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PubMed1996

Diagnostic accuracy of technologies used in low back pain assessment. Thermography, triaxial dynamometry, spinoscopy, and clinical examination.

STUDY DESIGN: A prospective blind study compared three new technologies to assess back pain. OBJECTIVE: To assess the diagnostic accuracy and comparability of thermography, triaxial dynamometry, and spinoscopy in the assessment of recent onset work-related low back pain. SUMMARY OF BACKGROUND DATA: The role of these technologies in assessing patients with low back pain is unproved. METHODS: Forty-one patients with low back pain and 46 control subjects were assessed by each technology and by two clinical examiners blind to clinical status. Twenty patients were trained to simulate a healthy back without low back pain, and 50% of the control subjects were trained to simulate the presence of a low back pain disorder. Each technology was interpreted on two occasions by each of two readers. RESULTS: Thermography performed significantly worse than did triaxial dynamometry, spinoscopy, and clinical examination. The diagnostic accuracy of the last three was similar, and inter-rater comparability did not differ significantly. Among simulators, the diagnostic accuracy of triaxial dynamometry and spinoscopy was significantly higher than that of clinical examination, although considerable inaccuracy remained in assessing individual subjects. CONCLUSIONS: The diagnostic accuracy of thermography in recent onset low back pain does not support its use. Among those simulating normality or low back pain, triaxial dynamometry and spinoscopy have greater diagnostic accuracy than does a single clinical evaluation. However, for an individual, the inaccuracy that remains limits the use of triaxial dynamometry or spinoscopy for diagnosis in recent onset low back pain.

Adult↗
PubMed1996

Low back pain: a twentieth century health care enigma.

Despite greater knowledge, expertise, and health care resources for spinal pathologies, chronic disability resulting from nonspecific low back pain is rising exponentially in western society. Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem. An historic review shows that there is no change in the pathology or prevalence of low back pain: What has changed in our understanding and management. There are striking differences in health care for low back pain in the United States and the United Kingdom, although neither delivers the kind of care recommended by recent evidence-based guidelines. Medical care for low back pain in the United States is specialist-oriented, of high technology, and of high cost, but 40% of American patients seek chiropractic care for low back pain instead. National Health Service care for low back pain in the United Kingdom is underfunded, too little and too late, and 55% of British patients pay for private therapy instead. Despite the different health care systems, treatment availability, and costs, there seems to be little difference in clinical outcomes or the social impact of low back pain in the two countries. There is growing dissatisfaction with health care for low back pain on both sides of the Atlantic. Future health care for patients with nonspecific low back pain should be designed to meet their specific needs.

Delivery of Health Care↗
PubMed1997

The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland.

STUDY DESIGN: A nationwide, cohort-based cross-sectional questionnaire survey as a part of a population study. OBJECTIVES: To evaluate the prevalence of low back pain among Finnish children and adolescents. SUMMARY OF BACKGROUND DATA: Low back pain is common already in adolescence, but the results concerning sex differences and peak age of the prevalence have been partly controversial. Also, previous studies have been limited to smaller geographic areas. METHODS: The subjects were 594 girls and 577 boys, a total of 1171 children and adolescents. They were pupils of 45 different public schools. Various areas of Finland were included in the sampling process to represent different parts of the country and different living conditions. The subjects completed a validated questionnaire by themselves or with the help of a parent or guardian. The questionnaire was checked by a supervisor when entering the field study. The questionnaire included items that investigated the subjects' past and current low back pain. Low back pain was classified on the basis of timing, duration, and location. Subjects reporting pain in the low back area that interfered with school work or leisure activities during the previous 12 months were defined as having low back pain. RESULTS: The prevalence of back pain was low (1%) among the 7-year-old and 10-year-old (6%) schoolchildren, but increased with age, being 18% both among 14- and 16-year-old adolescents. No gender difference was found. Recurrent or chronic pain was reported by 26% of the boys and 33% of the girls who reported low back pain, and the proportion of recurrent and chronic pains of all low back pain incidents increased with age. CONCLUSIONS: Low back pain is a relatively common complaint at adolescence. In addition, a significant part of the pains are recurrent or chronic already with 14-year-old adolescents.

Adolescent↗
PubMed1997

Employment and physical work activities as predictors of future low back pain.

STUDY DESIGN: A population-based longitudinal study conducted in northwest England for a 12-month period involving adults aged 18-75 years. OBJECTIVES: To determine physical factors related to employment that predict a new episode of low back pain. SUMMARY OF BACKGROUND DATA: Most epidemiologic studies that have examined the relation between occupation and back pain have been cross-sectional or retrospective in design. Because workers who have experienced low back pain may have changed jobs or work activities, it is important to use longitudinal studies that define "exposures" before the onset of symptoms. METHODS: From adults registered with two general practices in northwest England, 1412 people who were currently in employment and free of low back pain were identified. A lifetime occupational history was recorded for all participants, with details of activities performed in each occupation. Data on consultations for low back pain during the follow-up year were collected through computerized medical records, whereas those who had not consulted with low back pain were sent another questionnaire at the end of the 1-year follow-up. RESULTS: An increased risk of a new episode of low back pain was found in those whose jobs involved lifting/pulling/pushing objects of at least 25 lbs, or whose jobs involved prolonged periods of standing or walking. Risks were, in general, greater in women, for a first ever episode of back pain and for back pain that led to a general practice consultation. No clear relation between years of exposure to such factors and magnitude of risk was evident. CONCLUSIONS: Occupational activities, particularly in women, such as working with heavy weights or lengthy periods of standing or walking, were associated with the occurrence of low back pain. Short-term influences may be more important in the occurrence of new episodes rather than cumulative lifetime exposure, and emphasize that such morbidity may be avoidable.

Adult↗
PubMed1997

The epidemiology of low back pain in the rest of the world. A review of surveys in low- and middle-income countries.

STUDY DESIGN: A criteria-based review of the literature. SUMMARY OF BACKGROUND DATA: The literature on the epidemiology of low back pain is accumulating, but for the most part studies are restricted to high-income countries, which comprise less than 15% of the world's population. Little is known about the epidemiology of low back pain in the rest of the world. OBJECTIVES: To address the imbalance in the literature and to review the relatively few studies on the epidemiology of low back pain in low- and middle-income countries. Rates from these studies are contrasted with rates from selected high-income countries. In reviewing the literature, a hypothesis is tested: low back pain rates are higher in low-income countries than in high-income countries, not only because hard physical labor is more prevalent in low-income countries, but also because, unlike high-income countries, hard physical labor for older workers in low-income countries often is unavoidable. METHODS: Among other sources, articles for the review come from a search of the MEDLINE bibliographic database, with "back pain" and individual low- and middle-income countries entered as key words. To avoid recall biases, findings specifically on point prevalence are reviewed. RESULTS: Within the categories of low-income and high-income countries, low back pain rates vary twofold or more. In comparisons between these categories of countries, rates on the whole are higher among the general populations of selected high-income countries than among rural low-income populations; specifically, rates are 2-4 times higher among Swedish, German, and Belgium general populations than among Nigerian, southern Chinese, Indonesian, and Filipino farmers. Within low income countries, rates are higher among urban populations than among rural populations and still higher among workers in particular worksites, referred to as "enclosed workshops." CONCLUSIONS: The disparity in low back pain rates within categories of countries, high-income and low-income, calls attention to the high proportion of studies on the epidemiology of low back pain that are methodologically questionable. Recommendations are offered to improve the methodologic quality of this type of study. Conclusions may be drawn from comparisons between studies, although, in the absence of set methodologic standards, they are tentative. The considerably lower rates among populations of low-income farmers compared with rates of the affluent populations of selected northern European countries indicate that, contrary to the hypothesis proposed here, hard physical labor itself is not necessarily related to low back pain. The higher rates in urban low-income populations as compared with rates in rural low-income populations and the sharply higher rates among workers in enclosed workshops of low-income countries suggest a disturbing trend: low back pain prevalence may be on the rise among vast numbers of workers as urbanization and rapid industrialization proceed.

Adolescent↗
PubMed1997

Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions.

STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVES: To assess the effectiveness of the most common conservative types of treatment for patients with acute and chronic nonspecific low back pain. SUMMARY OF BACKGROUND DATA: Many treatment options for acute and chronic low back pain are available, but little is known about the optimal treatment strategy. METHODS: A rating system was used to assess the strength of the evidence, based on the methodologic quality of the randomized controlled trials, the relevance of the outcome measures, and the consistency of the results. RESULTS: The number of randomized controlled trials identified varied widely with regard to the interventions involved. The scores ranged from 20 to 79 points for acute low back pain and from 19 to 79 points for chronic low back pain on a 100-point scale, indicating the overall poor quality of the trials. Overall, only 28 (35%) randomized controlled trials on acute low back pain and 20 (25%) on chronic low back pain had a methodologic score of 50 or more points, and were considered to be of high quality. Various methodologic flaws were identified. Strong evidence was found for the effectiveness of muscle relaxants and nonsteroidal anti-inflammatory drugs and the ineffectiveness of exercise therapy for acute low back pain; strong evidence also was found for the effectiveness of manipulation, back schools, and exercise therapy for chronic low back pain, especially for short-term effects. CONCLUSIONS: The quality of the design, execution, and reporting of randomized controlled trials should be improved, to establish strong evidence for the effectiveness of the various therapeutic interventions for acute and chronic low back pain.

Acute Disease↗
PubMed1997

Community studies of the health service implications of low back pain.

STUDY DESIGN: Retrospective study using primary care physician case notes and a self-report questionnaire on the same randomly selected population sample. OBJECTIVES: To assess the prevalence, management, and outcomes of low back pain in the community, comparing, in the same random sample of registered patients, self-report questionnaire data and primary care physicians' records. SUMMARY OF BACKGROUND DATA: The financial and resource implications of low back pain are extensive. Data on consultations, investigations, and the management of low back pain are fragmentary and there are no comparisons estimating prevalence from case notes and self-report. METHODS: A retrospective study of prevalence, management, referral, and outcome covering the previous 12 months was carried out in three general practices using case notes and a self-report postal questionnaire on a sample of 900 patients over 18 years. RESULTS: Lifetime prevalence of low back pain was 62%. Annual prevalence was 48%, with 16% reporting low back pain at the time of report. Twenty-four percent consulted their primary care physician for low back pain, of whom 17% were referred to a hospital specialist. The annual consultation rate of patients with low back pain was similar to the rate for patients with chronic conditions. The activities of daily living were restricted in less than half, with few taking sick leave. The general health status of those reporting recent low back pain was significantly lower than those not reporting low back pain. Most felt that low back pain was self-limiting and would not consult health professionals for future episodes. There were substantial discrepancies between case notes recorded at consultation with the primary care physician and self-report regarding consultation and investigations. CONCLUSIONS: Prevalence rates were comparable with those reported in other studies. The significant discrepancies between data sources suggest patient recall bias or underrecording in case notes. The low consultation rate, time off, and day-to-day disability indicate that most episodes are self-limiting.

Adolescent↗
PubMed1998

Is hormone replacement therapy a risk factor for low back pain among postmenopausal women?

STUDY DESIGN: Cross-sectional study with two age cohorts. OBJECTIVE: To assess whether women receiving hormone replacement therapy after menopause have a higher prevalence of back problems than women who do not receive such treatment. BACKGROUND: Back pain is a common medical problem throughout life and especially during pregnancy. Hormonal factors have been proposed as a possible contributor. PATIENTS AND METHODS: A validated postal questionnaire was sent in early 1995 to all 1324 women of 55 years and 56 years of age residing in Linköping, Sweden. This questionnaire included questions about current hormone replacement treatment, previous and current back problems, medical care for back problems, parity, exercise and smoking habits, and occupation. RESULTS: The questionnaire was returned by 84.7% of the women. There was a significant, albeit weak, positive association between current use of hormone replacement treatment and low back pain. Previous back problems during pregnancy was a strong risk factor for current back pain, whereas neither current smoking nor regular physical exercise was a risk factor according to multiple logistic regression analysis. The interaction of smoking and an occupation involving heavy lifting significantly affected back pain. CONCLUSIONS: Women receiving hormone replacement treatment had a slightly, but significantly, higher prevalence of current back pain than nonusers (48% vs. 42%, respectively, P < 0.05), which could not be explained by differences in occupation, smoking habits, or current physical activity. Although the association between hormone replacement therapy and back problems is weak and probably of minor clinical importance, it is speculated that hormonal effects on joints and ligaments may be involved.

Cohort Studies↗
PubMed1998

Chronicity of back problems during working life.

STUDY DESIGN: A follow-up study of a cohort of 444 patients aged 16 to 59 years who consulted with their general practitioners (GPs) in 1987-1988 for an incident episode of back pain. OBJECTIVES: To determine the proportion of patients with back pain in whom chronic back problems develop after a follow-up of 7 years, to compare health outcomes and labor force participation of patients with and without chronic back problems and to identify determinants of chronicity. SUMMARY OF BACKGROUND DATA: The incidence and prevalence of back pain are very high. A large proportion of the costs related to medical consumption, absence from work, and disability are probably caused by chronic back problems. It is unknown what proportion of back problems become chronic, especially after a long follow-up period, and which factors can predict chronicity. METHODS: Data on the course of the symptoms and medical consumption from the period between 1987-1988 and 1991 were gathered retrospectively. Data on several health outcomes, including LFP, and data on some work characteristics were collected prospectively in 1991. A more extensive data set on health outcomes including psychologic status and working situation was collected in 1994. RESULTS: Chronic back problems developed in 28% of the patients. These patients reported more pain, higher levels of medical resource consumption, worse health outcomes, and lower labor force participation. Episodes of back pain before 1987-1988, severe pain in 1991, and disability score in 1991 were positively associated with chronicity in 1994, difficulties with job performance in 1991, and frequent stooping in the subgroup of patients who held a paying job in the follow-up period. CONCLUSIONS: Even after a follow-up of 7 years, the proportion of people with chronic back problems was high. The consequences for quality of life, labor force participation, and consumption of medical resources are clear. Further research is necessary to examine determinants and ways to prevent chronicity.

Adolescent↗
PubMed1998

A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care.

STUDY DESIGN: Randomized, controlled trial. OBJECTIVE: To evaluate a four-session self-management group intervention for patients with pain in primary care, led by trained lay persons with back pain. The intervention was designed to reduce patient worries, encourage self-care, and reduce activity limitations. BACKGROUND DATA: Randomized trials of educational interventions suggest that activating interventions may improve back pain outcomes. Expert opinion increasingly regards effective self-management of back pain as important in achieving good outcomes. In this study, an educational intervention designed to activate patients and support effective self-management was evaluated. METHODS: Six to 8 weeks after a primary care visit for back pain, patients were invited to participate in an educational program to improve back pain self-management. Those showing interest by returning a brief questionnaire became eligible for the study. Participants (n = 255) randomly were assigned to either a self-management group intervention or to a usual care control group. The effect of the intervention, relative to usual care, was assessed 3, 6, and 12 months after randomization, controlling for baseline values. The intervention consisted of a four-session group applying problem-solving techniques to back pain self-management, supplemented by educational materials (book and videos) supporting active management of back pain. The groups were led by lay persons trained to implement a fully structured group protocol. The control group received usual care, supplemented by a book on back pain care. RESULTS: Participants randomly assigned to the self-management groups reported significantly less worry about back pain and expressed more confidence in self-care. Roland Disability Questionnaire Scores were significantly lower among participants in the self-management groups relative to the usual care controls at 6 months (P = 0.007), and this difference was sustained at 12 months at borderline significance levels (P = 0.09). Among self-management group participants, 48% showed a 50% or greater reduction in Roland Disability Questionnaire Score at 6 months, compared with 33% among the usual care controls. CONCLUSIONS: Self-management groups led by trained lay persons following a structured protocol were more effective than usual care in reducing worries, producing positive attitudes toward self-care, and reducing activity limitations among patients with back pain in primary care.

Activities of Daily Living↗
PubMed1999

Mechanisms explaining the association between low back trouble and deficits in information processing. A controlled study with follow-up.

STUDY DESIGN: A controlled study with a 6-month follow-up period. OBJECTIVES: To find an explanation for the association between impairment in information processing, i.e., slow reaction times, and chronic low back trouble. SUMMARY OF BACKGROUND DATA: Low back trouble, chronic pain in general, and depression have been associated with impaired cognitive functions and slow reaction times. It is a common phenomenon that the preferred hand performs better than the nonpreferred hand in motor tasks. The authors hypothesized that chronic low back trouble hampers the functioning of short-term memory in a way that leads the preferred hand to loose its advantage over the nonpreferred hand, but that the advantage would be restored during the rehabilitation. METHODS: Sixty-one healthy control subjects and 68 patients with low back trouble participated in the study. Reaction times for the preferred and nonpreferred upper limbs were tested. A multiway analysis of covariance was used to examine the group, handedness, and rehabilitation effects on reaction times. The hypothesis was specifically tested with a third-degree interaction: group-handedness-rehabilitation. RESULTS: A significant interaction among group, handedness, and rehabilitation was found (P = 0.05). At the beginning, the reaction times for the preferred hand were faster among the control subjects (P = 0.001), but not among the patients with low back trouble (P = 0.62). After the rehabilitation, the preferred hand was faster both among the control subjects (P = 0.001) and the patients with low back trouble (P = 0.0002). During the rehabilitation, back pain, psychological distress, and general disability decreased significantly among the patients with chronic low back trouble. CONCLUSIONS: The results support the hypothesis that chronic low back trouble (i.e., pain, psychological distress, and general disability) hampers the functioning of short-term memory, which results in decreased speed of information processing among patients with chronic low back trouble.

Adult↗
PubMed1999

The prevalence of low back pain in the elderly. A systematic review of the literature.

STUDY DESIGN: The prevalence of low back pain in the older population (> = or 65 years) was reviewed in an analysis of the literature from 1966 to the present. OBJECTIVE: To determine the prevalence of low back pain in the geriatric population. SUMMARY OF BACKGROUND DATA: Back pain is one of the most frequently reported conditions affecting the adult population. However, the prevalence of low back pain in the older age population is not accurately known. METHODS: A methodologic search of five computerized bibliographic databases was performed to identify citations on the prevalence of low back pain in the elderly. Data were summarized, and prevalence studies were critically appraised in detail for their quality. RESULTS: There is wide variability in the reported prevalence of back pain. Many factors have been proposed to explain these findings including sample source, study design, definitions of back pain, and use of patient-reported data. Comorbidity among older patients also contributes to the variability in the reporting of prevalence of back pain. CONCLUSION: There is an under-representation of the older population in the back pain literature. The data in the current study suggest that the prevalence of low back pain in this population is not known with certainty and is not comparable with that in the younger population. The authors stress the need for future studies to improve the reporting of age information to make prevalence studies more informative and applicable.

Aged↗
PubMed2000

A review of the association between cigarette smoking and the development of nonspecific back pain and related outcomes.

STUDY DESIGN: A structured review of the epidemiologic literature was performed. Thirty-eight studies published in peer-reviewed journals were reviewed. The methodologic strengths and weaknesses of the studies were described and assessed qualitatively. Four studies were excluded because of difficulties in design or interpretation. OBJECTIVES: To provide a systematic analysis of the literature to assess the evidence as to whether smoking is associated with the prevalence and incidence of nonspecific back pain and related outcomes. SUMMARY OF BACKGROUND DATA: Evidence has been gathering regarding the association of smoking with nonspecific back pain and other back disorders, but a comprehensive summary and evaluation of the data have not been published. RESULTS: Positive associations between current smoking and nonspecific back pain were found in 18 of 26 studies in men and 18 of 20 studies in women. For sciatica and herniated discs, there were four of eight and one of five positive studies in men and women, respectively. The majority of these studies were cross-sectional (18 in men and 16 in women), with only a handful of prospective studies. Positive associations between past smoking and nonspecific back pain were reported in five of nine studies in men and five of six studies in women. In addition, increases in the prevalence and/or incidence of nonspecific back pain were found in the majority of studies in which level of consumption was analyzed and reported. An attempt was made to assess whether these results could be artifactual arising from selection bias, confounding bias, publication bias, or errors in measurement. As well, the biologic mechanisms were summarized that have been suggested by various investigators. CONCLUSIONS: The available data are consistent with the notion that smoking is associated with the incidenceand prevalence of nonspecific back pain, but there are too few studies to make any conclusions for the other end points (e.g., sciatica, herniated discs). It cannot be ruled out that the association is a statistical artifact arising from either selection or confounding factors, because the evidence for nonspecific low back pain derives mostly from cross-sectional studies. In addition, it cannot be stated unequivocally that smoking preceded back pain. Long-term follow-up studies are needed to eliminate the possibility that chronic back pain preceded smoking, to better estimate dose-response correlations, and to perform biologic measurements to elucidate possible mechanisms.

Adolescent↗
PubMed2000

Dural ectasia is associated with back pain in Marfan syndrome.

STUDY DESIGN: A cross-sectional age- and sex-matched study comparing the prevalence and size of dural ectasia in two groups of patients with Marfan syndrome. Group I comprised patients with moderate to severe back pain and Group II comprised patients without back pain. OBJECTIVES: To determine whether the presence and size of dural ectasia is associated with back pain in patients with Marfan syndrome. SUMMARY OF BACKGROUND DATA: Dural ectasia is present in more than 60% of patients with Marfan syndrome. Moderate to severe back pain is present in more than 50% of patients with Marfan syndrome. Most cases of significant low back pain in patients with Marfan syndrome do not have a clear cause. It would be useful for the clinician to know whether dural ectasia may be a cause of back pain in patients with Marfan syndrome with no other source. METHODS: Thirty two volunteers aged 30-50 with Marfan syndrome were enrolled as age- and sex-matched pairs with significant back pain (Group I) and without back pain (Group II). A completed questionnaire, physical examination, and magnetic resonance image of the lumbosacral spine were obtained. Dural volume caudal to L5 was calculated from the magnetic resonance data by specially designed software. RESULTS: Dural ectasia was present in 76% of the patients in Group I, and 41% of the patients in Group II. The proportion of patients with dural ectasia was significantly higher in Group I. Furthermore, the mean dural volume was significantly higher in Group I, and a significant correlation between dural volume and Oswestry pain score was noted. CONCLUSIONS: The presence and size of dural ectasia are associated with back pain in the Marfan syndrome. However, a high prevalence of dural ectasia (41%) exists even in patients with Marfan syndrome without back pain. The mere presence of dural ectasia therefore does not necessarily mean the patient will be symptomatic even though the two are associated.

Adult↗
PubMed2001

The significance of high lumbar mobility and low lumbar strength for current and future low back pain in adolescents.

STUDY DESIGN: This study comprised a cross-sectional part and a prospective part. OBJECTIVE: To study whether low lumbar extension strength, high lumbar mobility, and high mobility-extension strength ratios are related to current and future low back pain in adolescents. SUMMARY OF BACKGROUND DATA: Knowledge is sparse about the significance of lumbar mobility and strength for low back pain in adolescents. METHODS: The study population included all the adolescents in the eighth and ninth grades of a rural municipality (n = 44) and in an urban area (n = 61) during the 1996-1997 school year. At baseline, 88 adolescents (mean age, 14.7 years) participated in the study, giving a response rate of 84%. Low back pain was assessed by questionnaire as pain or discomfort in the low back during the preceding year. Sagittal lumbar mobility was tested by Schober's modified technique, and lumbar strength as static endurance extension strength. The follow-up part was conducted 3 years later, which included 98% of the adolescents. RESULTS: By bivariate and multivariate analyses in the cross-sectional part of the study, low back pain was found to be highly associated with low lumbar extension strength (P = 0.004-0.02), and high lumbar mobility-extension strength ratios (P = 0.005-0.04). Baseline low lumbar extension strength and high lumbar sagittal mobility-extension strength ratios (P = 0.03 and P = 0.02, respectively) predicted low back pain at follow-up assessment in multivariate analyses when control was used for gender, previous low back pain, physical activity, and well-being. No associations were found between plain sagittal mobility and low back pain. CONCLUSION: The study findings support theories suggesting insufficient strength and stability in the low back as important factors for both concurrent and future low back pain in adolescents.

Adolescent↗
PubMed2002

The six-month incidence of clinically significant low back pain in the Saskatchewan adult population.

STUDY DESIGN: A population-based, longitudinal, mailed survey was conducted. OBJECTIVE: To investigate the 6-month incidence and determinants of clinically significant low back pain in the Saskatchewan adult population. SUMMARY OF BACKGROUND DATA: Few studies have investigated the incidence of significant low back pain in general populations. When available, such studies often differ in the assessment of pain severity. This lack of consensus in measuring pain severity results in large differences in incidence rates. METHODS: A questionnaire requesting information on low back pain and other health conditions was mailed to randomly chosen individuals, ages 20 to 69, residing in the province of Saskatchewan, Canada. Of the 1131 (55%) who responded at baseline, 848 had not experienced clinically significant low back pain during the past 6 months. Clinically significant low back pain was assessed using the Chronic Pain Questionnaire, a 7-item scale that measures the intensity of chronic pain and associated disability. Individuals with no clinically significant low back pain were followed up at 6 months. RESULTS: At the follow-up assessment, 50 individuals reported clinically significant low back pain, representing a cumulative incidence of 8% (95% confidence interval, 6-10.4). In logistic regression models, marital status, rural residency, and history of back and neck pain were associated with the onset of clinically significant low back pain. CONCLUSIONS: The 6-month incidence of clinically significant low back pain is high in Saskatchewan. It is important to prevent this condition because of the high economic and social costs associated with it.

Adult↗
PubMed2002

Using the dallas pain questionnaire to classify individuals with low back pain in a working population.

STUDY DESIGN: Individuals with low back pain were classified by cluster analysis of their responses to the Dallas Pain Questionnaire. These results enabled development of an alternative simple classification tool that yielded results close to those obtained by the cluster analysis. OBJECTIVES: To use the Dallas Pain Questionnaire to classify workers with low back pain, and to develop a practical classification tool for physicians. SUMMARY OF BACKGROUND DATA: The severity of low back pain is important information for patient management. Questionnaires exploring the multidimensional aspect of low back pain have been used to classify individuals with low back pain. The Dallas Pain Questionnaire is a short self-administered questionnaire that explores the functional and emotional aspects of chronic low back pain. It was tested in a population still at work using a simplified scoring system. METHODS: The study included 765 persons with low back pain still at work who completed the self-administered questionnaire. Of these patients, 732 could be classified by cluster analysis according to their answers to the Dallas Pain Questionnaire. A classification tool was developed to categorize them. Using external variables, the groups thus formed were compared. RESULTS: Respondents were classified into four classes: class 1 (minor disability), class 2 (intermediate disability), class 3 (disability for some physical activities), and class 4 (physical disability and emotional disturbance). External pain-related variables were clearly associated with increasing low back pain severity as measured by this classification tool. CONCLUSIONS: The Dallas Pain Questionnaire discriminated between different groups of persons with low back pain. The proposed classification uses a short, simple practical tool to assess different levels of low back pain.

Adult↗
PubMed2004

Genetic and environmental contributions to back pain in old age: a study of 2,108 danish twins aged 70 and older.

STUDY DESIGN: Self-reported 1-month prevalence of back pain in older twins assessed at intake in a population-based longitudinal survey. OBJECTIVES: To determine the relative contribution of genetic and environmental factors to back pain in old age. SUMMARY OF BACKGROUND DATA: To date, genetic contributions to back pain in old age have not been assessed, to the authors' best knowledge. METHODS: Interview data given at entry into a nationwide cohort-sequential population-based survey of Danish twins aged 70 years and older in 1995, 1997, 1999, and 2001 form the basis of this analysis. Analysis of twin similarity was estimated using probandwise concordance rates, odds ratios, and tetrachoric correlations for back pain. Heritability (proportion of the population variance attributable to genetic variation) was estimated by bivariate probit estimation and adjusted for known significant environmental factors. Odds ratios for known environmental effects were estimated after controlling for age, sex, and genetic effects. RESULTS: Modest and nonsignificant differences between monozygotic and dizygotic twin pairs were found for probandwise concordance rates, odds ratios, and tet-rachoric correlations for both men and women. In the bivariate probit estimation, a current or previous diagnosis of osteoporosis, degenerative joint disease, or lumbar disc prolapse was found to significantly affect the risk of back pain. Additive genetic effects explained approximately one fourth of the liability to report back pain in men and none of the occurrence in women. Individual environmental effects were found to explain roughly 75% of the occurrence of back pain in men and 100% in women. CONCLUSIONS: Additive genetic effects are modest contributors to back pain in older men but not in women. A current or previous medical diagnosis of osteoporosis, degenerative joint disease, or lumbar disc prolapse is-strongly associated with back pain, also when genetic factors are controlled for. Because of inherent methodologic issues, this estimate of the genetic influence on back pain in old age is probably conservative.

Age Distribution↗