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PubMed1999

Oral contraception and other factors in relation to back disorders in women: findings in a large cohort study.

The Oxford-Family Planning Association contraceptive study includes 17,032 women, initially aged 25-39 years, recruited at 17 British family planning centers during the interval 1968-1974 and subsequently followed-up for periods up to 26 years. This article examines the pattern of referral to hospital for back disorders among these women. Certain back disorders have been reported to occur more frequently in oral contraceptive users than in other women, and back pain has also been reported in some women consequent to using an intrauterine device. The disorders considered were spinal osteoarthritis, displaced cervical disc, displaced lumbar disc, other and unspecified displaced disc, cervicalgia, unspecified back pain, and sprains and strains of the back. Spinal osteoarthritis and unspecified backache were the only two conditions significantly related (both positively) to age. Displaced lumbar disc and other and unspecified displaced disc were strongly positively related to height and weight. Unspecified backache showed similar, but less striking (in terms of the magnitude of the relative risks), associations with height and weight. Little evidence was found of any association between oral contraceptive use and any of the back disorders, and the same was true for intrauterine device use.

Adult↗
PubMedDate not supplied

Differentiating temporal electromyographic waveforms between those with chronic low back pain and healthy controls.

OBJECTIVES: Temporal activation patterns from abdominal and lumbar muscles were compared between healthy control subjects and those with chronic low back pain. STUDY DESIGN: A cross-sectional comparative study. BACKGROUND: Synergist and antagonist coactivity has been considered an important neuromuscular control strategy to maintain spinal stability. Differences in onset times and amplitudes have been reported from trunk muscle EMG recordings between healthy subjects and those with low back pain;however, evaluating temporal EMG waveforms should demonstrate whether differences exist in the ability of those with and those without low back pain to respond to changing perturbations. METHODS: The Karhunen-Loève expansion was applied to the ensemble-average EMG profiles recorded from four abdominal and three trunk extensor muscle sites while subjects performed a leg-lifting task aimed at challenging lumbar spine stability. The principal patterns were derived and the weighting coefficients for each pattern were the main dependent variables in a series of two-factor (group and muscle) mixed ANOVA models. RESULTS: Three principal patterns explained 96% of the variance in the temporal EMG profiles. The ANOVAs revealed statistically significant group and muscle main effects (P<0.05) for the principal pattern and significant group by muscle interactions (P<0.05) for patterns two and three. Post hoc analysis showed that patterns were not different among all muscle sites for the healthy controls, but differences were significant for the low back pain group. CONCLUSIONS: The healthy group coactivated all seven sites with the same temporal pattern of activation. The low back pain group used different activation patterns indicative of a lack of synergistic coactivitation among the muscle sites examined. RELEVANCE: These results provide a foundation for developing a diagnostic classifier of neuromuscular impairment associated with low back pain, that could be used to evaluate the effectiveness of therapeutic interventions to improve muscle coactivation.

Abdominal Muscles↗
PubMed2005

Transfer of the horizontal patient: the effect of a friction reducing assistive device on low back mechanics.

Recognizing that the transfer of bedridden patients is associated with a high rate of low back injuries, various devices have been developed to assist with sparing the patient handlers. The purpose of this study was to quantify the friction-reducing ability of three different 'sliding' patient transfer devices together with the subsequent consequences on the low back loads of people performing the transfers. Coefficients of friction of the devices were determined by 'transferring' a standard object and a 'patient' over several surfaces common to a hospital setting. Then three participants performed controlled transfers with the various devices. Electromyography to measure muscle activation levels together with external forces and kinematic positional data were collected during push, pull and twist transfers. Spine loads were estimated with a three-dimensional biomechanical static link-segment model of the human body. Simply sliding a patient on a cotton sheet (control condition) produced a coefficient of friction of 0.45. The assistive devices substantially reduced friction by well over one-half (coefficients of 0.18 - 0.21). However, when using the devices the subjects adopted a variety of postures and techniques, such that there were no consistent influences on trunk inclination, low back compression or muscle activation profiles. Direct measurement of reduced friction between the bed and the patient with a friction-reducing device together with measurement of the back loads when actually transferring a patient formed a proof of principle. Specifically, while the device lowers friction, the transfer technique adopted by the lifter must be proper to reduce low back loading and any subsequent risks of back troubles associated with patient transfers. The direction of hand forces and torso position remains important.

Adult↗
PubMed1999

The epidemiology of back pain in vocational age groups.

OBJECTIVES: To investigate the prevalence of back pain in a general population aged between 20 and 59 years. POPULATION: A representative sample of 2000 individuals from Ostergotland County, Sweden (population 400,000). STUDY DESIGN: Cross-sectional study using a questionnaire including the pain drawing. RESULTS: The observed point prevalence was 28% (95% confidence interval 26-31%). The adjusted prevalence taking into account the non-responders was 23% (21-25%). Lumbar pain with radiation was reported by 40%, while 4% had only cervical pain with radiation. Twelve per cent were on sick-leave due to back pain. Activity of daily life was affected mainly in the group of men aged 40-59 and only in household tasks. The back problems did not affect social activity. CONCLUSIONS: The prevalence of back problems in the vocational ages was found to be 23%. Only small parts of a pain population are on sick-leave or have changed working tasks because of back problems. The distribution of pain in most cases is combined with radiation to extremities and not isolated to a single region. The combination of different localisations shows the pain problem to be more than just a "low back" problem.

Adult↗
PubMed2001

Isokinetic measurement of trunk muscle strength in women with chronic low-back pain.

OBJECTIVES: To investigate the relationships among chronic low-back pain and obesity, total spinal range of motion, and trunk muscle strength. The short-term impact of trunk muscle strengthening exercises on this condition was also examined. DESIGN: A controlled, prospective study of trunk muscle strengths of patients with chronic low-back pain and the short-term impact of exercise on strength. The study group consisted of 25 female patients who had been experiencing low-back pain for at least 3 mo, and the control group included 20 age-matched women without known low-back trouble. The Davenport Index was used to calculate the body mass indexes of all subjects. The Oswestry Disability Questionnaire was used to assess pain in the study group. Full flexion and extension ranges of motion were measured, then isokinetic measurements of trunk muscles were performed at 60-, 120-, and 180-degrees/sec velocities. Isometric measurements were also recorded for both flexors and extensors at a 60-degree angle. RESULTS: Increased body mass index and decreased trunk muscle strength were found to be directly associated with chronic low-back pain (P < 0.05). After a 15-day standard trunk strengthening exercise program in the patient group, trunk muscle strength was found to be increased (P < 0.05). CONCLUSIONS: Obesity and decrease in trunk muscle strength are important factors in chronic low-back pain, and a trunk muscle strengthening program will be helpful in reducing the pain.

Abdominal Muscles↗
PubMed1984

Body movements and events contributing to accidental and nonaccidental back injuries.

During 1980, 1153 employees attended the Occupational Health Department with back pain out of a working population of 13,958 in a car factory. Four hundred one were absent from work and a further 64 patients were restricted by back pain and unable to perform their normal work. One hundred forty-seven cases of back pain arose at work, and 71 in and around the home. All those who were absent or restricted were questioned about the onset of back pain in order to distinguish between accidental and nonaccidental injuries (NAI), and an accident model was used to structure the information. There were 122 accidents, 114 NAI, and 165 patients who could not attribute a cause to their back pain. A significantly higher proportion of the NAI arose at home and, conversely, a higher proportion of accidents occurred at work. Eighty (66%) of the accidents were underfoot accidents, including 57 slips. There were highly significant differences between the body movements contributing to accidents and NAI. Significantly more of the NAI than the accidents involved load handling, but 52% of the patients able to attribute a cause to their back pain were not moving loads. While handling of loads is important, attention should be directed to other contributory factors such as unsafe floor surfaces and bending and twisting movements--not only at work but also in and around the home.

Accidents, Home↗
PubMed1993

A case-control study of risk factors for industrial low back injury. The utility of preplacement screening in defining high-risk groups.

Using a cohort of 8183 postal workers, this study assesses the efficacy of preplacement medical examinations in defining the risk of occupational low back injuries. From this cohort, 154 subjects with occupational low back injuries between 1983 and 1988 and 942 control subjects who did not have low back injuries were identified. A multivariate logistic regression shows that a history of prior disability, odds ratio 2.90 (95% confidence interval 1.88-4.48), and a heavy lifting job, odds ratio 1.91 (1.32-276) are associated with occupational low back injuries. However, a history of previous back injury on screening examination is not associated with subsequent occupational injury. The association between a history of disability and occupational low back injury has not been previously noted and warrants further research.

Adult↗
PubMed1998

Preventive measures of back muscle injury after posterior lumbar spine surgery in rats.

STUDY DESIGN: Postoperative back muscle injury was studied in rats. Postoperative findings were compared among three groups: 2-hour continuous back muscle retraction, 5-minute retraction release after 1 hour of retraction, and 5-minute release at every 40 minutes of retraction. OBJECTIVE: To determine whether intermittent release of the retractor during surgery is effective to prevent severe muscle injury. SUMMARY OF BACKGROUND DATA: In surgery performed on the extremities using a tourniquet, intermittent reperfusion intervals can permit extended tourniquet application when the operation is prolonged. However, there have been no specific studies on the effects of intermittent retraction release for postoperative back muscle injury. METHODS: The back muscle of rats was retracted using a self-retaining retractor for 2 hours. The 36 rats were divided equally into the following three groups: Group 1, 2 hours of continuous retraction; Group 2, two 1-hour retractions interposed with a 5-minute retraction release; and Group 3, three 40-minute retractions interposed with a 5-minute retraction release. In each group, the multifidus muscle was histologically analyzed at 48 hours, 1 week, and 6 weeks after surgery. The muscles were stained by a variety of histochemical methods. The level of serum CPK-MM isoenzyme was measured 48 hours after surgery. RESULTS: Postoperative back muscle degeneration was the most severe in Group 1. The concentration of CPK-MM in Group 1 was significantly higher than that in Groups 2 and 3. One week after surgery, the lesser diameter of regenerated fibers in Group 1 was smaller than that in Groups 2 and 3. The incidence of neurogenic muscle damage was the highest in Group 1. CONCLUSIONS: During posterior lumbar spine surgery, 5-minute retraction release after 1 hour or after 40 minutes of retraction was effective in preventing severe back muscle injury after surgery.

Animals↗
PubMed2003

Comparison of the Roland-Morris Disability Questionnaire and generic health status measures: a population-based study of workers' compensation back injury claimants.

STUDY DESIGN: Workers' compensation back injury claimants completed baseline and follow-up telephone interviews in a prospective population-based cohort study. OBJECTIVE: To compare the Roland-Morris Disability Questionnaire (RDQ) to widely used generic health status measures in a sample of workers with recent work-related back injuries in terms of validity, reliability, responsiveness to change, and floor and ceiling effects. SUMMARY OF BACKGROUND DATA: Little research has directly compared the validity and responsiveness of the RDQ to that of the Short-Form 12 or Short-Form 36 health status measures among individuals with back pain. Furthermore, there is little information concerning the validity, reliability, and responsiveness of the RDQ as a measure of functional outcomes for workers with back injuries. METHODS: Approximately 8 weeks (median) after filing low back injury claims, 309 workers completed the RDQ, Short-Form 12, and Short-Form 36 scales and gave information about their work status in computer-assisted telephone interviews. An average of 5 months later, 284 workers (91.9%) completed the measures again. RESULTS: The RDQ demonstrated excellent internal consistency and validity through correlations with other measures of physical functioning, ability to discriminate between those working and those not working, and much more responsiveness to change than the Short-Form 12 and Short-Form 36 scales. However, 15% of the sample did not answer one or more RDQ items. CONCLUSIONS: The RDQ is a valid measure of physical disability among workers with back injuries. Its greater responsiveness to change suggests its superiority to the Short-Form 12 and Short-Form 36 as an outcome measure in this population.

Adolescent↗
PubMed2006

Low back problems and possible improvements in nursing jobs.

AIM: This paper reports a study that aimed to evaluate the workload, to identify problems leading to the higher incidence rate of work-related low back injury among nurses in the orthopaedic and intensive care unit departments of the hospital, and to gather information about improvements that the nurses would like in the workplace. BACKGROUND: The literature shows that low back injuries are common among nurses, and intervention programmes are needed to address this problem. METHOD: The hospital injury records were examined in a retrospective study. In addition, a validated questionnaire was administered between January and May 2005 to 47 nurses (23 orthopaedic and 24 intensive care nurses). The questionnaire contained questions on workload, history of back injuries, problems, possible solutions and psychophysical measures of exertion. FINDINGS: The life-time incidence and point prevalence of low back pain were 65% and 30%, respectively, in orthopaedic nurses, and 58% and 25%, respectively, in the intensive care nurses. The mean weight handled was reported to be 47 +/- 30 kg by the orthopaedic nurses and 26 +/- 10 kg by the intensive care nurses. The low back scored highest for body-part discomfort - 4.6 and 4.0, respectively, on a 10-point scale. The rate of perceived job exertion was 6.7 +/- 1.8 (very strong), and 5.8 +/- 1.9 (strong) on Borg's 10-point scale. The total effort required by the job, rated on Visual Analogue Scales, was 67 +/- 14% and 68 +/- 15% of the maximum, respectively. The Borg scores and the total effort according to the Visual Analogue Scale, and the Borg scores and force effort on the Visual Analogue Scale were moderately correlated (r = 0.53, P < 0.01 for both comparisons). CONCLUSION: The methodology proposed here is practical for job evaluation and to design a participatory ergonomic intervention aiming at reducing low back injuries in nursing jobs. There are workload differences between nursing jobs. Lifting devices, biomechanical training, bigger rooms, adequate set-up and additional staff are suggested improvements.

Adult↗
PubMedDate not supplied

Surface EMG activity of the back musculature during axial spinal unloading using an LTX 3000 Lumbar Rehabilitation System.

Electromyographic (EMG) analysis has been used successfully to identify back muscle impairment in patients with low back pain. EMG signals from normal subjects during axial spinal unloading using an LTX 3000 device were obtained and spectral parameters of the electromyographic (EMG) signal were analyzed. The purpose of the study was to determine the optimal time for effective traction using the LTX 3000 rehabilitation device. These data will serve as a baseline for future studies to help assess back muscle function in low back patients undergoing rehabilitation. Three time points during axial spinal unloading were compared to pre-unloading to detect alterations in median power frequency (MPF), root-mean-square (RMS) and rectified integrated EMG (riEMG) during axial spinal unloading. There were reductions of riRMG during 0-10 minutes of axial spinal unloading in all muscle groups, followed by an increase in riEMG value from 10 to 15 minutes. A similar trend was seen in the RMS values. The MPF did not change during the course of unloading, indicating that there was likely no change in fatigue properties of the paraspinal muscles during axial spinal unloading. The optimal time for effective axial spinal unloading on the basis of muscle activity was determined to be 10 minutes of axial spinal unloading, and a back assessment procedure was presented that uses surface EMG electrodes to objectively characterize muscle activity and relative fatigue properties. Future studies will use this methodology to assess treatment outcome in a chronic low back pain population.

Adult↗
PubMed1976

Tenderness at motor points. A diagnostic and prognostic aid for low-back injury.

In patients with low-back injury the motor points of some muscles may be tender. Of fifty patients with low-back "strain", twenty-six had tender motor points and twenty-four did not, while forty-nine of fifty patients with radicular signs and symptoms suggesting disc involvement had tender motor points, and the one without such tender points had a hamstring contusion which limited straight leg raising. Of fifty controls with no back disability, only seven had mild tender points after strenuous activity, while forty-six of another fifty controls with occasional back discomfort had mild motor-point tenderness. In all instances the tender motor points were located in the myotomes corresponding to the probable segmental levels of spinal injury and of root involvement, when present. Patients with low-back strain and no tender motor points were disabled for an average of 6.9 weeks, while those with the same diagnosis but tender motor points were disabled for an average of 19.7 weeks, or almost as long as the patients with signs of radicular involvement, who were disabled for an average of 25.7 weeks. Tender motor points may therefore be of diagnostic and prognostic value, serving as sensitive localizers of radicular involvement and differentiating a simple mechanical low-back strain from one with neural involvement.

Adult↗
PubMed1994

Predicting work status for patients in an occupational medicine setting who report back pain.

OBJECTIVE: To determine the ability of patient-reported health status information to predict physician-determined fit-for-work status for patients reporting complaints of low back pain. DESIGN: Cross-sectional study using survey methods. SETTING: Occupational medicine section of a large multispecialty private clinic. PATIENTS: Four hundred sixty-two questionnaire packets were distributed to patients who were seen for work-related conditions or disorders over a 13-week period; 235 questionnaires were returned (51% response rate). One hundred seven responders reported low back pain and completed the Low Back Pain TyPE (Technology of Patient Experience) Tool. The mean (+/- SD) age of respondents was 39 (+/- 12) years; 67% of respondents were male, 70% were white, 87% were receiving worker's compensation, 58% were married, and 55% had a high school education or less. INTERVENTIONS: Questionnaire packets for self-administration containing health/functional status questions (short form [SF]-36, COOP Charts) and the Low Back Pain TyPE Tool were distributed to the patients. Other variables were abstracted from the medical records and administrative databases. MAIN OUTCOME MEASURES: The primary study outcome measured was fitness for work; patients were examined and categorized as fit or not fit for work by physicians who were unaware of the questionnaire results. RESULTS: Logistic regression analysis consisted of variables from 107 patients who reported low back pain. The final model contained the physical functioning scale (SF-36), employment status, smoking status, and physical functioning (SF-36) by gender interaction. Seventy-seven percent of the fit-for-work cases and 90% of the not-fit-for-work cases were correctly classified. CONCLUSION: Patient-reported physical function (as modified by gender), smoking status, and employment status predicted physician-determined work status for patients reporting low back pain in this study. Larger studies will be required to confirm this finding.

Adult↗
PubMed2001

Cyclobenzaprine and back pain: a meta-analysis.

BACKGROUND: Back pain is a common problem for which cyclobenzaprine hydrochloride is frequently prescribed. OBJECTIVE: To perform a systematic review of cyclobenzaprine's effectiveness in the treatment of back pain. METHODS: We searched MEDLINE, PsycLIT, CINAHL, EMBASE, AIDSLINE, HEALTHSTAR, CANCERLIT, the Cochrane Library, Micromedex, Federal Research in Progress, and the references of reviewed articles, and contacted Merck, Sharpe and Dohme for English-language, randomized, placebo-controlled trials of cyclobenzaprine in adults with back pain. Outcomes included global improvement and 5 specific domains of back pain (local pain, muscle spasm, range of motion, tenderness to palpation, and activities of daily living). Study quality was assessed using the methods of Jadad. Summary outcomes were obtained using a random-effects model. RESULTS: Patients treated with cyclobenzaprine were nearly 5 times (odds ratio, 4.7; 95% confidence interval, 2.7-8.1) as likely to report symptom improvement by day 14 as were those treated with placebo. Slightly fewer than 3 individuals (2.7; 95% confidence interval, 2.0-4.2) needed treatment for 1 to improve. The magnitude of this improvement was modest, with an effect size of 0.38 to 0.58 in all 5 outcomes (local pain, muscle spasm, tenderness to palpation, range of motion, and activities of daily living). Treatment efficacy for these 5 outcomes was greatest early, in the first few days of treatment, declining after the first week. Patients receiving cyclobenzaprine also experienced more adverse effects, the most common being drowsiness. CONCLUSIONS: Cyclobenzaprine is more effective than placebo in the management of back pain; the effect is modest and comes at the price of greater adverse effects. The effect is greatest in the first 4 days of treatment, suggesting that shorter courses may be better. Studies comparing the relative value of acetaminophen, nonsteroidal anti-inflammatory drugs, and cyclobenzaprine individually and in combination in the treatment of back pain are needed.

Amitriptyline↗
PubMed2002

Can a Back Pain E-mail Discussion Group improve health status and lower health care costs?: A randomized study.

BACKGROUND: Given the high health care utilization, limited evidence for the effectiveness of back pain interventions, and the proliferation of e-mail health discussion groups, this study seeks to determine if the Internet can be used to improve health status and health care utilization for people with chronic back pain. METHODS: Randomized controlled trial. Participants included 580 people from 49 states with chronic back pain having at least 1 outpatient visit in the past year, no "red-flag" symptoms, and access to e-mail. Major exclusion criteria included continuous back pain for more than 90 days causing major activity intolerance and/or receiving disability payments. INTERVENTION: Closed, moderated, e-mail discussion group. Participants also received a book and videotape about back pain. Controls received a subscription to a non-health-related magazine of their choice. MAIN OUTCOME MEASURES: Pain, disability, role function, health distress, and health care utilization. RESULTS: At 1-year treatment, subjects compared with controls demonstrated improvements in pain (P =.045), disability (P =.02), role function (P =.007), and health distress (P =.001). Physician visits for the past 6 months declined by 1.5 visits for the treatment group and by 0.65 visits for the control group (P =.07). Mean hospital days declined nearly 0.20 days for the treated group vs and increased 0.04 days for the control group (P =.24). CONCLUSIONS: An e-mail discussion group can positively affect health status and possibly health care utilization. It may have a place in the treatment of chronic recurrent back pain.

Back Pain↗
PubMed2000

Bipolar permanent magnets for the treatment of chronic low back pain: a pilot study.

CONTEXT: Chronic low back pain is one of the most prevalent and costly medical conditions in the United States. Permanent magnets have become a popular treatment for various musculoskeletal conditions, including low back pain, despite little scientific support for therapeutic benefit. OBJECTIVE: To compare the effectiveness of 1 type of therapeutic magnet, a bipolar permanent magnet, with a matching placebo device for patients with chronic low back pain. DESIGN: Randomized, double-blind, placebo-controlled, crossover pilot study conducted from February 1998 to May 1999. SETTING: An ambulatory care physical medicine and rehabilitation clinic at a Veterans Affairs hospital. PATIENTS: Nineteen men and 1 woman with stable low back pain of a mean of 19 years' duration, with no past use of magnet therapy for low back pain. Twenty patients were determined to provide 80% power in the study at P<.05 to detect a difference of 2 points (the difference believed to be clinically significant) on a visual analog scale (VAS). INTERVENTIONS: For each patient, real and sham bipolar permanent magnets were applied, on alternate weeks, for 6 hours per day, 3 days per week for 1 week, with a 1-week washout period between the 2 treatment weeks. MAIN OUTCOME MEASURES: Pretreatment and posttreatment pain intensity on a VAS; sensory and affective components of pain on the Pain Rating Index (PRI) of the McGill Pain Questionnaire; and range of motion (ROM) measurements of the lumbosacral spine, compared by real vs sham treatment. RESULTS: Mean VAS scores declined by 0.49 (SD, 0.96) points for real magnet treatment and by 0.44 (SD, 1.4) points for sham treatment (P = .90). No statistically significant differences were noted in the effect between real and sham magnets with any of the other outcome measures (ROM, P = .66; PRI, P = .55). CONCLUSIONS: Application of 1 variety of permanent magnet had no effect on our small group of subjects with chronic low back pain.

Chronic Disease↗
PubMed2000

Transcutaneous electrical nerve stimulation and acupuncture-like transcutaneous electrical nerve stimulation for chronic low back pain.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS), originally based on the gate-control theory of pain, is widely used for the treatment of chronic low back pain. Despite its wide use and theoretical rationale, there appears at first glance little scientific evidence to support its use. This Cochrane review examines the available evidence on TENS for the treatment of chronic back pain through an exhaustive search of the literature. OBJECTIVES: Transcutaneous electrical nerve stimulation (TENS) and acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) for chronic low back pain management have experienced a tremendous growth over the past 25 years. The objective of this review was to assess the effects of TENS and ALTENS for reducing pain and improving function in patients with chronic back pain. SEARCH STRATEGY: We searched MEDLINE up to November 1997, EMBASE from 1985 to September 1995, Amed and Ciscom to January 1995, reference lists of the retrieved articles, proceedings of conferences and contacted investigators in the field. SELECTION CRITERIA: Randomised trials comparing TENS or ALTENS therapy to placebo in patients with chronic low back pain. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data on pain reduction, range of movement, functional and work status. MAIN RESULTS: Six trials were included. The trials included 288 participants with an average age range of 45 to 50 years and approximately equal numbers of women and men. The overall odds ratio for improvement in pain for each comparison was: TENS/ALTENS versus placebo 2.11 (95% confidence interval 1.32 to 3. 38), ALTENS versus placebo 7.22 (95% confidence interval 2.60 to 20.01) and TENS versus placebo 1.52 (95% confidence interval 0.90 to 2.58). The odds ration for improvement in range of motion on ALTENS versus placebo was 6.61 (95% confidence interval 2.36 to 18.55). REVIEWER'S CONCLUSIONS: There is evidence from the limited data available that TENS/ALTENS reduces pain and improves range of motion in chronic back pain patients, at least in the short term. A large trial of ALTENS and TENS is needed to confirm these findings.

Chronic Disease↗
PubMed2000

Acupuncture for low back pain.

BACKGROUND: Although low back pain is usually a self-limiting and benign disease that tends to improve spontaneously over time, a large variety of therapeutic interventions are available for the treatment of low back pain. OBJECTIVES: The objective of this review was to assess the effects of acupuncture for the treatment of non-specific low back pain. SEARCH STRATEGY: We searched the Cochrane Complementary Medicine Field trials register, the Cochrane Controlled Trials Register (1997, issue 1), Medline (1966 - 1996), Embase (1988 - 1996), Science Citation Index and reference lists of articles. SELECTION CRITERIA: Randomised trials of all types of acupuncture treatment that involves needling for subjects with non-specific low back pain. DATA COLLECTION AND ANALYSIS: Two reviewers blinded with respect to authors, institution and journal independently assessed trial quality and extracted data. MAIN RESULTS: Eleven trials were included. The methodological quality was low. Only two trials were of high quality. Three trials compared acupuncture to no treatment, which were of low methodological quality and provide conflicting evidence. There was moderate evidence from two trials that acupuncture is not more effective than trigger point injection or transcutaneous electrical nerve stimulation (TENS). There was limited evidence from eight trials that acupuncture is not more effective than placebo or sham acupuncture for the treatment of chronic low back pain. REVIEWER'S CONCLUSIONS: The evidence summarised in this systematic review does not indicate that acupuncture is effective for the treatment of back pain.

Acupuncture Therapy↗