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PubMed2002

[Low back pain--what do we really know?].

Low back pain is one of the most frequent health problems of contemporary people. Therapy is usually conservative and symptomatic because in the most part of cases the etiology remains unknown. Evidence based medicine is putting itself in front also in the field of low back pain diagnosis and treatment. The therapy for low back pain is thoroughly and scientifically rigorously analized by the professionals from the Cochrane Collaboration. There are still not published enough randomized controlled studies to conclude about the effectiveness of most frequently used physical therapy modalities. There is a necessity for additional researching in that field.

Evidence-Based Medicine↗
PubMed2002

Characteristics of patients with chronic low back pain selected for surgery: a comparison with the general population reported from the Swedish lumbar spine study.

STUDY DESIGN: A group of surgical candidates with chronic low back pain was compared with a random sample of the general population. OBJECTIVES: To compare the sociodemographic, physical, and psychological characteristics of patients enrolled in a randomized trial of fusion surgery for chronic low back pain with those of an age- and gender-matched general population, and to assess whether the results of the current study can be generalized to other groups of subjects with chronic low back pain. SUMMARY OF BACKGROUND DATA: The patients with low back pain in industry, primary care, and rehabilitation clinics are well described, with evidence of increased psychological distress, social disturbance, and occupational dissatisfaction. The characteristics of surgical candidates with chronic low back pain are less well described and not compared with the general population. METHODS: Social, occupational, psychological, and physical data from self-administered questionnaires completed by 294 consecutive surgical candidates with chronic low back pain were compared with the same data from 278 subjects in an age- and gender-matched random sample of the Swedish general population. Data were analyzed with the general population sample divided in two subgroups: subjects with and those without back pain. RESULTS: The surgical candidates with chronic low back pain differed significantly from the control subjects free of back pain by demonstrating more smoking, general morbidity, and depressive symptoms as well as heavier occupation and self-assessed workload. However, they did not differ from the control subjects with back pain in these respects. In a multiple logistic regression analysis, physical disability was the only variable that independently discriminated between all three groups. The groups did not differ in terms of depressive symptoms. Differences were more obvious between the two general population groups than between the two groups with back pain. The rate of major depression was lower (9%) among the surgical candidates than in other reported groups with chronic low back pain. CONCLUSIONS: The surgical candidates in the current study resembled the average Swedish citizen with back pain. Although selected for treatment because of symptom severity, they did not otherwise differ substantially from the general population with back pain. On the contrary they unexpectedly were affected only a little by depressive symptoms, distinguishing them from patients with chronic low back pain in pain clinics and rehabilitation centers. Therefore, the results of the this outcome study are not generally applicable to every patient with chronic low back pain.

Adult↗
PubMed1988

The occurrence of maladaptive health-related behaviors and teacher-rated conduct problems in children of chronic low back pain patients.

Chronic low back pain (CLBP) is often associated with a complex of behaviors in the patient which cause interference in adaptive functioning of both the patient and the patient's family. This study examined a group of children of CLBP patients, a control group of children of diabetic patients, and a general control group of children. The study supported the hypothesis that, as a group, children of CLBP patients would exhibit a higher frequency of behaviors hypothesized to be learned through observation of and interaction with a CLBP parent than would children in either of the control groups. Significant differences between the pain group and the control groups on each of the nine teacher-reported and child self-report measures were observed. Implications and limitations of the study are discussed.

Back Pain↗
PubMed2004

Movements of the pelvis and lumbar spine during walking in people with acute low back pain.

BACKGROUND AND PURPOSE: Little is known about how acute low back pain affects pelvic and lumbar movements during walking. The aim of the present study was to determine if measurement of the amplitude of the angular movements of the pelvis and lumbar spine during walking is useful in the evaluation of people with acute low back pain. METHOD: The study used a repeated-measures and correlational design; 11 individuals with low back pain (tested in the acute phase and six weeks later when symptoms had resolved) and matched control subjects were tested during treadmill walking. A video-analysis system was used to measure the amplitudes of movements of the pelvis and lumbar spine during walking. Pain level was measured with a visual analogue scale (VAS). RESULTS: During walking, movements of the pelvis (axial rotation) and lumbar spine (lateral flexion) were reduced in people with acute back pain compared with the resolved condition, but were not different from a group without a history of back pain. The amplitudes of the frontal plane movements of the pelvis and lumbar spine were negatively correlated with the intensity of pain (r(s) = -0.74). CONCLUSIONS: Measurement of pelvic and lumbar movements during walking is unlikely to have useful clinical applications for individuals, or when discriminating between impaired and unimpaired people, but may be applied to groups for hypothesis testing in evaluating change in back pain over time. An hypothesized model to explain the observed movements has been proposed.

Acute Disease↗
PubMed1991

Low-back pain, its origin and risk indicators.

Low-back pain is a common ailment. Much is known of the pain-sensitive structures of the low back, but for a patient with acute low-back pain the cause can rarely be defined. Although the biochemical properties of the intervertebral discs and their degenerative changes have been unraveled, it is difficult to distinguish between pathological degeneration and normal changes due to aging. As a consequence of the problems in diagnosing back diseases, the most common measure of low-back morbidity in epidemiologic studies has been the occurrence of symptoms. A wide spectrum of work- and individual-related factors have been found to be associated with low-back pain, but little is known about the extent to which these factors are etiologic and the extent to which they are symptom-precipitating or symptom-aggravating.

Accidents, Occupational↗
PubMed1989

Determinants of vocational disability in patients with low back pain.

Eighty-seven unemployed subjects with low back pain were recruited from an orthopedic back pain clinic and were given a battery of physical and psychologic tests. Subjects were contacted six months later to determine their current compensation status and whether they had returned to work. Age, length of time out of work, how much they had lifted in their previous job, the number of weeks they had been compensated, current activity levels, leg pain, and various psychologic factors significantly differentiated those who worked from those who did not. Physical examination findings and testing of the ability to lift were not significantly related to return to work. It is suggested that demographic, job-related, and psychologic factors should be emphasized, rather than only physical capacity, in the evaluation of vocational potential and the assessment of disability in patients with low back pain.

Adult↗
PubMed1997

The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland.

STUDY DESIGN: A nationwide, cohort-based cross-sectional questionnaire survey as a part of a population study. OBJECTIVES: To evaluate the prevalence of low back pain among Finnish children and adolescents. SUMMARY OF BACKGROUND DATA: Low back pain is common already in adolescence, but the results concerning sex differences and peak age of the prevalence have been partly controversial. Also, previous studies have been limited to smaller geographic areas. METHODS: The subjects were 594 girls and 577 boys, a total of 1171 children and adolescents. They were pupils of 45 different public schools. Various areas of Finland were included in the sampling process to represent different parts of the country and different living conditions. The subjects completed a validated questionnaire by themselves or with the help of a parent or guardian. The questionnaire was checked by a supervisor when entering the field study. The questionnaire included items that investigated the subjects' past and current low back pain. Low back pain was classified on the basis of timing, duration, and location. Subjects reporting pain in the low back area that interfered with school work or leisure activities during the previous 12 months were defined as having low back pain. RESULTS: The prevalence of back pain was low (1%) among the 7-year-old and 10-year-old (6%) schoolchildren, but increased with age, being 18% both among 14- and 16-year-old adolescents. No gender difference was found. Recurrent or chronic pain was reported by 26% of the boys and 33% of the girls who reported low back pain, and the proportion of recurrent and chronic pains of all low back pain incidents increased with age. CONCLUSIONS: Low back pain is a relatively common complaint at adolescence. In addition, a significant part of the pains are recurrent or chronic already with 14-year-old adolescents.

Adolescent↗
PubMed1997

Relationships between spinal mobility, physical performance tests, pain intensity and disability assessments in chronic low back pain patients.

Correlations between the Oswestry Disability Questionnaire (ODQ), the Pain Disability Index (PDI), PDI subscales PDI factor 1 (PDI 1), PDI factor 2 (PDI 2) and visual analogue scale (VAS) pain intensity on the one hand and spine range of motion measures and static and dynamic functional performance tests on the other, were studied in 52 chronic low back pain patients. Comparable groups of male and female patients were studied. A moderately significant (p < 0.01) inverse correlation was observed between the ODQ and rotation to the left even after correction for age, but not when men and women were studied separately. A significant (r = -0.480, p < 0.001) inverse correlation was observed between the repeated squatting test and pain intensity and in men both pain intensity and disability correlated (r = -0.607, p < 0.001) with this particular test. Only for the women were there moderately significant (p < 0.01) inverse correlations between disability assessments and all the physical performance tests with the exception of the static back muscle test. In the women only the isometric lifting test showed a moderately significant inverse correlation (r = -0.504, p < 0.01) with pain intensity. Such apparent gender differences in the overlap between physical performance tests and self-report disability assessments and pain intensity may be clinically relevant. The results will, however, require confirmation on larger groups of chronic low back pain patients.

Adult↗
PubMed2000

Back pain: a case study.

Musculoskeletal complaints, especially back pain without trauma, are frequent health problems seen by nurse practitioners in community emergency centers and office settings. Back pain can be a symptom of serious health problems. This article presents the case of a Caucasian male in his early sixties who reported sudden onset of back pain after pushing a heavy object. Careful clinical assessment led the nurse practitioner with the collaborating physician to pursue diagnostic tests, which revealed thoracic and abdominal aortic aneurysms.

Aortic Aneurysm, Abdominal↗
PubMedDate not supplied

Cost-based evaluations of the treatment of back pain: a primer for health-care professionals.

BACKGROUND CONTEXT: There is an extensive literature on the costs of back pain and on cost-based evaluations of the effectiveness of alternative modes of care for back pain. An understanding of the adequacy of a study often requires information that is not part of the experience or training of health-care professionals. The article seeks to provide clinicians with some criteria by which to judge the validity of cost-based evaluations of the treatment and consequences of back pain. PURPOSE: This article is not a comprehensive, critical review of the research literature on the costs of back pain or the relative cost-effectiveness of different methods of care for back pain. It presents, instead, a discussion of some important characteristics of cost-related studies of back pain and some criteria that can be used to evaluate the validity of cost estimates and cost-effectiveness analyses related to back pain. STUDY DESIGN: A guide for the evaluation of cost-based studies of back pain. METHODS: A summary of criteria for the evaluation of the validity of cost-based studies of back pain. RESULTS: Three sets of criteria for evaluation, ranked from most important to least important. CONCLUSIONS: Application of the suggested criteria can enhance the ability of health-care professionals to better understand the limits and relative adequacy of cost-based studies of back pain.

Absenteeism↗
PubMed2005

The impact of anthropometric parameters on the incidence of low back pain.

Endogenic factors as one of possible reasons for low back pain were investigated and discussed in this study. The study included 122 male bus drivers, average age 44.2 years, average period of active service 24.4 years. The following anthropometric indexes have been calculated: Quetelet's index, percentage of body fat, relative body weight, Olivier's typologic index, Lorenz's constitution index and muscle index. According to inquiry form regarding history of low back pain the subjects were divided in two groups: 36 had no low back pain history and 76 had a history of recurrent low back pain. The results showed statistically nonsignificant differences in the anthropometric parameters and the calculated indexes between these two groups of subjects. The chosen subject sample showed that nutritional status, body build, constitution and muscular development are not associated with the incidence of low back pain.

Adult↗
PubMed1994

Managing low back pain: attitudes and treatment preferences of physical therapists.

BACKGROUND AND PURPOSE: We surveyed physical therapists about their attitudes, beliefs, and treatment preferences in caring for patients with different types of low back pain problems. SUBJECTS AND METHODS: Questionnaires were mailed to all 71 therapists employed by a large health maintenance organization in western Washington and to a random sample of 331 other therapists licensed in the state of Washington. RESULTS: Responses were received from 293 (74%) of the therapists surveyed, and 186 of these claimed to be practicing in settings in which they treat patients who have back pain. Back pain was estimated to account for 45% of patient visits. The McKenzie method was deemed the most useful approach for managing patients with back pain, and education in body mechanics, stretching, strengthening exercises, and aerobic exercises were among the most common treatment preferences. There were significant variations among therapists in private practice, hospital-operated, and health maintenance organization settings with respect to treatment preferences, willingness to take advantage of the placebo effect, and mean number of visits for patients with back pain. CONCLUSIONS AND DISCUSSION: These variations emphasize the need for more outcomes research to identify the most effective treatment approaches and to guide clinical practice.

Adult↗
PubMed2005

Intradiscal electrothermal treatment for chronic lower back pain patients with internal disc disruption.

Chronic lower back pain is one of the most common musculoskeletal problems; it is also the most expensive industrial injury. Not surprisingly, many treatments have been developed to combat this expensive and debilitating condition. One of these, intradiscal electrothermal treatment (IDET), was developed for patients with chronic discogenic lower back pain who failed to improve with any of the wide variety of non- surgical treatments. The present study sought to evaluate the efficacy of IDET for patients with chronic lower back pain. Twenty-five patients were enrolled in this prospective study; the patients received IDET between June 2001 and June 2003. MRI was used to confirm the diagnosis of internal disc disruption in all patients. The patients then underwent a pre-operative provocative test and discography. The follow-up duration was at least 1 year in all cases, and the visual analogue scale, recovery rate, and satisfaction of each patient were evaluated. The average age of the patients was 32 years (age range 18 to 49 years), and the patient group was 33% male and 67% female. Of the 25 patients, 5 underwent lumbar fusion surgery within 1 year of IDET. After IDET, 8 patients (32%) reported more pain than before, 14 patients (56%) reported less pain, and 3 patients (12%) experienced no change. Twelve patients (48%) were satisfied with IDET, 11 (44%) were dissatisfied, and 2 (8%) were undecided about the treatment. At least 1 year after IDET, nearly half the study patients were dissatisfied with their medical outcome. Consequently, 5 patients (20%) underwent fusion surgery at 1 year after IDET. Although other studies have shown good results with IDET for at least 2 years, this investigation suggests the IDET may be somewhat less effective. In order to firmly establish the efficacy of IDET for treating chronic discogenic lower back pain, additional studies with larger numbers of patients evaluated over longer time periods are recommended.

Adolescent↗
PubMed2005

[Evaluation of low back pain].

Patients with low back pain should be evaluated on their various clinical aspects. The evaluation instruments can be classified into four types: pain measures, function measures, psychosocial measures, and composite measures. The evaluation should be done by patient self-reporting style. Since it is difficult to evaluate patients with a single measure, the evaluation should be done with combination of several instruments.

Humans↗
PubMed2004

Comorbidity with low back pain: a cross-sectional population-based survey of 12- to 22-year-olds.

STUDY DESIGN: Cross-sectional, population-based survey. OBJECTIVES: To investigate the pattern of comorbidity with low back pain in adolescents. SUMMARY OF BACKGROUND DATA: Low back pain is usually dealt with as a specific and independent entity. However, the existing literature shows comorbidity to be common with low back pain, suggesting that low back pain may be part of a broader pattern of general health. The present knowledge is based on studies of adult populations; therefore, associations could be explained by work and lifestyle factors. Information in this area is lacking regarding subjects still unaffected by such factors. METHODS: A questionnaire-survey about general health, including low back pain, was carried out among twins registered in the population-based Danish Twin Registry. Associations between disorders were calculated and patterns of comorbidity investigated, by means of logistic regression and a finite mixture model. Finally a twin-control study was conducted. RESULTS: A total of 9,567 individuals, 12 to 22 years of age, responded to the questionnaire. Positive associations between low back pain and asthma and headache/migraine were demonstrated, mainly because of study participants with several disorders. No association between low back pain and atopic dermatitis/hay fever was found. The presence of two other disorders increased the probability of low back pain considerably more than the presence of only one other disorder. The finite mixture model indicated that the probability of belonging to a frail subgroup decreased from 60% at age 13 to 25% at age 21, and in the frail subgroups nearly all report low back pain and headache in the older ages. Furthermore, increasing duration of low back pain increased the likelihood of having other disorders. Results from the twin-control study were similar. CONCLUSION: Young people are more likely to suffer from asthma and headache, but not from atopic dermatitis/hay fever, if they have low back pain. All of the investigated disorders cluster in some individuals. A model of common origin for these seemingly independent disorders should be considered.

Adolescent↗
PubMed1999

Back pain prevalence in US industry and estimates of lost workdays.

OBJECTIVES: Back pain is the most common reason for filing workers' compensation claims and often causes lost workdays. Data from the 1988 National Health Interview Survey were analyzed to identify high-risk industries and to estimate the prevalence of work-related back pain and number of workdays lost. METHODS: Analyses included 30074 respondents who worked during the 12 months before the interview. A case patient was defined as a respondent who had back pain every day for a week or more during that period. RESULTS: The prevalence of lost-workday back pain was 4.6%, and individuals with work-related cases lost 101.8 million workdays owing to back pain. Male and female case patients lost about the same number of workdays. Industries in high-risk categories were also identified for future research and intervention, including those seldom studied. CONCLUSIONS: This study provides statistically reliable national estimates of the prevalence of back pain among workers and the enormous effect of this condition on American industry in terms of lost workdays.

Adult↗