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PubMed1994

Prevalence of back pain among nurses.

AIM: To provide estimates of the occurrence of back pain among nurses employed in the public health sector in Auckland, New Zealand. METHOD: A cross sectional survey was undertaken of all nurses employed by the Auckland Area Health Board as at July 1992. RESULTS: The lifetime prevalence of back pain was 74.4%. The lifetime prevalence of nursing-related back pain was 62.3%; the annual prevalence was 36.8%; and the point prevalence was 11.6%. Pacific Island nurses had a higher annual and point prevalence of nursing-related back pain compared with New Zealand European and Maori nurses. The annual and point prevalence was also higher among those working on geriatric, medical, orthopaedic and rehabilitation wards compared with other nursing environments. CONCLUSION: This study found a high prevalence of back pain among nurses, and in particular, nurses working in four specific work environments were identified as having greatest risk. These findings provide support for the targeting of intervention strategies which focus on work organisational factors.

Adult↗
PubMed1995

Low back pain and subsequent cardiovascular mortality.

STUDY DESIGN: This was a prospective cohort study based on data of the Mini-Finland Health Examination Survey collected between 1978 and 1980, with follow-up until the end of 1991. OBJECTIVE: A number of studies have revealed associations between smoking, cardiovascular diseases, and low back pain. Therefore, it has been suggested that atherosclerosis could be involved in the etiology of low back pain. Low back pain was studied for its prediction of mortality and, in particular, deaths from cardiovascular disease. SUMMARY OF BACKGROUND DATA: Of a nationally representative sample of 8000 people older than 29 years, 7217 (90%) participated in a comprehensive health examination. At interviews, 5459 (76%) had a history of low back pain. In a standardized clinical examination, 1253 (17%) were diagnosed as having chronic low back pain. METHODS: The follow-up information on mortality and causes of death was obtained from the Central Statistical Office of Finland. RESULTS: By the end of 1991, 1487 of the examinees had died, 815 from any cardiovascular disease and 501 from coronary heart disease. Neither the history of back complaints nor chronic low back pain predicted mortality. CONCLUSION: That low back pain does not affect longevity disagrees with the hypothesis that atherosclerosis resulting in death from cardiovascular disease is etiologically linked to low back pain.

Adult↗
PubMed1998

Chondromyxoid fibroma of bone presenting as chronic back pain.

OBJECTIVE: To discuss a case of chondromyxoid fibroma presenting with low back pain. CLINICAL FEATURES: A 50-yr-old man had an 8-yr history of low back pain. This was diagnosed and treated as arising from the disc and caused by spinal stenosis. Magnetic resonance imaging findings supported the clinical findings. Years later, a plain radiograph of the pelvis revealed an incidental abnormality of the right ilium, and the patient was subsequently referred to a musculoskeletal tumor center for treatment. INTERVENTION AND OUTCOME: The lesion was surgically removed and the defect was reconstructed via bone allograft. CONCLUSION: Such tumors are a rare cause of back pain. Tumors of the pelvis can at times present as back pain. In cases of refractory back pain, an X-ray of the pelvis can be a useful screening investigation. Chondromyxoid fibromas are rare tumors best treated by excision if they are amenable or by curettage and bone grafting procedures.

Back Pain↗
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↗
PubMed1981

Principal dimensions of the pain experience and psychological disturbance in chronic low back pain patients.

The principal dimensions of the pain experience of 102 patients with chronic low back pain were studied and components of the pain experience were compared to pre-treatment measures of emotional disturbance. Responses on the McGill Pain Questionnaire (MPQ) were factor analyzed revealing dimensions of the pain experience that seemed to represent sensory, affective, and evaluative aspects. Patients with high scores on the MMPI hypochondriasis scale portrayed their pain as more intense and as high in terms of affective and evaluative descriptors on the MPQ. Other MMPI scales reflecting emotional disturbance (depression, hysteria) were also associated with a more intense description of pain and higher scores on an affective descriptor dimension. The evaluation descriptive dimension was highly related to the overall intensity of the pain experience. Only the affective dimension was related to emotional disturbance separately from the effects of intensity alone.

Adult↗
PubMed2003

Effects of chronic low back pain, age and gender on vertical spinal creep.

This study investigated the effect of chronic low back pain, age, gender, and time of measurement on the magnitude of vertical spinal creep (VSC) and its recovery. A mixed design, involving three independent variables (chronic low back pain, age, and gender) and one repeated variable (time), was used. One hundred and six subjects of both genders, with and without chronic low back pain, aged between 20 and 60 years, participated in the study. The measurement of VSC and its recovery was performed using a seated stadiometer that allowed continuous measurement of VSC without changing the subject's posture over 25 min. Unloaded VSC was measured during the initial 5 min, followed by 10 min with an additional load of 15% of the subject's body weight and then for a further 10 min after the removal of the load. Subjects were grouped into one of eight categories according to the presence of chronic low back pain, age (20-39 years or 40-60 years) and gender. Repeated measures analysis of variance was computed. A significant increase in VSC with time of measurement was observed (p<0.001). No significant main effects for chronic low back pain, age, or gender were found at any time during the 25-min VSC testing protocol. Significant interactions were found between age and gender during the loaded (p=0.02) and unloaded (p=0.02) phases. A significant interaction was found between chronic low back pain and gender at the end of the unloaded phase (p=0.04). These findings suggest a combined influence of chronic low back pain, age, and gender on VSC and its recovery and that the dominance of each variable changed with the time of the measurement. Thus, subjects who differ in the presence of chronic low back pain, age, and gender should not be combined for statistical analysis of VSC and its recovery.

Adult↗
PubMed2005

The relationship between lumbar segmental motion and pain response produced by a posterior-to-anterior force in persons with nonspecific low back pain.

STUDY DESIGN: Cross-sectional. OBJECTIVE: To investigate the association between lumbar segmental motion and pain response during the application of a posterior-to-anterior (PA) force to the lumbar spinous processes in persons with nonspecific low back pain. BACKGROUND: Although low back pain is believed to be associated with altered segmental motion of the lumbar spine, the relationship between subjective reports of pain and objective measurements of segmental motion has not been established. METHODS AND MEASURES: Thirty-five individuals between 18 and 45 years of age with nonspecific low back pain (less than 3 months' duration) participated. All subjects participated in 2 separate procedures: (1) segmental motion assessment during a PA force application over the lumbar spinous processes using dynamic magnetic resonance imaging (MRI), and (2) pain assessment during a PA force application procedure outside of the MRI environment. Frequency counts were used to determine the lumbar segments that were most painful, and which functional spinal units had the most and least motion. Fisher exact tests were performed to determine if an association existed between the most painful segment and the functional spinal unit with the most or least motion. RESULTS: L5 was deemed the most painful segment in nearly half of the participants (48.1%). The L1-2 and L3-4 functional spinal units most frequently had the most motion (25.9% each) and the L4-5 functional spinal units most frequently had the least motion (29.6%). No association was found between the most painful segment and the functional spinal units with either the most or least motion. CONCLUSION: The results of this study indicate that an assumption regarding segmental motion cannot be inferred from the pain response when using a PA force application procedure.

Adolescent↗
PubMed1997

Movement disturbances of the lumbar spine and abnormal back muscle electromyographic findings in recurrent low back pain.

STUDY DESIGN: A cross-sectional analysis was done of patients with recurrent low back pain referring to the lower limbs. OBJECTIVES: To analyze dynamic radiographs of forward and backward bending of the lumbar back and to determine, using routine neurophysiologic measurements, the functional state of the lower nerve roots in patients with recurrent low back pain radiating to the lower limbs. METHODS: Clinical and neurophysiologic studies showed eight of the 108 patients with low back pain to have ventral root impingement at either L5 or S1 level. The remaining 100 patients, 56 women and 44 men (mean age, 37.6 years; range, 17-62 years), made up the study group for continuing investigation. History of low back pain ranged from 4 months to 20 years. RESULTS: Disturbed intervertebral movement was found in 51 of 100 patients. Twenty-seven percent had L5 or L4 anterolisthetic hypermobility, and 35% had L4 or L3 vertebral retrolisthesis. Vaguely delineated radiating sensations in the lower limbs were common (62%). Back muscle electromyographs were mostly (86%) normal in patients whose low back pain was localized. Conversely, almost three-fourths of those experiencing radiating or referred pain had abnormal electromyographs, consistent with a mild degree of axonal damage in the posterior branch of the lumbar nerve root innervating the medial paraspinal muscles. This finding was most common among patients with retrolisthesis and simultaneous degenerative changes. CONCLUSIONS: Evaluation of low back pain should include tests for degenerative retrolisthesis, especially in patients experiencing radiating sensations with no evidence of root impingement, because abnormal electromyographic findings showing denervation of the paraspinal muscles was most common in patients with degenerative retrolisthesis. To improve the functional support of the lumbar region, rehabilitation should be directed to the medial back muscles because they provide the most effective support for intervertebral motion and because mild disturbances appear to be associated with their innervation in recurrent low back pain.

Adolescent↗
PubMed1999

Medical management of back pain.

The most common causes of back pain and their medical treatment are discussed. These include: dermatologic problems and conditions resulting from saddle trauma; discomfort and stiffness owing to injured paraspinal muscles; pain associated with supraspinous ligament damage; osseous pain and nerve dysfunction related to the spine and sacroiliac area; and neurologic diseases that can manifest as back pain. Bitting problems, cervical pain, and coexisting lameness are also considered.

Animals↗
PubMed1997

A follow-up study of preventive effects on low back pain at worksites by providing a participatory occupational safety and health program.

Low back pain is still a common and serious issue at worksites. In order to evaluate preventive effects on low back pain by providing a participatory occupational safety and health program, we conducted a 10 year follow-up study at the Tokyo Metropolitan Bureau of Waste Management and examined yearly changes in the number of compensated and claimed low back pain. The participatory occupational safety and health program is based on a small-sized group and joint employee-employer involvements. This program includes analysis of occupational accidents, revision of the safety procedure manual, participatory training classes, improving and evaluating working procedures and personal protective equipment , and so on. The number of compensated low back pain from 1984 to 1994 has decreased from 318 to 87, and the number of claimed low back pain has decreased from 343 to 92. These results suggest that the participatory occupational safety and health program is effective in prevention of low back pain.

Follow-Up Studies↗
PubMed2002

Pain-drawing does not predict the outcome of fusion surgery for chronic low-back pain: a report from the Swedish Lumbar Spine Study.

Despite a widespread use of pain drawing in the selection of patients for surgical and non-surgical treatment, its value as a predictor of outcome is still not well documented. In a prospective multicentre randomised controlled trial of surgical and non-surgical treatment for chronic low-back pain (CLBP), two hypotheses were tested: (1). Pain drawing predicts outcome of treatment for CLBP, (2). Pain drawing is associated with psychological characteristics of patients with CLBP. Two hundred and sixty-four patients with severe CLBP of long duration completed pain drawings as part of a battery of questionnaires prior to treatment. They were followed up at 2 years post-treatment, with renewed completion of questionnaires. Outcome was measured in three ways: patient global assessment, change of disability/pain, and work status. The pain drawing was analysed by four different methods. The association between the pain drawings and outcomes was analysed. Personality traits and depressive symptoms were evaluated in the psychological assessment. None of the four methods of interpretation of the pain drawings demonstrated any significant association with outcome, in either the surgical or the non-surgical group. The pain drawing was associated with pre-treatment back pain intensity and depressive symptoms. No predictive value of the pain drawing regarding the outcome of treatment of CLPB was demonstrated. The concept of "organic/non-organic" pain in conjunction with chronic low-back pain is not supported by the results of the present study.

Adult↗
PubMed2000

Dural ectasia is associated with back pain in Marfan syndrome.

STUDY DESIGN: A cross-sectional age- and sex-matched study comparing the prevalence and size of dural ectasia in two groups of patients with Marfan syndrome. Group I comprised patients with moderate to severe back pain and Group II comprised patients without back pain. OBJECTIVES: To determine whether the presence and size of dural ectasia is associated with back pain in patients with Marfan syndrome. SUMMARY OF BACKGROUND DATA: Dural ectasia is present in more than 60% of patients with Marfan syndrome. Moderate to severe back pain is present in more than 50% of patients with Marfan syndrome. Most cases of significant low back pain in patients with Marfan syndrome do not have a clear cause. It would be useful for the clinician to know whether dural ectasia may be a cause of back pain in patients with Marfan syndrome with no other source. METHODS: Thirty two volunteers aged 30-50 with Marfan syndrome were enrolled as age- and sex-matched pairs with significant back pain (Group I) and without back pain (Group II). A completed questionnaire, physical examination, and magnetic resonance image of the lumbosacral spine were obtained. Dural volume caudal to L5 was calculated from the magnetic resonance data by specially designed software. RESULTS: Dural ectasia was present in 76% of the patients in Group I, and 41% of the patients in Group II. The proportion of patients with dural ectasia was significantly higher in Group I. Furthermore, the mean dural volume was significantly higher in Group I, and a significant correlation between dural volume and Oswestry pain score was noted. CONCLUSIONS: The presence and size of dural ectasia are associated with back pain in the Marfan syndrome. However, a high prevalence of dural ectasia (41%) exists even in patients with Marfan syndrome without back pain. The mere presence of dural ectasia therefore does not necessarily mean the patient will be symptomatic even though the two are associated.

Adult↗
PubMed2002

[Back pain outpatient clinic--preliminary experiences from Aust-Agder].

BACKGROUND: Back pain is a major health problem and the most important disorder associated with sickness absence. This report presents experiences from a back pain outpatient clinic. MATERIAL AND METHODS: We collected demographic data, diagnoses on the referrals (ICPC) and in the outpatient clinic (ICD-9) and recommendations given to 206 patients, referred 1 January to 30 April 1998. RESULTS: 41% were women (mean age 45), 59% men (mean age 44). Mean waiting time before appointment was 35 days compared to 49 days before the clinic was opened. 43% were prioritized for an appointment within two weeks; mean waiting time in this group was 16 days. 125 (63%) of 200 were referred with non-specific low back pain. Of these, 99 (79%) were given the same diagnosis in the clinic. 75 (37%) had a referral diagnosis of lumbar disk injury with radiation, of whom 46 (61%) were diagnosed with lumbar nuclear prolapse or lumbar spinal stenosis in the clinic. INTERPRETATION: An outpatient clinic may be a useful way to organise the specialist health service system for back pain patients.

Adolescent↗
PubMed1996

Diagnostic accuracy of technologies used in low back pain assessment. Thermography, triaxial dynamometry, spinoscopy, and clinical examination.

STUDY DESIGN: A prospective blind study compared three new technologies to assess back pain. OBJECTIVE: To assess the diagnostic accuracy and comparability of thermography, triaxial dynamometry, and spinoscopy in the assessment of recent onset work-related low back pain. SUMMARY OF BACKGROUND DATA: The role of these technologies in assessing patients with low back pain is unproved. METHODS: Forty-one patients with low back pain and 46 control subjects were assessed by each technology and by two clinical examiners blind to clinical status. Twenty patients were trained to simulate a healthy back without low back pain, and 50% of the control subjects were trained to simulate the presence of a low back pain disorder. Each technology was interpreted on two occasions by each of two readers. RESULTS: Thermography performed significantly worse than did triaxial dynamometry, spinoscopy, and clinical examination. The diagnostic accuracy of the last three was similar, and inter-rater comparability did not differ significantly. Among simulators, the diagnostic accuracy of triaxial dynamometry and spinoscopy was significantly higher than that of clinical examination, although considerable inaccuracy remained in assessing individual subjects. CONCLUSIONS: The diagnostic accuracy of thermography in recent onset low back pain does not support its use. Among those simulating normality or low back pain, triaxial dynamometry and spinoscopy have greater diagnostic accuracy than does a single clinical evaluation. However, for an individual, the inaccuracy that remains limits the use of triaxial dynamometry or spinoscopy for diagnosis in recent onset low back pain.

Adult↗
PubMed1996

Physical loading and performance as predictors of back pain in healthy adults. A 5-year prospective study.

We investigated muscle strength, aerobic power, and occupational and leisure-time physical loading as predictors of back pain in a 5-year follow-up study. A cohort of 456 adults aged 25, 35, 45 and 55 years, free of back pain, participated in measurements of anthropometric characteristics, aerobic power and muscle strength characteristics at baseline. The subjects' levels and types of physical activity and occupational physical loading were also determined. At 5 years after the baseline examinations 356 of these subjects (78.1%) were reached by mail, and 262 of them (73.6%) properly completed and returned a questionnaire including a detailed back pain history for the 5 years following the baseline measurements. Of this number 56 subjects (21%) who reported back pain (> 30 on a scale from 0 to 100) and functional impairment during the 5-year follow-up composed the marked back pain group. Other subjects (n = 71, 27%) noting lesser symptoms were included in the mild back pain group; 135 subjects (52%) reported having had no back pain. The subjects with marked back pain were on average taller than the subjects without back pain, while no such difference was found in body mass. Heavy occupational musculoskeletal loading (P = 0.005) and high general occupational physical demands (P = 0.036) predicted future back pain. Leisure-time physical activity, aerobic power or muscle strength characteristics were not predictive of future back pain.

Adult↗
PubMed2004

Work-related low back pain: secondary intervention.

A review of the literature indicates that non-specific low back pain is basically an age-related disorder that is affected by differences in occupation, genetics and personal behavior. The cause of low back pain is unknown in most cases, and most of the treatments in routine use are ineffective. There is no evidence that low back pain has decreased in recent years. Consequently, there are a growing number of investigators who believe that efforts at preventing low back pain are futile; that low back pain is an unavoidable consequence of life that will afflict two thirds of the adult population at some point in their lives. These investigators believe that programs aimed at reducing low back disability are likely to be more effective and less costly. Only a small percentage of people with low back pain become disabled, but this small percentage consumes most of the cost. The literature pertaining to the reduction of low back disability is reviewed and discussed. It is concluded that low back disability can be reduced, and that management (not the health care provider) has the primary responsibility for reducing disability.

Adult↗
PubMed1999

Recurrent low back pain and early disc degeneration in the young.

STUDY DESIGN: A prospective 9-year follow-up study involving randomized matched subgroups of 15-year-old schoolchildren with or without low back pain at baseline. OBJECTIVES: To evaluate the long-term persistence of initially reported recurrent low back pain, and to examine the significance of abnormalities found in magnetic resonance imaging of lumbar discs in individuals 15 and 18 years of age as possible contributors to persistently recurrent low back pain. SUMMARY OF BACKGROUND DATA: In surveys among children and teenagers during the past few years, as many as half of all children in a community report a history of low back pain. The current results, in accordance with previous findings, indicate that there is a subgroup of adolescents with more chronic symptoms which, in the authors' opinion, deserves more attention. Disc disease accompanying low back pain is a key issue both in research and clinical practice. The significance of early degenerative findings in the lumbar discs is not known. METHODS: In the survey of 14-year-olds (n = 1503), a subgroup (7.8%) with recurrent low back pain was found. A random sample of individuals with recurrent low back pain (n = 40) and an equal number of completely asymptomatic control subjects were selected for a comparative study. The selected groups were examined by magnetic resonance imaging at 15 and 18 years of age. The participation rate of youth at 14, 18, and 23 years of age for all three questionnaires was 82% (29 boys and 33 girls). Imaging data were interpreted by two blinded radiologists experienced in low-field-strength magnetic resonance imaging. In calculations of relative risks, the participants reporting recurrent low back pain in all phases of the study were compared with participants who had no persistently recurrent pain. RESULTS: Eleven participants (35%) in the original group with low back pain persistently reported recurrent pain. In 15-year-old participants with disc degeneration, the relative risk of reporting recurrent low back pain up to the age of 23 years was 16 (95% confidence interval 2.2-118) compared with those having no disc degeneration. In addition, disc protrusion and Scheuermann-type changes at 15 years contributed to the risk of persistently recurrent low back pain. CONCLUSIONS: The authors' earlier findings already favored the hypothesis of a causal relation between the early evolution of a degenerative process of lower lumbar discs and recurrent low back pain in the near future. The current results further strengthen this hypothesis, indicating that individuals with disc degeneration soon after the phase of rapid physical growth not only have an increased risk of recurrent low back pain at this age, but also a long-term risk of recurrent pain up to early adulthood.

Adolescent↗
PubMed2000

Health-related fitness, physical activity, and history of back pain.

The relationship between history of back pain and measurements of both health-related fitness and physical activity participation was examined in 233 males and 287 females aged 15-69 years. Participants were divided by gender into those reporting no history (NH) or a history (H) of recurring back pain. Analysis of variance indicated that trunk flexion, back extensor endurance, and physical activity participation were significantly higher for NH and waist girth significantly lower for NH in both genders. In females, mean abdominal muscular endurance was significantly higher in NH. Forward stepwise discriminant function analyses indicated that the best discriminators between NH and H were back extensor endurance and physical activity participation in both genders and waist girth in females. These findings support using measurements of trunk flexion, abdominal muscular endurance, back extensor endurance, physical activity participation, and waist girth as indicators of back fitness in the evaluation of back health.

Adolescent↗