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At least 1,603 records · Page 89Linked to original sources
PubMed1992

A new paradiscal injection technique for the relief of back spasm after chemonucleolysis.

Back spasm, or spasm of the back muscles, is the commonest adverse reaction encountered after chemonucleolysis. In order to overcome this troublesome complication, the authors present a new 'paradiscal injection technique'. After the injection of chymopapain into the affected disc, the needle is withdrawn to just outside the annulus. Bupivacaine is injected into the paradiscal 'space' which acts upon the paravertebral muscles. Eighty consecutive patients have been treated by chemonucleolysis with paradiscal injection for pain relief. All patients were discharged the same day or the following day and no immediate complications occurred. When reviewed 3 weeks later, only three (3.8%) patients complained of back pain (which was different in character to that present before the injection or was exacerbated by the injection). Pain persisted in the same patients until 6 months after the injection but was negligible. None of the remaining patients had developed back pain as a result of chymopapain. The authors suggest that the addition of paradiscal injection of bupivicaine after cymopapain injection can reduce the incidence of spasm of the back muscles. This technique is a major contribution to increasing the efficacy of chemonucleolysis for the treatment of herniated lumbar disc.

Adult↗
PubMed1992

MMPI scale 3 as a predictor of back injury report: what does it tell us?

Items and selected subscales of Scale 3 (Hysteria) of the MMPI were examined to pinpoint personality or emotional factors predictive of back injury reports in an industrial setting. Data were derived from a previous prospective-design study of back pain in volunteer hourly wage employees of an aircraft manufacturing company. After physical examination and completion of questionnaires pertaining to demographic, psychosocial (including the MMPI), and workplace factors, workers were followed for an average of 3 years. Those who subsequently reported back injury were compared with those who did not. In that study three variables predicted report of back injury, one of which was Scale 3 of the MMPI. Individual items, Ornduff et al. subscales of Psychological Denial and Body Concern, and the five Harris-Lingoes (1955) subscales of Scale 3 were analyzed. Three Harris-Lingoes subscales showed significant relationships to the criterion. Hy-3: Lassitude/Malaise; Hy-1: Denial of Social Anxiety; and, marginally, Hy-2: Need for Affection, significantly contributed to prediction effectiveness. Results and implications for the understanding of factors predicting back injury reports and for the medical evaluation of pain and the concept of pain are discussed.

Back Injuries↗
PubMed1979

Management of stab wounds of the back and flank.

Abdominal stab wounds are managed on a selective basis with increasing frequency. Retroperitoneal injuries are more difficult to evaluate; hence wounds to the flank and back pose different considerations. A retrospective review of 108 patients with deep stab wounds of the flank and back was compared with a prospective study of 109 patients selectively managed with similar injuries. Physical examination was accurate in 86% of flank and 88% of back wounds. Local exploration was an effective procedure in differentiating superficial from deep wounds. Peritoneal lavage may be more accurate in flank wounds but is probably less reliable with retroperitoneal injuries. Adjunctive studies are helpful in selected patients. The incidence of negative celiotomies was reduced from 85.2% to 7.3% when the selective approach was adopted. There was no mortality or increased morbidity in the series. Although the risk of retroperitoneal injury is greater with flank and back wounds, frequent examination by the same observer combined with adjunctive studies in selected cases appears to be a safe, reliable method of managing patients with stab wounds of the back and flank.

Back↗
PubMed1989

A prospective study of the role of cardiovascular risk factors and fitness in industrial back pain complaints.

The authors conducted a prospective study of risk factors for industrial back pain complaints among 3,020 aircraft manufacturing employees. The study subjects completed a cardiovascular risk questionnaire, and were asked about their smoking status and past medical history, including previous back problems. Premorbid submaximal treadmill testing to predict maximum oxygen uptake (Vo2max) was completed in 2,434 subjects who were not excluded from testing due to cardiovascular risk screening. During several years of subsequent follow-up, 279 subjects reported back problems. Those who reported smoking at the time of the premorbid examination were significantly more likely to report a subsequent back problem than nonsmokers (P = 0.002). When controlling for sex and age, cardiovascular fitness, as measured through VO2max, was not predictive of future back injury reports (P = 0.26).

Adult↗
PubMed1991

Determinants of sciatica and low-back pain.

Several factors were studied for their association with the prevalence of chronic low-back syndromes, sciatica, and unspecified low-back pain (LBP) in 2,946 women and 2,727 men (age range, 30-64 years) participating in the Mini-Finland Health Survey, a project aimed at comprehensive evaluation of the population's health. On the basis of a standardized clinical examination, a physician diagnosed sciatica in 5.1% and LBP in 11.6% of the subjects. Those with a previous traumatic back injury had a 2.5-fold risk of having sciatica or LBP. The fractions of sciatica and LBP attributable to such back injuries were estimated to be 16.5% and 13.7%, respectively. Sum indices of both physical and mental stress at work were found to be directly proportional to the prevalence of sciatica and LBP. Smokers had an increased risk of LBP, and body height was related positively to the prevalence of sciatica. These associations, however, were inconsistent between sex and age subgroups. In the presence of osteoarthritis in the knee, hip, or hand, LBP was prevalent (adjusted odds ratio [OR], 5.3; 95% confidence interval [CI], 4.1-6.9), but sciatica was not (OR, 1.1; 95% CI, 0.7-1.7). Diabetics were found to have a significantly decreased prevalence of LBP (OR, 0.4; 95% CI, 0.3-0.8). Many factors, independent of each other, determine the occurrence of chronic low-back syndromes. The determinants of sciatica and LBP are different to some extent.

Adult↗
PubMed1992

Decoupling of bilateral paraspinal excitation in subjects with low back pain.

This study compared bilateral paraspinal excitation in normal subjects and subjects with low back pain. Comparison was made between six control subjects and seven low back pain subjects who performed maximum-effort isometric trunk extension in minimum elapsed time at two trunk angles. Electromyographic signals were collected bilaterally from the paraspinal musculature. The time- and amplitude-normalized electromyographic data were analyzed using a repeatability criterion sensitive to temporal and amplitude differences. This analysis showed that low back pain subjects demonstrated temporal and amplitude decoupling of the paraspinal musculature bilaterally. Low back pain subjects also demonstrated clinically meaningful disruptions between paraspinal excitation and isometric trunk extension moment. This method may be useful in quantifying neuromotor control in low back pain for initial and follow-up clinical evaluation for static and dynamic functional tests.

Adult↗
PubMed1993

Primary prevention of back symptoms and absence from work. A prospective randomized study among hospital employees.

The personnel at a geriatric hospital were randomized into two groups. One group was allowed to exercise during working hours to improve back muscle strength, endurance, and coordination. The other group did not participate in the exercise program and received no further advice or information. After 13 months, the training group had increased back muscle strength. One subject had been absent from work 28 days in the training group whereas 12 subjects had been absent 155 days from work because of low back pain in the control group (P < 0.004). The back pain complaints and intensity of back pain in the training group also decreased in a statistically significant way. Every hour spent by the physiotherapist on the training group reduced the work absence among the participants by 1.3 days, resulting in a cost/benefit ratio greater than 10.

Absenteeism↗
PubMed1993

Isokinetic trunk strength and lifting strength measures. Differences and similarities between low-back-injured and noninjured workers.

Fifty-eight back pain patients and 21 entry-level Postal Service workers without low-back pain were evaluated using a variety of lumbar function measures. Isolated trunk strength and full lifting strength were gauged with isokinetic and isometric methods. Lumbar range-of-motion was computed using toe-touch and goniometers. Conventional clinical techniques such as toe touch and straight leg raise were effective in distinguishing back-injured from normal subjects. Isometric and isokinetic peak force and torque tests failed to show significant differences between low-back pain and job applicant groups. When compared with published norms, our job applicant group was significantly deconditioned. Our data suggest that asymptomatic, deconditioned subjects could be mistaken for back-impaired patients or symptom magnifiers.

Adult↗
PubMed1995

The prognostic consequences in the making of the initial medical diagnosis of work-related back injuries.

STUDY DESIGN: A cohort of 1848 workers, representative of all sectors of industry, who were compensated for a low back injury in 1988 but not in the previous 2 years, was followed over 24 months. OBJECTIVES: To determine the prognostic value of the physician's initial diagnosis of back problems. SUMMARY OF BACKGROUND DATA: In the absence of a standardized classification of diagnoses of back pain, this study aimed to provide an element of validity to a classification previously proposed that consists of "specific" and "nonspecific" back pain. METHODS: Medical charts were reviewed at the Quebec Worker's Compensation Board to extract the diagnosis made by the treating physicians within 7 days of the first day of absence from work. Diagnoses were categorized into "specific" (lesions of vertebrae and discs) and "nonspecific" (pain, sprains, and strains). The history of compensated work absence for low back pain in the following 24 months was obtained. RESULTS: A specific diagnosis was found in 8.9% (165) of the workers, accounting for 31.0% of the patients who accumulated 6 months or more of absence in 2 years. Increasing age and daily amount of compensation also were associated with an increased risk of chronicity. CONCLUSIONS: The physician's initial diagnosis was highly associated with the risk of chronicity. The explanation for this result is complex, involving the nature of the underlying lesion as well as the impact of the diagnosis "label" on the worker and on the physician-patient relationship.

Absenteeism↗
PubMed1999

Predictors of time loss after back injury in nurses.

STUDY DESIGN: A 2-year prospective inception cohort study of back injury in nurses. OBJECTIVES: To determine the extent to which characteristics of nurses, of the injury, and of the workplace predict occurrence and duration of time loss from work after back injury. SUMMARY OF BACKGROUND DATA: During 2 years, 320 nurses incurred 416 back injuries at a large teaching hospital in Winnipeg, Canada. Nurses injured on preselected wards were targeted for early intervention, including provision of modified work, whereas nurses injured on other wards received the usual care. METHODS: Time loss attributable to the back injury during the 6 months after injury was analyzed. Three statistical models were used to examine occurrence of time loss (logistic regression), duration of time loss (Tobit regression), and duration of time loss once an injury incurring time loss had been documented (least-squares regression). RESULTS: In 218 of the 416 injuries, the injured nurse consented to interview. Whereas perceived disability was related to whether a time loss injury would ensue, self-reported pain was strongly related to the duration of time loss once an injury had become a time loss injury. Duration of time loss was reduced by participation in the return-to-work program. Mechanism of injury, specifically injury occurring while lifting patients, resulted in greater time loss. CONCLUSIONS: Focusing on reducing the perception of disability at the time of injury is critical to preventing time loss, but once time loss has occurred, offer of modified work and attention to pain reduction are warranted. The findings add to the evidence that workplace-based intervention programs can be effective in reducing the morbidity resulting from back injury.

Accidents, Occupational↗
PubMed1996

General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines.

OBJECTIVE: To compare general practitioners' reported management of acute back pain with 'evidence based' guidelines for its management. DESIGN: Confidential postal questionnaire. SETTING: One health district in the South and West region. SUBJECTS: 236 general practitioners; 166 (70%) responded. OUTCOME MEASURES: Examination routinely performed, 'danger' symptoms and signs warranting urgent referral, advice given, and satisfaction with management. RESULTS: A minority of general practitioners do not examine reflexes routinely (27%, 95% confidence interval 20% to 34%), and a majority do not examine routinely for muscle weakness or sensation. Although most would refer patients with danger signs, some would not seek urgent advice for saddle anaesthesia (6%, 3% to 11%), extensor plantar response (45%, 37% to 53%), or neurological signs at multiple levels (15%, 10% to 21%). A minority do not give advice about back exercises (42%, 34% to 49%), fitness (34%, 26% to 41%), or everyday activities. A minority performed manipulation (20%) or acupuncture (6%). One third rated their satisfaction with management of back pain as 4 out of 10 or less. CONCLUSIONS: The management of back pain by general practitioners does not match the guidelines, but there is little evidence from general practice for many of the recommendations, including routine examination, activity modification, educational advice, and back exercises. General practitioners need to be more aware of danger symptoms and of the benefits of early mobilisation and possibly of manipulation for persisting symptoms. Guidelines should reference each recommendation and discuss study methodology and the setting of evidence.

Acute Disease↗
PubMed1993

Teaching and social support: effects on knowledge, attitudes, and behaviors to prevent low back injuries in industry.

An educational program designed to reduce low back injuries was modeled after several well-known back schools and taught to postal workers in a randomized trial of about 4,000 workers. Physical therapists taught 3 hours of class sessions, including knowledge, skills, and individual work station assessment, to small groups of workers and supervisors, with reinforcement every 6 months afterward. At 2 1/2 years, a random sample of 209 workers was surveyed for program impact on intermediate outcomes. We observed increased knowledge among experimental unit workers, but no significant improvements in behaviors associated with back health or in proportion of workers with tired backs. Experimental unit workers who had received training by the time of the survey were less likely to report helping/reinforcement for healthy behaviors than controls or untrained experimental unit workers. The program might have led trained workers to perceive a lack of support and reinforcement for back safety among coworkers and supervisors by sensitizing them to what is possible and raising expectations. There appeared to be group social effects in the dissemination of knowledge and perhaps of helpful behaviors; however, it is apparent that worker social support for change in health behaviors is a complex phenomenon that cannot always be relied upon to enhance program goals.

Back↗
PubMed2006

Non-specific low back pain in primary care in the Spanish National Health Service: a prospective study on clinical outcomes and determinants of management.

BACKGROUND: The Spanish National Health Service is a universal and free health care system. Non-specific low back pain (LBP) is a prevalent disorder, generating large health and social costs. The objectives of this study were to describe its management in primary care, to assess patient characteristics that influence physicians' decisions, and to describe clinical outcome at 2 months. METHODS: A cross-sectional sample of 648 patients with non-specific low back pain was recruited by 75 physicians (out of 361-20.8%) working in 40 primary care centers in 10 of the 17 administrative regions in Spain, covering 693,026 out of the 40,499,792 inhabitants. Patients were assessed on the day they were recruited, and prospectively followed-up 14 and 60 days later. The principal patient characteristics that were analyzed were: sex, duration of the episode, history of LBP, working status, severity of LBP, leg pain and disability, and results of straight leg raising test. Descriptors of management were: performance of the straight leg raising test, ordering of diagnostic procedures, prescription of drug treatment, referral to physical therapy, rehabilitation or surgery, and granting of sick leave. Regression analysis was used to analyze the relationship between patients' baseline characteristics and physicians' management decisions. Only workers were included in the models on sick leave. RESULTS: Mean age (SD) of included patients was 46.5 (15.5) years, 367 (56.6%) were workers, and 338 (52.5%) were females. Median (25th-75th interquartile range) duration of pain when entering the study was 4 (2-10) days and only 28 patients (4.3%) had chronic low back pain. Diagnostic studies included plain radiographs in 43.1% of patients and CT or MRI scans in 18.8%. Drug medication was prescribed to 91.7% of patients, 19.1% were sent to physical therapy or rehabilitation, and 9.6% were referred to surgery. The main determinants of the clinical management were duration of the episode and, to a lesser extent, the intensity of the pain (especially leg pain), a positive straight leg raising test, and degree of disability. The main determinant of sick leave was the degree of disability, followed by the characteristics of the labor contract and the intensity of leg pain (but not low back pain). After at least 2 months of treatment, 37% of patients were still in pain and approximately 10% of patients had not improved or had worsened. CONCLUSION: Although the use of X-Rays is high, determinants of physicians' management of LBP in primary care made clinical sense and were consistent with patterns suggested by evidence-based recommendations. However, after 2 months of treatment more than one third of patients continued to have back pain and about 10% had worsened.

Adult↗
PubMed2004

Etiology of low back pain in athletes.

Low back pain and injury is a common affliction for patients involved in athletic endeavors. For this reason, the health care professional should be cognizant of age-related and sports-specific considerations when evaluating athletes with low back complaints. An elevated index of suspicion with regard to specific etiologies of back pain proves invaluable in order to avoid the misdiagnosis of a more serious problem. Although a number of conditions exist that require more aggressive evaluation and treatment, the majority of low back pain in athletes is self-limiting. In this context, a treatment plan designed to increase low back and abdominal muscle strength, flexibility, and range of motion often proves beneficial not only in returning the athlete to competition, but also in preventing injury recurrence.

Athletic Injuries↗
PubMed2004

Pharmacological alternatives for the alleviation of back pain.

Drugs constitute a convenient option for low back pain and are commonly used. However, evidence for their efficacy is meagre. Many drugs used for back pain are no more, or only slightly more, effective than placebos. Others have side effects that outweigh their usefulness in relieving pain. On the basis of the evidence, no drug regimen can be legitimately recommended for back pain. The management of back pain requires measures other than drugs. One exception is the use of willow (Salix) bark for acute exacerbation of pain. Ironically, for chronic low back pain, the most effective and long-lasting outcomes have been documented for normal saline by injection into tender points in the lumbar spine.

Analgesics↗
PubMed2002

Inpatient hospital care for back disorders in relation to industry and occupation in Finland.

OBJECTIVES: The variation in hospital admission rates was studied for back disorders by industry and occupational title among gainfully employed Finns. METHODS: Admissions to Finnish hospitals in 1996 among 25- to 64-year-olds, based on the Hospital Discharge Register, were linked with sociodemographic data from the 1995 population census for the following primary diagnoses [International Classification of Diseases, 10th revision (ICD-10)]: all back disorders (M40.0-54.9; N (individual patients) 7,253), lumbar intevertebral disc disorders (M51.0-M51.9, N = 3,863), and other common back disorders (ICD-10: M47.1-47.2, M47.8-47.9, M48.0, M54.1, M54.3-54.5, M54.8-54.9; N = 2,433), with the total occupationally active workforce (same age range and gender) as reference. Age-standardized hospitalization rate ratios (SRR) were calculated. RESULTS: The highest SRR values for hospitalization for any back disorder were found for fishing (SRR 195), "other" mining and carrying (SRR 168), and sewage and refuse disposal (SRR 152) among the men and water transport (SRR 158), wood product (SRR 149) and pulp, paper and paper product (SRR 145) manufacturing among the women. Computer activities (SRR 44) among the men and insurance and pension funding (SRR49) among the women had the lowest SRR values. The occupations reindeer breeders and herders (SRR 495), agricultural workers (SRR 232), and paper product workers (SRR 205) among the men and plastic product (SRR 233), laundry (SRR 224), and agricultural (SRR 219) workers among the women had the highest SRR values. The lowest SRR values were observed for upper white-collar employees in public administration [men (SRR 40) and women (SRR 61)]. CONCLUSIONS: Hospitalization rates for back disorders were high for several physically strenuous industries and occupations.

Adult↗
PubMed2000

The representation of the back in idiomatic expressions--do idioms value the body?

OBJECTIVE: Whilst investigating the influence of patients' representations on the impact of teaching in the back school, we took an interest in 1) the place of the back in the French idioms referring to the body; and 2) the meaning these idioms convey about the back. METHODS: The idioms including body part terms were sought on the basis of a compilation of French idioms; it has to be noted that such a compilation, however excellent it may be, can only offer a partial view of lay conversation. Occurrence of body parts and of their connotations were assessed. Idioms were classified as positive, negative or neutral, keeping in mind the difficulties of a strict classification in such a field. Drawings were then performed on the basis of the results of the descriptive analysis. RESULTS: Globally, idiomatic expressions offer a rather negative picture of the body or at least suggest that the body is prominently used to express negative ideas and emotions. This is particularly striking for the idioms associated with the back. CONCLUSION: The analysis of idioms referring to the body allows us to 'see with our own eyes' another aspect of the representations of the body and the back, as they are conveyed in the French language.

Back↗
PubMed1987

Personal and job-related factors as determinants of incidence of back injuries among nursing personnel.

The purpose of this multicenter prospective cohort study was to assess personal and job-related factors as determinants of incidence of reported back injuries among nurses. The study population included 5,649 nurses who were surveyed by questionnaire and then observed for a 12-month study period. An annual injury rate of 4.9% was observed. Four factors were found to be significant (P less than .01) predictors of back injury. All four factors--service area, lifting, job category, and previously reported back injury--maintain significance when a forward stepping model of logistic regression is applied. The adjusted odds ratios observed are 4.26 for service areas where lifting occurs most as compared with areas where lifting occurs least; 2.19 for daily lifters v light, occasional, and nonlifters; 1.77 for nursing aides v registered nurses and supervisory personnel; and 1.73 for individuals who have previously reported back injury v those who have not reported previous injury. These findings strongly suggest that job-related rather than personal characteristics are the major predictors of back injury in nurses.

Accidents, Occupational↗