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PubMed2004

Prospective controlled study of the development of lower back pain in previously asymptomatic subjects undergoing experimental discography.

STUDY DESIGN: A prospective controlled longitudinal study. OBJECTIVES: To determine whether subjects, asymptomatic for lower back problems, who undergo experimental discography, will develop lower back problems during the medium term to the full term. SUMMARY OF BACKGROUND DATA: Previous work has shown significant pain on discographic injection in approximately 40% of asymptomatic subjects. It has been suggested that those subjects with painful injections would soon develop lower back pain (LBP) syndromes in the near future: that is, the experimental discography was detecting an imminent "pain generator" before clinically symptomatic. METHODS.: Fifty subjects without low back pain were recruited for clinical and psychometric testing, MRI scanning, and experimental lumbar discography to determine the rate of painful lumbar disc injections in select subjects without LBP history. After determining which subjects had painful injections, all subjects completing the discography protocol were prospectively followed at yearly intervals to determine the occurrence of LBP and LBP disability over time. Statistical methods were then used to determine the correlation, if any, between the asymptomatic subjects' clinical, MRI, and discography findings, and the subsequent LBP measures. Controls, not participating in the lumbar discography study, were also followed. Controls were matched for clinical features, sex, age, and occupational/recreational exposure. Follow-up examinations were performed at yearly intervals by blinded researchers using a scripted interview and completing standard questionnaires. RESULTS: A total of 46 of 50 completed the discogram, and all 46 subjects completed the final 4-year follow-up examination. There was a low incidence of LBP episodes in the experimental groups and control. A painful disc injection, independent of psychological profile, did not predict LBP or any other functional outcome measure at follow-up on multivariate analysis. The presence of an anular fissure seen on discography was weakly associated with the cumulative incidence of LBP episodes after discography (P = 0.08). The presence of high intensity zone on MRI in any disc was also weakly associated with the development of LBP episodes (P = 0.09). Psychometric profiles at the start of the study strongly and independently predicted future back pain (P = 0.01), medication usage (P = 0.002), and work loss (P = 0.01) over the 4-year study. Compared with controls not having undergone discography, there was no significant difference in back pain, function, work loss, doctors visits for back pain, or medication intake in any group. A subset in the injection group with somatization disorder had a higher LBP visual analog score compared with somatization disorder controls at 1 year,but this was not significant at 4 years after testing. CONCLUSIONS: Painful disc injections are poor independent predictors of subsequent LBP episodes in subjects initially without active lower back complaints. Anular disruption is a weak predictor of future LBP problems. Psychological distress and preexisting chronic pain processes are stronger predictors of LBP outcomes.

Cervical Vertebrae↗
PubMed2006

Nonspecific lower-back pain: surgical versus nonsurgical treatment.

UNLABELLED: We review evidence-based treatments for patients seeking care for lower-back pain and patients who have been diagnosed with nonspecific lower-back pain. The review is based on selected systematic reviews and national and international guidelines for the treatment of lower-back pain. Additional randomized controlled trials (ie, possibly those not previously included in the latest systematic reviews) were reviewed and added based on recommended procedures for the evaluation of methodological quality (ie, strong, moderate, and weak). In acute nonspecific lower-back pain (0-4 weeks duration of pain) there is moderate to strong evidence that self-care with over-the-counter medication and maintaining activity as tolerated or treatment with a limited number of sessions of manipulative therapy is effective for pain relief. In subacute nonspecific lower-back pain (4-12 weeks duration of pain) there is weak to moderate evidence that a graded activity program including exercises and cognitive behavioral treatment in combination is more efficient than usual care with regard to return to work. There is strong evidence that these programs reduce work absenteeism. In cases of chronic nonspecific lower-back pain (> 12 weeks duration of pain) a variety of treatments are available with limited and similar efficacy on pain and disability reduction. There is moderate evidence that surgery in chronic nonspecific lower-back pain is as effective as cognitive behavioral treatment with regard to pain, function, mood and return to work. Surgical indications for chronic nonspecific lower-back pain remain ill defined. LEVEL OF EVIDENCE: Level V (expert opinion). See the Guidelines for Authors for a complete description of levels of evidence.

Analgesics↗
PubMed2003

The weight of schoolbags and the occurrence of neck, shoulder, and back pain in young adolescents.

STUDY DESIGN: A cross-sectional study of 745 young adolescents in the area of two Regional Health Centers in the Netherlands. OBJECTIVES: To assess the occurrence of neck and/or shoulder and back complaints in young adolescents and examine relationships with type and weight of schoolbags and other physical and psychologic risk factors. SUMMARY OF BACKGROUND DATA: The occurrence of back pain in children and adolescents varies from 8% to 74% in the literature. Age, gender, and certain psychological factors appear to be important risk factors. An association with heavy schoolbags has been presumed but without clear scientific evidence. METHODS: A questionnaire was used, asking about complaints of back, neck, and/or shoulders and about potential risk factors including psychosomatic factors. Length and weight of the children were determined. Schoolbags were weighed, and the relative weight of the schoolbag was calculated. RESULTS: Neck and/or shoulder complaints and also back complaints were reported by about 45% of young adolescents. Severe complaints of neck and/or shoulder were reported by 6%, and severe back complaints by 7% of the schoolchildren. The (relative) weight of schoolbags was not related to complaints of neck and/or shoulder and back. Psychosomatic factors showed the strongest association with the occurrence of neck and/or shoulder and back complaints. CONCLUSION: Psychosomatic factors appear to be more strongly related to the occurrence of neck and/or shoulder and back complaints than the type and weight of the schoolbag and other physical factors. The role of psychosomatic factors should be further explored in future longitudinal research.

Adolescent↗
PubMed2003

Large-array surface electromyography in low back pain: a pilot study.

STUDY DESIGN: A large-array surface electromyography device was used to collect data from healthy pain-free persons and from those with acute or chronic low back pain. Images of regional muscle electromyographic activity were assessed visually, and maximum root mean square values were compared statistically. OBJECTIVE: To determine whether data differs by patient type. SUMMARY OF BACKGROUND DATA: Whereas there is a good understanding of the anatomy and psychosocial aspects of low back pain, there is a need to understand better the physiology of low back pain. METHODS: Large-array surface electromyography data were collected from the low back muscles of 201 participants over a 3-month period using a 63-electrode fixed array and a standardized protocol. Color images representing the voltage root mean square difference of each electrode pair were created. Three images from each of three positions (standing upright, standing in 20 degrees of trunk flexion, standing holding weights) were collected from each participant. Serial studies were performed on the acute population over a 6-week follow-up period. RESULTS: Images of regional muscle activity from 92.7% of normal controls (n = 163) showed symmetrical activity. Patients with acute (n = 13) or chronic (n = 25) low back pain had multifocal and/or asymmetrical patterns. Symmetrical patterns returned in the three patients whose acute pain resolved during the study. Maximum root mean square values were higher among patients with acute (P = 0.03) and chronic (P = 0.04) pain than among control subjects. CONCLUSIONS: Large-array surface electromyography produced data from patients with back pain that differed from data on subjects without back pain. This method may be useful in evaluating patients with low back pain.

Acute Disease↗
PubMed2003

Sitting with adjustable ischial and back supports: biomechanical changes.

STUDY DESIGN: The seat and back contact force, pressure distribution, lumbar lordosis, and low back muscle activities associated with a new seat design with adjustable ischial support and backrest were investigated using kinematic, kinetic, electromyographic, and radiographic measurements. OBJECTIVES: To investigate the biomechanical effects of adjusting ischial and backrest supports during sitting. SUMMARY OF THE BACKGROUND DATA: Sitting may induce posterior rotation of the pelvis, reduction of lumbar lordosis, and increases in muscle tension, disc pressure, and pressure on the ischium and coccyx, which may be associated with low back pain. A device that reduces the ischial load and maintains lumbar lordosis may help increase seating comfort and reduce low back pain. METHODS: Fifteen office workers with no known low back pain history were tested. Contact pressure distributions, reaction forces between the buttock-thighs and seat and between the back and backrest, load carried by the seat pan and backrest, sacral inclination, lumbar lordosis, intervertebral space of lumbar spine, and muscular activity in stabilizing the trunk were measured for sitting with and without ischial support and with adjustable back support. RESULTS: When the ischial support was relieved, the center of the force on the seat and on the legs of the chair, and the peak center of pressure on the seat, were significantly (P < 0.002) shifted forward toward the thighs. The total contact area on the seat pan and on the backrest was significantly decreased and increased, respectively (P < 0.001). The sacral inclination, total and segmental lumbar lordosis, and lumbar spine disc height were significantly increased for sitting upright with backrest, with the lumbar curve close to that during standing. CONCLUSIONS: Sitting with reduced ischial support and fitted backrest to the lower spine altered the contact area, reduced peak pressure under the ischia, reduced muscular activity, maintained total and segmental lumbar lordosis, rotated the sacrum forward, and increased lumbar intervertebral disc heights, which could potentially reduce low back pain.

Adult↗
PubMed2003

Systematic review of antidepressants in the treatment of chronic low back pain.

BACKGROUND: Three previous reviews have reached conflicting conclusions regarding the efficacy of antidepressants for patients with back pain. OBJECTIVES: To systematically review the efficacy of antidepressants for the treatment of patients with back pain and to determine whether there is evidence that outcomes vary between classes of antidepressants. MATERIALS AND METHODS: Best evidence synthesis of randomized, placebo-controlled trials of oral antidepressive agents in patients with back pain. Studies were identified by searching MEDLINE, PsycINFO, and the Cochrane Controlled Trials Registry. Two independent reviewers performed data extraction and assessed included studies with a 22-point methodologic quality assessment scale. Effect sizes were calculated if sufficient data were available. RESULTS: Twenty-two trials of antidepressants for the treatment of back pain were identified, of which seven studies of chronic low back pain met inclusion criteria. Among studies using antidepressants that inhibit norepinephrine reuptake (tricyclic or tetracyclic antidepressants), four of five found significant improvement in at least one relevant outcome measure. Assessment of these agents' impact on functional measures produced mixed results. No benefit in pain relief or functional status was found in three studies of antidepressants that do not inhibit norepinephrine reuptake. CONCLUSIONS: Based on a small number of studies, tricyclic and tetracyclic antidepressants appear to produce moderate symptom reductions for patients with chronic low back pain. This benefit appears to be independent of depression status. SSRIs do not appear to be beneficial for patients with chronic low back pain. There is conflicting evidence whether antidepressants improve functional status of patients with chronic low back pain.

Antidepressive Agents↗
PubMed2003

Asymmetry of premotor time in the back muscles of adolescent idiopathic scoliosis.

STUDY DESIGN: In 38 patients with adolescent idiopathic scoliosis (AIS), the correlation between left and right differences in premotor time (D-PMT) of back muscle and clinical findings were analyzed. OBJECTIVE: To investigate the clinical relevance of back muscle D-PMT in AIS. SUMMARY OF BACKGROUND DATA: There have been numerous studies investigating back muscle asymmetry of AIS by EMG, but to date, no studies have measured D-PMT in back muscles. MATERIALS AND METHODS: D-PMT in the back muscles measured in a similar manner as that in the extremity muscles was assessed in 10 nonscoliotic teenaged girls and 38 AIS patients. The correlation between back muscle D-PMT and four factors (age, Risser sign, Cobb angle, and progression of deformity) was investigated. RESULTS: The D-PMT values of back muscle at all levels in the control group were within +/-5 ms, but those in 20 of the 38 AIS patients were more than 5 ms. D-PMT at the lower-end vertebra level was strongly correlated with progression of deformity, but not with age, Risser sign, and Cobb angle. All five patients with D-PMT of more than 10 ms at the lower-end vertebra level had progressive deformity. CONCLUSIONS: D-PMT in back muscle at the lower end vertebra level in AIS correlated closely to the progression of scoliotic deformity, thus suggesting that this phenomenon is associated with the progression in AIS.

Adolescent↗
PubMed2004

A low back-specific version of the SF-36 Physical Functioning scale.

STUDY DESIGN: A prospective repeated measures design was used to produce a back-specific version of the Short Form-36 Physical Functioning scale (SF-36 PF) by Rasch analysis of a pool of items from the SF-36 PF, Oswestry Disability Questionnaire, and the Quebec Back Pain Disability Scale. OBJECTIVES: To identify items for a back-specific version of the SF-36 PF scale and to compare the psychometric properties of the new version with the original 10-item scale. SUMMARY OF BACKGROUND DATA: Adequate assessment of patient function requires the administration of a generic and a condition-specific questionnaire. A back-specific version of the SF-36 PF would facilitate comprehensive patient assessment in the clinical setting. METHODS: Consecutive patients with low back pain presenting for physiotherapy treatment were recruited at three public hospitals, three community health services, and four private practices. Patients completed questionnaires on two occasions 6 weeks apart. RESULTS: A scale of 18 items showed a better fit to the Rasch model than the original SF-36 PF scale. Items in the original scale that had a poor fit (INFIT/OUTFIT statistics outside the range 0.7-1.3) showed an acceptable fit in the new scale. The augmented scale had comparable reliability and improved responsiveness to the original 10-item SF-36 PF scale. The minimum detectable change (90% confidence) and the minimum clinically important difference were 12 points. Floor and ceiling effects were practically eliminated. The psychometric properties of the new scale were comparable to those of the Oswestry Disability Questionnaire. CONCLUSIONS: The Low-Back SF-36 PF18 comprises the 10-item SF-36 PF scale and four items each from the Oswestry and Quebec back pain questionnaires. The possible total score ranges from 0 to 100, with a higher score indicating better function. The new scale appears to offer advantages over the use of the original scale for the assessment of functioning in patients with low back pain.

Adolescent↗
PubMed2004

Psychosocial factors at work as predictors of hospitalization for back disorders: a 28-year follow-up of industrial employees.

STUDY DESIGN: A prospective cohort study. OBJECTIVES: To study the association of psychosocial factors at work with severe back disorders leading to hospitalization. SUMMARY OF BACKGROUND DATA: Some psychosocial factors at work have been related to back pain, but little is known about their predictive role in severe back disorders. METHODS: Psychosocial factors at work were studied by questionnaire and interview in 1973 among a cohort of 902 metal industry employees. Information on hospital admissions for back disorders from the Finnish Hospital Discharge Register in 1973-2000 was linked to the data. Cox proportional hazards regression was used to estimate the time between the assessment of risk factors and the first hospital admission for intervertebral disc disorders (36 cases) and other back disorders (47 cases). RESULTS: In a model including psychosocial factors and potential confounders, low job control versus high control was associated with a 3.2-fold risk (95% confidence interval, 1.3-7.8) of hospitalization for back disorders other than those of the intervertebral disc. The corresponding rate ratio for low versus high supervisor support was 2.9 (95% confidence interval, 1.3-6.3). Job demands, coworker support, and distress were not independently associated with these disorders. The result did not change when patients with chronic back disorder at baseline were excluded from the analysis. There was no association between psychosocial factors at work and hospitalizations for intervertebral disc disorders. CONCLUSION: Low job control and low supervisor support seem to increase the risk of hospitalization for back disorders other than intervertebral disc disorders.

Adult↗
PubMed2005

Low back pain on passive straight leg raising: the anterior theca as a source of pain.

STUDY DESIGN: A prospective clinical and radiologic investigation of two groups of patients presenting with either acute back pain only or acute leg pain only, yet similar restriction in straight leg raising (SLR). OBJECTIVES: To highlight a group of patients presenting with acute low back pain only, yet a restricted SLR normally associated with leg pain (sciatica) caused by a posterolateral disc prolapse. To determine the anatomic source of the pain in the low back pain only group. SUMMARY OF BACKGROUND DATA: A restricted SLR is commonly associated with leg pain (sciatica) due to compression of a nerve root by an intervertebral disc prolapse. Previous studies investigating pain patterns on SLR have suggested that central disc prolapses tend to induce back pain whereas the more lateral prolapses induce leg pain. Such research work has involved patients presenting with typical sciatic pain investigated by myelography and undergoing decompressive surgery. There are no studies specifically investigating patients presenting with low back pain only and reduced SLR. METHODS: Two groups of patients, one with acute low back pain only and one with acute leg pain only, yet showing similar restriction in SLR underwent MR imaging. The scans were reviewed "blind" by an experienced spinal radiologist and imaging features recorded according to a detailed protocol. The MR findings were then compared. RESULTS: Significant disc prolapses were seen equally in both groups. The disc prolapses in the back pain only group were more likely to be central, smaller, to compress the theca only, and to be at a higher lumbar level as compared with the leg pain only group. CONCLUSIONS: Acute low back pain associated with significant restriction in SLR is likely to be caused by a disc prolapse compressing the anterior theca.

Acute Disease↗
PubMed2005

Individual active treatment combined with group exercise for acute and subacute low back pain.

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To compare two fast-access evidence-based interventions for the treatment of simple low back pain. SUBJECTS: People aged 18-65 with a new episode of simple back pain causing them to be off work or on modified work for less than 1 year. SETTING: A district general hospital using a consultation/treatment room and a rehabilitation gym. METHODS: One group received a back advice booklet and one session of advice and then followed the normal route of care as directed by their general practitioner. The other group received the back booklet and one session of advice and also a back program. The back program consisted of a full assessment, immediately followed by one individual treatment, and then exercise classes over 1 to 2 weeks. OUTCOME MEASURES: (1) Rate of return to work, (2) pain scores and health status, and (3) cost effectiveness of interventions versus the financial cost to the individual or employer. RESULTS: On average, those receiving the individual treatment and group exercise took 7 days less off work. This represented a 35% reduction in the amount of time taken off work since study entry. The estimated cost saving of providing the extra service of a simple back program ranged between 250 pound (367 US dollars, 300 euro) and 578 pound (850 US dollars, 694 euro) for each patient. CONCLUSION: The results indicate that the costs of this active back program are more than reimbursed as a consequence of earlier return to work.

Absenteeism↗
PubMed2005

Satisfaction as a predictor of clinical outcomes among chiropractic and medical patients enrolled in the UCLA low back pain study.

STUDY DESIGN: Observational study conducted within a randomized clinical trial. OBJECTIVES: The objective of this study is to estimate the effects of patient satisfaction on subsequent changes in pain and disability among low back pain patients randomized to chiropractic or medical care in a managed-care practice setting. SUMMARY OF BACKGROUND DATA: Recent studies of low back pain treatments have shown chiropractic patients to be more satisfied with their care than medical patients. However, little is known about the relation between patient satisfaction and clinical outcomes. METHODS: A total of 681 low back pain patients presenting to three southern California healthcare clinics and screened for serious spinal pathology and contraindications were randomized to medical care with and without physical therapy, and chiropractic care with and without physical modalities, and followed for 18 months. Satisfaction with back care was measured on a 40-point scale and observed at 4 weeks following randomization. The primary outcome variables, observed between 6 weeks and 18 months of follow-up, are average and most severe low back pain intensity in the past week, assessed with 0 to 10 numerical rating scales, low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire, and remission from clinically meaningful pain and disability. Perceived change in low back symptoms was a secondary outcome. RESULTS: Greater satisfaction increased the odds of remission from clinically meaningful pain and disability at 6 weeks (adjusted odds ratio [OR] for 10-point increase in satisfaction = 1.61, 95% confidence interval [CI] = 0.99, 2.68), but not at 6, 12, or 18 months (6 months: adjusted OR = 1.05, 95% CI = 0.73, 1.52; 12 months: adjusted OR = 0.94, 95% CI = 0.67, 1.32; 18 months: adjusted OR = 1.07; 95% CI = 0.76, 1.50). Perception of improvement was greater among highly satisfied than less satisfied patients throughout the 18-month follow-up period. The estimated effects of satisfaction on clinical outcomes were similar for medical and chiropractic patients. CONCLUSIONS: Patient satisfaction may confer small short-term clinical benefits for low back pain patients. Long-term perceived improvement may reflect, in part, perceived past improvement as measured by satisfaction.

Adult↗
PubMed2006

Sleep disturbances as predictors of hospitalization for back disorders-a 28-year follow-up of industrial employees.

STUDY DESIGN: A prospective cohort study. OBJECTIVE: To study the relationship of sleep disturbances with severe back disorders leading to hospitalization. SUMMARY OF BACKGROUND DATA: Sleep disturbances are associated with persistent pain syndromes, but little is known about their relationship with back disorders. METHODS: The first hospital admission for back disorders from 1973 to 2000 was studied in a cohort of metal industry workers (n = 902). The occurrence of sleep disturbances at baseline was categorized as: none; 1 type (either difficulties in falling asleep/waking up at night or nightmares); or both types. Cox proportional hazards regression was used to estimate the time between the assessment of risk factors and first hospital admission for back disorders. RESULTS: Those individuals who had 1 type of sleep disturbance had a 2.1-fold (95% confidence interval 1.1-3.8) risk of back-related hospitalization, and those with both types of disturbance a 2.4-fold (1.2-4.6) risk, compared with those with no sleep disturbances. The hazard ratios were 2.1; 1.0-4.6 and 2.9; 1.2-7.1, respectively, when patients with chronic back disease or recurrent back symptoms at baseline were excluded from the analyses. CONCLUSION: These findings suggest that sleep disturbances are predictive of hospitalization for back disorders. The mechanism underlying this association warrants further study.

Aged↗
PubMed2006

Does physiotherapy management of low back pain change as a result of an evidence-based educational programme?

RATIONALE: The concept of evidence-based medicine is important in providing efficient health care. The process uses research findings as the basis for clinical decision making. Evidence-based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide. Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence. The use of opinion leaders to disseminate new evidence around the management of low back pain into practice has been proposed. AIMS: The aim of this study was to investigate if physiotherapists' clinical management of patients with low back pain would change following an evidence-based education package, which utilized local opinion leaders and delivered the best evidence. METHOD: Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster randomized by location of work, to two groups. The intervention group received an evidence-based programme on the management of low back pain, including advice regarding increasing activity levels and return to normal activity and challenging patients' fears and beliefs about their pain. The control group received a standard in-service training package on the management of common knee pathologies. The physiotherapists' clinical management of patients with low back pain was measured prior to training and 6 months post training. Outcome measures were based on physiotherapists completing 'discharge summary' questionnaires, which included information relating to the use and importance of therapies for treating their low back pain patients. RESULTS: There were few significant differences in treatment options between the intervention and control groups post training. Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain, there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention. CONCLUSIONS: Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain. This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice. Whilst there were some limitations in the overall size of the study, the results help to give an insight into the challenges faced by the health care system and researchers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care.

Diffusion of Innovation↗
PubMed1985

Prevalence and functional correlates of low back pain in the elderly: the Iowa 65+ Rural Health Study.

As part of an interview survey of a defined population of 3,097 rural persons 65 years and older (the Iowa 65 + Rural Health Study), the prevalence and functional correlates of specifically defined low back pain were studied. Low back pain was reported by 23.6 per cent of the women and 18.4 per cent of the men in the year prior to the survey, with prevalence rates declining with age. Forty per cent of those with low back pain noted its presence at the time of the interview. Over half had used analgesics. Use of medical and chiropractic services for this symptom was nearly 75 per cent; 25 per cent had at least one hospitalization directly related to low back pain and over 5 per cent had low back surgery. Limitation of walking, sitting, bending over, and performing household chores was reported by 15 to 40 per cent, and 21 per cent attributed sleep disturbance to the low back pain. Nearly 75 per cent of subjects with low back pain reported first onset of the problem prior to age 65, which has important implications for pathogenesis and prevention. The functional and clinical burdens of low back pain in this population of rural elderly were substantial and require further evaluation of risk factors and impact on health status.

Activities of Daily Living↗
PubMed1996

Low back pain in elite cross-country skiers. A retrospective epidemiological study.

Low back pain is a common complaint among competitive cross-country skiers. Fifty-three top male and 34 female skiers in the age group 16-25 were interviewed with a questionnaire regarding anthropometric parameters, training variables, back pain and other injuries. The frequency of back pain was 64% in the whole group, men affected slightly more often than women. Back pain was defined as previous or present recurrent skiing correlated backache that more or less affected skiing ability. Diagonal skiing style was the most commonly back pain-inducing style, whereas no skier experienced back pain when "skating" only. The low back was the predominant location of pain. Anthropometric and training variables seemed to be of little value in predicting back pain.

Adolescent↗
PubMed2002

Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys.

OBJECTIVES: To study changes in pain of the back and neck in adolescents between 1985 and 2001 and pain of the neck, shoulder, and lower back between 1991 and 2001. DESIGN: Biennial nationwide postal surveys, 1985-2001, and annual classroom surveys, 1996-2001. SETTING: Finland. PARTICIPANTS: 62 677 12, 14, 16, and 18 year olds and 127 217 14-16 year olds. MAIN OUTCOME MEASURES: Pain in the back and neck, neck and shoulder, or lower back, at least weekly. RESULTS: Prevalence of pain in the back and neck was greater in the 1990s than in the 1980s and increased steadily from 1993 to 1997. Pain of the neck and shoulder and pain of the lower back was much more common in 1999 than in 1991 and in 2001 than in 1999. Pain was more common among girls and older groups: pain of the neck and shoulder affected 24% of girls and 12% of boys in 14 year olds, 38% of girls and 16% of boys in 16 year olds, and 45% of girls and 19% of boys in 18 year olds; pain in the lower back affected 8% of girls and 7% of boys in 14 year olds, 14% of girls and 11% of boys in 16 year olds, and 17% of boys and 13% of girls in 18 year olds. CONCLUSION: Pain in the neck, shoulder, and lower back is becoming more common in Finnish adolescents. This pain suggests a new disease burden of degenerative musculoskeletal disorders in future adults.

Adolescent↗
PubMed2001

Formal education and back pain: a review.

OBJECTIVES: To summarise the scientific evidence on the relation between educational status and measures of the frequency and the consequences of back pain and of the outcomes of interventions among back pain patients, and to outline possible mechanisms that could explain such an association if found. DESIGN: Sixty four articles published between 1966 and 2000 that documented the association of formal education with back pain were reviewed. MAIN RESULTS: Overall, the current available evidence points indirectly to a stronger association of low education with longer duration and/or higher recurrence of back pain than to an association with onset. The many reports of an association of low education with adverse consequences of back pain also suggest that the course of a back pain episode is less favourable among persons with low educational attainment. Mechanisms that could explain these associations include variations in behavioural and environmental risk factors by educational status, differences in occupational factors, compromised "health stock" among people with low education, differences in access to and utilisation of health services, and adaptation to stress. Although lower education was not associated with the outcomes of interventions in major studies, it is difficult, in light of the current limited available evidence, to draw firm conclusions on this association. CONCLUSION: Scientific evidence supports the hypothesis that less well educated people are more likely to be affected by disabling back pain. Further study of this association may help advance our understanding of back pain as well as understanding of the relation between socioeconomic status and disease as a general phenomenon.

Adolescent↗