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PubMed2005

The effectiveness of calcitonin on chronic back pain and daily activities in postmenopausal women with osteoporosis.

The aim of this study was to investigate the effect of nasal calcitonin on chronic back pain and disability attributed to osteoporosis. The study design involved three groups of osteoporotic postmenopausal women suffering from chronic back pain. Group I consisted of 40 women with vertebral fractures, group II of 30 women with degenerative disorders and group III of 40 patients with non specific chronic back pain and without abnormality on plain X-rays. Pain intensity was measured using a numerical rating scale (NRS) and disability due to back pain was measured using the Oswestry disability questionnaire. The patients were randomly assigned to receive, for three months, either 200 IU intranasal salmon calcitonin and 1,000 mg of oral calcium daily (groups IA, IIA, IIIA) or 1,000 mg of oral calcium daily (groups IB, IIB, IIIB). Repeated measures ANOVA showed that there were no significant time, group or interaction effects for pain intensity and disability in any of the groups studied. Mean Oswestry and NRS scores were reduced during the follow-up period in the groups IA, IIIA, but the differences between the two time points were not statistically significant. Intranasal calcitonin has no effect on chronic back pain intensity and functional capacity of osteoporotic women regardless of the presence of fractures, degenerative disorders or chronic back pain of non-specific etiology.

Activities of Daily Living↗
PubMed2006

Movement coordination of the lumbar spine and hip during a picking up activity in low back pain subjects.

The effect of low back pain, with or without nerve root signs, on the joint coordination and kinematics of the lumbar spine and hips during everyday activities, such as picking up an object from the floor, are largely unknown. An experimental study was designed to compare lumbar spine and hip joint kinematics and coordination in subjects with and without sub-acute low back pain, while picking up an object in a sitting position. A three-dimensional real-time electromagnetic tracking device was used to measure movements of the lumbar spine and hips. Sixty participants with subacute low back pain, with or without straight leg raise signs, and twenty healthy asymptomatic participants were recruited. The ranges of motions of lumbar spine and hips were determined. Movement coordination between the two regions was examined by cross-correlation. Results showed that mobility was significantly reduced in subjects with back pain, who compensated for limited motion through various strategies. The contribution of the lumbar spine relative to that of the hip was, however, found to be similar in all groups. The lumbar spine-hip joint coordination was substantially altered in subjects with back pain, in particular, those with a positive straight leg raise sign. We conclude that changes in the lumbar and hip kinematics were related to back pain and limitation in straight leg raise. Lumbar-hip coordination was mainly affected by the presence of positive straight leg raise sign when picking up an object in a sitting position.

Adult↗
PubMed2006

Determinants of "return to work in good health" among workers with back pain who consult in primary care settings: a 2-year prospective study.

Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of "return to work in good health" (RWGH--a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects (n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of "success" in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of "failure" in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success.

Adaptation, Psychological↗
PubMed2006

Age as a predicting factor in the therapy outcome of multidisciplinary treatment of patients with chronic low back pain--a prospective longitudinal clinical study in 405 patients.

This prospective longitudinal clinical study evaluates the prognostic value of age in the therapy outcome of patients with chronic low back pain treated with a multidisciplinary therapy. Four hundred five patients with chronic low back pain for 3 months or longer and a corresponding sick leave for longer than 6 weeks underwent a 3-week standardized multidisciplinary therapy. Patients were assigned into three groups of age with comparable baseline values at T0. At the 6-month follow-up (T1) five different therapy outcomes were analysed and compared in the three groups: back-to-work status, generic health status (SF36), pain intensity, functional capacity, and satisfaction with the therapy. All three treatment groups improved significantly in all outcome criteria between T0 and T1 except of functional capacity, which did not improve in the older patients. In the total group, the back-to-work rate was 61.7%. At the final follow-up, there were significantly better results in terms of functional capacity and pain level in younger patients, whereas back-to-work rate and satisfaction with therapy did not show a significant difference between the groups analysed. According to the results of this study, older patients with chronic low back pain also derive significant benefit from a multidisciplinary treatment strategy, although in some outcome criteria results were inferior to those obtained in younger patients.

Adolescent↗
PubMed1987

Low-back pain during labor.

Earlier studies have shown that labor pain is highly variable in intensity and spatial location. Most women feel pain predominantly in the abdominal area whereas others complain about severe back pain. In addition to the pains associated with contractions, many women report continuous low-back pain. This study used the McGill Pain Questionnaire to examine each type of pain. Women during labor also tracked their perceived pain levels at the same time that contractions were registered on cardiotachographic records. The results show that continuous low-back pain is severe and is reported by about 33% of women during labor. It is described as being qualitatively different from the pains associated with uterine contractions. The pain of contractions felt in the back is often reported as "riding on" the continuous low-back pain so that both together may reach "horrible" or "excruciating" intensities. Continuous low-back pain is probably caused by the distention and pressure on adjacent visceral and neural structures in the peritoneum, in contrast to the rhythmic pains that are clearly related to contractions of the uterus. It is possible that each of these major kinds of pain may be controlled by different anesthesiologic and psychologic procedures.

Abdomen↗
PubMed1988

When back pain becomes disabling: a regional analysis.

Back pain is a common condition and in most cases is not disabling. We have investigated disabling back pain that leads to health care utilization, time lost from work, and high costs. Disabling back pain remains of obscure origin because the focus in studying it has been too narrow. Our indicator of disability is the industrial insurance claim rate for back sprain by county (N = 39) in the State of Washington. After controlling for the size of the labor force and the proportion of workers in occupations that are particularly at risk of back sprain, we determined the effect of 3 socioeconomic factors on the claim rate: the unemployment rate, percentage receiving food stamps, and per capita income. For 2 of the 3 years studied, socioeconomic factors accounted for about one-third of the variance in the claim rate. Even though claimants of industrial insurance are employed, the unemployment rate was significantly related to the claim rate in the 3 years studied. Our interpretation is that disability is a symptom of distress. Where there is a rise in job insecurity and an attendant rise in economic insecurity, there is a greater likelihood that back pain will become disabling.

Back Pain↗
PubMed1993

Coping activities in chronic low back pain: relationship with depression.

To help clarify the nature of coping activities in chronic pain, this study compared how depressed (n = 37) and non-depressed (n = 40) chronic low back pain (CLBP) patients attempted to cope with pain-specific and general non-pain life stressors, relative to matched healthy control subjects (n = 40). We hypothesized that depressed mood, rather than pain alone, would account for differences in coping activities between groups. Specifically, we expected that depressed CLBP patients would report a greater proportion of passive and avoidant coping responses and less active problem solving coping attempts than non-depressed patients and controls. Results indicated that depressed CLBP patients reported more passive-avoidant coping activities than did non-depressed CLBP patients and controls, whereas coping responses were similar for non-depressed CLBP patients and controls. Additionally, subjects across groups tended to report more passive-avoidant coping in response to the specific back pain stressor (i.e., exacerbation of back pain during activity) than to other life stressors. Finally, the magnitude of reported differences in coping attempts across groups varied as a function of the type of stressor (i.e., specific back pain stressor vs. general stressful life events), particularly with regard to a disinclination to seek social support in response to the back pain exacerbation. We conclude that: (1) chronic back pain patients may employ different coping activities when attempting to manage pain exacerbations than when confronting more general life stressors, and (2) an increased rate of passive-avoidant coping responses (relative to matched health controls) is associated with the combination of CLBP and concurrent depressed mood, rather than with CLBP alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMedDate not supplied

How emergency physicians approach low back pain: choosing costly options.

To determine ways in which emergency physicians approach the diagnosis and treatment of the common presenting complaint of low back pain, responses of emergency physicians to a questionnaire dealing with three hypothetical patients with different types of low back pain were taken from a stratified national random sample of eight medical specialties. For severe acute (with and without sciatica) or chronic low back pain, physicians were asked which tests and consultants they would use in pursuit of the diagnosis, and which treatments and specialty referrals they would recommend in each of the three scenarios. For diagnosis in the acute cases (pain less than 1 week), up to 22% of emergency physicians recommended computed tomography (CT scan) and 36% recommended magnetic resonance imaging (MRI). Specialist consultation would be sought for 61% of the acute sciatica patients, 32% of the acute nonsciatica patients, and 47% of the chronic patients. In approaching treatment, over 75% of emergency physicians would advise bedrest for an average of 3.5 to 4.5 days. Between 16% and 40% suggested physical therapy for the acute patients. Referrals to surgical specialists (orthopedist or neurosurgeon) were highest (81%) for acute sciatica, compared with 52% for chronic low back pain, and 41% for acute nonsciatic low back pain. In conclusion, given that most cases of acute low back pain resolve with minimal intervention, diagnostic imaging, laboratory testing, and early specialist consultation favored by many emergency physicians would add little except expense to understanding its etiology. For treatment, emergency physician recommendations for bedrest were longer than necessary and, for physical therapy, of no proven benefit.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed2005

Assessing patient utilities for varying degrees of low back pain.

RATIONALE AND OBJECTIVES: We sought to quantify patient preferences for mild, moderate, and severe low back pain via time-tradeoff analysis and utility measurement. MATERIALS AND METHODS: Forty-one patients being treated for low back pain in a tertiary care teaching hospital participated in the study. Patients were asked to decide which of three health states they were currently experiencing as well as which of the three health states was the worst experienced during their lifetime. A time-tradeoff analysis was performed, during which patients were asked the amount of time in each of the health states they would exchange for complete resolution of symptoms. We correlated (1) subjects' current health state with reported utility and (2) degree of previous low back pain with results of time-tradeoff measurements. RESULTS: All patients were willing to trade a greater number of life-years for resolution of symptoms given a more severe perceived health state. Utility decreased as severity of back pain scenarios increased, with an average utility of 0.93 +/- 0.11 for mild, 0.65 +/- 0.21 for moderate, and 0.18 +/- 0.17 for severe pain. No significant difference in time-tradeoff among subjects was identified based upon current health state on the day of interview. A statistically significant difference was seen in patients' willingness to trade time among those who had actually experienced severe pain versus those who had not. Kendall's correlation revealed that subjects who had experienced severe back pain exhibited significantly lower utilities (P < 0.01) compared with subjects who had never experienced severe pain. CONCLUSIONS: As expected, patients with severe low back pain were willing to sacrifice more potential years of life for resolution of symptoms, suggesting time-tradeoff can accurately reflect patient utility. 2. However, we found no correlation between a subject's current health state and reported utility.

Adult↗
PubMed2006

A cross-sectional study of self-reported back and neck pain among English schoolchildren and associated physical and psychological risk factors.

This study set out to identify the associations between ergonomics and other factors with back and neck pain among schoolchildren. Self-reported questionnaires were used to record health outcomes and potential risk factors in state schools. Six hundred and seventy-nine schoolchildren from Surrey in the United Kingdom aged 11-14 years took part. Twenty-seven percent of children reported having neck pain, 18% reported having upper back pain, and 22% reported having low back pain. A forward stepwise logistic regression was performed with pain categories the dependent variables. Neck pain was significantly associated with school furniture features, emotional and conduct problems, family history of low back pain and previous treatment for musculoskeletal disorders. Upper back pain was associated with school bag weight (3.4-4.45 kg), school furniture features, emotional problems and previous treatment for musculoskeletal disorders. Low back pain was associated with school furniture features, emotional problems, family history and previous injury or accident. It is important to recognise the influence of physical, psychological and family factors in children's pain.

Back Pain↗
PubMed2006

Side effects and adverse events related to intraligamentous injection of sclerosing solutions (prolotherapy) for back and neck pain: A survey of practitioners.

OBJECTIVE: To study the side effects and adverse events related to intraligamentous injection of sclerosing solutions (prolotherapy) for back and neck pain. DESIGN: Practitioner postal survey. SETTING: Postal survey of practitioners of prolotherapy for back and neck pain in the United States and Canada. PARTICIPANTS: A sample of prolotherapy practitioners from 2 professional organizations were surveyed about their training and experience, use of specific treatment procedures, estimated prevalence of side effects, and adverse events related to prolotherapy for back and neck pain. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Prevalence of side effects and adverse events. RESULTS: Surveys were completed by 171 practitioners (response rate, 50%). Ninety-eight percent held medical degrees, and 83% were board certified in various disciplines. Respondents had a median of 10 years of experience, during which they had treated a median of 500 patients and given a median of 2000 treatments. Side effects with the highest median estimated prevalence were pain (70%), stiffness (25%), and bruising (5%). There were 472 reports of adverse events, including 69 that required hospitalization and 5 that resulted in permanent injury secondary to nerve injury. The vast majority (80%) were related to needle injuries such as spinal headache (n = 164), pneumothorax (n=123), temporary systemic reactions (n = 73), nerve damage (n = 54), hemorrhage (n = 27), nonsevere spinal cord insult (ie, meningitis, paralysis, spinal cord injury) (n = 9), and disk injury (n = 2). CONCLUSIONS: Side effects related to prolotherapy for back and neck pain, such as temporary postinjection pain, stiffness, and bruising, are common and benign. Adverse events related to prolotherapy for back and neck pain are similar in nature to other widely used spinal injection procedures. Further study is needed to fully describe the adverse event profile of prolotherapy for back and neck pain.

Back Pain↗
PubMed2005

An active shape model for the reconstruction of scoliotic deformities from back shape data.

OBJECTIVE: The objective of the present study is to improve the accuracy and reliability of the spinal midline reconstructions in scoliosis from back shape data. Design. An active shape model which covers the variety of scoliotic curves with a minimum of adjustable parameters is designed for the reconstruction of the spinal midline based on rasterstereographic back surface measurements. BACKGROUND: To reduce the number of X-rays needed for patients with a scoliosis, an automatic method was developed for the reconstruction of spinal deformities from back shape data. METHODS: 264 digital X-rays of 264 patients with scoliosis were used as a training set. By examining the statistics of the vertebral body centres a point distribution model was derived. The model is used as a basis to reconstruct the spinal midline from back shape data (active shape model). RESULTS: 478 rasterstereographs of 114 scoliotic patients have been evaluated with this new procedure and with an existing procedure. Both procedures deliver a three-dimensional curve of the spinal midline. The frontal projections of these spinal midlines are compared with the vertebral centres of the corresponding 478 X-rays. The active shape model improved the results as compared to the existing procedure from sigma(x)=3.4mm to sigma(x)=3.0mm. CONCLUSION: The use of the active shape model improves the overall accuracy of the spinal midline reconstructions in scoliosis from back shape data.RELEVANCE. Improvements to the accuracy and the reliability of the three-dimensional spinal reconstruction based on back shape data, can lead to an additional reduction of X-rays for patients with a scoliosis.

Artificial Intelligence↗
PubMed2005

Trunk muscle recruitment patterns in specific chronic low back pain populations.

BACKGROUND: It is hypothesized that injury or degeneration of osteoligamentous spinal structures would require compensation by trunk musculature and alterations in motor control to maintain spine stability. While, biomechanical modeling has supported this hypothesis, studies of muscle recruitment patterns in chronic low back pain patients both with and without significant osteoligamentous damage have been limited. This study utilized a non-randomized case-control design to investigate trunk muscle recruitment patterns around the neutral spine position between subgroups of patients with chronic mechanical low back pain and asymptomatic controls. METHODS: Twenty subjects with chronic low back pain attributed to clinical lumbar instability were matched to 20 asymptomatic controls. In addition 12 patients with non-specific chronic low back pain were studied. Surface EMG from five trunk muscles was analyzed to determine activation levels and patterns of recruitment during a standing reach under two different loading conditions. FINDINGS: The chronic low back pain group with symptoms attributed to clinical instability demonstrated significantly higher activation levels of the external oblique and rectus abdominus muscles and lower abdominal synergist ratios than the control group. No significant differences were found between patient subgroups. INTERPRETATION: While these data demonstrate altered muscle recruitment patterns in patients with chronic low back pain, the changes are not consistent with Panjabi's theory suggesting that these alterations are driven by passive subsystem damage. However, the higher activation of global abdominal musculature and altered synergist patterns may represent a motor control pattern that has consequences for continued dysfunction and chronic pain.

Abdominal Muscles↗
PubMed2004

Factors that affect back pain among Hong Kong Chinese patients after cardiac catheterization.

BACKGROUND: Cardiac catheterization (CC) is a widely used cardiac investigation procedure in Hong Kong. However, back pain is frequently reported following CC due the prolonged bed rest after the procedure. AIM: The overall aim of this study was to examine factors associated with back pain among Hong Kong Chinese patients after femoral access for CC. METHODS: A prospective study, nested within a randomized clinical trial (RCT), employing secondary analysis of an existing data set from 419 Chinese adults receiving nonemergency CC, were used. Following a review of literature, gender, age, history of back pain, type of dressing on the puncture site, length of bed rest duration, turning privilege during bed rest, catheter size used for CC, duration of the procedure, duration of hemostasis, and body weight were identified as potential factors affecting back pain level. Back pain was assessed at 6 h and the next morning after CC, using the Numeric Pain Intensity Scale (NPIS). Analysis was done using multivariate analysis of variance (MANOVA), after testing for normality of the distribution. RESULTS: Turning privilege (p = 0.001), age (p = 0.04), and body weight (p = 0.006) were significantly related to level of back pain at 6 h and the next morning after CC. CONCLUSION: Results of this study may help nurses have a better understanding about patients' physical needs and appropriate nursing interventions that can be planned to enhance patient comfort following CC.

Adult↗
PubMed2005

Nonspecific low-back pain in Kuwaiti children and adolescents: associated factors.

PURPOSE: To investigate factors associated with low-back pain among Kuwaiti children and adolescents; and study their relation with social activities and school performance. METHOD: A cross-sectional population of 400 schoolchildren aged 10 to 18 years were selected from junior and high schools in one of the governorates in Kuwait. Data were collected through personal interviews using a questionnaire and analyzed using SPSS software. RESULTS: Older adolescent females who practice strenuous physical activities and spend a significant amount of time watching TV, and smokers were found to be significantly more likely to have low-back pain. Also, high grade-point average students were found to experience more low-back pain. Methods of carrying school materials were not significantly associated with low-back pain. Low-back pain did not significantly affect the number of absent days from school. CONCLUSIONS: The study suggests that back pain in Kuwaiti schoolchildren and adolescents is associated with older age, female gender, increase in physical activity, and time spent watching television.

Activities of Daily Living↗
PubMed2005

Back problems in Parkinson's disease: an underestimated problem.

STUDY DESIGN: Cross-sectional survey. OBJECTIVES: To estimate the extent of back pain in Parkinson's disease (PD). SUMMARY OF BACKGROUND DATA: PD is a common and disabling condition during the course of which back pain may develop. In contrast, the literature on the epidemiology of back pain in PD is poor. METHODS: Patients with PD, seen consecutively in a neurology clinic over a period of 4 months, were inquired about back pain through a self-questionnaire and compared to an age- and sex-matched control group of chronically ill patients. RESULTS: The study involved 104 parkinsonians (mean age: 67.3 years) who had had PD for an average of 11.6 years, and 100 controls (mean age: 65.8 years) who had chronic heart disease or diabetes for an average of 14.2 years. Sixty-two parkinsonians and 23 controls reported back pain. The prevalence was 59.6% in the parkinsonian group and 23.0% in the control group (P < 0.0001). Pain severity was evaluated with a visual analogic scale and averaged 54 +/- 23 mm in parkinsonians and 41 +/- 19 mm in control (P < 0.0001). CONCLUSIONS: Chronic back pain is quite common in PD. It is responsible for a substantial functional impact and needs more attention to reduce disability of such patients.

Adult↗
PubMed2007

Dynamic surface electromyographic responses in chronic low back pain treated by traditional bone setting and conventional physical therapy.

OBJECTIVE: This study compared the dynamic surface electromyographic (EMG) activities of back muscles and pain before and after traditional bone setting and physical therapy. METHODS: This study was a prospective clinical trial that compared surface EMG dynamic activities after traditional bone setting and physical therapy. Sixty-one patients (mean age, 41 years) with nonspecific low back pain were randomized into two subgroups by treatment. The patients underwent a dynamic EMG evaluation for which they were asked to stand and then bend forward as far as possible, stay fully flexed, and return to standing. A flexion-relaxation ratio was calculated by comparing maximal EMG activity while flexing with the average EMG activity in full flexion. Concentric (maximal EMG activity during extension) and eccentric (maximal EMG activity during flexion) ratios were also used in the analyses. RESULTS: Disability, depression, and visual analog scale scores decreased significantly after both treatments. The concentric ratio increased statistically in both groups after the treatments. The study failed to show a significant association between experienced back pain and EMG parameters. CONCLUSIONS: Both treatments seem to have a positive influence on back muscle function by improving muscle symmetry; however, the treatments had no effect on the flexion-relaxation phenomenon after 1 month. Active back exercise at home together with rehabilitation treatments might be effective and improve function for patients with chronic low back pain.

Adult↗
PubMed2005

A randomized, placebo-controlled trial of bupropion sustained release in chronic low back pain.

UNLABELLED: Clinical trials of the efficacy of antidepressant drugs in patients with chronic low back pain have had mixed results, possibly because of the different mechanisms of action of the drugs that have been studied. Because bupropion has a mechanism of action that differs from other antidepressants and has shown efficacy in neuropathic pain, a randomized, placebo-controlled, 2-period crossover trial was conducted to evaluate its efficacy in subjects with chronic low back pain. The primary efficacy variable was mean daily diary pain intensity ratings, and secondary pain intensity and relief outcomes included weekly pain intensity ratings, the McGill Pain Questionnaire (MPQ) Present Pain Intensity scale, pain relief ratings, and satisfaction with pain relief ratings. Adverse events were also assessed throughout the trial. Analyses were performed of an intention-to-treat sample of 44 patients, only 3 of whom met criteria for neuropathic low back pain. Daily and weekly pain intensity ratings, the MPQ Present Pain Intensity scale, and pain relief ratings were not significantly different following treatment with bupropion sustained release (SR) vs. placebo. These results suggest that bupropion SR was not significantly better than placebo in the treatment of patients with non-neuropathic chronic low back pain. PERSPECTIVE: Antidepressant medications that have both noradrenergic and serotonergic effects appear to have greater efficacy in patients with chronic low back pain than those with only serotonergic activity. We studied bupropion because it inhibits the reuptake of both norepinephrine and dopamine, but found no evidence of efficacy in patients with non-neuropathic chronic low back pain.

Adult↗