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PubMedDate not supplied

[The school for patients with chronic backache. Retrospective study of 93 severely handicapped patients with backache and their socio-occupational status].

A small percentage of low back pain sufferers are resistant to the various types of treatment tried and the problem becomes chronic. It is for this severely incapacitated group, threatened by socio-occupational misfortune, that we created: the School for Chronic Low Back Pain Sufferers. One hundred and five patients in whom treatment had failed were included after insurance programmes had agreed to provide cover. The system is of a multidisciplinary nature with hospitalisation for 5 days. The fate of 93 of these patients is known with a mean follow-up of 1 year. Quantified initial evaluation on an obstacle course confirmed that even severe low back pain sufferers were unaware of the basic rules for protection of the spine (mean score of 14/50 on admission). Socio-occupational fate analysed on the basis of a questionnaire showed: a high satisfaction index (90%) regardless of the subsequent outcome, and a correlation between follow-up time after the programme and the decrease in painful attacks (p less than 0.03, r = 0.23) or consumption of medications (p less than 0.01, r = 0.29). The relative simplicity of the system proposed, the situation of therapeutic impasse in which the patients for whom it is intended find themselves, the short time required and the results obtained confirm the importance of this multidisciplinary management approach being able to best envisage the possibilities of rehabilitation of the chronic low back pain sufferer, in particular when there are repeated periods off work.

Adult↗
PubMed1996

Long term backache after childbirth: prospective search for causative factors.

OBJECTIVES: To assess in a prospective randomised study the association between motor block resulting from high and low dose epidural infusions of bupivacaine in labour and the incidence of long term backache after childbirth, and to compare the incidence of backache in women not receiving epidural analgesia. DESIGN: Women requesting epidural analgesia in labour between October 1991 and March 1994 were randomised to receive infusions of either bupivacaine alone or low dose bupivacaine with opioid. Data were collected during labour and the immediate postpartum period from these women and from women recruited at random over the same time from those who had laboured without epidural analgesia. A postal questionnaire about symptoms was sent three months after childbirth to all women. Further data were collected one year after childbirth from those who had reported new backache at three months. SETTING: St Thomas's Hospital, London. SUBJECTS: 599 women were recruited, of whom 450 (75%) replied to a follow up questionnaire. RESULTS: 152 women (33.8% of responders) reported backache lasting three months after delivery and, of these, 33 (7.3%) had not previously suffered with backache. There were no significant differences between the treatment groups in the incidence of postnatal backache overall or of new backache or any symptoms after childbirth. Among all demographic, obstetric, and epidural variables examined the only factors significantly associated with backache after childbirth were backache before and during pregnancy. CONCLUSIONS: The incidence of new long term backache was not significantly increased in women who received epidural analgesia in labour. Motor block resulting from epidural local anaesthetic administration was not a significant factor in the development of backache.

Adult↗
PubMed2003

Backaches related to pregnancy: the risk factors, etiologies, treatments and controversial issues.

PURPOSE OF REVIEW: There is no clear documentation in either the anesthetic/pain or obstetric literatures regarding the management of backache related to pregnancy. Backache can occur during pregnancy, in labor, and postpartum; different stages should be managed differently. The purpose of this review is to discuss the different types of backache, to provide an overview of diagnosis and treatment options, and to address several controversial issues related to pregnancy-related backaches. RECENT FINDINGS: Gestational backache is a substantial problem and can have a significant impact on a pregnant woman's daily activities. Non-pharmacological/complementary treatments such as posture adjustment, acupuncture, physical therapy, physiotherapy, yoga, and chiropractic may become the first line of treatment options. In labor backache the posture of the parturient can have an effect in decreasing the intensity of pain. Allopathic medicine, regional techniques (epidural), and complementary interventions are routinely given to parturients. However, there is a major perception of differences among midwives, obstetricians and anesthesiologists in terms of the risks and benefits of labor epidural analgesia. Postpartum backache is usually self-limited, but for some mothers the pain can last from a few months to several years. Early literature suggested that this problem was associated with the use of epidurals, but recent data in the literature deny such an association. SUMMARY: Overall, backache related to pregnancy is a significant problem. Education is still the first line of intervention for preventing backaches related to pregnancy. Both allopathic and complementary medicines are frequently used as treatments for backache related to pregnancy.

Journal Article↗
PubMedDate not supplied

Sitting posture of subjects with postural backache.

OBJECTIVE: To test the construct validity of postural backache. To identify if individuals with backache sit for longer periods of sustained sitting and have more flexed relaxed sitting posture than individuals in a no backache group. METHODS: Following an initial questionnaire, student volunteers without a history of 'serious' back pain were classified as either postural backache group or no backache group. With the use of an activity diary that plotted activity every 5 minutes over a 3-day period, the average time spent in different postures was established. Relaxed sitting posture was evaluated using Dartfish software to analyze videotape after 10 minutes of sitting. RESULTS: The most common daytime activity of both groups was sitting, with average sitting time not significantly different between groups. Periods of uninterrupted sustained sitting and uninterrupted sustained studying were significantly longer, and the degree of flexion in relaxed sitting was significantly greater in the postural backache group (all P < .024). CONCLUSION: In a group of student volunteers, half reported postural backache. The group with backache sat for longer periods without interruption and had a more flexed relaxed sitting posture than the no backache group. These findings appear to validate McKenzie's concept of a postural syndrome.

Adult↗
PubMed1993

Assessing long term backache after childbirth.

OBJECTIVES: To investigate the factors associated with long term backache after childbirth, to assess all women reporting new onset long term backache, and to investigate any relation with pain relief in labour. DESIGN: Data collected from obstetric records and postal questionnaires or telephone interviews on morbidity after childbirth from all women delivering their first baby between March 1990 and February 1991, followed by analysis of data collected from outpatient consultations. SETTING: St Thomas's Hospital, London. SUBJECTS: Questionnaires were sent to 1615 women who had delivered their first baby in the defined period; 1015 either replied by post or were contacted by telephone. RESULTS: 299 women (29.5% of responders) reported backache lasting more than six months and of these 156 (15.4%) said they had had no back problems previously. Those women who had received epidural analgesia in labour were significantly more likely to report new onset backache (17.8%; 95% confidence interval 14.8% to 20.8%) than those who did not (11.7%; 8.6% to 14.8%). Younger women, unmarried women, and those reporting other antenatal symptoms were significantly more likely to report new long term backache. The 156 women reporting new backache were asked to attend an outpatient clinic and 36 (23%) did so. The majority had a postural backache which was not severe. Psychological factors were present in 14 women. CONCLUSIONS: Though new long term backache is reported more commonly after epidural analgesia in labour, it tends to be postural and not severe. There were no differences in the nature of the backache between those who had or had not received epidural analgesia in labour.

Adult↗
PubMed1997

Epidural dexamethasone reduces the incidence of backache after lumbar epidural anesthesia.

We performed a prospective, randomized, double-blind study to compare the effect of epidural dexamethasone on the incidence of postepidural backache after nonobstetric surgery. One thousand unpremedicated ASA physical status I or II patients scheduled for hemorrhoidectomy were randomly assigned to two groups: Group I patients received 25 mL 2% lidocaine with epinephrine 1:200,000 and 1 mL dexamethasone (5 mg) epidurally. Patients were interviewed at 24,48, and 72 h postoperatively using a standard visual analog scale (VAS) for evaluation of postepidural backache. A patient was considered to have postepidural backache when the postoperative VAS score was higher than the preoperative score. The incidence of postepidural backache in Group I patients for the 3 days were 22.8%, 17.4%, and 9.2%, all of which were significantly more frequent than observed in Group II patients (7.4%,5.6%, and 2.8%, P < 0.01). The severity and duration of postepidural backache were also significantly decreased in Group II patients. In our study, there was a significant association between postepidural backache and multiple attempts at epidural needle insertion. In summary, epidural dexamethasone reduced the incidence and severity of postepidural backache.

Adult↗
PubMed1989

Evaluation of a maternity cushion (Ozzlo pillow) for backache and insomnia in late pregnancy.

The effect of a wedge-shaped pillow (Ozzlo pillow) was compared with a standard hospital pillow, used to support the abdomen of a pregnant woman while lying on her side, in preventing or alleviating backache and backache-related insomnia; 92 women at 36 weeks' gestation completed the study. Backache was found to be very common (87%), the onset of pain occurring before 29 weeks in 59%. Age, parity, previous backache and type of bed used did not correlate with the backache scores during the period of study. Lower scores for backache were recorded by women in the week they used the Ozzlo pillow compared with the week they used the standard pillow. Sleeping was deemed better by the patient with the Ozzlo pillow, though actual sleeping scores did not corroborate this. While significantly more felt the Ozzlo pillow was superior to a standard pillow for backache and sleeping, some found both methods helpful. The simple measure of supporting the abdomen with a pillow when in lateral recumbency is likely to benefit many women in late pregnancy. A wedge-shaped pillow of the Ozzlo type, conforming to the shape of the abdomen and supporting it more closely, may be of greater help than a standard cushion or pillow.

Back Pain↗
PubMed1996

Anaesthetic characteristics and long-term backache after obstetric epidural anaesthesia.

Anaesthetic casenotes of 4700 women who had epidural anaesthesia for deliveries between 1978-1985 were examined to look for associations between various epidural characteristics and subsequently reported long-term backache. The data on long-term backache came from a postal questionnaire sent to the women. The only clear predictor of the occurrence of long-term backache was having experienced backache immediately after the birth whilst still in hospital. There were no relationships between long-term backache and the duration of the epidural or various indicators of the extent of motor or sensory block. Within the range of local anaesthetic concentration levels used in this series, the extent of block did not seem to affect backache, but the effect of minimal motor block with corresponding increased mobility, such as is available with low concentration anaesthetics mixed with opiates, merits further study.

Journal Article↗
PubMed1998

The labor productivity effects of chronic backache in the United States.

OBJECTIVES: Back pain afflicts approximately 31 million Americans, and is the number one cause of activity limitation in young adults. Little is known about the labor productivity costs associated with this chronic disease. Such information could provide useful input to employers considering alternative health benefits plans for managing their employees' health care needs. The goals of this study were to generate employee-level as well as national estimates of the labor productivity losses associated with chronic back ache. METHODS: Multivariate methods were used to isolate the effects of chronic backache on employment status and disability days. These results were combined with information on earnings to generate labor productivity cost estimates associated with chronic backache. The study used data from the National Medical Care Expenditure Survey (NMES), which provides information on health status, health care utilization and cost, work, disability, and sociodemographic characteristics for a nationally representative sample of the noninstitutionalized civilian population of the United States in 1987. RESULTS: Average annual productivity losses per worker due to chronic backache were $1,230 for male workers, measured in 1996 dollars, and $773 per female worker. These figures translated into aggregate annual productivity losses from chronic backache of approximately $28 billion in the United States. CONCLUSION: The labor productivity losses from chronic backache differed by gender and other sociodemographic characteristics. The aggregate labor productivity losses associated with chronic backache were quite large and comparable to estimates of the direct medical costs associated with treating this chronic illness.

Absenteeism↗
PubMed1990

Epidural anaesthesia and long term backache after childbirth.

OBJECTIVE: To examine the relation between epidural anaesthesia and long term backache after childbirth. DESIGN: Data from postal questionnaire on morbidity after childbirth sent to women who had delivered in one maternity hospital between 1978 and 1985 were linked to maternity case notes for each woman. SETTING: Maternity hospital in Birmingham. SUBJECTS: 11,701 Women who had delivered their most recent baby at the maternity hospital during the defined period and who returned their completed questionnaires. MAIN OUTCOME MEASURES AND RESULTS: Of the 1634 women who reported backache, 1132 (69%) had had it for over a year. A significant association was found between backache and epidural anaesthesia (relative risk = 1.8); 903 of 4766 women (18.9%) who had had epidural anaesthesia reported this symptom, compared with 731 of the 6935 women (10.5%) who had not had epidural anaesthesia. This association was consistent in both "normal" and "abnormal" deliveries, the only exception being after an elective caesarean section when no excess backache occurred after epidural anaesthesia. CONCLUSIONS: The relation between backache and epidural anaesthesia is probably causal. It seems to result from a combination of effective analgesia and stressed posture during labour. Further investigations on the mechanisms causing backache after epidural anaesthesia are required.

Anesthesia, Epidural↗