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PubMed1990

Effects of chronic back pain on the perception of experimental heat pain.

19 patients between 23 and 65 yr. of age whose chronic back pain was caused by lumbosacral disk disease and 19 healthy volunteers matched for age and sex were studied. Pain thresholds under phasic and tonic heat stimulation and thermal thresholds for warmth and cold were measured on the right hand. The patients rated any current back pain on a visual analog scale. There was a significant negative correlation between current back pain and the threshold for tonic pain, but there was no correlation between current back pain and either the threshold for phasic pain or temperature sensitivity. Hence, current back pain and experimental tonic pain seem to have an additive effect on pain perception because perceptual qualities are similar. Reduced somatosensory perception of chronic back pain patients could be demonstrated for temperature sensitivity and to a lesser degree for phasic pain, but as a consequence of the "opposing" effect of current back pain, not for tonic pain perception.

Arousal↗
PubMed2006

Relief of low back pain immediately after acupuncture treatment--a randomised, placebo controlled trial.

BACKGROUND: The purpose of this study was to examine the immediate effect of single acupuncture stimulation to the most painful point in patients with low back pain. METHOD: A randomised, evaluator-blinded, sham controlled clinical trial was conducted in which 31 patients with low back pain were randomly allocated to either an acupuncture group (n = 15) or a sham acupuncture group (n = 16). Both acupuncture and sham acupuncture were performed at the most painful point on the lower back of the subjects. For the acupuncture group, a stainless steel needle was inserted to a depth of 20 mm and manually stimulated (sparrow pecking method) for 20 seconds, while for the sham treatment a guide tube without a needle was placed at the point and tapped on the skin. Changes in low back pain were evaluated with a visual analogue scale (VAS) and the Schober test. Participants were also asked if they felt the needling sensation or not. The therapy and the evaluation were independently performed by two different acupuncturists. RESULTS: VAS score and the Schober test score showed significant improvement after treatment as compared with the sham group (P = 0.02, 0.001, respectively). There were no significant differences in the needling sensation between the acupuncture and sham group. CONCLUSION: These results suggest that acupuncture at the most painful point gives immediate relief of low back pain.

Acupuncture Points↗
PubMed1987

Persistent back pain due to malignant lymphadenopathy.

Back pain is a common problem in rheumatology clinics and has a wide differential diagnosis. Ten young patients are described with the syndrome of persistent back pain, severe enough to prevent sleep, and characteristically eased by sitting forwards, which accompanies malignant retroperitoneal lymphadenopathy. Spinal movements and x rays are typically normal. Repeated thorough examinations are required to detect superficial adenopathy or testicular swellings. Ultrasound scanning usually reveals the nodes, which can also be demonstrated by computed tomographic (CT) scanning. These young patients have a variety of cancers, many of which can be cured, so increased awareness of this syndrome could save lives.

Adult↗
PubMed1992

Role of psychosocial risk factors in work-related low-back pain.

The experience of low-back pain and its psychosocial associates were directly compared among sufferers drawn from three populations, a blue-collar working group, a white-collar working group, and a patient group. Sufferers drawn from the patient population revealed the expected psychological disturbance. There was no evidence of such involvement for sufferers still at work. Disability resulting from low-back pain was positively linearly related to severity of pain for sufferers drawn from working groups, irrespective of psychological disturbance. For patients, on the other hand, the presence of psychological disturbance modified the relationship between severity and disability such that no simple linear relationship existed between the two variables. Work dissatisfaction was not found to be related to the presence of, and did not account for disability resulting from, low-back pain in working subjects.

Adult↗
PubMed1996

The role of congruence between patient and therapist in chronic low back pain patients.

OBJECTIVE: To determine the role of congruence in the perception of the evolution of back pain during treatment and in the expectations about the future of back pain problems. Congruence was defined as the agreement between patient and therapist on various aspects of back pain problems and of treatment. DESIGN: Semistructured interviews at the beginning and the end of treatment. SUBJECTS: Seventy-one back pain patients and their therapists (6 chiropractors and 6 rheumatologists). MAIN OUTCOME MEASURES: Synthesized index of congruence based on 24 questions asked of both the patient and his/her therapist. RESULTS: The distribution of the congruence scores indicated a high level of congruence in 39.4% of the cases, an average level in 35.2% and a low level in 25.4%. The results demonstrated that congruence was significantly associated with the perception of an improvement in back pain. This positive perception was nevertheless associated with the expectation of persistence or recurrence of the back pain problem in the future. Noncongruence was correlated with the patient's estimation of a less favorable evolution of the back pain problem during the treatment and with a major difficulty for both the therapist and the patient to express clear expectations about the future of the patient's back pain problem. CONCLUSIONS: Congruence mainly reflects an agreement that the treatment is aimed at the management of a long-term condition rather than at the resolution of the back pain problem. Congruent patients seem to accept living with their back problems, a position shared by their therapists, whereas noncongruent patients do not seem to share this conception of back pain.

Adult↗
PubMed2006

Prevalence and characteristics of upper or mid-back pain in Finnish men.

STUDY DESIGN: Descriptive epidemiologic study. OBJECTIVES: To examine the 1-year prevalence, severity, and frequency of mid-back pain in a general population sample of men, with comparisons to neck and low back pain. SUMMARY OF BACKGROUND DATA: No previous studies reporting the characteristics of mid-back pain in a general population were found. METHODS: A total of 600 Finnish men 35 to 70 years of age were drawn from a population-based twin sample and interviewed with standardized pain questions. RESULTS: The 1-year prevalence of mid-back pain was 17.0% (95% confidence interval, 14.3-19.7) compared to 64.0% (95% confidence interval, 60.6-67.5) for neck and 66.8% (95% confidence interval, 63.4-70.3) for low back pain. The frequency of pain over the previous year among those with mid- and low back pain was less than for neck pain. The mean severity of the worst pain episode was highest for low back pain followed by mid-back and neck pain, which were similar. Associated disability tended to be less frequent from mid-back pain (23.5% vs. 30.3%-41.1%). Odds ratios for neck and low back pain when mid-back pain was reported were 2.32 and 2.86, respectively. CONCLUSION: The prevalence of mid-back pain was approximately one fourth that of neck and low back pain and was somewhat less likely to be disabling. In cases of mid-back pain, spinal comorbidity was nearly always reported.

Adult↗
PubMedDate not supplied

Nonspecific back pain in children. A search for associated factors in 14-year-old schoolchildren.

BACKGROUND: Nonspecific back pain in children is nearly as common as in adults but is associated with a number of age-specific risk factors including female gender, a family history of low back pain, a high level of physical activity, and prolonged sitting. OBJECTIVE: To investigate potential school-related risk factors for back pain in children, most notably schoolbag weight expressed as a percentage of body weight (relative schoolbag weight), whether the schoolbag is carried by hand or by a shoulder harness, how the child travels to and from school, and sitting positions. PATIENTS AND METHODS: 123 eighth-graders, 58 girls and 65 boys, with a mean age of 14 +/- 0.6 years, completed an anonymous self-questionnaire during a school day involving six hours of classes. Their schoolbag was weighed on the same day. RESULTS: Most respondents traveled to and from school in a vehicle (70%), made one trip in each direction each day (75%), and carried their schoolbag by the shoulder harness (92%). The prevalence of back pain on the study day was 27.6%, whereas the cumulative prevalence for the last 12 months was 82.9% with 16.3% of respondents reporting a single episode of pain, 57.7% recurrent pain, and 8.9% chronic pain. A need for a physician visit for back pain was reported in 18.7% of cases, and 14.6% of respondents had missed school and/or sporting activities because of back pain. Female gender was associated with current back pain (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.1). A relative schoolbag weight of 20% or more was associated with a history of back pain (OR, 3.1; 95% CI, 1.0-9.2), and this effect was larger in children who traveled to and from school on foot and in those who carried their schoolbag in their hand. Sitting on the edge of the chair while completing the questionnaire was significantly associated with a history of a physician visit for back pain (OR, 3.1; 95% CI, 1.0-9.5). Neither handedness nor the position of the questionnaire on the table were significantly associated with back pain in our study population. CONCLUSIONS: The findings from this cross-sectional study indicate a need for a longitudinal prospective study designed to identify etiologic and prognostic factors of back pain in adolescents, with the goal of devising preventive strategies likely to reduce the risk of low back pain in adulthood.

Adolescent↗
PubMed2002

The clinical importance of changes in outcome scores after treatment for chronic low back pain.

When measuring treatment effect in chronic low back pain with multi-item outcome instruments, it is necessary, both for clinical decision-making and research purposes, to understand the clinical importance of the outcome scores. The aims of the present study were three-fold. Firstly, it aimed to estimate the minimal clinically important difference of three multi-item outcome instruments (the Oswestry Disability Index, the General Function Score and the Zung Depression Scale) and of the visual analogue scale (VAS) of back pain. Secondly, it aimed to estimate the error of measurement of these instruments; and its third aim was to describe the clinical meaning of score change. The study population consisted of 289 patients treated surgically or non-surgically in a randomised controlled trial. The minimal clinically important difference was estimated with patient global assessment as the external criterion. It was compared with the standard error of measurement of the instruments. The individual items of the instruments were compared for score changes related to improvement and deterioration. The standard error of measurement of the Oswestry Disability Index, the General Function Score and the Zung Depression Scale was 4, 6 and 3 units, respectively. The 95% tolerance interval was 10, 16 and 8 units, respectively. The minimal clinically important difference was 10, 12 and 8-9 units, respectively, thus not significantly exceeding the tolerance interval. The minimal clinically important difference of VAS back pain was 18-19 units, well exceeding the 95% tolerance interval, which was 15 units. Improvement after treatment for chronic low back pain tends to occur to a greater extent in sleep disturbance, ability to do usual things and psychological irritability, but to a lesser extent in the ability to sit, stand and lift. We conclude that the VAS of back pain is responsive enough to detect the minimal clinically important difference, whereas the smallest acceptable score changes of the Oswestry Disability Index, the General Function Score and the Zung Depression Scale may require an increase to exceed the 95% tolerance interval when used for clinical decision making and for power calculation. Despite improvement after treatment, the ability to sit, stand and lift, remain notable problems.

Activities of Daily Living↗
PubMed2002

Real-time assessment of pain behavior during clinical assessment of low back pain patients.

The development of procedures for assessing factors that contribute to pain and disability is crucial for clinical and epidemiologic studies. The present paper describes a system for in vivo, real-time assessment of pain behaviors integrated with a standardized physical examination for low back pain patients. The principles for measuring five categories of pain behavior--guarding, touching/rubbing, words, sounds and facial expressions--and for parsing the physical examination are described. The system was learned by five observers who then applied it during the physical examinations of 176 patients classified as suffering from sub-acute or chronic pain. The system was also applied to 77 patients in a test-retest consistency study. Measures of guarding, words, sounds and facial expression showed adequate psychometric properties. The test-retest consistency of guarding, sounds and facial expression was moderate-to-good, suggesting that these behaviors were consistent over the test-retest interval and promising for future study. The advantages and limitations of the technique are discussed and ways of modifying it to simplify coding and enhance the accuracy and reliability of its application are suggested. Overall, the technique shows promise for clinical and epidemiologic research.

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↗
PubMed2002

Episodes of low back pain: a proposal for uniform definitions to be used in research.

STUDY DESIGN: Literature review and group discussions. OBJECTIVE: To propose uniform definitions for low back pain episodes to be used in research. BACKGROUND: Different definitions of episodes have been used in low back pain studies. This hampers comparison of study results. Definitions are proposed for episodes of low back pain, care for low back pain, and work absence because of low back pain. METHODS: In a Medline search, we identified about 1200 papers, of which 81 possibly contained a definition of episodes. In group discussions, we decided which definitions to propose and discussed their applicability. RESULTS: We found few definitions in the literature. In the group discussions we decided to define an episode of LBP as a period of pain in the lower back lasting for more than 24 hours, preceded and followed by a period of at least 1 month without low back pain. An episode of care for low back pain was defined as a consultation or a series of consultations for low back pain, preceded and followed by at least 3 months without consultation for low back pain. An episode of work absence due to low back pain was defined as a period of work absence due to low back pain, preceded and followed by a period of at least 1 day at work. CONCLUSIONS: In many studies, episodes of low back pain are mentioned without a clear definition. We consider our proposed definitions of episodes to be arbitrary but well considered. We advise that they be tested for use in future research.

Absenteeism↗
PubMed1996

[Radiographic clinical and functional diagnosis and treatment of low back pain associated with pelvic malposition].

UNLABELLED: Low back pain ist frequently associated with malposition of the pelvis due to an imbalance of the postural muscles. In these patients functional malposition of both the sacrum and the ileum can be observed, resulting in differences in the length of the legs. We investigated whether the return to a normal position correlated with pain relief. METHODS: A total of 40 control patients and 65 patients with low back pain were included in this retrospective study. Prior to the start and at the end of the treatment period the differences in the length of the legs were determined manually and radiographically at the ankles with the patient in the supine and sitting position. Furthermore, somatic dysfunctions at C0/C1 or C2/C3 were determined in all patients. In the low back pain group, 39 patients were treated with manual therapy at the cervico-occipital joints and/or infiltration of the iliosacral joint with local anaesthetics and 26 patients were treated with parenteral non-steroidal anti-inflammatory drugs (NSAIDs). The success of the treatment was determined after 6 months and correlated with a return to the normal pelvic position. RESULTS: Somatic dysfunction at C0/C1 or C2/C3 and differences in the length of the legs were observed in 32 control patients and in all patients with low back pain. Manual therapy/lidocaine infiltration resulted in complete long-term pain relief in 23 patients (59 %), while in the NSAID group only 4 patients (15 %) became pain free (P < 0.05). Long-term pain relief significantly correlated with normalization of the pelvic position. CONCLUSION: Differences in the length of the legs can be successfully treated by manual therapy at C0/C1 or C2/C3 in the majority of patients with pelvic malposition. However, infiltration of the iliosacral joints is often required as additional therapy for short-term and long-term pain relief. Treatment with NSAIDs alone is only seldom effective in cases of pelvic malposition and rarely affords long-term pain relief.

English Abstract↗
PubMed1998

Back pain following epidural anaesthesia in labour.

PURPOSE: To determine the factors associated with the development of post-partum back pain following epidural anaesthesia for labour and delivery and its incidence. METHODS: A prospective observational cohort study was conducted in a University affiliated tertiary care hospital. Women presenting for labour and delivery who were planning to have epidural anaesthesia were eligible for study. Baseline data were obtained from the women and obstetrical and anaesthetic data from the hospital chart. Women were contacted by phone at four to six weeks post-partum and questioned regarding the presence of any back pain and pain lasting longer than 14 days. RESULTS: Three hundred women entered the study and follow-up was obtained in 270 (90%). The incidence of back pain was 30.7% and back pain lasting longer than 14 days was 8.5%. Nulliparity was associated with a decreased risk of developing back pain post-partum but this decrease was only associated with pain lasting more than 14 days: Odds Ratio (OR) [95% confidence interval] 0.32 [0.11-0.94]. A previous history of back pain was strongly associated with the development of any back pain (OR 43.85 [9.97-192.9] but not with pain lasting longer than 14 days (OR 2.16 [0.71-6.58]). Age, weight and the duration of the second stage of labour were not associated with the development of back pain. CONCLUSIONS: Back pain following epidural anaesthesia is common but persistent back pain is much less common. A previous history of back pain increases the likelihood of post-partum back pain following epidural anaesthesia. Nulliparity is associated with a decreased risk.

Adult↗
PubMed2006

Use of conventional and alternative treatment strategies for a case of low back pain in a F/A-18 aviator.

BACKGROUND: Low back pain can diminish jet pilot concentration and function during flight and be severe enough to ground pilots or cause decreased flying time. The objective of this case report is to present an example of the integration of chiropractic care with conventional treatments for the management of low back pain in a F/A-18 aviator. CASE PRESENTATION: The patient had insidious severe low back pain without radiation or neurological deficit, resulting in 24 hours of hospitalization. Spinal degeneration was discovered upon imaging. Four months later, it still took up to 10 minutes for him to get out of bed and several minutes to exit the jet due to stiffness and pain. He had discontinued his regular Marine Corps fitness training due to pain avoidance. Pain severity ranged from 1.5-7.1 cm on a visual analog scale. His Roland Morris Disability Questionnaire score was 5 out of 24. The pilot's pain was managed with the coordinated efforts of the flight surgeon, physiatrist, physical therapist, and doctor of chiropractic. Following this regimen he had no pain and no functional disability; he was able to fly multiple training missions per week and exercise to Marine Corps standards. CONCLUSION: A course of care integrating flight medicine, chiropractic, physical therapy, and physiatry appeared to alleviate pain and restore function to this F/A-18 aviator with low back pain.

Journal Article↗
PubMedDate not supplied

Experimentally induced pain perception is acutely reduced by aerobic exercise in people with chronic low back pain.

This study examined whether subjects with chronic low back pain demonstrate exercise-induced analgesia to experimentally induced pressure pain. We employed a repeated measures design to study eight subjects with chronic low back pain (mean +/- standard deviation age = 40 +/- 10, duration of pain = 7 +/- 4 years). Pain ratings were measured immediately before and 2 minutes and 32 minutes after 25 minutes of cycle ergometry (5 minutes at 50% peak oxygen uptake, then 20 minutes at 70% peak oxygen uptake). We based the pain ratings on subject input on a visual analog scale at 10-second intervals during the 2-minute pressure pain stimulus to the nondominant index finger. Compared with preexercise values, pain ratings were significantly (p < 0.05) decreased after exercise at both 2 and 32 minutes postexercise. We conclude that pressure pain perception can be reduced for more than 30 minutes following aerobic exercise from leg cycling among people with chronic low back pain.

Adult↗
PubMed1998

Methodologic issues in low back pain research in primary care.

STUDY DESIGN: Narrative review and discussion of the selected literature. OBJECTIVES: To discuss some important methodologic challenges in low back pain research in primary care. SUMMARY OF BACKGROUND DATA: Many methodologic problems must be confronted when conducting low back pain research. Some of these problems are back pain specific or specific to the primary care setting. METHODS: Methodologic problems related to four research issues will be discussed: study designs, definition of low back pain, determinants of low back pain, and outcome assessment. RESULTS: Two fundamentally different study designs are frequently used in low back pain research, namely observational studies and experimental studies. The definition of low back pain is typically restricted to a highly variables self-reported symptom, the sensation of pain in the back. There clearly is a need for an evidence-based classification system for low back pain. Because a tenable theoretical framework is lacking, it is difficult to know which determinants of low back pain should be quantified. Low back pain studies focus usually on health-related quality-of-life outcome parameters. The identification of the minimum clinically relevant changes for the most important outcome instruments needs further consideration. CONCLUSIONS: In years to come, low back pain researchers are challenged to overcome some of these (and other) problems to enhance the quality of low back pain research in primary care.

Clinical Trials as Topic↗
PubMed1994

Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain.

The effect of low back pain on the size of the lumbar multifidus muscle was examined using real-time ultrasound imaging. Bilateral scans were performed in 26 patients with acute unilateral low back pain (LBP) symptoms (aged 17-46 years) and 51 normal subjects (aged 19-32 years). In all patients, multifidus cross-sectional area (CSA) was measured from the 2nd to the 5th lumbar vertebrae (L2-5) and in six patients, that of S1 was also measured. In all normal subjects, CSA was measured at L4 and in 10 subjects measurements were made from L2-5. Marked asymmetry of multifidus CSA was seen in patients with the smaller muscle being on the side ipsilateral to symptoms (between-side difference 31 +/- 8%), but this was confined to one vertebral level. Above and below this level of wasting, mean CSA differences were < 6%. In normal subjects, the mean differences were < 5% at all vertebral levels. The site of wasting in patients corresponded to the clinically determined level of symptoms in 24 of the 26 patients, but there was no correlation between the degree of asymmetry and severity of symptoms. Patients had rounder muscles than normal subjects (measured by a shape ratio index), perhaps indicating muscle spasm. Linear measurements of multifidus cross-section were highly correlated with CSA in normal muscles but less so in wasted muscles, so CSA measurements are more accurate than linear dimensions. The fact that reduced CSA, i.e., wasting, was unilateral and isolated to one level suggests that the mechanism of wasting was not generalized disuse atrophy or spinal reflex inhibition.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed2001

Assessment of sexual activity in patients with back pain compared with patients with neck pain.

Recent research has shown significant adverse effects of chronic low back pain on sexual activity in 46% of patients. To establish whether and how chronic low back pain adversely affects sexual activity, a questionnaire-based study was conducted on a patient group (low back pain) and a comparison group (neck pain). Patients were administered a visual analog scale, a series of conventional questionnaires, and a specifically designed sexual activity questionnaire covering frequency of intercourse before and since onset of pain, discomfort during intercourse, satisfaction with sexual life, and comfortable and uncomfortable basic coital positions. Patients with low back pain reported more interference than did patients with neck pain, and women with low back pain were more affected than men. Compared with the other groups, women with low back pain had greater reduction in frequency of intercourse, more marked discomfort during intercourse, and more interference with their sexual lives. The most pain generating position was prone for both genders, and the most comfortable one was supine. Sexual impairment, more marked in women, seems to be related to the triggering of pain by intercourse and to psychologic factors.

Adult↗