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PubMed1980

Evaluation and prediction of back pain during military field service.

Questions regarding back pain in different body positions and earlier sick-listing due to back disorders have been answered by 5093 men aged 23--47 (average age 37) who were about to do military field service. Fifty-three % reported that they had had back pain at some time and 14% stated that they had been sick-listed for more than one month in all due to back troubles. A subsample was subjected to a standardized physical examination of the back, average examination time 9 min, and the frequency and location of pain, stiffness of other impairments are given. Subjects who experienced back pain during the field service and whose military post was physically heavier than their civilian occupation had on an average lower isometric strength in abdominal muscles as well as in back muscles than other subjects. The physical examination of the lumbar spine was more efficient in separating subjects who experienced back pain during military field service, than information on earlier sick-listing due to back troubles and heaviness of the military post as compared to civilian occupation.

Abdominal Muscles↗
PubMed2005

Transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain.

BACKGROUND: Chronic low-back pain (LBP) affects a significant proportion of the population. Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as an adjunct to the pharmacological management of pain. However, despite its widespread use, the usefulness of TENS in chronic LBP is still controversial. OBJECTIVES: The aim of this systematic review was to determine the effectiveness of TENS in the management of chronic LBP. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2005), MEDLINE, EMBASE and PEDro up to April 1, 2005. SELECTION CRITERIA: Only randomized controlled clinical trials (RCTs) evaluating the effect of TENS on chronic LBP were included. Abstracts were excluded unless further data could be obtained from the authors. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials and extracted data using predetermined forms. Heterogeneity was tested with Cochrane's Q test. A fixed effect model was used throughout for calculating continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results are presented as weighted mean differences (WMD) with 95% confidence intervals (95% CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences (SMD) were calculated by dividing the difference between the treated and control by the baseline variance. SMD were used when different scales were used to measure the same concept. Dichotomous outcomes were analyzed with odds ratios. MAIN RESULTS: The only two RCTs (175 patients) meeting eligibility criteria differed in study design, methodological quality, inclusion and exclusion criteria, type and method of TENS application, treatment schedule, co-interventions and final outcomes. In one RCT, TENS produced significantly greater pain relief than the placebo control. However, in the other RCT, no statistically significant differences between treatment and control groups were shown for multiple outcome measures. Pre-planned subgroup analyses, intended to examine the impact of different stimulation parameters, sites of TENS application, treatment durations and baseline patient characteristics were not possible due to the small number of included trials. AUTHORS' CONCLUSIONS: There is inconsistent evidence to support the use of TENS as a single treatment in the management of chronic LBP. Larger, multi-center, randomized controlled trials are needed to better assess the true effectiveness of TENS. Special attention should be given to the risks and benefits of long-term use, which more appropriately addresses the realities of managing chronic low-back pain.

Chronic Disease↗
PubMed2001

Treadmill study of the range of back movement at the walk in horses without back pain.

OBJECTIVE: To evaluate back movement during walking in horses. ANIMALS: 22 adult horses with no history or signs of back pain. PROCEDURE: 3-dimensional movements of markers on the hooves, head, and back were measured with a motion analysis system while the horses were walking on a treadmill. The positions of markers on the hooves, head, and the skin above the spinous processes of T5, T10, T16, L3, and 2 sacral vertebrae were recorded. From a minimum of 6 walking motion cycles/horse, marker movement and the time of occurrence of minimum and maximum marker positions within the motion cycle were determined. Angles were calculated between the markers on the head, T16, and S4 or S5 and between the markers on T5, T16, and S4 or S5. RESULTS: Lateral back movement was maximal at L3, where it reached (mean +/- SD) 3.5 +/- 0.8% of the horses' height at the withers. Maximum dorsoventral back movement was found at the sacrum, where it reached 4.7 +/- 1.3% of the height at the withers. In the horizontal plane, the angle between T5, T16, and S4 or S5 was altered by 11 +/- 2.5 degrees during the motion cycle. In the sagittal plane, the angle between the head, T16, and S4 or S5 was altered by 7 +/- 3 degrees. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study may be used as basic kinematic reference data for evaluation of back movement in horses.

Animals↗
PubMed1989

Clinical assessment and interpretation of abnormal illness behaviour in low back pain.

Patients with chronic low back pain present with a mixture of symptoms and signs. Some are a direct consequence of physical pathology whereas others are attributable to associated and appropriate psychological and behavioural changes. At times the latter may be out of keeping with the degree of physical pathology and thus have specific significance in terms of the affective and cognitive disturbances that are also present and which may be the basis for abnormal illness behaviour. In an attempt to demonstrate more clearly the relationship between physical, psychological and behavioural components of illness, this paper draws on two data sets in patients with low back pain. The first explores the relationship between behavioural symptoms and signs, objective physical impairment, pain and disability and psychometric measures of distress together with scales making up the illness behaviour questionnaire (IBQ) of Pilowsky and Spence. A second data set is used to assess the value of the IBQ in understanding how psychological distress and behavioural signs and symptoms are related to the outcome of surgical treatment. The results gained reveal that behavioural symptoms and signs are directly related to the physical severity of low back disorder, the patient's report of pain and disability and the outcome of surgical treatment. Scores on the IBQ were strongly related to measures of affective disturbance and psychological distress. More specifically the disease affirmation scale of the IBQ, incorporating scales for disease conviction and psychological versus somatic focussing was an important dimension in relation to the behavioural symptoms and signs, thereby confirming results gained by other workers. Disease conviction and lack of response to clinicians' reassurances regarding illness - a situation in which abnormal illness behaviour is often deemed to exist - should not be seen simply as a function of the disease process, but more as a psychological coping mechanism for certain individuals under stress. The significance of this observation is discussed in relation to decisions regarding the overall assessment of chronic pain patients and their treatment.

Back Pain↗
PubMed2006

Characterizing the course of low back pain: a latent class analysis.

Understanding the course of back pain is important for clinicians and researchers, but analyses of longitudinal data from multiple time points are lacking. A prospective cohort study of consecutive back pain consulters from five general practices in the United Kingdom was carried out between 2001 and 2003 to identify groups defined by their pain pathways. Patients were sent monthly questionnaires for a year. Longitudinal latent class analysis was performed by using pain intensity scores for 342 consulters. Analysis yielded four clusters representing different pathways of back pain. Cluster 1 ("persistent mild"; n = 122) patients had stable, low levels of pain. Patients in cluster 2 ("recovering"; n = 104) started with mild pain, progressing quickly to no pain. Cluster 3 ("severe chronic"; n = 71) patients had permanently high pain. For patients in cluster 4 ("fluctuating"; n = 45), pain varied between mild and high levels. Distinctive patterns for each cluster were maintained throughout follow-up. Clusters showed statistically significant differences in disability, psychological status, and work absence (p < 0.001). This is the first time, to the authors' knowledge, that latent class analysis has been applied to longitudinal data on back pain patients. Identification of four distinct groups of patients improves understanding of the course of back pain and may provide a basis of classification for intervention.

Adult↗
PubMedDate not supplied

Identifying neuropathic pain among patients with chronic low-back pain: use of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale.

BACKGROUND AND OBJECTIVES: Although the literature contains information about prevalence and incidence of low-back pain (LBP), little information is available about the contribution of the neuropathic element to LBP. Our study was designed to investigate the prevalence of neuropathic pain among a sample of chronic LBP patients in Saudi Arabia by use of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale. METHODS: A total of 1,169 patients from 117 centers agreed to participate in the study over a period of 6.5 months. The LANSS pain scale was applied to each patient in an interview format. The characteristics of pain and sensory dysfunction were tested and recorded. RESULTS: According to the LANSS pain scale, 639 patients (54.7%) had scores of 12 points or more, which suggested a neuropathic type of pain, and 530 patients (45.3%) had scores of less than 12, which suggested a nociceptive type of pain. Factors that are associated with neuropathic pain are advanced age, female gender, increased height, white race, hypertension and diabetes, a history of smoking, previous back surgery, and previous medications. CONCLUSION: Neuropathic pain is a major contributor to chronic LBP, and the LANSS pain scale is a useful tool to distinguish patients with neuropathic pain from those with nociceptive pain.

Adolescent↗
PubMed1988

Resolution of back pain with the wide abdominal rectus plication abdominoplasty.

Back pain is classified most easily into three types (1) muscle spasm, (2) herniated nucleus pulposus (HNP), and (3) facet syndrome and/or nerve compression. It is possible the wide abdominal rectus plication procedure will be beneficial to all three groups, but currently I limit the procedure to those back pain patients who are improved with a back brace or corset and those without back pain undergoing elective abdominoplasty. Contraindications would be (1) anticipating additional pregnancy, (2) back pain not relieved or improved by corset or brace, (3) severe or progressive disk signs, and (4) bladder and/or bowel dysfunction. Further detailed studies of the mechanism of action and of the biomechanical effect as evaluated by conventional radiology, CAT scan, and nuclear magnetic resonance imaging, as well as physical measurement, are in progress and will be forthcoming.

Abdominal Muscles↗
PubMed2003

Physical impairment index: reliability, validity, and responsiveness in patients with acute low back pain.

STUDY DESIGN: Cohort study of patients with acute low back pain undergoing physical therapy. OBJECTIVES: Examine the reliability and validity of the Physical Impairment Index in a group of patients with acute low back pain and determine the responsiveness and minimum detectable change of the index and its component tests. SUMMARY OF THE BACKGROUND DATA: The Physical Impairment Index was originally described as a reliable and valid means of assessing physical impairment in patients with low back pain. The psychometric properties of the index have not been reported in patients with acute low back pain, nor has its responsiveness been examined. METHODS: Seventy-eight patients with acute (<3 weeks duration) low back pain participating in a clinical trial were assessed at baseline and after 4 weeks. Interrater reliability of the index was examined in a subgroup of 20 patients. Validity was examined through correlations with concurrent measures of pain, disability, and psychosocial variables. Changes in the index over 4 weeks were used to assess responsiveness and minimum detectable change. RESULTS: Interrater reliability of the index was high (intraclass correlation coefficient = 0.89), and its validity was generally supported by the pattern of correlations. The index was more responsive to change than any of its component tests but was less responsive than the Oswestry disability score. The minimum detectable change on the index was approximately 1 point. CONCLUSIONS: The Physical Impairment Index appears to be a reliable and valid measure of physical impairment for patients with acute low back pain and may be useful as an adjunct outcome measure for studies involving these patients. Further research on patients with chronic pain is needed before it can be advocated for outcomes research with this population.

Acute Disease↗
PubMed2004

Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain.

Patients with chronic low back pain (LBP) frequently demonstrate high scores for fear-avoidance beliefs and distress. We need better knowledge about fear-avoidance beliefs and distress in early stages of LBP. The objectives of this study were to compare the level of fear-avoidance beliefs and distress in patients with acute LBP to patients with chronic LBP, and to assess the relationship of fear-avoidance beliefs and distress to disability in acute and chronic LBP. Two different back pain groups including 123 patients with acute and 233 patients with chronic LBP were studied. Main outcome measures were Oswestry Disability Index and work loss. The scores for fear-avoidance beliefs and distress in patients with acute LBP were significantly lower than among patients with chronic LBP. The results of the multivariate regression analyses, adjusting for sociodemographic, pain and clinical variables, demonstrated that whereas fear-avoidance beliefs for physical activity and distress were significantly associated with the Oswestry Disability Index, fear-avoidance beliefs for work and distress were significantly associated with work loss. The associations showed the same pattern in acute and chronic LBP. In addition, several of the pain and clinical variables were significantly associated with the Oswestry Disability Index and fingertip-floor distance was associated with work loss. In conclusion, fear-avoidance beliefs and distress influence pain-related disability both in early acute and long-term chronic LBP. The results replicate previous reports on the association between pain experience, fear-avoidance beliefs, distress, and disability in chronic LBP, and extend the findings to patients at an early stage of acute LBP.

Activities of Daily Living↗
PubMed1991

Back pain: a study of twins.

To evaluate the relationship between genetic factors and back pain, 5029 MZ and 7876 DZ twin pairs were investigated by a questionnaire. The data were analyzed with regard to physical symptoms, eg, back pain, and certain work conditions. Pain was reported by about 17% of the male and 13% of the female twins in the material. The occurrence of back pain was strongly associated with work load, especially among the male twins. Twin concordance regarding back pain was considerably higher in MZ than in DZ twins. Of four groups who were studied, statistically significant differences between the two twin categories were observed in three cases. This result supports the assumption that a relationship exists between genetic factors and the occurrence of back pain. Official registrations for sick-leave pay in a sample of 247 twins confirmed the interview information on back pain. Just a few cases were wrongly classified, ie, they were sick-listed because of back pain but had stated no back pain in the questionnaire.

Adolescent↗
PubMed1993

Role of the surgical position in the development of postoperative low back pain.

The aetiology of postoperative back pain is contentious. Although the role of the surgical position has not been fully established, the lithotomy position is often implicated. In order to investigate this common surgical complication further, a prospective study has been performed on 101 hysterectomy patients. The supine (52 patients) and the lithotomy (49 patients) positions have been compared and contrasted within this series. Ten patients in the supine group (20%) and seven patients in the lithotomy group (14%) developed postoperative low back pain (p > 0.1). The mean duration of symptoms postoperatively for the whole series was 7 months. We conclude that postoperative backache is an under-estimated complication of surgery and that this problem occurs equally whether the supine or the lithotomy positions are used.

Adult↗
PubMed1995

The Quebec Back Pain Disability Scale. Measurement properties.

STUDY DESIGN: The Quebec Back Pain Disability Scale is a 20-item self-administered instrument designed to assess the level of functional disability in individuals with back pain. The scale was administered as part of a larger questionnaire to a group of 242 back pain patients. Follow-up data were obtained after several days and after 2 to 6 months. OBJECTIVES: The goal of this study was to determine whether the Quebec scale is a reliable, valid, and responsive measure of disability in back pain, and to compare it with other disability scales. SUMMARY OF BACKGROUND DATA: A number of functional disability scales for back pain are being used, but their conceptual validity is uncertain. Unlike most published instruments, the Quebec scale was constructed using a conceptual approach to disability assessment and empirical methods of item development, analysis, and selection. METHODS: The authors calculated test-retest and internal consistency coefficients, evaluated construct validity of the scale, and tested its responsiveness against a global index of change. Direct comparisons with the Roland, Oswestry, and SF-36 scales were carried out. RESULTS: Test-retest reliability was 0.92, and Cronbach's alpha coefficient was 0.96. The scale correlated as expected with other measures of disability, pain, medical history, and utilization variables, work-related variables, and socio-demographic characteristics. Significant changes in disability over time, and differences in change scores between patients that were expected to differ in the direction of change, were found. CONCLUSIONS: The Quebec scale can be recommended as an outcome measure in clinical trials, and for monitoring the progress of individual patients participating in treatment or rehabilitation programs.

Adolescent↗
PubMed2003

Is low back pain in youth associated with weight at birth? A cohort study of 8000 Danish adolescents.

INTRODUCTION: Low back pain has been associated with an increased risk of several diseases and with poor general health. Also low birth weight has been associated with an increased susceptibility to various diseases as well as with poor general health. Thus, low birth weight could be a common factor--indicating a general frailty with an increased risk of both low back pain and overall morbidity. To our knowledge, the association between low back pain and birth weight has not previously been investigated. This study investigates the correlation between birth characteristics and low back pain in adolescence. MATERIAL AND METHODS: Analyses are based on data from The Danish Twin Registry. Information about low back pain is from a postal survey, and information about birth characteristics are from The Danish Medical Birth Register. Analyses include 8278 individuals aged 12-22 years--an age at which they are still largely unaffected by the influence of working life. Possible associations between low back pain, birth weight, birth length, ponderal index, gestational age and Apgar scores are investigated by the use of logistic regression analysis. RESULTS: The odds ratio for the lifetime prevalence of low back pain increases from 1.21 (0.94-1.56) for a birth weight of 2000-2500 g to 1.97 (1.35-2.88) for a birth weight of > 3500 g compared to the smallest weight group (< 2000 g) in males, whereas there is a small statistically insignificant, positive association for females. The same pattern is seen for the one-year prevalence of low back pain. No associations are documented between low back pain and other birth factors. The positive association between low back pain and birth weight is independent of other birth factors and of anthropometric measures in adolescence. CONCLUSION: There is a statistically significant association between high birth weight and the risk of developing low back pain in males but not in females. Our results do not indicate that frailty at birth increases the risk of low back pain in adolescence.

Adolescent↗
PubMed1997

Back pain claim rates and the business cycle.

The causes of reported occupational back pain are controversial. Many observers appear to believe that job insecurity increases back pain compensation claims during recessions. The purpose of this study was to formally examine the impact of macro-economic forces-the business cycle-on the incidence of lost-time back pain claim rates in order to elicit clues to both its aetiology and reporting patterns. For Ontario between 1975 and 1993, age- and sex-adjusted lost-time back pain claim rates, stratified by industry sector (construction, manufacturing and trade), were regressed on the unemployment rate of the industry sector using time series methods. As a comparison group, the association between "acute" claim (fractures, lacerations, etc.) and the business cycle was also tested. Both back pain claim rates and acute claim rates increased during boom periods and decreased during recessionary periods. Time series analyses confirmed that these associations were statistically significant. The elasticities between claim rates and the unemployment rate were similar for back pain claims and acute claims. In addition, these associations were consistent in direction across all three industrial sectors tested. These results rebut the view that back pain claims increase during recessionary times.

Absenteeism↗
PubMed2004

Can health care utilization explain the association between socioeconomic status and back pain?

STUDY DESIGN: Cross-sectional population-based study. OBJECTIVES: To assess whether the association between socioeconomic status and severe back pain can be explained by the preceding health care utilization for back pain. SUMMARY OF BACKGROUND DATA: The ways in which socioeconomic status affects the occurrence of back pain are unclear. METHODS: Age- and gender-adjusted odds ratios with 95% confidence intervals for the association between indicators of socioeconomic status and severe current back pain (high intensity and/or high disability: no/yes) were investigated in an interview among 770 study participants out of 1113 study participants with a recent history of back pain in a survey among 2731 adults. RESULTS: The point prevalence of severe current back pain (39.8%) was related to educational level and health insurance status. Prior health care utilization for back pain was about 2-fold more prevalent in adults with severe current back pain. Members of private health insurance (odds ratio 0.60, 95% confidence interval 0.37-0.99) were less likely to report prior consultation of a general practitioner for back pain. Members of sick funds for white-collar workers (odds ratio 2.81, 95% confidence interval 1.43-5.51) and private insurance (odds ratio 2.81, 95% confidence interval 1.02-6.24) and individuals with intermediate educational level (odds ratio 1.76, 95% confidence interval 1.05-2.95) utilized more physical therapy for the treatment of back pain. After additionally adjusting for health care utilization, the associations between educational level or health insurance status and severe current back pain remained unchanged. CONCLUSIONS: The data suggest that education, health insurance status, and health care utilization are independently associated with severe current back pain in a society with universal access to health care.

Adult↗
PubMed2005

How to prevent low back pain.

This chapter summarizes the European Guidelines for Prevention in Low Back Pain, which consider the evidence in respect of the general population, workers and children. There is limited scope for preventing the incidence (first-time onset) of back pain and, overall, there is limited robust evidence for numerous aspects of prevention in back pain. Nevertheless, there is evidence suggesting that prevention of various consequences of back pain is feasible. However, for those interventions where there is acceptable evidence, the effect sizes are rather modest. The most promising approaches seem to involve physical activity/exercise and appropriate (biopsychosocial) education, at least for adults. Owing to its multidimensional nature, no single intervention is likely to be effective at preventing the overall problem of back pain, although there is likely to be benefit from getting all the players onside. However, innovative studies are required to better understand the mechanisms and delivery of prevention in low back pain.

Exercise Therapy↗
PubMed2005

Childhood and early adult predictors of risk of incident back pain: Ontario Child Health Study 2001 follow-up.

Musculoskeletal disorders of the back and spine are a leading cause of disability in working-age populations. There is limited information on the potential consequences of childhood socioeconomic and health status on the risk of incident back pain in early adulthood. The authors describe factors associated with having had a first episode of back pain during the past year in the Ontario Child Health Study, a prospective cohort study of children who were aged 4-16 years at the time of enrollment in 1983 and were resurveyed in 2001. Respondents reporting a first episode of back pain (n=143) were compared with respondents who had never experienced back pain (n=896). The annual incidence of a first episode of back pain in this sample of young adults was 74.7/1,000. Following adjustment for age, sex, childhood conditions, childhood health status, and measures of early adult health, behavior, socioeconomic status, and work environment, the risk of incident back pain was associated with both low (odds ratio (OR)=1.86, 95% confidence interval (CI): 1.14, 3.03) and moderate/high (OR=1.85, 95% CI: 1.07, 3.02) levels of psychological distress, current heavy smoking (OR=1.85, 95% CI: 1.10, 3.10), lower levels of parental education in childhood (OR=1.72, 95% CI: 1.06, 2.80), and emotional or behavioral disorders in childhood (OR=1.87, 95% CI: 1.02, 3.41). The associations of low childhood socioeconomic status and childhood emotional and behavioral disorders with risk of incident back pain in early adulthood are important findings with implications for better understanding the etiology of soft-tissue disorders.

Adolescent↗
PubMed1988

Low back pain in the elderly: practical management concerns.

Low back pain occurs in 90% of the adult population. Previous episodes of low back pain in young adults predisposes to exacerbations and chronic problems in the elderly. Radiographic abnormalities demonstrating osteoarthrosis of the lumbar spine and facet joints and varying degrees of disk bulge and disk degeneration are the rule in both asymptomatic and symptomatic patients. Therefore, clinical assessments rather than purely morphological assessments are necessary to assess treatment plans and prognosis in elderly low back pain patients. Osteoarthritic changes are more often asymptomatic than symptomatic. CT and MRI demonstrations of spinal stenosis should be correlated with clinical findings to determine appropriate management decisions. Most elderly patients with low back pain with or without sciatica and with only radiographic CT or MRI rather than clinical evidence of spinal stenosis can be successfully managed conservatively.

Aged↗