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PubMed1994

An international comparison of back surgery rates.

SUMMARY OF BACKGROUND DATA: Although high geographic variation in back surgery rates within the United States have been documented, international comparisons have not been published. METHODS: The authors compared rates of back surgery in eleven developed countries to determine if back surgery rates are higher: 1) in the United States than in other developed countries, 2) in countries with more neurologic and orthopaedic surgeons per capita, and 3) in countries with higher rates of other surgical procedures. Data on back surgery rates and physician supply were obtained from health agencies within these eleven countries. Country-specific rates of other surgical procedures were available from published sources. RESULTS: The rate of back surgery in the United States was at least 40% higher than in any other country and was more than five times those in England and Scotland. Back surgery rates increased almost linearly with the per capita supply of orthopaedic and neurosurgeons in the country. Countries with high back surgery rates also had high rates of other discretionary procedures such as tonsillectomy and hysterectomy. CONCLUSIONS: These findings illustrate the potentially large impact of health system differences on rates of back surgery. Better outcome studies, however, are needed to determine whether Americans are being subjected to excessive surgery or if those in other developed countries are suffering because back surgery is underutilized.

Australia↗
PubMed1994

The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part III: Back pain.

OBJECTIVES: This study determined health and well being of persons with adolescent idiopathic scoliosis (AIS) more than 10 years after referral. This communication will present results related to back pain. STUDY DESIGN: This study was designed as a comparative retrospective cohort study. Subjects referred for AIS between 1960 and 1979 to a large pediatric hospital in Montreal, Quebec, were entered into the cohort. A population-based control group was selected from the general population of Quebec using a telephone survey. METHODS: Back pain was assessed by postal questionnaires administered, in 1990, to the AIS cohort and to the control group. Most outcomes were ordinal and, thus, odds ratios were estimated using ordinal regression while adjusting for potential confounding factors. RESULTS: Among the 1,476 AIS subjects responding, 73% experienced one or more episodes of back pain in the past year, significantly more than the 1,755 controls (56%); for current back pain, these proportions were also significantly different: 44% for AIS subjects and 24% for controls. In comparison to controls, AIS subjects reported pain that was more intense, continuous, generalized throughout the back, and radiating into the extremities. AIS subjects were also more restricted in many usual daily activities. Little variability was observed in the prevalence of current back pain and back pain in the past year according to treatment and degree of curvature. Difficulty with managing pain, lifting, walking, and socializing was, however, associated with severity. The results of this study suggest that back pain is responsible for a considerable amount of disability and handicap in later life. Health professionals involved with the management of persons with AIS need to consider this important outcome and need to put in place procedures for the identification, investigation, prevention, and treatment of back pain.

Activities of Daily Living↗
PubMed1995

Impact of a medical back care program on utilization of services and primary care physician satisfaction in a large, multispecialty group practice health maintenance organization.

STUDY DESIGN: Samples of patients with new back pain were compared at two medical centers, one with and one without a medical back care program. OBJECTIVES: To measure the impact of a medical back care program on use of services and physician satisfaction in a health maintenance organization. SUMMARY OF BACKGROUND DATA: A medical back care program is staffed with specially trained primary care physicians and provides consultative and educational services to the medical center. METHODS: Program impact on services was measured by comparing the number of physician office visits, consultations, physical therapy referrals, and imaging procedures provided to a sample of patients with back pain at the two medical centers. Physician satisfaction with care provided to patients with back pain was measured by a survey sent to primary care physicians at both medical centers. RESULTS: At the medical center with a back care program, 42% fewer consultations, 59% fewer physical therapy referrals, and 33% fewer imaging procedures were ordered. Less expensive consultations with back care physicians in medicine or family practice were ordered more frequently than consultations with either neurologists or orthopedists. This change in pattern of care took place without significantly altering clinical course. The effect of the program on the rate of surgery was not measured. CONCLUSIONS: The results of this study support the benefits of an organized medical back care program.

Adolescent↗
PubMed1995

Low back pain and subsequent cardiovascular mortality.

STUDY DESIGN: This was a prospective cohort study based on data of the Mini-Finland Health Examination Survey collected between 1978 and 1980, with follow-up until the end of 1991. OBJECTIVE: A number of studies have revealed associations between smoking, cardiovascular diseases, and low back pain. Therefore, it has been suggested that atherosclerosis could be involved in the etiology of low back pain. Low back pain was studied for its prediction of mortality and, in particular, deaths from cardiovascular disease. SUMMARY OF BACKGROUND DATA: Of a nationally representative sample of 8000 people older than 29 years, 7217 (90%) participated in a comprehensive health examination. At interviews, 5459 (76%) had a history of low back pain. In a standardized clinical examination, 1253 (17%) were diagnosed as having chronic low back pain. METHODS: The follow-up information on mortality and causes of death was obtained from the Central Statistical Office of Finland. RESULTS: By the end of 1991, 1487 of the examinees had died, 815 from any cardiovascular disease and 501 from coronary heart disease. Neither the history of back complaints nor chronic low back pain predicted mortality. CONCLUSION: That low back pain does not affect longevity disagrees with the hypothesis that atherosclerosis resulting in death from cardiovascular disease is etiologically linked to low back pain.

Adult↗
PubMed1995

The prevalence of low back pain in the literature. A structured review of 26 Nordic studies from 1954 to 1993.

STUDY DESIGN: A systematic review was done for all prevalence studies on low back pain in the Nordic population between 1954 and 1992 that could be identified. OBJECTIVE: To investigate the homogeneity of data. SUMMARY OF BACKGROUND DATA: Costs resulting from low back pain are steadily increasing, but it is not known whether this has been caused by changes in healthcare behavior or whether there is an underlying increase in the occurrence of low back pain in the general population. The prevalence rate of low back pain has been continually estimated over the last 40 years, but are the studies sufficiently homogeneous to allow pooling of data? METHODS: Twenty-six population-based epidemiologic surveys on the occurrence of low back pain in the Nordic countries were assessed for the following criteria: quality of the report according to a checklist related to the representativeness of the study sample, quality of data, and definition of low back pain; study design (study population, definition of low back pain, and recall periods); probability of data, taking into account the quality of the report, the definition of low back pain, type of population, age, and sex. RESULTS: Only 10 studies fulfilled a minimum of 75% of the methodologic criteria. There were large differences between studies regarding study design, and the poolability of data was limited to a few studies, none of which fulfilled all of the above criteria. CONCLUSION: A more stringent, systematic, and uniform methodologic approach to studying the prevalence (or incidence) of back pain is needed.

Adolescent↗
PubMed1995

Minnesota Multiphasic Personality Inventory profiles in persons with or without low back pain. A 20-year follow-up study.

STUDY DESIGN: A general health survey including a cross-sectional study of 404 men and women aged 50 years who underwent follow-up evaluation at ages 60 and 70 years. OBJECTIVES: The participants completed the Minnesota Multiphasic Personality Inventory at age 50 and 60 years and were interviewed at age 60 and 70 years regarding low back pain experienced in the preceding 10 years. SUMMARY OF BACKGROUND DATA: Minnesota Multiphasic Personality Inventory data in low back pain patients are derived mainly from selected materials. This study presents data from a general population and sheds light on the controversy: "What comes first--Minnesota Multiphasic Personality Inventory changes or low back pain?". METHODS. Within the frame of a general health survey where the primary aim was to study cardiovascular risk factors, the participants completed a shortened Danish version of the Minnesota Multiphasic Personality Inventory at age 50 and 60 years; low back pain data were collected at interviews at age 60 and 70 years, and this study focused on the Hypochondriasis-Depression-Hysteria scales of the Minnesota Multiphasic Personality Inventory. RESULTS: Presence of low back pain from ages 50 to 60 and from ages 60 to 70 years was associated with elevated Hypochondriasis-Depression-Hysteria scales at age 50 and 60 years. Profiles showing the "conversion-V" configuration were present with a history of low back pain, at the 50-year and 60-year Minnesota Multiphasic Personality Inventory test. Minnesota Multiphasic Personality Inventory scores collected at age 50 years were not different between those who did report and those who did not report low back pain during the decade from 60 to 70 years, provided that they had not experienced low back pain during the period from age 50 to 60 years. CONCLUSIONS: Elevations of Minnesota Multiphasic Personality Inventory Hypochondriasis-Depression-Hysteria scales were shown in persons with a history of low pack pain. The results indicated that low back pain is preceded by elevated Minnesota Multiphasic Personality Inventory scales was not supported.

Age Distribution↗
PubMed1995

Risk of myocardial infarction among subjects visiting a doctor because of back disorder. A case--control study in Finnish farmers.

STUDY DESIGN: A nested case-control study was made to analyze the correlation between back trouble and myocardial infarction. OBJECTIVES: The purpose of the present study was to determine whether individuals visiting a doctor because of back trouble have an increased risk for myocardial infarction. SUMMARY OF BACKGROUND DATA: According to previous results, back pain precedes myocardial infarction in young and middle-aged male farmers. There are no previous results concerning the risk of myocardial infarction among patients visiting a doctor because of back pain. METHODS: The basic cohort includes 3172 Finnish farmers. Those having myocardial infarction from February 1, 1980 through December 31, 1992 were considered case studies. Three matched control subjects were selected for every case subject. The final group had 83 case subjects and 249 matched control subjects. Case subjects and control subjects were compared according to doctor visits because of back complaint during the follow-up period, which began February 1, 1980 and ended on the date of myocardial infarction of each case subject. RESULTS: Fewer case subjects than control subjects visited a doctor because of back disorders during the follow-up period. This was especially true for nonspecific back pain (odds ratio = 0.51; confidence interval = 0.25-1.05). CONCLUSION: Atherosclerosis is not a probable cause of any kind of back pain among individuals visiting a general practitioner because of back complaint.

Adult↗
PubMed1996

How common is low back pain in the Nordic population? Data from a recent study on a middle-aged general Danish population and four surveys previously conducted in the Nordic countries.

STUDY DESIGN: Data were obtained in a Danish cross-sectional postal survey and compared with information from four methodologically similar studies conducted in some of the Nordic countries between 1977-1985. OBJECTIVES: The objectives were to estimate the lifetime cumulative incidence and the 1-year period prevalence of low back pain in the general population, to study whether there are any differences in the occurrence of low back pain according to age and sex, and to investigate whether low back pain is on the increase. SUMMARY OF BACKGROUND DATA: The prevalence of low back pain commonly is thought to be high, but estimates differ considerably between studies. It is also not known whether low back pain is more common in men or women or in certain age groups, and it is unclear whether the prevalence of low back pain has increased in the past years. METHODS: Prevalence estimates were established in a current study, and results then were adjusted to suit the age and sex criteria of four previous studies. RESULTS: Between 60-65% of 30- to 50-year-old men and women living in the Nordic countries reported at least one incident of low back pain during their lifetime, based on the information from four studies with a total sample size of 3513. The most likely 1-year period prevalence estimate is between 44-54%, based on two studies and a total sample of 2035 individuals. There was no consistent evidence favoring higher figures with increasing age or relating to any of the genders. No clearly observed time-related trend was noted. CONCLUSIONS: When data were examined from five methodologically similar studies on the 30- to 50-year-old Nordic population, there was reasonable consistency of prevalence figures. Thus, approximately 66% report having had low back pain at least sometime during their lifetime and approximately 50% sometime during the preceding year, with no significant differences relating to age or sex. The best method to investigate whether low back pain is on the increase might be through replicate studies.

Adult↗
PubMed1996

The natural history of low back pain in adolescents.

STUDY DESIGN: A 5-year longitudinal interview and questionnaire-based survey of back pain in adolescents. OBJECTIVES: To determine the natural history of back pain during adolescence in boys and girls and to explore the influence of sports participation and lumbar flexibility. SUMMARY OF BACKGROUND DATA: Previous data on low back pain and flexibility in adolescents have come largely from cross-sectional studies with differing definitions and age groups. A longitudinal study would offer a more detailed description of aspects of the natural history of back pain. METHODS: A cohort of 216 11-year-old children was given a structured questionnaire about back pain. Follow-up evaluation was annual for 4 more years. Lumbar sagittal mobility was measured in first and last years. Life-table analysis was the chosen statistical method. RESULTS: Annual incidence rose from 11.8% at age 12+ to 21.5% at 15+ years. Lifetime prevalence rose from 11.6% at age 11+ to 50.4% at age 15+ years. Experience of back pain was frequently forgotten. Recurrent pain was common, usually manifesting as such rather than as progression from a single episode; few children required treatment. Back pain was more common in boys than girls, especially by age 15 years. There was a positive link between sports and back pain only for boys. Severity and flexibility were not related to sex, treatment, or sport. CONCLUSIONS: Back pain in adolescents is common; it increases with age and is recurrent, but in general does not deteriorate with time. Much of the symptomatology may be considered a normal life experience, probably unrelated to adult disabling trouble.

Adolescent↗
PubMed1996

Occupational risk factors for the first-onset and subsequent course of low back trouble. A study of serving police officers.

STUDY DESIGN: A survey of occupational risks for low back trouble in two police forces discordant for one known physical stressor (wearing body armor weighing approximately 8.5 kg. OBJECTIVES: To determine the hazard for first-onset and subsequent course of low back trouble associated with occupational physical and psychosocial stressors. SUMMARY OF BACKGROUND DATA: Various occupational physical stressor have been associated with the prevalence of back pain, but their relationship with first-onset low back trouble is uncertain. Psychosocial factors reportedly are important determinants of chronicity. METHODS: Anamnestic data on low back trouble were collected from representative random samples of "exposed" and control forces, along with variables describing exposure to occupational physical stressors and sports results. Psychometric tests were administered. RESULTS: Occupational risk factors for first-onset low back trouble were determined from lifetables based on officers with no previous back pain history. Survival time to first onset was affected adversely by wearing body armor and, less so, by vehicular exposure and sports participation. The proportion with persistent (chronic) trouble did not depend on length of exposure since onset, but longer service was associated with recurrent episodes. Chronicity was related to distress and blaming police work. Work loss was associated with blaming work and wearing body armor. Changing to lighter duties after development of low back trouble occurred rarely. CONCLUSIONS: Exposure to occupational physical stress seems detrimental; It reduced survival time to first-onset of low back trouble. Recurrence was associated with time since onset, but persistent trouble was not. Sports participation was a risk if occupational hazards were high.

Adult↗
PubMed1997

Low synthesis rate of type I procollagen is normalized during active back rehabilitation.

STUDY DESIGN: Open, prospective trial with patients participating in an active back restoration program. OBJECTIVES: To compare the concentrations of biochemical indicators of Type I and III collagen synthesis and Type I collagen degradation in the serum of patients with chronic low back pain and healthy control subjects and to evaluate the effect of active back rehabilitation based on vigorous exercise on collagen metabolism. SUMMARY OF BACKGROUND DATA: The aim of active back rehabilitation is to restore the physical function of low back pain patients falling into the so-called "deconditioning syndrome." The changes in functional muscle strength measurements during the restoration rehabilitation program always depend on motivation, learning phenomena, and fear of pain and injury, so that even more objective ways of showing changes in physical activity are needed. METHODS: Specific radioimmunoassays for the amino-terminal (PINP) and carboxy-terminal (PICP) propeptides of Type I procollagen, the amino-terminal propeptide of Type III procollagen (PIIINP), and the cross-linked carboxy-terminal telopeptide of Type I collagen (ICTP) were used for serum samples obtained from 41 patients before, during, and after an active back restoration program and from 16 age- and sex-matched healthy control subjects. RESULTS: The circulating concentrations of PINP and PICP were initially lower in the patients ([mean +/- SD] 35.3 +/- 12.5 micrograms/L and 119.0 +/- 32.6 micrograms/L, respectively) than in the control subjects (47.9 +/- 18.0 micrograms/L and 136.7 +/- 47.7 micrograms/L, respectively; P < 0.05 for PINP). Toward the end of the active back rehabilitation program, both PINP and PICP increased in the patients (P < 0.001 for the increase between the initial level and the end of rehabilitation). There was a significant difference in the time courses of these changes, with the circulating PICP concentration increasing earlier than that of PINP. In the intervention group, the PIIINP concentration also increased (P < 0.01), whereas the ICTP concentration remained unchanged, with a tendency to decrease. No changes occurred in the control subjects. CONCLUSIONS: Active back rehabilitation based on vigorous exercise increases. Type I collagen synthesis in patients with chronic low back pain; this may provide a means of objectively verifying the effects of such rehabilitation.

Adult↗
PubMed1997

Back problems and atherosclerosis. The Study of Osteoporotic Fractures.

STUDY DESIGN: A cross-sectional and prospective study of osteoporotic fractures. OBJECTIVES: To investigate the correlation between lower extremity arterial disease or history of cardiovascular disease and back pain, back function, osteoporosis, and vertebral fractures. BACKGROUND: It has been postulated that atherosclerosis may compromise blood flow to bone and soft tissues in the back, causing pain and disability. Recent studies have presented conflicting results. METHODS: At baseline, information on back pain and function, general functional status, cardiovascular history, and general lifestyle variables was obtained from 1492 elderly white women (mean age, 71 years) enrolled in the Study of Osteoporotic Fractures. Lateral radiographs of the lumbar and thoracic spine were obtained, and lower extremity arterial disease was assessed. Follow-up information was obtained an average of 3.7 years later. RESULTS: At baseline, 82 women had arterial disease, 443 had a history of cardiovascular disease, and 277 had vertebral fractures; 58 women had one or more additional vertebral fractures during the follow-up period. After adjustment for age, women with cardiovascular disease were more likely to have back pain and disability as a result of the back pain than women free of cardiovascular disease; at the follow-up examination, the back-related disability was more than twice as likely to have worsened in the cardiovascular disease group. No correlation was found between arterial disease and back problems. Neither the prevalence of vertebral fractures at baseline, nor the incidence of vertebral fractures was associated with the presence of arterial disease or cardiovascular disease. CONCLUSIONS: Results indicated that back problems in elderly women are associated with self-reported cardiovascular disease, but not with objectively assessed lower extremity arterial disease.

Aged↗
PubMed1997

Determinants of isokinetic and psychophysical lifting strength and static back muscle endurance: a study of male monozygotic twins.

STUDY DESIGN: Retrospective cohort. OBJECTIVES: To determine the relative contributions of anthropometric factors, physical activity, back and neck pain, overall health, and familial aggregation (the combined effects of genetics and childhood environment) to different measurements of adult back muscle function. SUMMARY OF BACKGROUND DATA: Many methods of muscle testing are employed in the attempt to predict, prevent, treat, and rehabilitate low back pain. Poor correlations between the test results suggest that they are measuring different attributes and have different determinants. METHODS: Muscle function tests, magnetic resonance images, and a detailed interview were obtained in 65 pairs of monozygotic male twins. RESULTS: Familial aggregation was the strongest determinant of isokinetic and psychophysical lifting and static back endurance, explaining 56%, 32%, and 15% of the variances, respectively, beyond that which age alone predicted. Back pain and physical loading in work and leisure explained 2%, 0%, and 23% of the variances. CONCLUSIONS: The combined effects of genetics and childhood environment play a dominant role in determining adult back muscle function. Physical loading at work and leisure, back and neck pain history, overall health, and anthropometric factors had a comparatively minor role, suggesting that the potential of interventions to increase and sustain back muscle function in healthy adults, measured through these tests, may be limited. The relative contributions of constitutional, behavioral, and environmental factors differ substantially in the three tests, and provide insights into what these commonly used tests actually reflect or measure. This knowledge can be used to guide more appropriate selection and interpretation of results of back muscle function tests.

Adult↗
PubMed1998

At what age does low back pain become a common problem? A study of 29,424 individuals aged 12-41 years.

STUDY DESIGN: A cross-sectional study was performed in a Danish population of individuals 12-41 years of age. OBJECTIVES: To study the lifetime cumulative incidence, the 1-year period prevalence, and point prevalence of low back pain in the general population and to investigate whether there were any differences in the occurrence of low back pain that were related to age and gender, especially in young individuals. SUMMARY OF BACKGROUND DATA: The epidemiologic literature fails to provide a credible estimate of the prevalence of low back pain in children and adolescents compared with that of adults. METHODS: A postal questionnaire was sent to 34,076 twins who were born between 1953 and 1982 and listed in the population-based Danish Twin register. The response rate was 86%. RESULTS: The prevalence of the various definitions of low back pain increased greatly in the early teen years (earlier for girls than for boys), and by the ages of 18 years (girls) and 20 years (boys) more than 50% had experienced at least one low back pain episode. The pattern for the 1-year period prevalence of low back pain was very similar to that for the lifetime prevalence; both started at 7% (95% confidence interval, 5-9%) for the 12-year-old individuals and reached 56% (95% confidence interval, 53-59%) and 67% (95% confidence interval, 62-71%), respectively, for the 41-year-old individuals. The pattern for the point prevalence resembled that of the more than 30 days of low back pain reported in the preceding year; the rate increased steadily from 1% (95% confidence interval, 0-2%) to 1.7% (95% confidence interval, 14-20%). There was a general tendency for more women to report low back pain than men, but this difference generally was not statistically significant. CONCLUSIONS: The study of the causes and prevention of low back pain needs to be focused on childhood and adolescence.

Adolescent↗
PubMed1998

Association between measures of spinal mobility and low back pain. An analysis of new attenders in primary care.

STUDY DESIGN: Comparison of spinal movements in new attenders to primary care with an episode of low back pain with a sample with no recalled history of ever having had low back pain. OBJECTIVES: To examine the association between restriction of spinal movement and the presence of low back pain in primary care. SUMMARY OF BACKGROUND DATA: The presence of restriction in spinal mobility has frequently been investigated by specialists in the clinical setting. What is not known, however, is whether an association exists between pain and restriction in those newly presenting to primary care and whether these measurements can be used to discriminate between those with and without back pain. METHODS: The study participants consisted of 344 consulters to two general practices, prospectively ascertained in the South Manchester Back Pain Study, who were compared with 118 individuals from the same practices who denied ever having back pain. The two groups were compared for right and left lateral flexion, standing extension, modified Schober's test, finger-to-floor distance, and right and left knee extension. RESULTS: There was a statistically significant reduction in all planes in those with low back pain. Modified Schober's, standing extension, and left knee extension were the most discriminatory, with likelihood ratios of approximately 5 for the optimal cutoff. Restriction of three or more of these seven movements was observed in 50% of the low back pain cases and in less than 5% of the pain-free participants. Stratification by presence or absence of radiation of pain to the legs did not alter these findings. CONCLUSIONS: Measures of spinal mobility are restricted to varying extents in a community-based sample of subjects with low back pain. Maximal discrimination was observed when restriction was present in three or more planes. The utility of these measures in predicting outcome remains to be assessed.

Adult↗
PubMed1999

Influence of estrogen-progestin treatment on back pain and disability among slim premenopausal women with low lumbar spine bone mineral density. A 2-year placebo-controlled randomized trial.

STUDY DESIGN: A 2-year randomized controlled trial. OBJECTIVES: To examine the possible preventive or aggravating effect of estrogen-progestin treatment on the back symptoms of slim premenopausal women with low lumbar spine bone mineral density. SUMMARY OF BACKGROUND DATA: The incidence of back pain, sciatica, or both starts to increase clearly among 45-54-year-old Finnish women. METHODS: Forty-eight 39- to 49-year-old premenopausal women with a body mass index of 21 or less and a lumbar spine bone mineral density (L2-L4) of 1.1 +/- 1 g/cm3 or less compared with the normative population were recruited into the study. The women were assigned randomly to receive either estradiol-noretisteron acetate treatment or placebo. Back pain, symptoms, and disability were assessed with the Million and Oswestry questionnaires and pain drawings during the follow-up period at 0, 12, and 24 months. Inquiry also was made concerning previous back pain and sciatica history. RESULTS: There was a statistically significant decrease in nighttime back pain (P < 0.001) and the total Oswestry disability scores (P < 0.004) in the hormone-treated group compared with the control group during the follow-up, but no statistically significant differences were found in daytime back pain. At baseline, the cumulative incidence in a history of pain radiating from the buttock to the foot in this osteopenic study group was 31/48, (64.5%; 95% CI 50.5-78.6), which is much more than the predicted 20/48, (42.4%; 95% CI 39.0-45.7) at this age according to a previous population study. The cumulative incidence of at least one back pain episode 44/48, (91.7%; 95% CI 83.6-99.8) was somewhat higher in these participants than was predicted for a comparative population of women this age, 38/48 (79.2%; 95% CI 70.2-87.3). CONCLUSIONS: It seems that this regimen may have alleviating effects on nighttime back pain and functional back disability in slim osteopenic premenopausal women.

Adult↗
PubMed1999

The association between cigarette smoking and back pain in adults.

STUDY DESIGN: A retrospective cohort study of adolescent idiopathic scoliosis. A comparison group of persons without scoliosis was also selected randomly from the general population. OBJECTIVES: To estimate the association between level of cigarette smoking and the prevalence and severity of back pain. METHODS: A postal questionnaire was used to elicit information on smoking histories, a variety of indices of low back pain, and potential confounding factors. The association between smoking and back pain was estimated separately for men and women in the cohort and in the comparison group using ordinal regression models. RESULTS: The questionnaire was completed by 1287 women and 184 men who had adolescent idiopathic scoliosis and by 1130 women and 621 men in the comparison population who did not have scoliosis. Statistically significant associations between back pain and current cigarette smoking were found in the two groups of women and men with scoliosis, but not among men selected from the general population. In the three former groups, proportional odds ratios comparing current smokers to persons who never smoked ranged from 1.4 to 1.9. Among current smokers, the prevalence of back pain increased with cigarette consumption, and the proportional odds ratios ranged from 1.2 to 1.8 per 10 pack-years (no. of cigarettes smoked per day x no. of years/20). In these three groups, intensity, frequency, and duration of episodes of back pain also were found to increase with smoking consumption. CONCLUSION: The finding that smokers have more frequent episodes of back pain may imply that smoking exacerbates back pain, and the observation that stronger associations between back pain and smoking were found in the scoliosis cohort suggests that smoking may have a greater impact on persons with damaged spines.

Adolescent↗
PubMed2000

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

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

Activities of Daily Living↗