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PubMed1995

Influence of physical, psychological and behavioural factors on consultations for back pain.

Over 34,000 questionnaires were used to study occurrence and consultations for back pain in the community. The 12-month period prevalence was 24% and 13% of the sample consulted a doctor. Elderly women were at greatest risk of back pain. The consultation rate increased in both sexes throughout middle age, but declined in men over the age of 55 yr. Back pain was associated with the Goldberg General Health Health Questionnaire score suggesting psychiatric morbidity [odds ratio (OR) = 2.05; confidence interval (CI) 1.89-2.23], obesity (OR = 1.59; CI 1.40-1.79), and cigarette smoking (OR = 1.52; CI 1.36-1.70). Vigorous daily activity was positively associated with back pain in men aged 18-39 yr (OR = 1.37; CI 1.02-1.85), and women aged 18-39 yr (OR = 1.50; CI 1.08-2.09), but was negatively associated with back pain in women aged over 65 yr (OR = 0.35; CI 0.16-0.76). Alcohol consumption was also negatively associated with back pain (OR = 0.72; CI 0.62-0.85). The prevalence of arthritis, constipation and respiratory disorders was increased in those who consulted for back pain corrected for the other variables. Thus back pain was substantially more common in women compared to men over 55 yr. Psychiatric morbidity, cigarette smoking and obesity were associated with back pain at all ages, but the effect of physical exercise appeared to change with age. Further studies are required to explain the sex differences and nature of the associations.

Adolescent↗
PubMed2005

[Epidemiological characteristics of low back pain in selected sample of rehabilitation centre "Reumal" in Fojnica].

Low back pain, with or without propagation to lower extremities, still remains challenge not only for therapy but as diagnostic entity as well. This is the reason why literature is regularly refreshed with new epidemiological studies of low back pain. Six years retrospective study included 55.725 patients rehabilitated in Rehabilitation centre "Reumal" in Fojnica, from January 1997 to December 2002. From this sample it has been isolated 12.296 patients with diagnosis referred to low back pain, in order to get certain epidemiological parameters of low back pain, as: intrahospital prevalence, gender and age overview, overview of diagnostic entities referred to low back pain and their relationship to gender. Total prevalence of low back pain was 22,6 %, ranging from 17,8 % to 28,6 % by years. This epidemiological parameter of low back pain, as well as others, correlate with data of other studies.

Adult↗
PubMed1992

Epidemiology of low back pain.

At present, although there have been many epidemiological studies of risk factors for low back pain, there are few risk factors established in prospective studies; and our understanding of them remains relatively crude. Individuals in jobs requiring manual materials handling, particularly repeated heavy lifting and lifting while twisting, are at increased risk of back pain leading to work absence. In addition, exposure to whole-body vibration and job requirements for static postures are associated with back pain. Individual trunk strength has not been consistently demonstrated as associated with back pain; although there is some suggestion that when work requirements for heavy lifting exceed individual capacities, back pain is more likely to occur. The pattern of peak age at onset in the 20's is consistent with back pain development early in working life. Among other individual characteristics, only cigarette smoking has consistently been associated with back pain; and the biological mechanism for this finding is not understood. Evidence with respect to spinal flexibility, aerobic capacity, educational attainment and other variables is suggestive but not consistent. There is some evidence that the individual's relation to work, expressed as job satisfaction or supervisor rating, is also related to work absence due to back pain. While it is possible to describe, however crudely, the characteristics placing people at risk for back pain leading to work absence and/or medical attention, the problem of predicting chronicity and thus identifying patients for more intensive clinical intervention remains unresolved. At this time, only age of the patient and certain clinical features of the back pain such as the presence of sciatic symptoms, duration of the current episode, and history of prior episodes are consistently demonstrated predictors. In chronic patients, there is suggestive evidence that spinal flexibility, trunk strength, and certain psychological characteristics such as coping skills, fear and avoidance of pain or movement, job satisfaction, attribution of fault and hysterical or hypochondriacal features are associated with treatment failure. In addition, there is suggestive evidence that the availability of alternative work placement may allow for earlier return to work than otherwise. While the availability of disability compensation in excess of usual wages may serve as a disincentive to return to work. The latter-cited remain to be verified, while findings in chronic patients remain to be tested in acute. Further, the role of physical demands of work in duration of back pain episodes has not been well studied.

Adult↗
PubMed1983

EMG biofeedback used to reduce standing levels of paraspinal muscle tension in chronic low back pain.

Twenty chronic low back pain (LBP) patients with relatively high standing paraspinal EMG levels (greater than 5 microV) were randomly assigned to 2 groups. One group (N = 10) received EMG biofeedback training to reduce standing paraspinal EMG levels, the other group (N = 10) served as a waiting list control group. Changes in perceived pain (duration X intensity) and paraspinal EMG in standing position were measured at a 3 week pretreatment baseline, during the 3 week treatment period, and at a 3 week post-treatment baseline. Compared to patients in the waiting list control group, those who received EMG biofeedback showed a significant decrease in standing paraspinal EMG from pretreatment to post-treatment baseline. However, no significant differences in reported pain were found during these periods. It is concluded that reduction of standing paraspinal EMG does not lead to reduction in pain.

Adult↗
PubMedDate not supplied

Back pain in former intercollegiate rowers. A long-term follow-up study.

BACKGROUND: Research has shown that 32% of intercollegiate rowers develop back pain during their college career. HYPOTHESIS: Rowers who develop back pain in college are more likely than the general population to have back pain later in life. STUDY DESIGN: Survey. METHODS: Surveys from 1561 former intercollegiate rowing athletes were analyzed. Subjects who completed the surveys had graduated from college at a mean and median of 13 years previously, with a range of 0 to 20 years between graduation and completion of the survey. The survey was designed to determine the presence of back pain and its severity before, during, and after intercollegiate rowing. Back pain was defined as pain that lasted at least 1 week. RESULTS: Age was a significant predictor of back pain after college. Nevertheless, the lifetime prevalence of back pain in former intercollegiate rowers was no different from that of the general population (51.4% versus 60% to 80%). However, rowers who developed back pain in college had more subsequent back pain than rowers who were asymptomatic in college (78.9% versus 37.9%). Rowers who were asymptomatic in college had significantly lower rates of back pain as they aged than did the general population. The mean severity of current back pain was 3.5 +/- 1.9 on a scale of 1 to 10. CONCLUSIONS: Intercollegiate rowers are no more likely than the general population to have back pain later in life.

Adult↗
PubMed2006

Study of the prevalence and risk factors for low back pain in truck drivers in the state of São Paulo, Brazil.

OBJECTIVE: To investigate the prevalence of low back pain in truck drivers and check for possible risk factors related to the presence of low back pain. METHODS: A questionnaire was developed including personal factors such as age, practice of physical and sports activities, general health habits, occupation-related issues, and factors associated with low back pain. The body mass index (ratio of body weight to the square of height, kg/m2) was calculated. Of 489 male truck drivers assessed, 410 were enrolled into the study. The statistical analysis was divided into 2 stages: descriptive analysis of data, and binary logistical regression, where the response (dependent) variable (presence of low back pain) was associated with each independent variable to check for correlation with low back pain. RESULTS: Of the 410 truck drivers evaluated, 242 (59%) presented with low back pain, while 168 (41%) did not have low back pain. The only factor correlated with the presence of low back pain was the number of working hours; the other factors had no correlation with low back pain. CONCLUSION: The prevalence of low back pain in truck drivers was 59%. The number of working hours was the only variable associated with occurrence of low back pain, with an average of about 1 hour longer work time for drivers with low back pain compared to those without it and with an odds ratio of 1.07 (P = 0.026).

Adult↗
PubMed1982

Aortic aneurysm producing back pain, bone destruction, and paraplegia.

Back pain and paraplegia are uncommon presenting symptoms/signs of aortic aneurysms. Extensive destructive changes were noted in the lower lumbar vertebrae in a 79-year-old man with an aneurysm that had eroded into the spine. The association of back pain with vertebral body erosion requires evaluation for vertebral or paravertebral abscess, neoplasia, and aortic aneurysm. Arteriography is usually required to demonstrate continuity with the vertebral body and to exclude the coincidental association of an aortic aneurysm with another pathology, i.e., neoplasm. Aggressive surgical treatment is recommended for any rapidly expanding aneurysm. The natural history of the untreated lesion is one of rapid demise.

Aged↗
PubMed2002

The cochrane review of advice to stay active as a single treatment for low back pain and sciatica.

STUDY DESIGN: A systematic review was conducted within the Cochrane Collaboration Back Review Group. OBJECTIVES: To assess the effects of advice to stay active as a single treatment for patients with acute low back pain or sciatica. SUMMARY OF BACKGROUND DATA: Low back pain is a common reason for consulting a health care provider, and advice on daily activities constitutes an important part in the primary care management of low back pain. METHODS: All randomized studies available in systematic searches (electronic databases, contact with authors, reference lists) were included. Two reviewers independently selected trials for inclusion, assessed the validity of the included trials, and extracted data. Investigators were contacted to obtain missing information. RESULTS: Four trials, with a total of 491 patients, were included. In all the trials, advice to stay active was compared with advice for bed rest. Two trials were assessed as having a low risk of bias, and two as having a moderate to high risk of bias. The results were heterogeneous. The results from one high-quality trial of patients with acute, simple low back pain found small differences in functional status (weighted mean difference on a 0 to 100 scale, 6.0; 95% CI, 1.5-10.5) and length of sick leave (weighted mean difference, 3.4 days; 95% CI, 1.6-5.2) in favor of staying active, as compared with advice to stay in bed 2 days. The other high-quality trial compared advice to stay active with advice to rest in bed 14 days for patients with sciatic syndrome, and found no differences between the groups. One of the high-quality trials also compared advice to stay active with advice to engage in exercises for patients with acute, simple low back pain, and found improvement in functional status and reduced sick leave in favor of advice to stay active. CONCLUSION: The best available evidence suggests that advice to stay active alone has little beneficial effect for patients with acute, simple low back pain, and little or no effect for patients with sciatica. There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica. Because there is no considerable difference between advice to stay active and advice for bed rest, and there are potential harmful effects of prolonged bed rest, it is reasonable to advise people with acute low back pain and sciatica to stay active. These conclusions are based on single trials.

Activities of Daily Living↗
PubMed1989

[Low back pain and instability of the pelvic ring].

Low back pain is a major cause of disability, and a large percentage of patients with low back pain have no identifiable pathology. In this review of the literature low back pain is considered from the point of view of dysfunction of the pelvic joints. The reliability of the commonly used tests, signs and procedures are considered. Inflammatory causes such as ankylosing spondylitis are well documented to cause low back pain, but mechanical factors apart from intervertebral disc protrusion are largely speculative.

Back Pain↗
PubMedDate not supplied

Is low-back pain prevalent among Kuwaiti children and adolescents? A governorate-based study.

OBJECTIVE: To measure the magnitude of the problem of low-back pain among 10- to 18-year-old Kuwaiti schoolchildren in Hawalli Governorate. SUBJECTS AND METHODS: A cross-sectional multistage stratified random sample of 400 schoolchildren (199 males and 201 females) of ages 10-18 years were selected from two junior and two high schools in Hawalli Governorate, Kuwait. Data on age, gender and characteristics of low-back pain such as duration, location and frequency were collected through personal interviews using a questionnaire. Low-back pain was defined as pain in the back from the 12th rib to the buttock area. RESULTS: According to our definition, reported lifetime prevalence of low-back pain was found to be 57.8% (50.8% in male and 64.7% in female students), while the point prevalence was 35% (20.6% in male and 39.3% in female students). More female students reported low-back pain than male students, and the prevalence of low-back pain was found to increase with age in both sexes. The age of onset of low-back pain was 14 years in males and 13 years in females. The majority of students (92.1% in males, 84.6% in females) reported pain in the low back. Almost 46% of students related their low-back pain to accidents. A significantly higher proportion of male students (58.4%, compared to females 36.2%) reported low-back pain caused by accident or with duration of recovery less than a week (21.8% for males as compared to 16.2% for female students). Female students reported more recurrent or continual low-back pain. CONCLUSION: Low-back pain is common among Kuwaiti students in Hawalli Governorate. Prevalence of low-back pain increased with age in both sexes. Female students reported more frequent low-back pain than male students.

Adolescent↗
PubMed1997

The association between clinical findings on physical examination and self-reported severity in back pain. Results of a population-based study.

STUDY DESIGN: A cross-sectional population-based study of back pain. OBJECTIVE: To evaluate the association between clinical findings on physical examination and subjective severity in nonspecific back pain. SUMMARY OF BACKGROUND DATA: Assessment of severity of back pain always has been controversial. Most studies evaluating the role of clinical findings in back pain have been hospital- or clinic-based, often representing a highly select population. This selection is avoided in the population-based approach of the present study. METHODS: Approximately 4,000 German inhabitants of Lubeck, aged 25-74, were selected randomly from the local population registry and received a postal questionnaire. Those who reported "back pain today" (n = 1200) or "back pain within the past 12 months but no back pain before" (n = 75) were invited to come in for a clinical examination. Thirty-four physical measurements were taken. They were divided into four groups: static measurements, dynamic measurements, neurologic findings, and non-organic physical signs. Self-reported severity of back pain was measured by a pain questionnaire and a 12-item activities of daily living list to assess functional disability. RESULTS: Within each of the four groups of physical measurements, those that corresponded best with the subjective severity of back pain could be identified (e.g., rotation, lateral flexion, and fingertip-floor distance, scoliosis, the position of the side plumb line, and pain on percussion of the spine pseudo-Lasegue and hand muscle-strength). Those that corresponded best could be differentiated statistically from less correlative measurements such as kyphosis and lordosis; flexion of the lumbar, thoracic, or cervical spine, abdominal muscle strength, and axial loading. The agreement between the classification of back pain severity based on clinical findings and the classification based on self-reports was moderate (kappa = 0.47). CONCLUSIONS: Assessment of severity in back pain can only partly be based on the clinical findings of a physical examination. There is a relatively weak agreement between the results of physical examination and the subjective reporting of pain and disability.

Activities of Daily Living↗
PubMed2002

Motion palpation findings and self-reported low back pain in a population-based study sample.

BACKGROUND: Although the clinical usefulness of motion palpation has not been established, it is one of the most commonly used diagnostic methods by chiropractors. Notably, its sensitivity, specificity, and validity in general have not been adequately studied, and most study samples have consisted of student volunteers. OBJECTIVE: To determine the prevalence of positive motion-palpation findings (so-called fixations and spontaneous pain response) in relation to self-reported low back pain status and to determine the sensitivity and specificity of the motion-palpation technique carried out on the sacroiliac and lumbar joints. DESIGN: Study subjects were examined by 1 examiner (out of 7 possible), who was unaware of their low back pain status. Information on low back pain was then collected in a self-report questionnaire. SETTING: Research laboratory at the Odense University Hospital, Denmark. PARTICIPANTS: One hundred eighty-four twins, consisting of a subset of healthy twins taken from a panel of population-generated twins aged 19 to 42 years, made up the study sample. Examiners consisted of 7 biomechanics (chiropractic) students from the University of Southern Denmark who were proficient in motion palpation. MAIN OUTCOME MEASURES: The prevalence rates of motion palpation-determined fixations and of spontaneous pain reactions in response to motion palpation were studied in relation to anatomic area, self-reported low back pain status, and each other. RESULTS: The point period prevalence of low back pain was 14%. Fixations were found in 43% of the study sample, and 25% appeared to have a painful reaction to motion palpation. There was no logical pattern of fixations and spontaneous pain reactions in relation to the low back pain status. The sensitivity was generally low (always below 60%) for fixations and pain, whereas the specificity was higher, significantly so for pain in the mid lumbar area. There was no strong association between fixations and the examiners' interpretation of a spontaneous pain reaction in response to motion palpation. CONCLUSION: Motion palpation does not appear to be a good method to differentiate persons with or without low back pain. It is possible to dissociate the findings of fixations and those of pain reactions.

Adult↗
PubMed1995

Diagnosis and management of low back pain and sciatica.

Acute low back pain with associated sciatica is usually a benign, self-limited disorder. Appropriate medical treatment may include passive forms of physical therapy, including McKenzie exercises, manipulation, medication and therapeutic injections. After pain is controlled, the patient should be taught self-management techniques, including exercises and ergonomic protection of the spine. Evidence is increasing that exercise programs are effective, although the optimal regimen has yet to be defined and may vary from patient to patient. Chronic low back pain is a complex disorder that must be managed aggressively with a multidisciplinary approach that addresses physical, psychologic and socioeconomic aspects of the illness. Self-administered traction, corsets, medications and other treatment methods may prove to be useful adjuncts to an active program of exercise and education that promotes functional restoration.

Algorithms↗
PubMed1991

Electromyographic recordings of low back pain subjects and non-pain controls in six different positions: effect of pain levels.

Surface electromyographic (EMG) activity recordings of bilateral paraspinal muscle tension were measured twice on 20 non-pain controls and on 46 low back pain subjects (21 individuals with intervertebral disk disorders and 25 subjects with unspecified musculoskeletal backache) during 6 positions: standing, bending from the waist, rising, sitting with back unsupported, sitting with back supported, and prone. Back pain subjects were measured during both low pain and high pain states. Results revealed a non-significant trend for all subjects, regardless of diagnosis, to have higher paraspinal muscle tension levels on the second (or high pain) assessment. A significant diagnosis by position interaction was observed which was similar to the interaction in our previous study which employed only a single measurement session. Analysis of simple main effects revealed this to be due to control subjects during the standing position having lower EMG levels than the back pain groups, and intervertebral disk disorder subjects having higher EMG levels than the other groups during the supported sitting position. As in our previous study, diagnosis was found to be a clinically significant factor, in that controls had much fewer clinically abnormal readings than back pain patients. The lack of a significant effect for pain state is congruent with findings in the headache literature. The importance of clearly defined diagnostic categories in low back pain research and the utility of measuring subjects in various positions is discussed, as are possible explanations for lack of significant pain state findings.

Adolescent↗
PubMedDate not supplied

The effect of coping strategies on the relief of pain following surgical intervention for lower back pain.

Subjects' use of coping strategies was assessed by use of the Coping Strategy Questionnaire in a sample of 50 back pain patients prior to undergoing a laminectomy procedure. Three factors--Self-Reliance, Loss of Control, and Active Coping and Suppression--accounted for a large proportion of variance in questionnaire responses. Two of these factors--Self-Reliance and Loss of Control--were found to be predictive of postsurgical adjustment above and beyond what may be predicted on the basis of either patients' presurgical medical status (type of disc and disability status) or their tendency to somaticize. This study also replicates previous findings in the literature regarding the effect of type of disc and one's tendency to somaticize on surgical outcome.

Adaptation, Psychological↗
PubMed1989

Differential treatment responses on somatic pain indicators after EMG biofeedback training in back pain patients.

Treatment responses to relaxation-oriented EMG biofeedback (EMGBF) in patients categorized in terms of the Back Pain Classification Scale (BPCS) were examined. It was demonstrated that the previously observed effectiveness of EMGBF training became even more pronounced when the patients were divided into "organic" and "functional" subtypes according to the BPCS. The "organic" group showed the greatest degree of improvement. The mechanism of treatment effectiveness is discussed with reference to physiological changes, i.e., restoration of appropriate back muscle strength and back muscle functioning.

Adult↗
PubMed2004

Acute low back pain: assessment and management.

BACKGROUND: Back pain is a common presenting problem in Australian general practice. Serious causes, however, are rare. Tumours, infections and fractures account for less than 1% of cases and can usually can be recognised or excluded by taking a careful history. Patients should expect a good outcome. OBJECTIVE: This article summarises the management of acute low back pain and sets out the key points in history taking including alerting factors for serious disorders, and psychosocial factors that enable a rational management plan. DISCUSSION: A specific cause of pain need not be established for appropriate management to be instituted, with the active engagement of the patient as partner. Although no pattern of pain is diagnostic, a sudden onset of unremitting pain should be regarded as a 'red flag' to a serious underlying disorder. In accordance with evidence based principles, clinicians need to take into account previous experience, personal preferences, and cultural factors when recommending therapy for individual patients.

Acute Disease↗
PubMed2004

The external fixator: a tool for evaluation of complex low back pain problems.

BACKGROUND: The selection of patients with low back pain for fusion is especially difficult when previous surgical interventions failed and/or invasive tests (discograms, facet blocks) do not allow or do not clearly identify the painful motion segment. Test fixation with an external fixator may mimic a definite internal fixation, such as a fusion, and may help select patients for a more favorable result. The purpose of the study was to clarify if temporary back pain relief by external fixation is predictive for back pain relief after final internal fixation and fusion. METHODS: A retrospective study of 63 patients up to 6 years after evaluation of low back pain problems with an external fixator (index operation) was conducted. The data were collected from the charts based on a protocol that patients had to fill in during evaluation, and the actual state was checked during a clinical investigation at the outpatient clinic. The protocol monitored pain (Visual Analog Scale), pain medication, and work status. Based on the first two parameters, the effect of external fixation was defined as a general estimation as positive, doubtful, or negative. The same parameters were reassessed at follow-up control. RESULTS: In 38 patients, the immobilization test did improve the pain situation, in 11 it remained unchanged, and in 14 the pain got worse. Thirty-eight patients (not identical with the above) underwent definitive fusion afterward, whereas 25 were not operated on. Twenty-one of 30 patients with a positive effect undergoing surgery showed an improved situation after fusion, and 8 of 22 patients without further operation were improved at follow-up. Nine of 12 patients with a negative immobilization test did stay in a bad situation at follow-up. CONCLUSION: The external fixator as a tool for evaluation of patients with low back pain is an expensive measure with a considerable complication risk and only justified in selected patients when any other measure fails to assess and evaluate a patient's situation. If the test fixation reveals no benefit, the patients will remain in a bad situation whatever the therapeutic measure will be. Therefore the main value of the external fixator assessment is the selection of these patients that should not undergo surgery. A positive test fixation means a 72% chance for a satisfactory outcome at least two years after surgery, whereas without surgery the chance for some spontaneous improvement is 57% if the test immobilization did show some improvement. With respect of the "negative" selection of this group of patients (complex history, previous interventions) in our as well as in others series, the obtained results seem acceptable and the use of this invasive diagnostic measure in this group of patients seems justified. Statistical analysis did not show differences of significance as the numbers in the individual groups was too small.

Adult↗