to muscle inhibition in patients with chronic low back pain: an experimental investigation based on superimposed electrical stimulation.

OBJECTIVE: To evaluate muscle strength, as a component of physical deconditioning, and central activation ratio, representing the performance level during testing, in patients with chronic low back pain as compared to healthy controls, and to evaluate the contribution of cognitive-behavioral and pain-related factors to the central activation ration of patients with chronic low back pain. METHODS: Twenty-five patients with chronic low back pain and 25 age and gender-matched controls participated. Muscle strength, that is, peak torque of the quadriceps muscle, was measured on a Cybex dynamometer. During peak torque, the quadriceps muscle was percutaneously stimulated using superimposed electrical stimulation, generating an additional twitch torque in case of submaximal performance. The central activation ratio was calculated as peak torque/(peak torque + additional twitch torque). To evaluate cognitive-behavioral and pain-related factors influencing the central activation ratio, measures of fear of injury, pain catastrophizing, psychologic distress, and pain intensity were used. Differences between groups were tested using either T tests or Mann-Whitney U tests. Associations were tested by partial correlation coefficients controlling for gender. RESULTS: The male:female ratio was 15:10. Mean age and chronic low back pain duration were 42.7 (+/-9.5) and 9.9 (+/-8.3) years, respectively. Mean muscle torque (per kg lean body mass) in patients (1.95 Nm/kg +/-0.8) was less than in controls (3.16 Nm/kg +/-0.7) (P < 0.01). Median central activation ratio was lower in patients (P < 0.05). Patients experiencing increased psychologic distress and patients with a higher current pain level showed a lower central activation ratio (P < 0.05). CONCLUSIONS: When interpreting decreased muscle strength in terms of physical deconditioning in patients with chronic low back pain, submaximal performance has to be taken into account. The results suggest that patients with chronic low back pain who report increased psychologic distress and a higher level of current pain tend to show increased inhibition of muscle activity, leading to submaximal performance.

Adolescent↗
PubMed1997

The benefits of back pain.

BACKGROUND: Chronic lower back pain (CLBP), without definable cause, is a symptom commonly presented to GPs, accounting for a significant proportion of their workload; it is also a common reason for sickness absence, and thus of national economic importance. OBJECTIVES: This qualitative study aims to explore how sufferers of CLBP describe their pain and its impact on their lives, and how their problem is dealt with in the consultation with their family doctor. METHOD: Semi-structured interviews were carried out with a sample of attenders at a back pain clinic set up in general practice. Transcription and analysis was carried out using a grounded-theory approach. RESULTS: Sufferers of CLBP describe withdrawal from normal social obligations, including work. They view their GP as being unable to help and, because of this, the doctor becomes a resource through which their social and economic inactivity can be legitimated. CONCLUSIONS: Presenting with CLBP permits the patient a good deal of power over the GP: it is difficult for the GP to challenge the patient's ideas without damaging the relationship. GPs are forced to collude with the patient's definition of ill-health, which may not be in the best interests of the patient or society.

Adult↗
PubMed2002

Low back pain in schoolchildren: occurrence and characteristics.

Low back pain in adolescents is perceived to be uncommon in the clinic setting. However, previous studies have suggested that it may be an important and increasing problem in this age-group. The aim of this study was to determine the prevalence and important symptom characteristics of low back pain such as duration, periodicity, intensity, disability and health seeking behaviour at young ages. A population-based cross-sectional study was conducted including 1446 children aged 11-14 years in the North-West of England. A self-complete questionnaire was used to assess low back pain prevalence, symptom characteristics, associated disability and health seeking behaviour. An additional self-complete questionnaire amongst parents sought to validate pain reporting. The 1-month period prevalence of low back pain was 24%. It was higher in girls than boys (29 vs. 19%; 2=14.7, P<0.001) and increased with age in both sexes (P<0.001). Of those reporting low back pain, 94% experienced some disability, with the most common reports being of difficulty carrying school bags. Despite this high rate of disability, few sought medical attention. Adolescent low back pain is common although medical attention is rarely sought. Such symptoms in childhood, particularly as they are so common, may have important consequences for chronic low back pain in adulthood.

Adolescent↗
PubMed2003

The effects of McKenzie exercises for patients with low back pain, our experience.

OBJECTIVE: To investigate influence of McKenzie exercises on decreasing the pain in patients with low back pain, to show occurrence of Centralization sign, as a predictor of good treatment outcomes and to evaluate use of McKenzie exercises, as a routine method for lower back pain in Physical Medicine and Rehabilitation Centres. DESIGN: Clinical, prospective, manipulative study. SETTING: Physiotherapy and Rehabilitation Clinic in Community Based Rehabilitation Centers and Institute for Physical Medicine and Rehabilitation affiliated with a Medical College Sarajevo. PARTICIPANTS: Thirty-four patients with symptoms of low back pain. INTERVENTIONS: McKenzie exercise program for low back pain were performed individually to the need and possibility of each patient. Patients attended exercise program daily, under supervision of physiatrist and physiotherapist and do it also at home, five times a day in series of 5 to 10 repetition each time, depending of stage of disease and pain intensity. The average training period was 15,5 days. MAIN OUTCOME MEASURES: All patients were assessed before and after the treatment. Visual Analog Scale (VAS) measured intensity of pain, localization of pain was noted on special forms and Shober test was used to show differences in spinal movement before and after the treatment. RESULTS: Measurements of spinal movements and flexibility of spine showed significant improvement in all patients. Average difference in values of Shober test before and after treatment was 1,1 cm with SD 0,98. Difference test was t=6,263 with significant difference p<0,01. Mean pain intensity was reduced significantly as a result of treatment. Pain was reduced on VAS for X=2,8 with S.D. 1,56. Difference Test was t=10,332, with significant difference p<0.01. 61,5% of total number of participants had signs of centralisation (6% were in acute stage of pain, 32% in subacute and 23,5% in chronic pain). Centralisation sign was noted in 40% of acute patients, 57.5% subacute and 80% of chronic patients with a low back pain who exercised McKenzie program. CONCLUSIONS: McKenzie exercises for low back pain are beneficial treatment for increasing flexibility of spine and improving the pain with better results in pain relief. Although done by minimally trained physiotherapists in McKenzie approach, McKenzie exercises are successful method for decreasing and centralising the pain and increasing spinal movements in patients with low back pain.

Journal Article↗
PubMed1996

Persistent back pain and sciatica in the United States: patient characteristics.

Low back pain is an extremely common, seriously disabling, nonfatal public health problem worldwide. The National Low Back Pain Study was a multicenter study of a large, heterogeneous group of patients who have been referred to either a neurosurgeon or an orthopedic surgeon for the evaluation and treatment of a persistent complaint of low back pain. In this paper, we characterize persistent low back pain patients and their complaints, describe the impact of persistent low back pain on the patients' functional and psychological status, report on the patients' medical characteristics, and identify treatments that are currently prescribed for these patients. Persistent low back pain is most common among people in their mid-to-late thirties and early-to-mid forties. The patients are mostly white, well educated, and generally affluent. The majority are gainfully employed, but some quit working because of pain and those who do tend to be less educated, and more likely to be involved in litigation. The average patient has had low back pain intermittently for 10 years. The pain is usually well localized but its severity varies considerably. Besides pain, most persistent low back pain patients report a variety of motor and sensory deficits. Patients also report significant functional impairment at work, at play, and at home. The typical patient does not, however, display significant psychological distress. Most patients have consulted multiple health care providers, have received a variety of treatments, and have used a variety of medications to alleviate pain; a few have been subjected to more aggressive treatment measures including surgery, intradiscal therapy, and narcotic and psychoactive drugs. None of these treatments has been effective. Physical examinations of these patients do not provide significant clues for making a definitive diagnosis. Nonspecific abnormalities such as muscle spasm, tenderness, and trigger points are quite common, but motor weakness and sensory deficits in the lower extremities, and reflex changes in the knees and ankles, are much less common. The classic combination of reflex changes, motor weakness, and sensory deficits associated with specific protruded discs are extremely rare even though one of three patients had a diagnosis of disc herniation. Diagnostic imaging studies revealed that the majority of persistent low back pain patients have spondylotic abnormalities involving root compression or lumbar instability or both, with root compression as the primary cause of the complaint. Myofascial syndrome and lumbar instability were the next most common diagnoses. After a thorough evaluation by specialists in spinal disorders, three of five persistent low back pain patients were prescribed an additional course of conservative therapy, one of five was prescribed surgery, and the rest were prescribed no treatment. Persistent low back pain patients appear to be a distinct group of low back pain patients who are different from patients who have similar nonpersistent acute symptoms and those who have the chronic pain syndrome characterized by significant behavioral and psychological co-morbidities.

Adult↗
PubMed2004

Low back pain: diagnosis, treatment, and prognosis.

Low back pain seems to be an integral part of most human lives and cause different degrees of suffering and disability. The exact cause of the pain cannot be identified in most instances. The making of the diagnosis rests mainly on the patient's history, location, and duration of the pain. Different diagnostic tests have not been proven to add much information and even advanced imaging seems not to be able to identify where the pain comes from in the majority of cases. In establishing a working relationship between the patient and the health care provider the physical examination may be valuable. If the specific cause for the pain cannot be found, there cannot be any specific treatment applied. The multitude of different treatments offered to patients must be regarded as pain modulating modalities and not as cures for low back pain. There is no treatment that has been proven to be highly effective. The natural history of low back pain seems in general to be favourable, but of concern is the consequence of long term or permanent disability. Fear avoidance behaviour has been shown to be part of the disabling pathway in chronic low back pain. Cognitive interventions, designed to remove fear and uncertainty, and to give the patient the confidence that the back is robust even if it hurts, seem promising.

Diagnosis, Differential↗