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PubMed1998

Comparative view of the socioeconomic impact of migraine versus low back pain.

The burden of migraine in terms of cost and impact on socioeconomic indicators is still controversial. In a recent comparative study between migraineurs and controls from the French general population, we show that only general practitioner (GP) consultations and complementary examinations are more frequent in migraineurs. In this paper, we compare the socioeconomic impact of migraine versus another common neurological disease, low back pain, which has similar consequences in term of deficiencies, disabilities, and handicaps. Our study is a subproject of the Gazel cohort study, conducted on 20,000 volunteers working in the "Electricité et Gaz de France" company. The socioeconomic impact was evaluated prospectively by the number of workdays missed between 1989 and 1992 in 436 subjects with migraine but without low back pain (M group), 590 subjects with low back pain but without migraine (L group), 555 subjects with migraine and low back pain (ML group), and in 1005 subjects without headache or low back pain (C group). Moreover, in 1993 all subjects completed a mailed questionnaire on their 6-months' history of use of medical services. The number of workdays missed during this 4-year period was statistically greater in the ML group (58.1 days), followed by the L group (38.4 days), the C group (35.1 days), and the M group (31.8 days) (p = 0.0001). For the use of medical services, the results were different according to the different indicators: GP consultations were more frequent in the ML and M groups, specialist consultations and complementary examinations in the L and C groups. In conclusion, migraine and low back pain seem to have a similar socioeconomic impact. Absenteeism is particularly high when both neurological disorders are present.

Absenteeism↗
PubMed2002

Bone density in chronic low back pain: a pilot study.

BACKGROUND AND OBJECTIVE: Levels of physical activity in chronic low back pain patients are relatively low due to their fear of provoking pain. This may have a secondary impact on maintenance of bone mass. The objective of this study is to determine if patients with chronic low back pain are at a higher risk of bone demineralization. DESIGN: Bone mineral density (BMD) was measured in 25 chronic low back pain patients at the lumbar spine, hip and distal forearm. SETTING: A university hospital. SUBJECTS: Twenty-five chronic low back pain patients (mean age 45 years) enrolled on a residential back pain rehabilitation programme. RESULTS: Thirteen patients (52%) were osteopenic or osteoporotic in one or more sites. BMD at the lumbar spine was generally lower than the mean BMD of age-matched subjects (p = 0.04). There was no significant relationship between BMD and duration of pain, disability, sex or previous surgical intervention. CONCLUSIONS: Chronic low back pain patients have an increased incidence of osteopenia and osteoporosis. This finding reinforces the importance of motivating patients to incorporate exercise into daily life. Given the limited set of subjects used in the present study, further studies are required.

Adult↗
PubMed2006

The effect of lifting and lowering an external load on repositioning error of trunk flexion-extension in subjects with and without low back pain.

OBJECTIVE: To determine whether the repositioning error of trunk flexion-extension in individuals with low back pain is different from that in those not experiencing low back pain when lifting and lowering external loads. DESIGN: A case-control study. SETTING: Physical therapy department of a medical centre. SUBJECTS: Twenty subjects with subacute low back pain and 20 control subjects without low back pain. INTERVENTIONS: Tasks with and without lifting and lowering an external load. MAIN OUTCOME MEASURES: The trunk repositioning errors were measured with Measurand Shape Tape. RESULTS: In subjects with low back pain, trunk repositioning errors were significantly reduced when lifting and lowering an external load in the direction of flexion (3.77 +/- 1.26 degrees in a loaded condition versus 4.82 +/- 2.97 degrees in an unloaded condition; P < 0.05) and extension (3.17 +/- 2.15 degrees in a loaded condition versus 5.03 +/- 3.74 degrees in an unloaded condition; P < 0.05). In control subjects, trunk repositioning errors were not significantly changed when lifting and lowering an external load in the direction of flexion (2.80 +/- 1.39 degrees in a loaded condition versus 2.63 +/- 1.24 degrees in an unloaded condition; P > 0.05) and extension (2.87 +/- 11.40 degrees in a loaded condition versus 3.15 +/- 11.50 degrees in an unloaded condition; P > 0.05). The direction of motion (trunk flexion or extension) was not shown to be significant in this study. CONCLUSION: Performing the task whilst lifting or lowering a submaximal load showed a reduced trunk repositioning error in subjects with subacute low back pain. Lifting and lowering a submaximal load might be considered as one of the rehabilitative strategies to hasten a return to work.

Adult↗
PubMed2001

Recall bias, pain, depression and cost in back pain patients.

OBJECTIVES: To investigate the relationship between recall bias for pain stimuli in chronic low back pain patients and the cost of managing their back pain in primary care. DESIGN: A retrospective cross-sectional investigation. METHOD: A sample of 63 low back pain patients were interviewed in a primary care setting. Information was gathered on their pain intensity, disability ratings, depression, anxiety, and duration of pain. They were also presented with a surprise recall test for pain descriptors. The cost of each patient's treatment specifically for back pain in the previous 12 months was calculated. The relationship between the cost of back pain treatment and the scores from the interview were calculated first for total cost, and then for the breakdown of individual cost items. RESULTS: Results indicated that recall bias for pain stimuli were significantly related to total cost (R2 = 8%). A detailed analysis revealed that pain intensity was related to the number of appointments with the general practitioners; depression scores related to the number of appointments with the in-house osteopaths; and recall bias for pain stimuli related to referrals to external experts (out-patients). A minority of patients high on recall bias was found to account for a disproportionate amount of the cost. CONCLUSION: Although no causal path can be deduced from the findings, the study provides a novel approach to measuring psychological factors in back pain in reference to health care utilization. It is limited by its retrospective design, and should be followed by prospective studies to understand fully the relationship between cognitive bias and utilization of health services.

Adolescent↗
PubMed2005

A clinical return-to-work rule for patients with back pain.

BACKGROUND: Tools for early identification of workers with back pain who are at high risk of adverse occupational outcome would help concentrate clinical attention on the patients who need it most, while helping reduce unnecessary interventions (and costs) among the others. This study was conducted to develop and validate clinical rules to predict the 2-year work disability status of people consulting for nonspecific back pain in primary care settings. METHODS: This was a 2-year prospective cohort study conducted in 7 primary care settings in the Quebec City area. The study enrolled 1007 workers (participation, 68.4% of potential participants expected to be eligible) aged 18-64 years who consulted for nonspecific back pain associated with at least 1 day's absence from work. The majority (86%) completed 5 telephone interviews documenting a large array of variables. Clinical information was abstracted from the medical files. The outcome measure was "return to work in good health" at 2 years, a variable that combined patients' occupational status, functional limitations and recurrences of work absence. Predictive models of 2-year outcome were developed with a recursive partitioning approach on a 40% random sample of our study subjects, then validated on the rest. RESULTS: The best predictive model included 7 baseline variables (patient's recovery expectations, radiating pain, previous back surgery, pain intensity, frequent change of position because of back pain, irritability and bad temper, and difficulty sleeping) and was particularly efficient at identifying patients with no adverse occupational outcome (negative predictive value 78%- 94%). INTERPRETATION: A clinical prediction rule accurately identified a large proportion of workers with back pain consulting in a primary care setting who were at a low risk of an adverse occupational outcome.

Adolescent↗
PubMed2005

[Back pain is a major problem for many pregnant women].

OBJECTIVES: To evaluate the prevalence of back pains, identify their location and the association between age, time of pregnancy, nervous injury and the presence of pain prior to pregnancy. METHODS: Back pain was identified by means of a descriptive study. From January to December of 2001, using a questionnaire structured by the authors, 203 pregnant women arriving for Pre-natal care were interviewed after selection in the waiting rooms of the Primary Health care Units of the city of Paulínia (state of São Paulo). RESULTS: Prevalence of back pain was of 79.8%; of these location in the lumbar region was reported by 80.8% and in the sacroiliac by 49.1% of the pregnant women. Pain was more frequent among younger women. Prevalence of back pain did not increase with progress of pregnancy. Symptoms of nervous injury not related to the site of the back pain were reported by 47.7% of those pregnant. CONCLUSION: Almost 80% of the pregnant women reported back pain at some time during pregnancy. The most often reported sites were the lumbar and sacroiliac. Pain was more frequent among the younger women. Half of the pregnant women reported symptoms of nervous injury.

Adult↗
PubMed1996

Long-term back problems and physical work exposures in the 1990 Ontario Health Survey.

OBJECTIVES: This study sought to provide data on the relationship of work exposures to long-term back problems in a population survey. METHODS: The Ontario Health Survey in 1990 used a representative population sample of the province. It included data on long-term back problems, occupational activity, and physical work exposures. The current study examined relationships between these variables. RESULTS: The prevalence of long-term back problems was 7.8% in working-age adults. It generally increased with age. Long-term back problems were more prevalent in blue-collar occupations and among those not working, as well as among people with less formal education, smokers, and those overweight. Physical work exposures--awkward working position, working with vibrating vehicles or equipment, and bending and lifting--were all associated with a greater risk of back problems. The number of simultaneous physical exposures was monotonically related to increased risk. CONCLUSIONS: Within the limitations of the data and assuming the relationship to be causal, about one quarter of the excess back pain morbidity in the working population could be explained by physical work exposures.

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↗
PubMed1994

Pharmacological management of back pain syndromes.

The symptom of back pain may be the result of many different pathologies. As such, patients with back pain require careful assessment to determine whether the cause is from the spine or other systems. For acute mechanical back pain, treatment is often symptomatic. Symptomatic treatment may include analgesics, anti-inflammatories and/or muscle relaxants. Patients may also need hypnotics in the short term to help them sleep at night. However, drug therapy should be reduced and stopped as soon as possible. Furthermore, too much bedrest may be counterproductive. Paracetamol (acetaminophen) is the standard treatment for transient back pain. More severe pain may require the addition of an opioid, such as codeine or dextropropoxyphene. Morphine and pethidine (meperidine) may be necessary in patients with back pain due to neoplastic disease or osteoporotic fracture. However, the opioid analgesics are associated with dependence, tolerance and adverse effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic efficacy comparable with paracetamol. Individual patients respond differently to different NSAIDs, and several agents may have to be tried. Long term therapy with NSAIDs is necessary in diseases with an inflammatory component such as ankylosing spondylitis. Calcitonin reduces bone resorption and bone blood flow, and has been suggested to have central analgesic effects. As such, it has been used successfully in patients with Paget's disease, osteolytic bone disease and osteoporosis. Bisphosphonates also inhibit osteoclastic bone resorption and may be useful in Paget's disease, osteolytic metastases and osteoporotic fractures. Other drugs which may be useful in relieving back pain associated with specific circumstances include the tricyclic antidepressants, anxiolytics, antiepileptic agents, corticosteroids, colchicine and chymopapain.

Adrenal Cortex Hormones↗
PubMed2002

Aggressive exercise as treatment for chronic low back pain.

Exercise has long been a standard of treatment for back pain. Over the last 2 decades, the use of intense, non-pain-contingent exercises for treatment of chronic back pain has received increased advocacy. The main goals of these treatments are to improve functioning of painful lumbar soft tissue and to decrease the fears and concerns of patients about using their backs for daily activities. The methodology of an aggressive quota-based exercise approach to back pain is outlined in this article. This approach relies on objective quantification of physical capabilities, treatment directed at altering these parameters, and repeat quantification for determination of treatment efficacy and positive feedback. By eliminating impairments in back function, altering fears and beliefs about pain, and reducing disability, patients with chronic low back pain can achieve meaningful improvements in their quality of life.

Behavior Therapy↗
PubMed2003

Efficacy of epidural injections of Kenalog and Celestone in the treatment of lower back pain.

OBJECTIVE: Epidural corticosteroid injections have been used extensively to treat lower back pain, but the relative effectiveness of one corticosteroid versus another has never been reported in a large patient series. We retrospectively reviewed 597 patients who had epidural corticosteroid injections to determine any difference in Kenalog or Celestone efficacy. MATERIALS AND METHODS: We reviewed charts and self-reported pain score evaluations of 597 patients who received either Kenalog or Celestone Soluspan as an epidural injection for the treatment of lower back pain from 1997 to 2002 at our university hospital and affiliated Veterans Affairs hospital. Kenalog was used for the initial 2 years and Celestone was used for the next 3 years. Fluoroscopic guidance was used to confirm epidural location, and each patient was injected with a mixture of 5 mL of 0.5% preservative-free lidocaine and 2 mL of either Kenalog 40 mg/mL (triamcinolone acetonide injectable suspension) or Celestone Soluspan 6 mg/mL (betamethasone sodium phosphate and betamethasone acetate injectable suspension). Each patient was given a standardized pain evaluation sheet that used an 11-point scale for initial pain severity. Scoring of pain compared with baseline during the following 14 days was based on a 5-point scale of pain improvement or worsening. RESULTS: On days 0-3 after the procedure, no statistical significance in improvement of lower back and buttock pain was seen between groups. On day 7, 59% of Celestone recipients and 73% of Kenalog recipients showed improvement in lower back pain (p = 0.002, Pearson's chi-square test), and 58% of Celestone recipients and 75% of Kenalog recipients had improvement in leg or buttock pain (p < 0.001). On day 14, 54% of Celestone recipients and 71% of Kenalog recipients showed improvement in lower back pain (p < 0.001), and 54% of Celestone recipients and 71% of Kenalog recipients had improvement in leg or buttock pain (p < 0.001). CONCLUSION: The epidural injection of Celestone Soluspan and Kenalog reduced lower back and radicular pain in more than half the patients, although Kenalog reduced pain in a significantly larger number of patients than Celestone Soluspan at 1 and 2 weeks after injection.

Anti-Inflammatory Agents↗
PubMed2003

Comparative effects of treatment with etidronate and alendronate on bone resorption, back pain, and activities of daily living in elderly women with vertebral fractures.

The purpose of the present study was to compare the effects of treatment with etidronate and alendronate on bone resorption, back pain, and activities of daily living (ADL) in elderly women with vertebral fractures. Fifty elderly women, 63-84 years of age, with back pain due to osteoporotic vertebral fractures were randomly divided into two groups with 25 patients in each group: the cyclical etidronate treatment group (200 mg/day for 2 weeks per 3 months) and the alendronate treatment group (5 mg/day). The level of urinary cross-linked N-terminal telopeptides of type I collagen (NTx) measured by an enzyme-linked immunosorbent assay, back pain evaluated with the face scale score, and the ADL score (disability) determined with a questionnaire were assessed before and 3 and 6 months after the start of treatment. No significant differences in these parameters were found between the two groups before the treatment. The urinary NTx level, the face scale score, and the ADL score decreased significantly in both groups. Although the reduction in the urinary NTx level was significantly greater in the alendronate group than in the etidronate group, the reduction in the face scale score was transiently significantly greater in the etidronate group than in the alendronate group. However, changes in the ADL score did not significantly differ between the two groups. The present study showed that although back pain was reduced and ADL was improved in both treatment groups of elderly women with vertebral fractures, the mechanism for the reduction in back pain differs to some extent between the two treatment groups. A double-blind placebo-controlled study is needed to confirm the therapeutic effects of these agents on back pain and deterioration of ADL.

Activities of Daily Living↗
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↗
PubMed1995

Exercises for chronic low back pain: a clinical trial.

Different training models are effective for the treatment of chronic low back pain, but no consensus has been found. Earlier studies have emphasized training of spinal mobility and back strength. To evaluate if other physiological parameters, such as coordination, are of equal importance, we performed a randomized trial on 40 consecutive patients with chronic low back pain. Two training models were compared: 1) intensive training of muscle endurance and 2) muscle training, including coordination. In both groups, training was performed 1 hour twice a week for 3 months. Pain score, disability score, and spinal mobility improved in both training groups without differences between the two groups. Only intensive training of muscle endurance improved isokinetic back muscle strength. At study entry, we found a significant correlation between spinal mobility and dysfunction, but after the training, no correlation was found between improvement of spinal mobility or isokinetic back extension strength and improvement of function or pain level. We conclude that coordination training for patients with chronic low back pain is as equally effective as endurance training.

Adolescent↗
PubMed1999

Low back pain and its relation to the hip and foot.

STUDY DESIGN: Case study. OBJECTIVE: To describe a treatment approach for a patient with recurrent low back pain who also had asymmetry in hip rotation between the left and right sides. BACKGROUND: The patient's chief complaint was dull, intermittent unilateral low back pain during the past 3 years. METHODS AND MEASURES: The patients was a 35-year-old man with recurrent unilateral low back pain. The findings of the physical therapy examination suggested sacroiliac joint dysfunction. Also, evaluation later showed evidence of unilateral excessive foot pronation on the same side of the excessive hip lateral rotation. The finding of excessive hip lateral rotation and excessive foot pronation on the same side of the unilateral low back pain suggested a possible connection between low back symptoms, hip, and lower extremity dysfunction. RESULTS: The treatment of the hip and the subtalar joint of the foot eliminated the reoccurrence of the patients signs and symptoms of sacroiliac joint dysfunction. CONCLUSIONS: This case report demonstrates the successful treatment of a patient with low back pain who exhibited multiple impairments in the sacroiliac, hip, and subtalar joints.

Adult↗
PubMed1999

Lumbar spine kinesthesia in patients with low back pain.

STUDY DESIGN: Single-group, posttest only, using a sample of convenience. OBJECTIVE: To measure the repositioning error of subjects with low back pain for lumbar sagittal movement using a simple kinesthetic test previously described. BACKGROUND: Patients with low back pain are commonly observed to have difficulty in adopting a mid or neutral position of the lumbar spine. METHODS AND MEASUREMENTS: Twenty subjects with low back pain were required to reproduce an upright neutral posture of the lumbar spine following movement into flexion in a sitting position. Trunk positioning accuracy was measured with an electromagnetic tracking device. RESULTS: The mean absolute value of the repositioning error in the sagittal plane was 2.25 degrees +/-0.88 degrees on day 1 and 2.32 degrees +/-1.62 degrees on day 2. The performance of patients with low back pain was similar to that of asymptomatic patients in a previous study, although subjects with low back pain overshot the neutral position more frequently (79%) than did nonimpaired subjects (50%). CONCLUSIONS: Subjects with low back pain may have attempted to use extra mechanoreceptive cues to compensate for some kinesthetic deficit. Nevertheless, the kinesthetic test used was not sensitive enough to detect any repositioning deficits, and reasons for this are explored.

Adult↗
PubMed2001

Assessment of short-term physical loading of the back: is serum keratin sulfate an appropriate biomarker?

STUDY DESIGN: A prospective experimental study. OBJECTIVES: To investigate the potential of serum keratan sulfate (KS) as an indicator of biochemical changes in intervertebral discs induced by physical loading of the back. BACKGROUND: By providing objective information on exposure and effects at the tissue level, biomarkers may enable us to improve our understanding of the intermediate steps between exposure to physical loading and the occurrence of back disorders. Serum KS has been proposed as a potential biomarker of the molecular changes in intervertebral discs that occur because of physical loading and are a potential cause of back disorders. METHODS AND MEASURES: Thirty-two nonimpaired men volunteers with a mean age of 22.5+/-2.3 years participated in the experimental condition, a manual lifting task, as well as in the control condition, lying on the back. Serum KS levels were measured immediately before and after both conditions, as well as 24 hours and 1 week later. RESULTS: No significant changes in serum KS levels were found after exposure to physical loading (mean SD serum KS before, 287.4+/-83.9 ng/mL; immediately after, 279.5+/-65.5 ng/mL; 24 hours after, 266.6+/-71.9 ng/mL; and 1 week after, 268.9+/-79.3 ng/mL), and no significant changes were found after lying on the back for 8 hours (mean+/-SD serum KS before, 273.0+/-94.3 ng/mL; immediately after, 261.6+/-68.9 ng/mL; 24 hours after, 277.3+/-68.9 ng/mL; and 1 week after, 274.5+/-68.5 ng/mL). CONCLUSIONS: These results indicate that the serum KS level is not suitable as a biomarker of the effects of short-term physical loading of the back induced by a manual lifting task.

Adult↗
PubMed2004

Paraspinal musculature and skin temperature changes: comparing the Thermacare HeatWrap, the Johnson & Johnson Back Plaster, and the ABC Warme-Pflaster.

STUDY DESIGN: Prospective, randomized, crossover design. OBJECTIVES: To compare the effectiveness of the Johnson & Johnson Back Plaster, the ABC Warme-Pflaster, and the ThermaCare HeatWrap on skin and paraspinal muscle temperature. Also, to compare the subjects' heat perception for the 3 products. BACKGROUND: Heat therapy is a common treatment for low back pain and disability. There are a number of products on the market that are suggested to relieve low back pain by providing warmth to the back; however, their effectiveness for increasing tissue temperature compared with heat sensation has not been tested. METHODS AND MEASURES: To measure paraspinal muscle temperature, 1 thermocouple monofilament was inserted into the paraspinal muscle 2 cm from the skin surface at the L3 level using a 20-gauge 1.25-in (3.15-cm) sterile catheter. To measure skin interface temperature, 2 thermocouples were placed on the skin at distances of 5 cm and 7 cm from the insertion site. The Isothermex was used to record temperatures to the nearest 0.1 degrees C for 120 minutes. The subjects also rated heat perception using a 10-cm visual analog scale at 0, 30, 60, 90, and 120 minutes. Analysis of covariance models were used for statistical analysis. RESULTS: There was a significant product x time interaction (F14,231 = 3.77, P<.0001) at the intramuscular site, but there was not a significant product x time interaction (F14,231 = 1.03, P = .4228) at the skin site. Both the main effects for product (F2,33 = 41.59, P<.0001) and time (F3,51 = 19.02, P<.0001) were significant for the visual analog scale data. The ThermaCare HeatWrap produced significant increases in both skin and intramuscular temperatures with less heat sensation. The Johnson & Johnson Back Plaster and the ABC Warme-Pflaster increased temperature at the skin surface and provided the greatest heat sensations, but they did not provide intramuscular heat. CONCLUSIONS: The ThermaCare HeatWrap is more effective at increasing temperature at a 2-cm depth with less perceived heat compared to the Johnson & Johnson Back Plaster and the ABC Warme-Pflaster. The latter 2 products provide a sensation of heat but do not actually provide a muscle temperature change at a depth of 2 cm.

Adult↗