Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “BACK”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,675 records · Page 93Linked to original sources
PubMed2006

[Does the quality of Web sites related to low back pain meet patients expectations? A systematic review].

INTRODUCTION: An assessment of 36 back-pain-related French-language Web sites, miming a patient search strategy, was previously done by use of evidence-based items. Medical information quality was poor, as already noted about English-language Web sites. Thus, patients' expectations may exceed that provided by Web sites with simple medical information. OBJECTIVES: To study whether French-language Web sites related to low back pain meet patients expectations and to valid a rating scale including patients' expectations. MATERIALS AND METHOD: First we reviewed French-language Web sites with new keywords and medical gateways. Second, we systematically double assessed back pain-related Web sites with a health care professional and patient-centered scale. RESULTS: We found 30 additional Web sites not found with the previous search, 7 focusing on patient information. The rating scale is valid, and its use on a Web site sample leads to results different from those generated by an evidence-based medicine rating scale but close to a more global assessment. DISCUSSION: French-language Web sites related to low back pain do not meet patients' expectations. Patients participation in Web site assessment or construction could help to close the gap between the expectations of people with low back pain and information delivered by doctors.

Evidence-Based Medicine↗
PubMed2006

Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of continuous low-level heat wrap therapy for the prevention and early phase treatment (ie, 0-48 h postexercise) of delayed-onset muscle soreness (DOMS) of the low back. DESIGN: Two prospective randomized controlled trials. SETTING: Outpatient medical facility. PARTICIPANTS: Sixty-seven subjects asymptomatic of back pain and in good general health (mean age, 23.5+/-6.6 y). INTERVENTIONS: Participants performed vigorous eccentric exercise to experimentally induce low back DOMS. Participants were assigned to 1 of 2 substudies (prevention and treatment) and randomized to 1 of 2 treatment groups within each substudy: prevention study (heat wrap, n=17; control [nontarget muscle stretch], n=18) and treatment study (heat wrap, n=16; cold pack, n=16). Interventions were administered 4 hours before and 4 hours after exercise in the prevention study and between hours 18 to 42 postexercise in the treatment study. MAIN OUTCOME MEASURES: To coincide with the expected occurrence of peak symptoms related to exercise-induced low back DOMS, hour 24 postexercise was considered primary. Pain intensity (prevention) and pain relief (treatment) were primary measures, and self-reported physical function and disability were secondary measures. RESULTS: In the prevention study, at hour 24 postexercise, pain intensity, disability, and deficits in self-reported physical function in subjects with the heat wrap were reduced by 47% (P<.001), 52.3% (P=.029), and 45% (P=.013), respectively, compared with the control group. At hour 24 in the treatment study, postexercise, pain relief with the heat wrap was 138% greater (P=.026) than with the cold pack; there were no differences between the groups in changes in self-reported physical function and disability. CONCLUSIONS: In this small study, continuous low-level heat wrap therapy was of significant benefit in the prevention and early phase treatment of low back DOMS.

Adult↗
PubMed2005

Clinically important outcomes in low back pain.

Four important domains directly related to low back pain are: pain intensity, low-back-pain-specific disability, patient satisfaction with treatment outcome, and work disability. Within each of the domains, different questionnaires have been proposed. This chapter focuses on validated and widely used questionnaires. Details of the background and the measurement properties, and of the minimally clinically important change (MCIC) using these questionnaires, are described. The MCIC can be estimated using various methods and there is no consensus in the literature on what the most appropriate technique is. This chapter focuses primarily on two adequate and frequently used methods for estimating the MCIC. We argue that the MCIC should not be considered as a fixed value and that the MCIC values presented in this chapter are used as indications. For patients with subacute or chronic low back pain, the MCIC for pain on a visual analogue scale (VAS) should at least be 20mm and for acute low back pain it seems reasonable to suggest that the MCIC should at least be at the level of approximately 35mm. If a numerical rating scale (NRS) is used it seems reasonable to suggest that the MCIC should at least be 3.5 and 2.5 for patients with acute and chronic low back pain, respectively. For functional disability as measured with the Roland Disability Questionnaire it seems reasonable that the MCIC should at least be 3.5 points, whereas an MCIC of at least 10 points when the Oswestry Disability Index is used. For global perceived effect, we argue that the MCIC is most appropriately defined in terms of at least 'much improved' or 'very satisfied', instead of including 'slightly improved'. Finally, we argue that, from the point of view of cost effectiveness, every day of earlier return to work is important. The exact value for the MCIC can be determined, taking into account the aim of the measurement, the initial scores, the target population and the method used to assess MCIC.

Disability Evaluation↗
PubMed2006

Chronic low back pain in a working-age adult.

Low back pain is an extremely common patient complaint. Most cases resolve fairly quickly after the acute episode. However, a small but significant number of patients develop chronic low back pain; a persistent disabling condition. Patients suffer from unremitting pain and often become functionally impaired. Multiple patient characteristics have been identified that place patients at risk for developing chronic low back pain. Currently, it is difficult to find clinical guidelines on how best to manage chronic low back pain, and it remains a substantial treatment challenge for both physicians and patients. The causes, risk factors, prognosis and treatment strategies for chronic low back pain will be discussed in this chapter. The evidence regarding different pharmacological and non-pharmacological treatment modalities will be reviewed and a logical, focused treatment strategy will be outlined.

Adult↗
PubMed2004

Commonly used muscle relaxant therapies for acute low back pain: a review of carisoprodol, cyclobenzaprine hydrochloride, and metaxalone.

BACKGROUND: Low back pain is a leading reason for primary care visits. Many treatment options are available, but some lack scientific support. OBJECTIVE: The aim of this review was to discuss the etiology of low back pain and the relative risks and benefits of muscle relaxants commonly prescribed for the management of back pain. METHODS: We searched Intercontinental Marketing Services data for January 2003 through January 2004 to determine the most commonly prescribed agents for the management of musculoskeletal pain. Carisoprodol, cyclobenzaprine hydrochloride, and metaxalone represented >45% of all such prescriptions. Cochrane Library, MEDLINE, and EMBASE databases were searched (time frame: 1960 through January 2004; search terms: back pain, carisoprodol, cyclobenzaprine, metaxalone, muscle relaxants, and pharmacotherapy) and reference lists of identified articles were hand-searched. RESULTS: Three trials of carisoprodol (N = 197) were located in the Cochrane Library database. Two double-blind, randomized, placebo-controlled trials evaluating the safety and efficacy of cyclobenzaprine hydrochloride (N = 1405) were identified in the literature. Three double-blind, placebo-controlled trials were identified for metaxalone (N = 428) in 2 reports. The types of adverse events seen with these agents involved the central nervous system, including drowsiness/sedation, fatigue, and dizziness. However, the efficacy of cyclobenzaprine hydrochloride was shown to be independent of its sedative effects, which were dose related. The potential for abuse with carisoprodol is of growing concern. CONCLUSIONS: Analgesic pain management for low back pain due to muscle spasm may be combined with a muscle relaxant. Cyclobenzaprine hydrochloride has the most recent and largest clinical trials demonstrating its benefit, but carisoprodol and metaxalone also appear to be effective. However, carisoprodol's usefulness is mitigated by its potential for abuse.

Amitriptyline↗
PubMed2006

The role of exercise in the prevention and management of acute low back pain.

The transition from acute pain to chronic pain and onward to disability is burdensome emotionally and financially to individual sufferers, loved ones, employers, and the health care system. Up to 40% of acute low back pain cases can become chronic and lead to disability in some cases. Treatments that reduce risk of chronic pain by successful management of acute low back pain are highly desirable. Prevention of acute low back pain is even more desirable. Exercise has been part of the armamentarium of treating and preventing acute low back pain, especially as a means of avoiding disability. This article critically reviews studies of the role of exercise in the management and prevention of low back pain.

Acute Disease↗
PubMed2005

Decline in physical activity, disability and pain-related fear in sub-acute low back pain.

AIM OF INVESTIGATION: To evaluate whether a perceived decline in the level of physical activity after the onset of pain (PAD) is more appropriate in the explanation of disability as compared to the actual level of physical activity (PAL) in patients with sub-acute back pain. METHODS: Patients with 4-7 weeks of non-specific low back pain (LBP) participated in this study. Their habitual physical activity level before the back pain started (H-PAL), their actual level of physical activity (PAL) and their perceived decline in the level of physical activity after the onset of pain (PAD) were assessed. The association between these physical activity related variables and perceived disability (QBPDS), fear of movement/(re)injury (TSK), pain catastrophizing (PCS) and pain intensity (VAS) was examined. The role of PAD as a mediator in the association between fear of movement/(re)injury and disability was examined by three linear regression analyses. RESULTS: 123 patients (66 male and 57 female) with a mean age of 44.1 years (SD=10.3) participated in this study. PAD was significantly correlated with disability, fear of movement/(re)injury, pain catastrophizing and pain intensity. PAD and PAL appeared more important in the explanation of disability in the subgroup of patients who were physically active before their back pain started. Generally, PAD indeed mediated the association between fear of movement/(re)injury and disability. CONCLUSIONS: The perceived decline in physical activity, rather than the current physical activity itself is important in the evaluation of the impact of activity related changes on disability in low back pain.

Activities of Daily Living↗
PubMed2006

Persistent back pain--why do physical therapy clinicians continue treatment? A mixed methods study of chiropractors, osteopaths and physiotherapists.

AIMS: (a) To investigate how widespread is the use of long term treatment without improvement amongst clinicians treating individuals with low back pain. (b) To study the beliefs behind the reasons why chiropractors, osteopaths and physiotherapists continue to treat people whose low back pain appears not to be improving. METHODS: A mixed methods study, including a questionnaire survey and qualitative analysis of semi-structured interviews. Questionnaire survey; 354/600 (59%) clinicians equally distributed between chiropractic, osteopathy and physiotherapy professions. Interview study; a purposive sample of fourteen clinicians from each profession identified from the survey responses. Methodological techniques ranged from grounded theory analysis to sorting of categories by both the research team and the subjects themselves. RESULTS: At least 10% of each of the professions reported that they continued to treat patients with low back pain who showed almost no improvement for over three months. There is some indication that this is an underestimate. reasons for continuing unsuccessful management of low back pain were not found to be primarily monetary in nature; rather it appears to have much more to do with the scope of care that extends beyond issues addressed in the current physical therapy guidelines. The interview data showed that clinicians viewed their role as including health education and counselling rather than a 'cure or refer' approach. Additionally, participants raised concerns that discharging patients from their care meant sending them to into a therapeutic void. CONCLUSION: Long-term treatment of patients with low back pain without objective signs of improvement is an established practice in a minority of clinicians studied. This approach contrasts with clinical guidelines that encourage self-management, reassurance, re-activation, and involvement of multidisciplinary teams for patients who do not recover. Some of the rationale provided makes a strong case for ongoing contact. However, the practice is also maintained through poor communication with other professions and mistrust of the healthcare system.

Allied Health Personnel↗
PubMed2005

The effect of exercise on the intensity of low back pain in pregnant women.

OBJECTIVE: To investigate the effect of exercise during pregnancy on the intensity of low back pain and kinematics of spine. METHOD: A prospective randomized study was designed. 107 women participated in an exercise program three times a week during second half of pregnancy for 12 weeks and 105 as control group. All filled a questionnaire between 17-22 weeks of gestation and 12 weeks later for assessment of their back pain intensity. Lordosis and flexibility of spine were measured by Flexible ruler and Side bending test, respectively, at the same times. Weight gain during pregnancy, Pregnancy length and neonatal weight were recorded. RESULT: Low back pain intensity was increased in the control group. The exercise group showed significant reduction in the intensity of low back pain after exercise (p<0.0001). Flexibility of spine decreased more in the exercise group (p<0.0001). Weight gain during pregnancy, pregnancy length and neonatal weight were not different between the two groups. CONCLUSION: Exercise during second half of the pregnancy significantly reduced the intensity of low back pain, had no detectable effect on lordosis and had significant effect on flexibility of spine.

Biomechanical Phenomena↗
PubMed2005

Psychological distress confirmed as predictor of long-term back-related functional limitations in primary care settings.

BACKGROUND AND OBJECTIVE: Among the possible predictors of back pain outcomes that have been studied, indices of psychological distress have been found to have a high prognostic value. This study aimed at assessing the validity of a predictive model of long-term back-related functional limitations that is based on psychological distress, in a new sample of subjects. STUDY DESIGN AND SETTING: The study was conducted with 860 French-speaking workers who consulted for nonspecific back pain in primary care settings of the Quebec City area. They were interviewed at baseline and again 2 years later. Psychological distress and back-related functional limitations were measured respectively with items drawn from the Symptom Checklist 90 Revised and the Roland-Morris Disability Questionnaire. Analyses were conducted by forcing the model previously developed on a sample of English-speaking health maintenance organization (HMO) members of Washington state. RESULTS: The model correctly classified 82% of subjects as to their functional limitation status at 2 years. The accuracy of the prediction was similar to that reported in the original study. CONCLUSION: The fact that this predictive model of back-related functional limitations led to similar results in a different sample of subjects and in another language brings strong support to its validity.

Adolescent↗
PubMed2006

Parenteral corticosteroids for Emergency Department patients with non-radicular low back pain.

Although not recommended for low back pain, the efficacy of systemic corticosteroids has never been evaluated in a general low back pain population. To test the efficacy of systemic corticosteroids for Emergency Department (ED) patients with low back pain, a randomized, double-blind, placebo-controlled trial of long-acting methylprednisolone was conducted with follow-up assessment 1 month after ED discharge. Patients with non-traumatic low back pain were included if their straight leg raise test was negative. The primary outcome was a comparison of the change in a numerical rating scale (NRS) 1 month after discharge. Of 87 subjects randomized, 86 were successfully followed to the 1-month endpoint. The change in NRS between discharge and 1 month differed between the two groups by 0.6 (95% confidence interval -1.0 to 2.2), a clinically and statistically insignificant difference. Disability, medication use, and healthcare resources utilized were comparable in both groups. Corticosteroids do not seem to benefit patients with acute non-radicular low back pain.

Adult↗
PubMed2004

Biomechanical assessments of lumbar spinal function. How low back pain sufferers differ from normals. Implications for outcome measures research. Part I: kinematic assessments of lumbar function.

OBJECTIVE: To review new and advanced biomechanical assessment techniques for the lumbar spine and illustrate the differences in lumbar function in patients with low back pain and asymtomatic subjects. DATA SOURCES: The biomedical literature was searched for research and reviews on spinal kinematic differences between low back pain subjects and healthy controls. A data search for articles indexed on MEDLINE until April 2002 was performed. RESULTS: Kinematic measurements of lumbar function were categorized into 3 areas where low back patients may differ from normals: (1) end range of motion during simple movements; (2) higher order kinematics (displacement, velocity, and acceleration) during complex movement tasks; and (3) spinal proprioception. The assessment of higher order kinematics during complex movement tasks is the most highly researched and the most successful in describing differences between the populations. The use of simple end range of motion appears questionable, while assessing spinal proprioception is the least researched, yet shows potential in highlighting differences between low back sufferers and asymptomatics. CONCLUSION: Current kinematic biomechanical assessment techniques are capable of identifying functional differences between low back pain populations and controls. The use and validity of the majority of these techniques as outcome measures are currently unknown, yet may be valuable in generating functional diagnoses, evaluating the mechanisms of current therapies, and prescribing specific rehabilitation programs.

Biomechanical Phenomena↗
PubMed2004

Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study.

OBJECTIVE: To document the potential role of maintenance chiropractic spinal manipulation to reduce overall pain and disability levels associated with chronic low-back conditions after an initial phase of intensive chiropractic treatments. METHODS: Thirty patients with chronic nonspecific low-back pain were separated into 2 groups. The first group received 12 treatments in an intensive 1-month period but received no treatment in a subsequent 9-month period. For this group, a 4-week period preceding the initial phase of treatment was used as a control period to examine the sole effect of time on pain and disability levels. The second group received 12 treatments in an intensive 1-month period and also received maintenance spinal manipulation every 3 weeks for a 9-month follow-up period. Pain and disability levels were evaluated with a visual analog scale and a modified Oswestry questionnaire, respectively. RESULTS: The 1-month control period did not modify the pain and disability levels. For both groups, the pain and disability levels decreased after the intensive phase of treatments. Both groups maintained their pain scores at levels similar to the postintensive treatments throughout the follow-up period. For the disability scores, however, only the group that was given spinal manipulations during the follow-up period maintained their postintensive treatment scores. The disability scores of the other group went back to their pretreatment levels. CONCLUSIONS: Intensive spinal manipulation is effective for the treatment of chronic low back pain. This experiment suggests that maintenance spinal manipulations after intensive manipulative care may be beneficial to patients to maintain subjective postintensive treatment disability levels. Future studies, however, are needed to confirm the finding in a larger group of patients with chronic low-back pain.

Adult↗
PubMed2005

Physical and emotional functioning of adult patients with chronic abdominal pain: comparison with patients with chronic back pain.

UNLABELLED: Adults with chronic abdominal pain remain a poorly defined population, despite the debilitation and depression associated with this therapeutically challenging condition. This study compared patients with chronic abdominal pain with an empirically well-known group of patients with chronic pain (back pain) to investigate similarities and differences in their physical and mental functioning. This retrospective, cross-sectional study included 136 patients with abdominal pain and 364 patients with back pain seen in a comprehensive pain rehabilitation center. Patients' functioning was assessed with the Short Form-36 Health Survey, Multidimensional Pain Inventory, Center for Epidemiological Studies-Depression scale, and Coping Strategies Questionnaire-Catastrophizing subscale. Both the abdominal and back pain patients reported long-standing and severe pain, numerous surgery procedures, poor functioning, and high prevalence of depression. When age, education, and marital status were controlled for, analyses showed that although patients with abdominal pain reported significantly better physical functioning than patients with back pain (P < .001), their overall health perception was significantly poorer (P < .001). Although less prevalent, it is clear that patients with chronic abdominal pain exhibit poor functioning and prevalence of depression that are comparable to patients with chronic back pain. This study also suggests distinct characteristics that are vital to consider for effective treatment of this chronic pain population. PERSPECTIVE: As a result of being an overlooked and poorly defined population, adults with chronic abdominal pain might not receive adequate pain management treatment. Learning more about the physical and emotional functioning of patients with long-standing abdominal pain can increase recognition of the needs of and improve treatment for this population.

Abdominal Pain↗
PubMed2005

Patient-physiotherapist agreement in low back pain.

UNLABELLED: Agreement between patients' and health professionals' perceptions has been shown to be low to moderate for different aspects of the patients' pain experience. Little is known, however, about patient-physiotherapist agreement in low back pain. The study objectives were to describe patient-physiotherapist agreement for low back pain intensity and functional limitations, and to identify correlates of agreement. A cross-sectional design was used. Seventy-eight patients with acute/subacute nonspecific low back pain and their respective physiotherapists were included in the study. After the initial physiotherapy consultation, patients and physiotherapists completed a Numerical Rating Scale and the Roland-Morris Disability Questionnaire. Intraclass correlation coefficients (ICC) were used to measure chance-corrected agreement. Patients' and physiotherapists' mean ratings were also compared using paired t tests. Multiple regression analyses were conducted to identify factors associated with agreement measures. The level of agreement was moderate for pain intensity (ICC = 0.55, 95% confidence interval [CI]: 0.38-0.69) and functional limitations (ICC = 0.56, 95% CI: 0.22-0.74). Both variables were rated significantly (P < .05) lower by the physiotherapists than by the patients. Higher ratings by the patients for pain and functional limitations were related to higher differences in perceptions between patients and physiotherapists. This report shows that physiotherapists' perceptions of their patients' pain intensity and functional limitations often differ from their patients'. PERSPECTIVE: The findings of this study indicate that there are frequent discrepancies between patients' and physiotherapists' perceptions of the patients' low back pain experience. Gaining a better understanding of the level of patient-physiotherapist agreement and identifying the correlates of agreement may help improve physiotherapists' interventions with people with low back pain.

Acute Disease↗
PubMed2006

Factors associated with early opioid prescription among workers with low back injuries.

UNLABELLED: Prescription of opioids for nonmalignant musculoskeletal pain has increased substantially in recent years, but there is little information on the incidence of, or factors associated with, such prescription for work-related back pain. In a prospective cohort study (N = 1,067), we examined associations between worker sociodemographic and other characteristics and opioid prescription within six weeks of the first medical visit for workers' compensation claims for work loss due to back injury. We examined administrative, pharmacy, and worker-reported data. In bivariate logistic regression models, Hispanics were less likely than non-Hispanic whites to receive opioid prescriptions, and very high body mass index, daily tobacco use, greater pain and physical disability, pain radiating below the knee, injury severity categorizations (from medical records) of major sprain and radiculopathy, and worse mental health were associated with opioid prescription. Adjusting for demographics, pain intensity, and physical disability, opiate prescription was significantly associated with daily tobacco use, pain radiating below the knee, and injury severity categories (major sprain and radiculopathy). Knowledge of worker characteristics associated with early opioid prescription may be useful in future studies of the role of early pain treatment in influencing subsequent course of pain and disability among workers with back injuries. PERSPECTIVE: Little is known about patient characteristics that may influence physicians' decisions concerning prescription of opioids for acute back pain. Not surprisingly, workers with more severe back injuries are more likely to be prescribed opioids, but reasons for prescription disparities based on ethnicity and tobacco use warrant further study.

Adult↗
PubMed2005

A model of dynamic sacro-iliac joint instability from malrecruitment of gluteus maximus and biceps femoris muscles resulting in low back pain.

The objective of this work is to propose a biomechanical model of sacro-iliac joint dysfunction as a cause of low back pain. Sacro-iliac joint is known to be a source of low back pain. We also know that it is a very stable joint with little mobility. Surrounding lower limb and back muscles contribute a major part of this stability. Gait analysis studies have revealed an orderly sequence of muscle activation when we walk - that contributes to efficient stabilisation of the joint and effective weight transfer to the lower limb. Gluteus maximus fibres-lying almost perpendicular to the joint surfaces are ideally oriented for this purpose. Biceps femoris is another important muscle that can also influence joint stability by its proximal attachment to sacrotuberous ligament. Altered pattern of muscle recruitment has been observed in patients with low back pain. But we do not know the exact cause-effect relationship. Because of its position as a key linkage in transmission of weight from the upper limbs to the lower, poor joint stability could have major consequences on weight bearing. It is proposed that sacro-iliac joint dysfunction can result from malrecruitment of gluteus maximus motor units during weight bearing. This results in compensatory biceps over activation. The resulting soft tissue strain and joint instability may manifest itself in low back pain. If our hypothesis holds true, it may have positive implications for patients with sacro-iliac joint dysfunction - who could be offered a definite diagnosis and targeted physiotherapy. It may be possible to identify patients early in a primary care setting and offer direct physio referral. They could benefit from exercises to improve strengthening and recruitment of the affected muscles.

Buttocks↗
PubMed2004

Chronic back pain and major depression in the general Canadian population.

Chronic pain and depression are two of the most common health problems that health professionals encounter, yet only a handful of epidemiological studies have investigated the relationship between these conditions in the general population. In the present study we examined the prevalence and correlates of major depression in persons with chronic back pain using data from the first cycle of Canadian Community Health Survey in a sample of 118,533 household residents. The prevalence of chronic back pain was estimated at 9% of persons 12 years and older. Rates of major depression, determined by the short-form of the Composite International Diagnostic Interview, were estimated at 5.9% for pain-free individuals and 19.8% for persons with chronic back pain. The rate of major depression increased in a linear fashion with greater pain severity. In logistic regression models, back pain emerged as the strongest predictor of major depression after adjusting for possible confounding factors such as demographics and medical co-morbidity. The combination of chronic back pain and major depression was associated with greater disability than either condition alone, although pain severity was found to be the strongest overall predictor of disability.

Adolescent↗