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PubMed2000

Predictors of participation in primary care group-format back pain self-care interventions.

OBJECTIVE: The goal of this study was to explain how primary care back pain patients who volunteer for a group-format self-care intervention differ from nonvolunteers. This is relevant to the generalizability of studies that rely on volunteers as well as the characteristics of patients who do not seek out self-care interventions. SETTING: This study was conducted at a large health maintenance organization in western Washington state. PATIENTS: "Volunteers" (n = 481) were primary care back pain patients participating in randomized trials of a self-management intervention who were recruited through passive nonintensive means (a mailed invitation). "Nonvolunteers" (n = 967) consisted of a representative sample of consecutive back pain patients. We compared the baseline characteristics of these two groups. RESULTS: The relatively small percentage (8%) of primary care back pain patients who volunteered for, and ultimately participated in, group self-management classes tended to be white, older, better educated, and more likely to be retired than nonvolunteers. The two groups did not differ significantly on most clinical measures, including pain intensity and persistence. Patients experiencing the highest (and lowest) levels of pain-related activity interference were less likely to volunteer than those with moderate activity limitations, however. CONCLUSIONS: Those individuals volunteering to participate in a group-format self-care intervention in a primary care setting differed from nonvolunteers primarily on demographic measures as opposed to clinical measures. Back pain patients experiencing the highest levels of activity limitations were somewhat less likely to participate than those with moderate activity limitations. Recruitment for effective self-care interventions is an important issue in determining their impact on a population basis.

Activities of Daily Living↗
PubMed2000

Prediction of functional disability, recurrences, and chronicity after 1 year in 180 patients who required sick leave for acute low-back pain.

The aim of the study was to identify factors that predict low-back pain outcome at 12 months and thus to identify patients at risk for poor long-term outcomes. One hundred-eighty patients, all disabled by acute low-back pain, were included. Outcome (dependent) variables were Oswestry disability score, recurrences during the study year, and chronicity defined as 90 or more days off work for low-back pain during the study year, or a disease-specific sick-leave rate (a variable created by the authors) of more than 25%. Stepwise logistic regression analysis was performed. Thirty-three percent of the patients had an Oswestry score greater than 25, indicating moderate disability at the 1-year follow-up evaluation. Pain on coughing at study entry predicted a high likelihood of disability at 1 year, with a threefold risk. Many work days missed as a result of low-back pain in the past 2 years and lack of stimulating work tasks predicted recurrences during the year. A high Oswestry score assessed at study entry was the only factor that predicted chronicity. The factors revealed in the current study should help the clinician to identify patients at risk. The authors propose that the revealed predictors should be investigated extensively at the patient's first visit for acute low-back pain.

Adult↗
PubMed1999

Phantom limb, residual limb, and back pain after lower extremity amputations.

This study describes the sensations and pain reported by persons with unilateral lower extremity amputations. Participants (n = 92) were recruited from two hospitals to complete the Prosthesis Evaluation Questionnaire which included questions about amputation related sensations and pain. Using a visual analog scale, participants reported the frequency, intensity, and bothersomeness of phantom limb, residual limb, and back pain and nonpainful phantom limb sensations. A survey of medication use for each category of sensations also was included. Statistical analyses revealed that nonpainful phantom limb sensations were common and more frequent than phantom limb pain. Residual limb pain and back pain were also common after amputation. Back pain surprisingly was rated as more bothersome than phantom limb pain or residual limb pain. Back pain was significantly more common in persons with above knee amputations. These results support the importance of looking at pain as a multidimensional rather than a unidimensional construct. They also suggest that back pain after lower extremity amputation may be an overlooked but very important pain problem warranting additional clinical attention and study.

Adult↗
PubMedDate not supplied

Preventing back injury among nurses.

Back injury and subsequent back pain are highly prevalent in nursing. This article explores multidimensional factors with respect to working behaviors, physical fitness, and environments that contribute to both acute and cumulative back injuries to nursing staff. Specific interventions to reduce the risk for back injury are examined. The practice of proper posture, body mechanics, and lifting techniques are reviewed. Exercises to increase flexibility, muscle strength, and endurance are encouraged to reduce the gap between job physical demands and human capabilities. Nurses are also encouraged to be knowledgeable about ergonomic principles and to be active in identifying and using these principles. Research needs and approaches to the study of the back injury problem of nurses are also suggested.

Back Pain↗
PubMed1988

Resolution of back pain with the wide abdominal rectus plication abdominoplasty.

Back pain is classified most easily into three types (1) muscle spasm, (2) herniated nucleus pulposus (HNP), and (3) facet syndrome and/or nerve compression. It is possible the wide abdominal rectus plication procedure will be beneficial to all three groups, but currently I limit the procedure to those back pain patients who are improved with a back brace or corset and those without back pain undergoing elective abdominoplasty. Contraindications would be (1) anticipating additional pregnancy, (2) back pain not relieved or improved by corset or brace, (3) severe or progressive disk signs, and (4) bladder and/or bowel dysfunction. Further detailed studies of the mechanism of action and of the biomechanical effect as evaluated by conventional radiology, CAT scan, and nuclear magnetic resonance imaging, as well as physical measurement, are in progress and will be forthcoming.

Abdominal Muscles↗
PubMed1997

Back pain in children and adolescents: a retrospective review of 648 patients.

Back pain in children has long been considered a serious condition with an organic cause. The staff of the Shriner's Hospital had been informally noting that diagnoses among children with back pain had been changing. We conducted a retrospective study of 648 patients with spinal disorders treated at the Shriner's Hospital for Crippled Children, Spokane Unit, between January 1991 and June 1993. The patients were divided into two groups: those with pain and those without pain. It was found that back pain with no organic cause was the primary diagnosis in 57% of the group having pain. Only one child had a diagnosis of malignancy, and there were no cases of active infection. In the group with pain, three interesting associations were found concerning psychosocial problems, disability, and litigation. It was found that the diagnoses in children with back pain treated at this referral center during the study period parallel those in the adult population with back pain.

Adolescent↗
PubMed1978

Early and subtle signs in low-back sprain.

The authors have previously reported myalgic hyperalgesia as a useful localizing sign in "low-back sprain" patients with no physical findings. This paper describes some other subtle signs related to the phenomenon of denervation supersensitivity which is well known to physiologists and clinicians involved in peripheral nerve disease, yet its related signs have not been applied to low-back pain. Following denervation of some neurons, muscle and peripheral receptors become supersensitive to transmitter substances and to different forms of stimuli. Since the peripheral nerve is a mixed nerve, findings are multiphasic and include autonomic dysfunction, trophic changes, cutaneous and myalgic hyperalgesia, and increased muscle tone. One or more of these signs occurred in 30 patients with secondary low-back pain but less often in 30 patients with primary or mechanical low-back pain; their presence, though slight, in asymptomatic controls may identify those individuals with a vulnerable back.

Adolescent↗
PubMedDate not supplied

The incidence of low-back pain in adult scoliosis.

To date no knowledge of the incidence of scoliosis in adults and its relationship to low-back pain is available. In order to arrive at an understanding of low-back pain in adult scoliosis, a study of 5000 intravenous pyelograms was performed. The incidence of lumbar and thoracolumbar curves was 2.9%. One hundred and fifty-nine of the 189 patients found to have scoliosis were contacted. The incidence of back pain was 59% (similar to that in the general population). Back pain was subdivided into mild (44%), moderate (49%), or severe (7%). The curve was subdivided into three categories: 10-24 degrees, 25-44 degrees, and 45+ degrees. Of the 82 idiopathic curves with pain, 64 were in group 1, 15 in group 2, and 3 in group 3. Forty-three percent had mild pain, 50% had moderate pain, and 7% had severe pain. As the degree of curvature increased, the severity of pain increased, especially for curves of more than 45 degrees. Patients without back pain tended to have smaller curves. the presence of facet sclerosis correlated with a history of pain in 64%. There was a high correlation between radiologic changes at the curve apex and pain. Age bore no relationship to the incidence of pain.

Adult↗
PubMedDate not supplied

Correlation of objective measure of trunk motion and muscle function with low-back disability ratings.

A study was undertaken to examine relations among some objective and subjective measures of low-back-related disability in a group of 41 low-back pain patients and in seven pain-free control subjects. Subjective measures of disability were obtained by Oswestry patient questionnaires. Oswestry disability score related significantly (P less than 0.001) to presence or absence of relaxation in back muscles during flexion. Mean trunk strength ratios were inversely related to disability score (P less than .05), and trunk mobility was meaningfully reduced (P less than .01). Despite loss of motion, a large enough excursion was observed to predict presence of back muscle relaxation. These findings imply that myoelectric signal levels, trunk strength ratios, and ranges of trunk motion may be used as objective indicators of low-back pain disability.

Activities of Daily Living↗
PubMed1988

Familial predisposition to discogenic low-back pain. An epidemiologic and immunogenetic study.

The first-degree relatives (parents, siblings and children) of 284 patients complaining of discogenic low-back pain (Group I), 114 patients who had undergone surgery for lumbar disc herniation (Group II), and 280 individuals who had never complained of low-back pain (Group III) were surveyed by self-completed questionnaires. Of the families in Group I and Group II, 35 and 37%, respectively, had at least one member with a history of discogenic back pain and 5 and 10%, respectively, had one or two members who had undergone disc surgery. Of the asymptomatic subjects in Group III, only 12% had at least one or more affected relatives and 1% had a relative who had undergone disc surgery; of the affected families, 41% had two or more members with a history of back pain. The proportion of symptomatic relatives in the affected families was higher among sedentary workers and motor vehicle drivers than among heavy or light manual workers. An immunogenetic study comparing the frequencies of HLA-A, B, and C antigens in 39 patients who had undergone lumbar disc surgery with those in 60 asymptomatic individuals showed no significant differences between the two groups. This study indicates that there is a strong familial predisposition to discogenic low-back pain, and suggests that the etiology of degenerative disc disease is related to both genetic factors, not linked to the HLA antigen system, and environmental factors.

Adult↗
PubMed1989

Back pain after Harrington rod instrumentation for idiopathic scoliosis.

The purpose of this study is to compare preoperative and postoperative back pain problems in 182 patients operated on for idiopathic scoliosis. Preoperatively 32% of the patients presented with back pain, increasing to 66% postoperatively. Minor degrees of back pain increased (from 45 to 65%) and more severe complaints decreased (from 55 to 35%). Moderate to severe back pain increases from 0 to 46%, together with lower hook placement from L1 to L5. It is concluded that, ideally, the lower limit of the fusion should not go beyond L1 or L2. Lower fusions are prone to give more back pain, with major problems, however, only in a minority of cases (7% in fusions to L4-L5).

Activities of Daily Living↗
PubMed1990

Back pain and radiologic changes in the thoraco-lumbar spine of athletes.

Back pain and radiological changes of the thoraco-lumbar spine were investigated in 142 top athletes, representing wrestling, gymnastics, soccer and tennis (age range 14-25 years). All groups of athletes reported back pain at high frequencies (50-85%). Male gymnasts had significantly increased incidence and severity of back pain as compared to the rest of the athletes. Radiological abnormalities occurred in 36-55% of the athletes. Reduced disc height, Schmorl's nodes and change of configuration of vertebral bodies correlated with back pain (P less than 0.05, P less than 0.01 and P less than 0.05). Significant covariation between these types of abnormalities was found. Athletes with great demands on the back are thus subjected to an increased risk of symptomatic damage of the spine.

Adolescent↗
PubMed1991

Prevalence of back pain in pregnancy.

The prevalence of back pain was studied in 855 pregnant women who were followed from the 12th week of pregnancy, every 2nd week, until childbirth. The 9-month period prevalence was 49%, with a point prevalence of 22-28% from the 12th week until delivery. Because 22% of the women had back pain at the 12th week of the pregnancy, the 6-month incidence was 27%. Based on pain drawings, back pain was classified into three groups: In one group, pain was localized to the sacroiliac areas and increased as pregnancy progressed; in the other two groups, pain either decreased or did not change, respectively. True sciatica with a dermatomal distribution occurred in only 10 women (1%). Back problems before pregnancy increased the risk of back pain, as did young age, multiparity, and several physical and psychological work factors.

Adult↗
PubMed1991

Somatic versus nonsomatic shoulder and back pain experience in middle age in relation to body build, physical fitness, bone mineral content, gamma-glutamyltransferase, occupational workload, and psychosocial factors.

This study selected 205 subjects aged 55 years who had shoulder and/or back pain complaints to determine the relationship of somatic and nonsomatic pain experience to body build, physical fitness, bone mineral content, serum levels of gamma-glutamyltransferase, occupational workload and intelligence test, educational level, life success, social support, stress at work, monotonous work, and job decision latitude. Men with a somatic back pain drawing experienced more stress at work and had higher serum levels of gamma-glutamyltransferase, indicating a higher intake of alcohol and/or painkillers, but were more satisfied with their jobs compared with men who had a nonsomatic pain drawing. Women with obvious shoulder signs and symptoms and/or a somatic back pain drawing tended heavier than women without symptoms, had higher serum levels of gamma-glutamyltransferase, and found their jobs more mentally demanding than did women with shoulder and/or back pain experience but without obvious shoulder signs and symptoms and/or a nonsomatic back pain drawing.

Back Pain↗
PubMed1992

Objective clinical evaluation of physical impairment in chronic low back pain.

The aim of this study was to investigate physical impairment in patients with chronic low back pain, to develop a method of clinical evaluation suitable for routine use, and to consider the relationship between pain, disability, and physical impairment. Twenty-seven physical tests were investigated. Permanent anatomic and structural impairments of spinal deformities, spinal fractures, surgical scarring, and neurologic deficits were excluded as not relevant to the patient with low back pain in the absence of nerve root involvement or previous surgery. Three consecutive 20-patient reproducibility studies were used to develop reliable methods of examination for 23 of the tests. Only four tests were excluded as unreliable: sacral angle, pelvic tilt, and separate lumbar and pelvic extension, none of which are part of routine clinical examination or have any proven relationship to disability. The remaining 23 physical tests were evaluated in 70 asymptomatic subjects and 120 patients with chronic low back pain. Passive knee flexion, passive hip flexion, hip flexion strength, hip abduction strength, pain reproduction on each of these tests, and the prone extension strength test were excluded because they were too closely related to nonorganic and behavioral responses to examination. Eight tests successfully discriminated patients with low back pain from normal subjects and were significantly related to self-report disability in activities of daily living: pelvic flexion, total flexion, total extension, lateral flexion, straight leg raising, spinal tenderness, bilateral active straight leg raising, and sit-up. Factor analysis failed to demonstrate an underlying statistical dimension of physical impairment. However, an empirical combination of total flexion, total extension, average lateral flexion, average straight leg raising, spinal tenderness, bilateral active straight leg raising, and sit-up provided an equally satisfactory alternative. Simple cut-offs from normal subjects made the scale simple and quick to use. This final scale successfully discriminated 78% of patients and normal subjects and explained 25% of the variance of disability, with a specificity of 86% and sensitivity of 76%. This scale provides an objective clinical evaluation that meets the criteria for evaluating physical impairment, yet is simple, reliable, and suitable for routine clinical use. It should, however, be emphasized that all the tests included in the final scale are measures of current functional limitation rather than of permanent anatomic or structural impairment. This raises questions about the physical basis of permanent disability due to chronic low back pain.

Activities of Daily Living↗
PubMed1993

Influence of some biomechanical factors on low-back pain in pregnancy.

Several biomechanical factors were recorded intermittently in 855 pregnant women from the 12th to the 36th week of gestation and were related to back pain occurrence during pregnancy. The three factors related to the development of back pain were abdominal sagittal diameter, which correlated with back pain, with a coefficient of 0.15 (P < 0.01); transverse diameter (r = 0.13, P < 0.01); and depth of the lumbar lordosis, which correlated with a coefficient of 0.11 (P < 0.01). In the group of women who were pregnant for their first time, there was a significantly lower peripheral joint laxity in the 12th week in those women who, later in pregnancy, developed back pain. These correlations suggest that back pain in pregnancy can not be explained primarily by biomechanical factors.

Abdomen↗
PubMed1993

Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome.

Impairment and disability after back surgery is a common diagnostic and therapeutic problem. For the most part the reasons are unclear. Of 178 patients who had undergone laminectomies 2-5 years earlier, 14 patients with good recovery and 21 patients with poor recovery but no evidence of restenosis on computed tomography were selected by the Oswestry index. According to radiologic, neurophysiologic, and muscle biopsy evidence most patients (13 of 15 studied) suffering from the severe postoperative failed back syndrome had dorsal ramus lesions in one or more segments covered by the scar and local paraspinal muscle atrophy at the corresponding segments. Disturbed back muscle innervation and loss of muscular support leads to the disability and increased biomechanical strain and might be one important cause to the failed back syndrome. It may be possible to develop operating techniques that save back muscle innervation better than the usual ones.

Adult↗
PubMed1993

Spinal posture, sagittal mobility, and subjective rating of back problems in former female elite gymnasts.

This study analyzed posture, spinal sagittal mobility, and subjective back problems in former female elite gymnasts in comparison with matched control subjects. The former gymnasts had less thoracic kyphosis than the control subjects. No difference in thoracic range of motion was found. In the lumbar spine there was no difference as to either posture or sagittal motion. The former gymnasts did not report a higher frequency of current back problems. In the former gymnasts 27% had subjective back problems. In the control subjects the corresponding value was 38%. We did not find any correlation between posture or range of motion and subjective rating of back problems in either of the groups. In conclusion, former female elite gymnasts did not have more back problems than an age matched control group.

Adult↗