SEARCH · Search PubMed

Results for “Back Pain”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 865 records · Page 48Linked to original sources

PubMed1996

Pain measurement in elders with chronic low back pain: traditional and alternative approaches.

Pain evaluation typically relies upon the use of self-report instruments. The validity of these tools is questionable in many older adults, however, particularly those with cognitive impairment. Rating of pain behavior (e.g. grimacing, sighing) by an objective observer represents an alternative pain assessment strategy which has been validated in subjects of heterogeneous ages. The purpose of this study was to examine, in a group of community-dwelling elderly with low back pain and lumbosacral osteoarthritis, the concurrent validity of observational pain behavior rating techniques as compared with self-report instruments and the degree to which pain and pain behavior relate to disability. Thirty-nine cognitively intact subjects, age > 65 years, without depression, other sources of pain, or other known spinal pathology underwent the following measures: (1) pain self-report using the verbal 0-10 scale, vertical verbal descriptor scale, Arthritis Impact Measurement Scales and McGill Pain Questionnaire; (2) pain behavior was sampled during two protocols, one, identical to that used by Keefe and Block (Behav. Ther., 13 (1982) 363-375), that required subjects to sit, stand, walk, and recline for 1-2 minute periods (which we have labelled the traditional protocol), and a second, more demanding protocol that was designed to simulate activities of daily living that place a premium on axial movement (the 'ADL' protocol); (3) disability was assessed using the Roland questionnaire, a 6 month global disability question and the Jette Functional Status Index; and (4) radiographic evaluation of the lumbosacral spine; osteoarthritis was quantitated using a previously validated scoring system. Interrelationships among pain, pain behavior and disability measures were tested using canonical correlations. Self-reported pain was associated with pain behavior frequency; the association was stronger when the ADL protocol was used, as compared with the traditional protocol. The association between pain and disability was modestly strong with both self-report instruments and pain behavior observation when the ADL protocol was used, but not when the traditional protocol was used. Our findings suggest that pain behavior observation is a valid assessment tool in the elderly. In addition, it seems that observation of elders during performance of activities of daily living may be a more sensitive and valid way of assessing pain behavior than observing pain behavior during sitting, walking, standing, or reclining.

Activities of Daily Living↗

PubMedDate not supplied

Prevalence of pre-existing recurrent low back pain in college athletes.

This study questioned 1,040 college athletes about recurrent low back pain during their initial preparation physical examination. Only 20 athletes (1.9%) reported a previous history of recurrent low back pain. There were no differences between sports and history of back pain. Since low back pain is a frequent complaint during the career of college athletes and previous back pain is a risk factor for future pain, this data suggests that the majority of college athetes are not predisposed to low back pain secondary to a previous injury.

Adolescent↗

PubMed1997

Oral contraceptives and back pain in women in a Swedish community.

BACKGROUND: Female back pain is a clinical problem-especially low back pain with symptoms from the pelvic posterior region-that is often aggravated in connection with pregnancy and childbirth. Hormones have been suggested as an aetiologic factor. This study is aimed to determine whether additional hormone preparations, i.e. oral contraceptives (OC), may contribute to the increased frequency of such pain. METHODS: A register study was conducted to investigate the use of drugs and health care use in a female population with known OC consumption. Specifically, we registered the number of primary health care visits for low back pain, comparing OC users with non-OC using age-matched women with otherwise equal circumstances. RESULTS: OC users recorded a significantly higher incidence of low back symptoms during the study period compared to non-users. Pregnancy was not found to be a confounding factor. CONCLUSIONS: The intriguing association between OC use and a higher incidence of low back pain, does not enable us to conclude that there is a causal connection, but it should lead to further studies.

Adolescent↗

PubMed2005

Workplace stress, lifestyle and social factors as correlates of back pain: a representative study of the German working population.

OBJECTIVES: To investigate the prevalence of back pain in the German working population and the relationship between back pain and workplace stresses, lifestyle and social factors. METHODS: The first National Health Survey of the Federal Republic of Germany was carried out between October 1997 and March 1999. It comprised a representative epidemiological cross-sectional study of the working population, with a total sample of 3,488 persons between the ages of 18 and 69 years. The participants took part in a medical examination and answered a self-rating questionnaire. The relationship between subjective back pain and workplace stresses and social and lifestyle factors was investigated with bivariate tests and multiple logistical regression analyses. RESULTS: The 7-day prevalence for back pain in the German working population was found to be 34%, and the 1-year prevalence was 60%. The odds ratios were significantly higher in women, persons of lower socioeconomic status, married and depressed persons and non-athletes. Carrying heavy loads or maintaining a single working posture were the most significant work-related correlates of back pain, for members of both the female and male working population, while environmental stress and psychological stress correlated significantly with back pain in men only. CONCLUSIONS: This study reports the first representative epidemiological prevalence data for back pain, and its correlates and potential risk factors, for the German working population. To reduce the negative impact of back pain the most promising behavioural and conditional prevention measures in the workplace would be to reduce carrying stress and to vary working posture. In addition, a more active, athletic lifestyle, plus the avoidance of being overweight, should provide an additional protective or preventive effect.

Adolescent↗

PubMed1983

Psychological factors in the treatment of back pain by spinal manipulation.

Ninety patients with low back pain completed a short form of the Minnesota Multiphasic Personality Inventory (MMPI) and, subsequently, received spinal manipulative therapy. Most (84%) of the patients reported immediate relief following manipulation but the extent of that relief was not correlated with any psychological measure. However, several days after treatment, the percentage of patients reporting improvement was much lower (55%) and lack of improvement was associated with elevated scores on hypochondriasis (Hs), and functional low back pain (Lb). Unimproved patients also tended to report longer durations of back pain prior to treatment. Multiple regression analyses indicated that pain duration and the psychological factors were independent predictors of the response to treatment. It is suggested that, although a single manipulative treatment will often relieve the immediate cause of back pain, underlying psychosomatic factors may predispose the condition to recur.

Adult↗

PubMed2002

The relationship between resting blood pressure and acute pain sensitivity in healthy normotensives and chronic back pain sufferers: the effects of opioid blockade.

Resting blood pressure is inversely correlated with acute pain sensitivity in healthy normotensives. This study tested: (1) whether endogenous opioid activity is necessary for this adaptive relationship to occur, (2) whether this relationship is altered in chronic low back pain (LBP), and (3) whether endogenous opioid dysfunction underlies any such alterations. Fifty-one pain-free normotensives and 44 normotensive chronic LBP sufferers received opioid blockade (8 mg naloxone i.v.) or placebo blockade (saline) in randomized, counterbalanced order in separate sessions. During each session, subjects participated in a 1-min finger pressure (FP) pain task followed by an ischemic (ISC) forearm pain task. Among pain-free normotensives, elevated resting systolic (SBP) and diastolic (DBP) blood pressure were associated with significantly higher ISC pain thresholds (P values <0.05). Elevated SBP was also associated with significantly lower FP pain ratings (P<0.05). Opioid blockade had no significant effect on the BP-pain relationships detected (P values >0.10). In combined groups analyses, a significant subject typexSBP interaction (P<0.005) was found on ISC pain threshold: elevated SBP was associated with higher pain threshold in pain-free controls, but with lower pain threshold in LBP subjects. Although subject typexBP interactions on FP and ISC pain ratings were not significant, inclusion of LBP subjects in these analyses resulted in the overall relationship between BP and pain sensitivity becoming positive (P values <0.05). Opioid blockade exerted no significant main or interaction effects in these combined groups analyses (p values >0.10). Higher DBP was associated with greater clinical pain intensity among the LBP subjects (P<0.001). Overall, these results suggest: (1) endogenous opioids do not mediate the inverse relationship between resting blood pressure and acute pain sensitivity in pain-free normotensives; (2) the BP-pain sensitivity relationship is altered in chronic pain, suggesting dysfunction in pain regulatory systems, and (3) these alterations are not related to opioid dysfunction.

Acute Disease↗

PubMed2001

[Treatment of low back pain--significance, principles and danger].

Today, a wide range of efficient analgesic and non-analgesic drugs for the treatment of back pain are available. However, drugs should never be the only mainstay of a back pain treatment program. Non-steroidal antiinflammatory drugs (NSAID) are widely used in acute back pain. NSAIDs prescribed at regular intervals are effective to reduce simple back pain. The different NSAIDs are effective for the reduction of this pain. They have serious adverse effects, particularly at high doses, in the elderly, and on long-term administration. The new cyclooxygenase II-inhibitors have less gastrointestinal complications. But the long-term experiences are limited up to now. Considerable controversy exists about the use of opioid analgesics in chronic noncancer pain. Many physicians are concerned about the effectiveness and adverse effects of opioids. Other clinicians argue that there is a role for opioid therapy in chronic noncancer pain, e. g. especially in chronic low back pain. There is a low incidence of organ toxicity in patients who respond to opioids. The incidence of abuse and addiction is likewise relatively low. The potential for increased function and improved quality of life seems to outweigh the risks. However, there is a lack of randomised controlled trials (RCT) on opioid therapy in a multimodal pain treatment approach. Clinical experience and some studies suggest administration of sustained release opioids because of better comfort for the patient and less risks for addiction. The opioids should be selected due to the specific side effects of the different drugs. For patients with pre-existing constipation transdermal fentanyl should be preferred. Antidepressant medications have been used for the treatment of chronic back pain, though there is only little scientific evidence for their effectiveness. There is no evidence for the use of antidepressants in acute low back pain. Trials of muscle relaxants for patients with acute back pain have used a wide range of agents, e. g. benzodiazepines. They mostly reduce acute back pain, but they have significant adverse effects including drowsiness and psychological and physical dependence even after relatively short treatment. Benzodiazepines are not indicated in the treatment of chronic back pain. Drugs are sometimes necessary for the patients to begin and persevere a multimodal treatment program. Drug therapy should be terminated as soon as other treatment strategies succeed. Unfortunately, no studies exist evaluating the place of analgesics within a multimodal treatment program.

Analgesics, Opioid↗

PubMed2003

Effects of measurement strategy and statistical analysis on dose-response relations between physical workload and low back pain.

BACKGROUND: In epidemiological studies on physical workloads and back complaints, among the important features in modelling dose-response relations are the measurement strategy of the exposure and the nature of the dose-response relation that is assumed. AIM: To evaluate the effect of these two features on the strength of the dose-response relation between physical load and severe low back pain. METHODS: The study population consisted of 769 workers in nursing homes and homes for the elderly. Observations at the workplace were made of 212 subjects. These observations were analysed to determine exposure to physical load according to two measurement strategies: the individual approach and the group approach. The nature of the dose-response relation was evaluated with nested logistic regression models. RESULTS: The group approach resulted in higher odds ratios for the associations between physical load and low back pain than the individual approach. Spline logistic regression models appeared to describe the dose-response relation between physical load and low back pain best. The corresponding curve showed small changes in risk for small changes in exposure, whereas the categorical model only showed sudden large changes in risk at predefined exposure values. CONCLUSION: The choice for a particular measurement strategy of physical load influences the strength of the associations between physical load and severe low back pain. Spline models allow changes in risk over the whole exposure range and are therefore a promising approach to identify quantitative dose-response patterns between physical load and low back pain.

Health Surveys↗

PubMed2003

Model for the work-relatedness of low-back pain.

OBJECTIVES: This study aimed at developing a model for determining the work-relatedness of low-back pain for a worker with low-back pain using both a personal exposure profile for well-established risk factors and the probability of low-back pain if the worker were unexposed to these factors. METHODS: After a systematic review of the literature, the pooled prevalence of low-back pain in an unexposed population and the pooled odds ratio (OR) for each risk factor was calculated in a meta-analysis using a random effect model. An unbiased risk estimate for each risk factor was obtained by correcting the pooled OR for confounding by other risk factors. The probability of low-back pain was calculated with a logistic regression model. The input was (i) the age-dependent prevalence when not exposed and (ii) the unbiased risk estimates per risk factor of low and high exposure. The etiologic fraction was calculated to determine the level of work-relatedness. RESULTS: The pooled prevalence for low-back pain among unexposed subjects was 22%, 30%, and 34% for the <35-year, 35-to-45-year, and >45-year age categories, respectively. The pooled OR was 1.51 [95% confidence interval (95% CI) 1.31-1.74] for manual materials handling, 1.68 (95% CI 1.41-2.01) for frequent bending or twisting, 1.39 (95% CI 1.24-1.55) for whole-body vibration, and 1.30 (1.17-1.45) for job dissatisfaction. For high exposure to manual materials handling, frequent bending or twisting, and whole-body vibration, the pooled OR was 1.92, 1.93, and 1.63, respectively. CONCLUSIONS: The model is the first that estimates the probability of work-relatedness for low-back pain for a given worker with low-back pain seen by a general practitioner or an occupational health physician.

Humans↗

PubMed2005

[Risk factors for back pain in children and adolescents].

Factors that have led to the increasing prevalence of back pain amongst children and adolescents living in industrialized nations are mostly unknown. The following literature review was aimed at determining the risk factors for back pain amongst children and adolescents. We searched both PUBMED and MEDLINE between the years 1985 and 2003 for the keywords "children or adolescents" and "back pain". Only data published in original articles were used. The risk for suffering back pain is influenced by physical, behavioural, emotional and social factors. The effects of physical activity, sitting, muscle status, weight of schoolbags, exercise, television and computer use, as well as age and gender on the development of back pain in children and adolescents were examined. Associations between continuous or recurring back pain and psychosocial factors (lifestyle, emotional factors, social relationships) could be demonstrated. There was no relationship between changes of the spine seen by radiological tests and the development of chronic back pain. Longitudinal epidemiological studies are urgently needed to delineate the risk factors for the development as well as the natural history of chronic back pain in the young.

Adolescent↗

PubMed1998

On the course of low back pain in general practice: a one year follow up study.

OBJECTIVES: Knowledge on the clinical course of low back pain presented in general practice is poor. Preceding studies offer a fragmentary view only, whereas further knowledge is important to enable the assessment of the prognosis. The object of this study is to investigate the course of low back pain presented in general practice to enable the assessment of the prognosis. METHODS: A one year follow up study on the clinical course of low back pain in consecutive cases receiving usual care in general practice. During a period of two years 15 general practitioners from Amsterdam and surrounding areas included consecutive patients with both chronic and recent onset low back pain. After the initial visit, each patient was monitored for a period of 12 months. The follow up consisted of monthly postal questionnaires on the course of the low back pain and the related disability. RESULTS: A total of 443 of 605 patients identified were included in the follow up, which was fully completed by 269 patients. In general, patients with less serious low back pain participated less often or did not complete the follow up. At 12 weeks 35% and at the end of the follow up 10% of the population, respectively, still suffered from low back pain. Both the pain and the disability seemed to diminish quickly after the initial visit, and both seemed to stabilise at a lower level if the low back pain did not disappear completely. About three of four patients, whose pain disappeared before the end of the follow up, endured one or more relapses within a year. The median time to a relapse was about seven weeks, and its median duration about six weeks. Both the pain and the disability turned out to be less severe during relapses. The median time to recovery for patients whose low back pain developed more than seven weeks before the initial visit, was four weeks longer than for patients with more recently developed low back pain at the initial visit. CONCLUSIONS: The clinical course of low back pain presented in general practice, for the most patients, clearly is less favourable than expected. It takes more than just a few weeks to recover, and relapses occur within a year in most cases. Fortunately, both the pain and the disability quickly diminish, even if the low back pain does not resolve within a few weeks.

Acute Disease↗

PubMedDate not supplied

Contribution of nonspinal comorbidity to low back pain outcomes.

OBJECTIVE: To determine the involvement of comorbidity to outcomes in a cohort of acute mechanical low back pain patients. METHODS: Incident low back pain cases (n=7077) in the acute or subacute phase assessed between January 1, 1999 and December 31, 2001 were included. Patients were categorized into 1 of 2 groups on the basis of their current medical history: (1) those with at least 1 of 7 medical histories considered (Comorbidity Group, n=539), or (2) those with only low back pain (Back Pain Group, n=6538). Main outcome measures were: change in perceived function and visual analog scale (VAS) pain rating from initial assessment to discharge, and total number of treatment days. RESULTS: There were no baseline statistically significant differences in VAS pain rating, questionnaire score, or symptom duration between groups. Odds ratios (ORs) were adjusted to reflect age and sex differences between groups. Logistic regression analysis revealed no statistically significant difference for change in functional score (OR=1.002) between groups; there were marginal differences in change in VAS pain rating (OR=1.08) and total number of treatment days (OR=1.006). chi analysis revealed no statistically significant differences in medication use, global pain rating, or pain control ability posttreatment, between groups. DISCUSSION: Significant ORs were barely greater than 1.00 and were likely the result of the large sample size. The clinical course for comorbid patients, who may seem more complicated at the start of treatment, is just as favorable.

Adult↗

PubMed2004

Responsiveness of pain, disability, and physical impairment outcomes in patients with low back pain.

STUDY DESIGN: Cohort study. OBJECTIVE: To conduct a head-to-head comparison of the responsiveness of pain, disability, and physical impairment measures in patients with low back pain. SUMMARY OF BACKGROUND DATA: Pain, disability, and physical impairment measures are routinely measured in clinical practice and clinical research. However, to date, a head-to-head comparison has not been performed. METHODS: A numerical pain scale (0-10), the 24-item and 2 modified 18-item versions of the Roland Morris questionnaire, the patient specific functional scale, and physical impairment measures were completed by 155 patients with low back pain at baseline and then again after 6 weeks together with an 11-point global perceived effect scale. Responsiveness was evaluated by using effect sizes and t tests, correlating the change scores for each outcome with the global perceived effect score and by calculating the Guyatt responsiveness index. RESULTS: The most responsive outcome proved to be the patient specific functional scale (effect size = 1.6), followed by the numerical pain scale (effect size = 1.3) and 24-item Roland Morris questionnaire (effect size = 0.8). The responsiveness of the two 18-item Roland Morris versions was equal to the 24-item version. However, the physical impairment measures were not very responsive (effect size 0.1-0.6). The ranking of the responsiveness indices was consistent across all statistical analyses. CONCLUSIONS: Physical impairments are routinely measured in clinical practice and clinical research, but the lower responsiveness indicates that this approach is not optimal. Our findings suggest that more emphasis should be placed on change in pain and disability scores than on change in physical impairments.

Activities of Daily Living↗

PubMed1996

Patients' views of low back pain and its management in general practice.

BACKGROUND: Low back pain is a common and persistent problem. Research studies seeking to improve the quality of management of this condition have tended to ignore the opinions of patients. There is a growing acceptance of the importance of taking patients' views into account in developing management and educational programmes for a variety of conditions. AIM: This study set out to elicit the views of patients concerning low back pain and its management in general practice. METHOD: Fifty-two in-depth interviews were conducted with patients selected from a broad range of 12 general practices. RESULTS: Analysis of the interviews identified seven themes relating to: quality of life, prognosis, secondary prevention, help-seeking behaviour, explanation of underlying pathology, satisfaction with general practitioner management, and complementary therapy. Different patient viewpoints or perspectives were expressed within each of these themes. Patients adapted to the progress of their low back pain and were not seeking a 'magical cure' from either conventional or complementary therapies. CONCLUSION: Patients' views on low back pain are heterogeneous. The dissatisfaction expressed with medical explanations for the pain may be related to superficial clinical management and the constraints of general practice. Good management of low back pain needs to take patients' complex views of the condition into account.

Adolescent↗

PubMed1992

The relationship between back pain and lead apron use in radiologists.

Anecdotal experience has suggested that back pain in radiologists may result from extensive wearing of lead aprons. To investigate this possibility, we sent questionnaires to 688 radiologists in various subspecialties whose use of lead aprons varied from none to moderate to extensive. The questionnaire included both objective items that quantitated apron use and back pain and subjective items that asked, for example, if the respondent believed that lead aprons were responsible for his or her back pain. We received 236 responses (34% response rate). Objective data from those radiologists who had experienced no back pain before wearing a lead apron (179 radiologists, 26% of those surveyed) were tabulated; respondents were grouped according to age, time spent wearing a lead apron, and degree of back pain. Odds ratios were calculated. Answers to subjective questions for all respondents were tabulated. Back pain was reported by 52% of those who estimated their lead apron use at greater than or equal to 10 hr per week, the mean response, as opposed to 46% of those who wore lead aprons fewer than 10 hr a week. These and related results were not statistically significant. Our study does not prove that wearing a lead apron is a significant risk factor for the development of back pain.

Adult↗

PubMed2006

Back pain in whitewater rafting guides.

OBJECTIVE: The purpose of this study was to quantify rates of back pain among whitewater rafting guides and to look for correlations between the presence of back pain and specific activities associated with guiding. The secondary objective was to provide suggestions for outfitters according to the results of this study, which may be of assistance to their guide staff. METHODS: A mail-out-mail-back survey was sent to 2510 rafting guides working in Washington, Oregon, Idaho, Utah, Colorado, and the Grand Canyon during the summer of 2004 to quantify whitewater raft guiding characteristics and incidence of back pain. RESULTS: Of the 390 surveys returned, 77.4% of guides reported back pain while guiding and 20.8% had back pain lasting longer than 1 week at the time of the survey. Stacking 5 or more inflated boats for transport was correlated with the presence of pain (chi(2) = 8.4, v = 1, P < .01), and loading and unloading rafts while guests are waiting was correlated with back pain lasting longer than 1 week (chi(2) = 8.1, v = 1, P < .01). CONCLUSIONS: The rates of back pain among, and activities of, whitewater rafting guides were reported. Rates of back pain among whitewater rafting guides who returned our survey appear similar to the general population. Although determining a particular cause of pain is difficult, the typical injury seems to be relatively minor in scope.

Adolescent↗

PubMed2005

Longterm reduction of back pain risk in women with osteoporosis treated with teriparatide compared with alendronate.

OBJECTIVE: To compare the effects on back pain of teriparatide versus alendronate, we analyzed the reporting of back pain in a head to head comparator trial and a followup study. METHODS: In the comparator trial, women were randomized to receive either daily self-injected teriparatide 40 microg plus an oral placebo (n = 73), or daily oral alendronate 10 mg plus self-injected placebo (n = 73). Treatment was for a median 14 months. After completion of the comparator trial, 72% of these patients enrolled in a nontreatment followup study. Adverse events were recorded at each comparator trial visit and followup study visit, and the incidence of new or worsening back pain in each group was compared. RESULTS: During the comparator trial, compared with women randomized to alendronate 10 mg, women randomized to teriparatide 40 microg had reduced risk for any back pain (relative risk 0.27, 95% CI 0.09-0.82) and moderate or severe back pain (relative risk 0.19, 95% CI 0.04-0.86). The differences in the reporting of back pain between the teriparatide treated women and the alendronate treated women were sustained during an interval including the comparator trial plus 18 additional months. During an interval including the comparator trial plus 30 additional months, teriparatide treated patients had numerically fewer occurrences of back pain and moderate or severe back pain. CONCLUSION: Compared with women randomized to alendronate 10 mg, women randomized to teriparatide 40 microg had reduced risk of back pain during the trial and 2.5 years of followup.

Aged↗

PubMed2002

Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain.

The present study was carried out to examine possible mechanisms of back muscle dysfunction by assessing a stabilising and a torque-producing back muscle, the multifidus (MF) and the iliocostalis lumborum pars thoracis (ICLT), respectively, in order to identify whether back pain patients showed altered recruitment patterns during different types of exercise. In a group of healthy subjects (n=77) and patients with sub-acute (n=24) and chronic (51) low back pain, the normalised electromyographic (EMG) activity of the MF and the ICLT (as a percentage of maximal voluntary contraction) were analysed during coordination, stabilisation and strength exercises. The results showed that, in comparison with the healthy subjects, the chronic low back pain patients displayed significantly lower (P=0.013) EMG activity of the MF during the coordination exercises, indicating that, over the long term, back pain patients have a reduced capacity to voluntarily recruit the MF in order to obtain a neutral lordosis. In contrast, during the stabilisation exercises, no significant differences between patients and controls were found for the normalised EMG activity of the two muscles. These findings indicated that, during low-load exercises, no insufficiencies in back muscle recruitment were evident in either subacute or chronic back pain patients. During the strength exercises, the normalised activity of both back muscles was significantly lower in chronic low back pain patients (P=0.017 and 0.003 for the MF and ICLT, respectively) than in healthy controls. Pain, pain avoidance and deconditioning may have contributed to these lower levels of EMG activity during intensive back muscle contraction. The possible dysfunction of the MF during coordination exercises and the altered activity of both muscles during strength exercises may be of importance in symptom generation, recurrence or maintenance of low back pain.

Acute Disease↗