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PubMed1998

Conservative treatment in patients sick-listed for acute low-back pain: a prospective randomised study with 12 months' follow-up.

We evaluated three different conservative treatment methods for acute low-back pain patients in groups following a manual therapy programme, an intensive training programme, or a general practitioner programme, the latter serving as the control group. Patients aged 19-64 years on sick leave for low-back pain with or without sciatica were included in a prospective randomised study evaluating outcomes such as impairment, pain, functional disability, socio-economic disability and satisfaction with the treatment or explanations. Evaluation by unbiased observers was performed at 1, 3 and 12 months. The three treatment groups were comparable at baseline. With regard to satisfaction, the patients in the manual therapy programme and those in the intensive training programme were more satisfied with the treatment than those in the general practitioner programme at all follow-ups. With regard to the explanations of current low-back pain episodes, the patients in the manual therapy programme were more satisfied than those in the general practitioner programme at all follow-ups. The manual therapy programme group were also more satisfied with the explanations than those in the intensive training programme at the 1-month follow-up. However, no differences were revealed between the groups with respect to outcomes on measures of impairment, pain, functional disability or socioeconomic disability. All three study groups showed rapid improvement. After 1 month a significant improvement was noted in all outcome values compared with the values on entry to the study. Within the limitations discussed in our study, it is concluded that (1) patients sick listed with acute low-back pain, with or without sciatica, will be significantly improved after 1 month regardless of conservative treatment programme; (2) they will be more satisfied with the treatment if they are referred to a manual treatment programme or a training treatment programme; (3) they will be more satisfied with the explanations of the acute low-back problem if they are referred to one of the above groups, especially the manual treatment group; (4) they will not show any other differences with respect to subjective and objective variables, either at short-term or at long-term follow-ups.

Acute Disease↗
PubMed1999

Prolonged low-back pain in young athletes: a prospective case series study of findings and prognosis.

We investigated the prognosis of low-back pain and the association of clinical symptoms and anatomic findings among young athletes. Consecutive patients, aged between 12 and 18 years, who had low-back pain that had interfered with their training for at least 4 weeks were included in the case series. All the patients participated in a standardized interview and clinical examination, and plain radiographs and magnetic resonance images were also obtained. Most patients also participated in technetium bone scan examination. In 15 out of 19 subjects there were anatomic abnormalities that corresponded with the location and type of clinical symptoms. Twelve subjects had changes in the disk-vertebral end plate complex and eight had a positive bone scan indicative of posterior vertebral arch stress reaction. Six out of eight boys and two out of 11 girls had stress reaction (P = 0.043). Restriction of painful activities was recommended to all subjects, restriction of activities and the use of a dynamic low-back brace for the first 3 months was recommended to patients with posterior vertebral arch stress reaction. The self-reported intensity of low-back pain (scale 0-100) among all the patients was 69 +/- 16 (mean +/- SD) at baseline and 18 +/- 21 at the 1-year follow-up (P < 0.0001). In conclusion, the reasons for prolonged back pain among young athletes are usually established by imaging studies. A knowledge of anatomic abnormalities may help in tailoring training programmes and avoiding the progression of changes during growth. Simple restriction of painful activities usually leads to good recovery.

Adolescent↗
PubMed2005

Urinary excretion of type I collagen cross-linked N-telopeptide and serum bone-specific alkaline phosphatase analysis to determine the correlation of age and back-pain related changes in elderly women.

We evaluated bone turnover using biochemical markers in 273 women over 60 years of age with suspected osteoporosis. Their age range was 60-96 years, with an average of 72.7 years. Patients with disorders that might affect bone metabolism were excluded. Those complaining of back pain within 6 months before or after examination were assigned to the back-pain group. Serum bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker, and the urinary N-terminal telopeptide of type I collagen (NTX) was measured as a bone resorption marker. Both BAP and NTX levels increased in individuals over 60 years of age; moreover, these markers were significantly higher in subjects aged over 80 years. Among elderly patients, both BAP and NTX levels were significantly higher in those with back pain than in those without, and in a similar way were observed to increase in parallel with age from the 60-year point. We found that both NTX and BAP increased with aging, and that the increase in these bone turnover markers was closely related to back pain. We also showed that NTX and BAP levels increased significantly in women over 80 years, and specifically in patients with back pain.

Aged↗
PubMed2004

[Is Qi Gong suitable for the prevention of low back pain?].

Low back pain is one of the main problems of health care, and has many causes. To prevent low back pain daily activities are highly important--static work as well as dynamic movement--carried out in an ergonomic and economical way. Studies have shown that the compliance of patients with regard to exercise training and ergonomic recommendations is not very high. The main posture of Qi Gong training is similar to the recommended posture by low back schools. Qi gong exercises respect basic physiological and ergonomic principles of movement in every way. Qi Gong fulfils the most important criteria for the prevention and therapy of idiopathic low back pain. Qi Gong training requires no special equipment. It is simple and can be undertaken everywhere. A growing number of people have become interested in Qi Gong, and train regularly and effectively. Low back pain rarely occurs in such people, and therefore Qi Gong should be considered as one of the most effective means of prevention.

Breathing Exercises↗
PubMed2006

Soft tissue determinants of low back pain.

Low back pain is one of the complaints most commonly seen in the clinical setting. Correctly or incorrectly, these patients are often given the diagnosis of fibromyalgia, myofascial pain syndrome, disk herniation, or some other label. It is important to recognize the soft tissue causes of low back pain and understand how they can be most appropriately diagnosed and managed. Nonligamentous disorders of the low back region may occur in isolation or in combination with underlying discogenic, ligamentous, and facet-mediated causes of pain. Therefore, in order to fully evaluate and treat a patient with low back pain, it is necessary to consider and address these soft tissue conditions. This paper reviews soft tissue causes of low back pain and discusses how they are most appropriately diagnosed and managed.

Fascia↗
PubMed2006

Chronic low back pain: progress in therapy.

Low back pain is a common complaint in the primary care setting. Although most patients with acute low back pain will improve with conservative treatment, back pain often recurs, and a subset of patients will progress to chronic and sometimes disabling symptoms. A variety of treatments have been used for chronic low back pain; the best evidence supports intensive rehabilitation programs that include tailored exercise therapy in conjunction with cognitive behavioral interventions and education. The benefit of medications, including nonsteroidal anti-inflammatory drugs, analgesics, and possibly antidepressants or muscle relaxants, must be weighed against potential adverse effects. There is insufficient evidence regarding the effectiveness of many of the available therapies for chronic low back pain, and well-designed, randomized controlled trials are needed to clarify the role of these treatments.

Analgesics↗
PubMed1985

Factors associated with self-reported back-pain prevalence: a population-based study.

We present a study of demographic factors associated with self-reported back pain prevalence in a population-based study. Study variables were age, gender, occupation, physical demand of occupation, income, education and marital status. Crude associations of the independent variables and reported back pain were in general agreement with other cross-sectional studies. Multiway contingency tables and multivariate models were employed for further analyses. When we controlled each of the other variables, only gender, education and marital status remained strongly associated with reported back pain. Using these three variables plus age, we developed regression models for the prediction of back pain and identified a steep gradient of prevalence: the highest prevalence (44-46%) was in no-longer-married women aged 50-64, regardless of education, while the lowest prevalence (9-11%) was in men who were married and had greater than a high school education. Because the models employ only census-type variables, they should be easy to validate or use to predict back pain prevalence in other populations.

Adult↗
PubMed1987

Trunk muscle function and low back disorders: a ten-year follow-up study.

Low back disorders and trunk muscle function were studied by questionnaire, interview, clinical examination, and performance tests in 902 employees in the metal industry. The survey was repeated after a 10-yr interval for 654 persons. For those who were allowed to participate in the muscle function tests, the prevalences of clinical findings in the low back and of chronic lumbosacral disease were inversely associated with muscle function in both cross-sectional studies. This association seems not to be explained by the interference of pain with muscle function tests. There was no association between muscle function at baseline and either the 10-yr incidence of chronic low back disease or the development of low back symptoms. Men with poor muscle function at baseline had a slightly elevated risk for the appearance of clinical findings at follow-up. There was an inverse association between the clinical findings at baseline and muscle function at follow-up. The association between low back disorder and trunk muscle function seems to result from an effect of the former on the latter, but poor muscle function may also contribute to the risk of disorder.

Back Pain↗
PubMed1990

Hypothalamic effects on medullary reticular activation of deep back muscle EMG.

Medullary reticular stimulation can activate deep back muscle EMG in urethane-anesthetized female rats. Midbrain central gray stimulation can facilitate brainstem reticular control over deep back muscles. Since these deep back muscles lateral longissimus (LL) and medial longissimus (ML) execute the vertebral dorsiflexion of lordosis behavior, and since the motor control hierarchy sketched above parallels lordosis behavior circuitry, we tested the hypothesis that medial hypothalamic lesions (which, in behavioral experiments, decrease lordosis) can also reduce medullary reticular activation of deep back muscle EMG. Urethane-anesthetized rats were tested systematically for amplitude of lateral longissimus (LL) and medial longissimus (ML) EMG responses to electrical stimulus trains applied to the nucleus gigantocellularis (NGC) of the medullary reticular formation, before and after electrolytic lesions of the ventromedial hypothalamus (n = 18) or control sites (n = 30). Bilateral ventromedial hypothalamic lesions were able to greatly reduce EMG responses in LL and ML, often with a time course similar to previous lordosis behavioral results. Surprisingly, lesions at the anterior ventromedial nucleus pole were particularly effective, and may reflect importance of intraventromedial local neurons. Although, on the average, various control lesions were less effective, the ventromedial hypothalamic effect was not unique. For example, it was possible to see an EMG decrease following lesions of the dorsomedial thalamus. Nevertheless, EMG loss was not well correlated with changes in the cortical EEG, and thus does not appear to be a simple consequence of changes in "arousal." In conclusion, it appears that ventromedial hypothalamic neurons can affect medullary reticular control of back muscle EMG, but must share this role with other forebrain elements.

Animals↗
PubMed1987

Description of pain and the relationship with psychological factors in patients with low back pain.

Description of pain and the relationship with psychological factors was studied in 82 patients with low back pain. Both description of pain and psychological factors were found to have high loadings on one dimension, without being identical variables. A relationship was found between psychological factors and the duration of back pain but not to a degree to which the back pain is found to be explained somatically. The description of pain bore no relationship to the duration of back pain nor to the degree to which back pain can be somatically explained.

Adult↗
PubMed1989

Electromyographic recordings of 5 types of low back pain subjects and non-pain controls in different positions.

Surface EMG recordings of bilateral paraspinal muscle tension were measured on 207 subjects (29 non-back pain controls, 20 individuals with spondyloarthritis, 52 with intervertebral disk disorders, 66 with unspecified musculoskeletal backache, 17 with some combination of the above 3 groups and 23 subjects with other types of back pain, including unknown, scoliosis and psychogenic) in 6 positions: standing, bending from the waist, rising, sitting with back unsupported, sitting with back supported and prone. Results of both individual and group analyses revealed a significant main effect of diagnosis. Post hoc analyses (Duncan's) revealed controls to have significantly lower overall EMG levels than the intervertebral disk disorders and unspecified musculoskeletal backache groups. A significant diagnosis by position interaction was observed. Analysis of simple main effects revealed this to be due primarily to control subjects during the standing position having lower EMG levels than all other groups, and intervertebral disk disorder subjects having higher EMG levels than all other groups during the supported sitting position. The importance of clearly defined diagnostic categories in low back pain research and the utility of measuring subjects in various positions are discussed.

Adult↗
PubMed1989

Determinants of return-to-work among low back pain patients.

This prospective study identifies physical, behavioral, and psychosocial correlates of subsequent employment status in a sample of low back pain patients. The sample of 150 subjects was drawn from 2 populations of persons with chronic low back pain: 87 individuals who were receiving care at a university low back pain clinic, and 63 individuals who had applied for (but not yet received) Social Security compensation on the basis of low back pain. All subjects had worked at least 3 months prior to their latest unemployment period and were currently out of work. Initial assessment included a medical history, physical examination, biomechanical testing, psychiatric interview, and MMPI testing. All subjects were followed up 6 months later to determine whether they had returned to work. Cross-sectional group comparisons at the time of initial assessment showed that, after controlling for the effects of age, the two samples differed on several physical and biomechanical measures, the Social Security group reflecting a more chronic picture. Group differences on physical variables were found, but most significant differences disappeared when adjusted for length of time out-of-work. Longitudinal analyses showed that few objective physical or biomechanical measures were associated with return-to-work at 6 months, while a number of psychosocial variables were significant predictors of 6-month work status. The data suggest that exclusive reliance on the physical examination to determine level of disability, without consideration of psychosocial conditions, and without adjusting for the confounding effects of age and length of time out-of-work, is not empirically justified. Logistic regression analysis was used to ascertain the relative contribution of each predictor to outcome and to illustrate the hypothetical effects of changes in the levels of selected risk factors on the likelihood of return-to-work. Implications for interventions with low back pain patients are discussed and future research directions suggested.

Age Factors↗
PubMed1992

Symptoms of impairment, disability and handicap in low back pain: a taxonomy.

The functional consequences on everyday living which result from chronic low back pain commonly require services which are difficult to access. This deficiency in meeting the needs of these patients is partially explained by inadequacies in clinical assessment. Medical evaluation may be exhaustive, but frequently the assessment of physical and psycho-social dysfunction at the personal and family level is inadequate. In low back pain, as with most chronic ailments, there is no agreed-upon taxonomy of the functional consequences of the disorder upon which to establish a comprehensive clinical appraisal. In this paper a taxonomy is presented for the impairments, disabilities and handicaps which result from chronic low back pain. The taxonomy has been based on data from a survey of 74 individuals with low back pain and is structured generally according to the International Classification of Impairments, Disabilities and Handicaps (WHO 1980). The taxonomy is proposed as a conceptual framework and vocabulary for both clinical practice and research. The taxonomy is not a measurement instrument nor does it indicate the frequency of occurrence of disabilities. A classification is basic to the advancement of scientific understanding, and usage of a standard vocabulary such as this plays an important role in establishing a responsive health service capable of meeting the needs of the population with chronic low back pain.

Activities of Daily Living↗
PubMed1993

A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability.

Pilot studies and a literature review suggested that fear-avoidance beliefs about physical activity and work might form specific cognitions intervening between low back pain and disability. A Fear-Avoidance Beliefs Questionnaire (FABQ) was developed, based on theories of fear and avoidance behaviour and focussed specifically on patients' beliefs about how physical activity and work affected their low back pain. Test-retest reproducibility in 26 patients was high. Principal-components analysis of the questionnaire in 210 patients identified 2 factors: fear-avoidance beliefs about work and fear-avoidance beliefs about physical activity with internal consistency (alpha) of 0.88 and 0.77 and accounting for 43.7% and 16.5% of the total variance, respectively. Regression analysis in 184 patients showed that fear-avoidance beliefs about work accounted for 23% of the variance of disability in activities of daily living and 26% of the variance of work loss, even after allowing for severity of pain; fear-avoidance beliefs about physical activity explained an additional 9% of the variance of disability. These results confirm the importance of fear-avoidance beliefs and demonstrate that specific fear-avoidance beliefs about work are strongly related to work loss due to low back pain. These findings are incorporated into a biopsychosocial model of the cognitive, affective and behavioural influences in low back pain and disability. It is recommended that fear-avoidance beliefs should be considered in the medical management of low back pain and disability.

Activities of Daily Living↗
PubMed1989

A back school in The Netherlands: evaluating the results.

The use of an education program for patients with chronic low back pain (Back School) has been investigated. The effect evaluation is based on a pretest-post-test-control group design, including a follow-up after 8 weeks. The Maastricht Back School is based on the theory that pain is also maintained by emotional, cognitive and environmental factors. Information and training are given on these and physical factors. The purpose of the course is to teach patients to manage their own pain problem. The results suggest that the Back School program for patients with chronic low back pain can have a positive effect.

Adult↗
PubMed2003

[French translation and cultural adaptation of the "Back Book"].

OBJECTIVES: To develop an information booklet for French speaking low back pain patients, promoting staying active as a single treatment for low back pain. MATERIALS AND METHODS: A four-step procedure was used to obtain the information booklet. Selection of a booklet using a literature search and pre-defined criterias. Translation/back-translation technique with a method used for health-related quality of life cross-cultural adaptation method. Content validity assessment by a knowledge questionnaire submitted to 32 low back pain patients hospitalized for treatment and a review by two independent MD. Check accordance of the translated document with original authors and editor guidelines. RESULTS: The use of a standardized translation/back-translation procedure permitted to obtain a translation of the back book suitable for French patients. The significant improvement (P = 10(-6)) in patients' knowledge confirmed the quality of the translation. CONCLUSIONS: Translation and cultural adaptation of an information booklet should allow cross-cultural studies in the field of information for low back pain patients.

Cultural Characteristics↗
PubMed2004

[Chronicity, recurrence, and return to work in low back pain: common prognostic factors].

OBJECTIVE: To determine the common risk factors of recurrence, chronicity and non return to work in low back pain. MATERIAL AND METHOD: A systematic review of the literature was done by searches of Medline, Embase, Pascal, the Cochrane database and also in the unindexed literature. Keywords used were low back pain, chronic, risk factors, recurrence, predictive value of tests, prognosis, confounding factors. Studies were assessed by two readers using the ANAES (French Agency for Health Assessment) scale allowing classification into high-, moderate- and low-quality trials. The scientific evidence level of the identified risk factors depend on the methodological quality of the studies, the number of studies in agreement, the coherence of their results and their clinical relevance. RESULTS: Fifty-four high quality studies were included. Several prognostic factors are common to the three described clinical situations. A history of low back pain (including the concept of pain severity, duration, disability, leg pain, related sickness leave and a history of spinal surgery), low level of job satisfaction and poor general health are highlighted with a strong level of evidence. Socioprofessionel and psychological factors including employment status, amount of wage, workers' compensation, and depression were found but with moderate level of evidence. Physical factors including lifting time per day and work postures were also found with moderate level of evidence. CONCLUSION: This study confirm that several prognostic factors are commun to recurrence, chronicity and non return to work in low back pain. Early identification of these factors is important in understanding, and hopefully preventing, the recurrence or the progression to chronicity and disability in low back trouble.

Chronic Disease↗
PubMed2006

[Psychobehavioural assessment for chronic low back pain].

INTRODUCTION: Psychobehavioural assessment may be a complementary approach to assess response to treatment for pain and disability in patients with low back pain. OBJECTIVES: To assess the correlation between psychobehavioural factors and pain and disability in patients with chronic low back pain in France. METHODS: We asked 83 patients with chronic low back pain to complete questionnaires during a primary care consultation by a general practitioner. Pain was measured by a visual analog scale (VAS), disability by the Quebec Back Pain Disability Scale and psychobehavioural factors by the Fear-Avoidance Beliefs Questionnaire (FABQ) and the Coping Strategy Questionnaire (CSQ). RESULTS: Pain was poorly correlated with anxiety (R = 0.36) and scores on the FABQ 1 (R = 0.46) and FABQ 2 (R = 0.30) and not correlated with depression (R = 0.22), duration of pain evolution (R = 0,10) and body mass index (R = 0.12). The duration of stopping work was poorly correlated with disability (R = 0.35) and FABQ 1 score (R = 0.43) and not correlated with pain (R = 0.11), anxiety (R = 0.11), depression (R = 0.26) and FABQ 2 score (R = 0.23). Disability was poorly correlated with scores on the FABQ 1 (R = 0.45) and FABQ 2 (R = 0.3), anxiety (R = 0.39) and depression (R = 0.47) and not correlated with pain (R = 0.25). Dramatization is the only way to cope with pain and was correlated with pain (R = 0.34), scores on the FABQ 1 (R = 0.47) and FABQ 2 (R = 0.43), disability (R = 0.38), anxiety (R = 0.44) and depression (R = 0.46). The use of prayer was poorly correlated with FABQ 1 score (R = 0.37) and anxiety (R = 0.30). Distraction was poorly correlated with scores on the FABQ 1 (R = 0.40) and FABQ 2 (R = 0.30). No strategy was correlated with duration of pain and stopping work. DISCUSSION-CONCLUSION: All the correlation assessments with psychobehaviour factors are weak. So evaluating each of these parameters will be interesting. Duration of pain was not correlated with increasing pain or change in behavioural strategy. Psychobehavioural factors are more invalidating than pain. More study is needed to assess psychobehavioural therapies in patients with low back pain.

Adult↗