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PubMed2000

[Multidisplinary approach to chronic back pain: postrehabilitation resumption of work the same 3-4 years later as after 6 months].

OBJECTIVE: To determine the results of a multidisciplinary programme for people with chronic back pain 3 to 4 years post-programme. DESIGN: Prospective cohort study. METHOD: In 1996, 143 patients with chronic back pain had participated in an outpatients programme, of 4 weeks duration, at a Back AdviceCentre. A follow-up study took place 6 months post-programme. This involved 99 men and 44 women, who at the start of the programme had a mean age of 41.6 (SD: 8.5; range: 23-58) and had experienced back pain for a mean period of 46.3 months (SD: 36.3). In January/February 2000 the patients were contacted by telephone and completed questionnaires concerning their current work status, pain intensity, perceived disability and complaints. The same questionnaires had been completed at the start of the programme and 6 months post-programme. Differences across the three scores were tested in a multivariate test for repeated measurements. RESULTS: Data were obtained from 130 patients; 103 (79%) persons were completely returned to work. The response was 92% (n = 130). As a result of back pain, 14 patients (11%) could not work or worked reduced hours compared with the premorbid situation. (This percentage was 13% at 6 months post-programme.) A further 9 patients (7%) could not work or worked reduced hours due to other health complaints. The average level of pain, disability and complaints was still lower (p < 0.001) than the pre-programme situation. CONCLUSION: The percentage of people who permanently returned to work following the multidisciplinary approach to chronic back pain, remained stable over a period of 3 to 4 years. The results were comparable to those obtained at 6 months post-programme.

Adult↗
PubMed2001

Rating specific chiropractic technique procedures for common low back conditions.

OBJECTIVE: To rate specific chiropractic technique procedures used in the treatment of common low back conditions. DESIGN AND METHODS: A panel of chiropractors rated specific chiropractic technique procedures for their effectiveness in the treatment of common low back conditions, based on the quality of supporting evidence after systematic literature reviews and expert clinical opinion. Statements related to the rating process and clinical practice were then developed through a facilitated nominal consensus process. RESULTS: For most low back conditions presented in this study, the three procedures rated most effective were high-velocity, low- amplitude (HVLA) with no drop table (side posture), distraction technique, and HVLA prone with drop table assist. The three rated least effective were upper cervical technique, non-thrust reflex/low force, and lower extremity adjusting. The four conditions rated most amenable to chiropractic treatment were noncomplicated low back pain, sacroiliac joint dysfunction, posterior joint/subluxation, and low back pain with buttock or leg pain. CONCLUSIONS: The ratings for the effectiveness of chiropractic technique procedures for the treatment of common low back conditions are not equal. Those procedures rated highest are supported by the highest quality of literature. Much more evidence is necessary for chiropractors to understand which procedures maximally benefit patients for which conditions.

Acute Disease↗
PubMed2000

Chronic back problems among workers.

OBJECTIVES: This article examines associations between selected work- and non-work-related factors and the incidence of chronic back problems over the next two years. DATA SOURCE: The data are from the longitudinal household component of the National Population Health Survey, conducted by Statistics Canada. The analysis is based on 3,234 male and 3,129 female respondents who, in 1994/95, were aged 16 or older, employed, rated their health as good, very good or excellent, and reported no diagnosed chronic back problems. ANALYTICAL TECHNIQUES: All analyses were weighted to represent the Canadian population in 1994/95. Unadjusted cross-tabulations and multiple logistic regression were used to examine the associations between respondents' characteristics in 1994/95 and newly diagnosed chronic back problems in 1996/97. MAIN RESULTS: More than 1 million (9%) Canadian workers aged 16 or older developed chronic back problems between 1994/95 and 1996/97. Back injury, chronic stress, depression, and being aged 40 to 49 were significantly associated with subsequent chronic back problems.

Activities of Daily Living↗
PubMed2002

[A case of spinal sarcoidosis complaining of chest and back pain as a first manifestation and mimicking syringomyelia on MRI].

The patient was a 24-year-old female complaining of bell-shaped chest and back pain with visual disturbance. Chest X-ray showed bilateral hilar lymphadenopathy without the presence of pleural effusion. Bronchoalveolar fluid showed lymphocytosis with an elevated CD 4/CD 8 ratio. Transbronchial lung biopsy demonstrated a non-caserous granulomatous lesion with an accumulation of epitheloid cells, suggesting lung sarcoidosis. No abnormality of electrocardiogram was detectable, and spinal tap for examination of chest and back pain demonstrated on elevated level of beta 2-microglobulin, and a normal angiotensin converting enzyme level. Spinal MRI showed a lineal lesion mimicking syringomyelia on T 2-weighted image. Steroid administration was started for the chest and back pain, since the spinal lesion was suspected due to spinal sarcoidosis. All clinical and laboratory findings, without the presence of pleural effusion or cardiac fluid, supported the diagnosis of spinal sarcoidosis causing chest and back pain. In the literature, patients with spinal sarcoidosis manifesting chest and back pain and with a MRI finding mimicking syringomyelia have been rarely reported. This case might be important in considering spinal cord sarcoidosis as a differential diagnosis of chest and back pain.

Adult↗
PubMed2002

Task and postural factors are related to back pain in helicopter pilots.

BACKGROUND: A previous survey by Shear et al. revealed a high prevalence of back pain in Royal Navy helicopter aircrew, compared with controls. It was recommended that a second survey be undertaken, taking account of flying tasks and cockpit ergonomics. This was the purpose of the present investigation. METHOD: A questionnaire containing items on back pain and posture was circulated to all 246 acting pilots, with returns of 75%. The questionnaire sought information on pain in both the flying pilot and co-pilot/instructor roles. RESULTS: The 12-mo prevalence of back pain was 80%. Task-related back pain was greatest in instrument flying (72%) and least in the co-pilot and instructor roles (24%). Self-ratings of posture indicated that forward flexed trunk postures predominated in the flying roles and were most extreme in instrument flying. In non-flying roles, symmetrical, reclining postures were more often reported. No demographic or psychosocial variables were significantly related to back pain prevalence or disability. CONCLUSIONS: Much of the back pain experienced by helicopter pilots appears to be due to the posture needed to operate the cyclic and collective controls. In instrument flying, it is suggested that the visual demands of scanning the displays may exacerbate the pain by causing the pilot to lean further forward.

Aerospace Medicine↗
PubMedDate not supplied

Prevalence of pre-existing recurrent low back pain in college athletes.

This study questioned 1,040 college athletes about recurrent low back pain during their initial preparation physical examination. Only 20 athletes (1.9%) reported a previous history of recurrent low back pain. There were no differences between sports and history of back pain. Since low back pain is a frequent complaint during the career of college athletes and previous back pain is a risk factor for future pain, this data suggests that the majority of college athetes are not predisposed to low back pain secondary to a previous injury.

Adolescent↗
PubMed2003

Low back pain, sacroiliitis, and the relationship with HLA-B27 in Crohn's disease.

OBJECTIVE: To determine the prevalence of sacroiliitis in patients who have back pain in Crohn's disease (CD) using computed tomography (CT); and to reassess the association of sacroiliitis in CD with HLA-B27. METHODS: A total of 134 consecutive patients with CD completed a questionnaire about musculoskeletal symptoms. Those reporting low back pain were assessed, including plain radiographs and CT of the sacroiliac joints. HLA-B27 status was determined in patients with and without back pain. RESULTS: There were 70 (52%) patients with low back pain, of whom 31 (45%) had CT evidence of sacroiliitis. These were characterized by more frequent morning spinal stiffness and positive sacroiliac compression tests even when sacroiliitis was not suspected. Nine had previously recognized radiological and clinical ankylosing spondylitis (AS), and of these 78% were HLA-B27 positive. Of those with newly identified sacroiliitis, 14% were HLA-B27 positive. This frequency was not statistically dissimilar to the 9% HLA-B27 positivity of those without back pain. CONCLUSION: Sacroiliitis defined by CT is a common cause of low back pain in CD. A relationship of sacroiliitis and HLA-B27 could be confirmed only for those with classical AS. Our results accord with the possibility that sacroiliitis in CD is an isolated phenomenon, which is unrelated to HLA-B27 and which may evolve into classical spinal ankylosis in genetically susceptible subjects.

Adult↗
PubMed2003

Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine.

STUDY DESIGN: A comparative study of trunk muscle recruitment patterns in healthy control subjects and patients with chronic low back pain was conducted. OBJECTIVE: To assess trunk muscle recruitment in patients with low back pain. SUMMARY OF BACKGROUND DATA: Conflicting evidence has been reported on the level and pattern of trunk muscle recruitment in patients with low back pain. The disparities can be explained partly by methodologic differences. It was hypothesized that trunk muscle recruitment patterns may be altered in patients with low back pain to compensate for reduced spinal stability. METHODS: For this study, 16 patients with low back pain and 16 matched control subjects performed slow trunk motions about the neutral posture and isometric ramp contractions while seated upright. Ratios of electromyographic amplitudes and estimated moment contributions of antagonist over agonist muscles and of segmentally inserting muscles over muscles inserting on the thorax and pelvis only were calculated. In addition, model simulations were performed to assess the effect of changes in muscle recruitment on spinal stability. RESULTS: The ratios of antagonist over agonist, and of lumbar over thoracic erector spinae electromyographic amplitude and estimated moment contributions were greater in the patients than in the control subjects. The simulation model predicted that these changes would effectively increase spinal stability. CONCLUSIONS: Trunk muscle recruitment patterns in patients with low back pain are different from those in healthy control subjects. The differences are likely to be functional with respect to enhancement of spinal stability in the patients.

Adult↗
PubMed2003

Obesity and low back pain.

Obesity and low back pain (LBP) are common health problems among patients attending Primary Health Care (PHC) in general practice at the United Arab Emirates (UAE). The objective of this study was to determine whether obesity is associated with low back pain. A cross-sectional face-to-face interview questionnaire survey was conducted. The questionnaire was a modified version of the Roland-Morris Scale for evaluating back disability. The interviews were conducted in Arabic by qualified nurses. A multi-stage stratified sample 1,103 UAE national aged 25-65 years, who attended PHC clinics for any reason, were invited to participate but only 802 subjects were eligible to be included for the statistical analysis. The data were analyzed using univariate and multivariate statistical methods. Of the 802 subjects, 428 (53.4%) were males and 374 (46.6%) were females. The mean age of the males was 40.5 +/- 11.5 years and females was 38.2 +/- 10.5 years (p = 0.004). The mean BMI of the males was 26.4 +/- 7.4 and females was 27.8 +/- 5.6 (p = 0.002). The overall prevalence of LBP in the present study was 64.9% (95% confidence interval, 61.0-68.8) and respectively, 56.1% in males and 73.8% in females. The results revealed that there was association between BMI and some socio-demographic variables with the respect of with low back pain. Back pain had more influence on the life style habits on females than in males. Stepwise multiple regression analysis showed that only age (p < 0.0001), educational level (p = 0.001), gender (p = 0.002), place of living (p = 0.019), BMI (p < 0.0001), and housing condition (p = 0.02) had significant effect on the presence of LBP in patients. The present study showed that obesity is moderately associated with low back pain.

Adult↗
PubMed1992

Surface EMG topography and pain distribution in pre-chronic back pain patients.

The relationship between surface EMG recordings from paraspinalis recording sites and subjective pain ratings were examined in a group of pre-chronic back pain patients. thirty-eight back pain patients without major orthopedic diagnosis and a pain duration between 2 to 6 months participated in a three week long subjective pain rating. Following the completion of their pain diary, the paraspinal sites were assessed under the "static" postural conditions of sitting and standing using an EMG scanning procedure. Results of the correlational analysis revealed significant and positive relationships between pain and muscle activity in the upper back (Trapezius, T1 paraspinalis sites) and significant but negative relationships between erector spinae activity (L3 paraspinalis site) and pain. When considering etiological factors of pre-chronic back pain, the results support both the organicity model for upper back, as well as the biomechanical model for the lower back.

Adult↗
PubMed2003

Low back pain and lifting: a review of epidemiology and aetiology.

The incidence of low back pain has continued to increase in modern society, despite the considerable amount of scientific research that has aimed to isolate its exact aetiology. Although low back pain is still largely idiopathic, research has identified over one hundred risk factors for the condition. Of these risk factors, manual material handling tasks are perhaps the most widely explored within the biomechanical literature, as these tasks have been associated with high mechanical stresses on the lower back. Numerous technique-related variables have been addressed by researchers, whilst the influence of intra-abdominal pressure has also been considered. In addition to this, the implications of variations in the size and structural composition of the load have also been assessed. However, low back pain continues to pose a significant threat to the financial stability and happiness of millions of people worldwide. In addition, a number of functional work capacity assessment tests use lifting as a method for assessment of return to work condition. Many of these tests are not standardised and do not consider the implications of low back loading. Therefore new research attempts in this area are justified and should aim to identify the extent of the association that exists between the known risk factors and the incidence of low back pain.

Biomechanical Phenomena↗
PubMed2003

[A case of Guillain-Barré syndrome starting from severe upper back pain].

Examination of a 58-year-old woman who had developed severe upper back pain showed left peripheral type of facial nerve palsy, sensory disturbance of limbs and body trunk (Th7-9), cerebellar ataxia and generalized hyporeflexia. Upper back pain increased at night and was resistant to NSAIDs, antianxiety agents, opioids, and corticosteroids. Concentrations of serum CK and cerebrospinal fluid total protein were elevated. Electromyography (EMG) of perivertebral muscles (Th7-10) showed reduced recruitment and polyphasic potential. Several days later, our patient developed weakness of limbs and respiratory failure, and required mechanical ventilation. From these findings, we diagnosed her as having Guillain-Barré syndrome (GBS) and began treatment with intravenous immunoglobulin therapy. All symptoms including upper back pain improved gradually, and she had recovered almost completely by the 40th hospitalization day. Pain, especially lower back and leg pain, have attracted attention as common symptoms in GBS. However, only one GBS patient with initial severe upper back pain has been reported. Although the precise mechanism of pain in GBS remains unclear, EMG findings lead us to surmise our patient's pain originated from the nerve roots. Limb and back pain should therefore be taken into account for the diagnosis and treatment of GBS patients.

Back Pain↗
PubMed1978

The usefulness of x-ray examinations in the evaluation of patients with back pain.

Process and outcome data from 440 patients with back pain were analyzed. As a part of their care, 106 patients (24 percent) had back x-ray examinations. The non-x-rayed group of patients was used as a naturally occurring control group to determine what contribution back radiographs made to the cost, to the diagnoses and therapeutic decisions of providers, and to the outcome and satisfaction of patients. Although back x-rays contributed more to the cost of patient care than any other diagnostic study, their contribution to diagnosis was minimal, and had little effect on therapeutic decisions. Patients receiving back x-rays were more likely to have had prolonged symptoms at their first visit, and less likely to be symptom-free at four weeks, but were more likely to be satisfied with their care. The authors conclude that, for patients under 50, back x-ray examinations have negligible diagnostic value and their use could be reduced without decreasing the quality of medical care.

Adolescent↗
PubMed1992

[Descriptive epidemiology of low-back pain in Algiers].

A survey by polling of households was undertaken in Algiers with the aim of measuring the incidence of ordinary low back pain and to assess its consequences from the standpoint of the handicap caused. 1,301 households were polled, i.e. 6,956 individuals aged 15 and over in whom the existence of low back pain was sought by questioning. The overall incidence rate of low back pain was 90.9 per thousand. The incidence of low back pain increased markedly with age, exceeding 250 per thousand in women aged 50 to 59. There was no significant difference in incidence between different socio-occupational groups. Almost 45% of cases of low back pain had been present for more than 5 years. More than 90% of low back pain sufferers were totally independent. The proportion of severe handicaps, partially possibly due to the advanced age of the individuals concerned, was relatively low.

Adolescent↗
PubMedDate not supplied

[Vibration, back pain and physical exercise in high-risk professionals: a cross-sectional study].

Repeated loads and vibration stress in professional settings are relevant risk factors for back pain. Aim of this cross-sectional study was to estimate: a) the prevalence of back pain in two high-risk professional samples (helicopter pilots and bus drivers); b) the association between physical/sports exercise and back pain subjective perception across age. Prevalence of back pain is 94% in helicopter pilots and 74% in bus drivers; prevalence of back pain significantly increases with age. The positive effect of regular physical/sports exercise on subjective back pain significantly decreases with age. Physical or sports exercise adapted to structural characteristic of patients can result effective in diminishing personal impairment in subjects at professional risk.

Adolescent↗
PubMed2004

Greater trochanter bursitis pain syndrome in females with chronic low back pain and sciatica.

Trochanteric bursitis is a clinical condition which simulates major hip diseases and low back pain, it may also mimic nerve root pressure syndrome. Patients with greater trochanteric bursitis pain syndrome (GTBPS) usually suffer from pain radiating to the posterolateral aspect of the thigh, paraesthesiae in the legs, and tenderness over the iliotibial tract.. The purpose of this study is to indicate the similarity between the clinical features of the GTBPS and those of chronic low back pain, and to highlight the importance of diagnosing GTBPS in patients complaining of low back conditions. Three hundred female patients were included in this prospective study. All patients complained about chronic low back pain or sciatica and had a failed long term conservative treatment. Local injection of the tender peritrochanteric area was only done in half of the patients (group 1). Patients were required to answer the Oswestry Disability Index Questionnaire during all periods of follow-up. Patients of group 1 had a better clinical outcome (p < 0.0005) than the patients in group 2 where no injection was done. We conclude that greater trochanter bursitis pain syndrome is a frequent syndrome which may be associated with low back symptoms. Patients with a long standing history of low back pain and sciatica should be routinely checked for GTBPS. GTBPS is easy to diagnose and can be treated. Peritrochanteric infiltration with glucocorticoids mixed with 2% lidocaine relieves patients from their symptoms for a long period of time. Recurrence should always be expected, but treatment may be repeated.

Activities of Daily Living↗
PubMed2005

Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain.

BACKGROUND AND PURPOSE: The purpose of this randomized controlled trial was to examine the usefulness of the addition of specific stabilization exercises to a general back and abdominal muscle exercise approach for patients with subacute or chronic nonspecific back pain by comparing a specific muscle stabilization-enhanced general exercise approach with a general exercise-only approach. SUBJECTS: Fifty-five patients with recurrent, nonspecific back pain (stabilization-enhanced exercise group: n=29, general exercise-only group: n=26) and no clinical signs suggesting spinal instability were recruited. METHODS: Both groups received an 8-week exercise intervention and written advice (The Back Book). Outcome was based on self-reported pain (Short-Form McGill Pain Questionnaire), disability (Roland-Morris Disability Questionnaire), and cognitive status (Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia, Pain Locus of Control Scale) measured immediately before and after intervention and 3 months after the end of the intervention period. RESULTS: Outcome measures for both groups improved. Furthermore, self-reported disability improved more in the general exercise-only group immediately after intervention but not at the 3-month follow-up. There were generally no differences between the 2 exercise approaches for any of the other outcomes. DISCUSSION AND CONCLUSION: A general exercise program reduced disability in the short term to a greater extent than a stabilization-enhanced exercise approach in patients with recurrent nonspecific low back pain. Stabilization exercises do not appear to provide additional benefit to patients with subacute or chronic low back pain who have no clinical signs suggesting the presence of spinal instability.

Abdominal Muscles↗
PubMed2005

Reliability of the Roland - Morris Disability Questionnaire (Thai version) for the evaluation of low back pain patients.

OBJECTIVE: To determine the reliability of the Thai version of the Roland - Morris disability questionnaire in low back pain patients. MATERIAL AND METHOD: To develop Thai version of the Roland - Morris disability questionnaire and test it in 120 low back pain patients. Reliability of the Thai version of the Roland - Morris disability questionnaire was assessed by internal consistency using Cronbach's alpha coefficient. RESULTS: The overall Cronbach's alpha coefficient of the scale was 0.83. The Cronbach's alpha coefficient of each question in the Thai version of the Roland - Morris disability questionnaire exceeded 0.7 (range, 0.71- 0.93). The Cronbach's alpha coefficient tested in acute or chronic low back pain patients whether they have back pain only or back pain with radiculopathy which also exceeded 0.7 (range, 0.83-0.87). CONCLUSION: The Thai version of the Roland - Morris disability questionnaire is a reliable tool for assessing functional disability of low back pain in Thai patients.

Adult↗