Back pain. Back pain and charity.
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Adult↗
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Back pain, back abnormalities, and competing medical, psychological, and social factors as predictors of sick leave, early retirement, unemployment, labour turnover and mortality: a 22 year follow up of male employees in a Swedish pulp and paper company.
A total of 391 male employees in a Swedish pulp and paper company were followed up for 22 years. As a part of a health examination in 1961 back pain reported by the subjects and abnormalities of the back as judged by the physicians were investigated with respect to predictive power regarding sick leave, early retirement, unemployment, labour turnover, and mortality during the follow up period. Univariate analysis showed that abnormalities of the back were better than back pain for predicting early retirement. Neither back pain nor back abnormalities had any predictive power with respect to long term sick leave, labour turnover, or mortality. Multivariate analyses of 26 variables were performed. Both self assessment of general health and back abnormalities were predictive for early retirement with a diagnosis of back disorder on the retirement certificate but self assessed health was a stronger predictor. Age, smoking, and neuroticism were predictors regarding early retirement for all diagnoses. Education had a negative association; neuroticism did not predict early retirement with a diagnosis of back disorder.
Absenteeism↗
The effects of common medical interventions on pain, back function, and work resumption in patients with chronic low back pain: A prospective 2-year cohort study in six countries.
STUDY DESIGN: A prospective cohort study with identical questionnaires and inclusion criteria was performed. OBJECTIVES: To compare in six different countries the frequencies and effects of the common medical interventions used for patients with low back pain who are work incapacitated. SUMMARY OF BACKGROUND DATA: Low back pain is a huge problem with increasing costs for health care, industry, and society. METHODS: Cohorts of employed men and women ages 18 to 59 years who had been sick-listed (100%) for a minimum of 90 days because of low back pain were recruited in Denmark, Germany, Israel, Sweden, the Netherlands, and the United States. The subjects received three separate questionnaires with identical questions after 90 days, 1 year, and 2 years. The questionnaires included separate questions about background factors, treatment, and the like, as well as validated scales such as the Hannover Activities of Daily Living, von Korff pain score, Short Form-36, and Karasek-Theorell. Working status was obtained from registers. Main outcome measures were working/not working, back function, and pain. RESULTS: All three questionnaires were completed by 2080 subjects in the six countries. With few exceptions, there were great similarities in the appointments, examinations, and treatments in the different countries. Considerable differences were found between the back surgery rates, which ranged from 6% in Sweden to 32% in the United States during the first 90 days of the study. Very few of the interventions had any noticeable positive effects on work resumption, pain, or back function. Back surgery in Sweden was a striking exception, positively affecting all three outcome measures. The frequencies of work resumption within the first year ranged from 73% in the Netherlands to 32% in Denmark. CONCLUSIONS: Almost none of the commonly occurring and frequently practiced medical interventions for patients who are sick-listed because of low back pain had any positive effects on either the recorded health measures or work resumption.
Activities of Daily Living↗
Low back pain--back care through proper lifting technique.
The study was designed to evaluate the level of knowledge of the subjects about back care and proper lifting techniques. Two groups of subjects were taught correct lifting method and back care through practical demonstrations and illustrated diagrams. The subjects' knowledge was measured pre- and post-test, using written and practical tests. Subjects with low back pain and those without back pain both benefited from the training. The need for physiotherapists to teach back injury prevention to the general populace was highlighted.
Adolescent↗
Pain-related impairment and health care utilization in children and adolescents: a comparison of orofacial pain with abdominal pain, back pain, and headache.
OBJECTIVE: The purpose was to compare orofacial (temporomandibular) pain with other pain complaints regarding impairment and health care utilization in a sample of 1,011 children and adolescents from a metropolitan area in Germany. METHOD AND MATERIALS: Individuals aged 10 to 18 years were sampled in schools using a 2-stage cluster technique. Orofacial pain in the previous month was assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Additionally, participants were questioned about headache, back pain, abdominal pain, pain-related impairment, and health care utilization (visits to doctors, analgesic consumption) in the previous month. RESULTS: Headache was reported by 50% (95% CI: 45% to 56%) of participants, stomach pain by 36% (95% CI: 32% to 41%), back pain by 31% (95% CI: 25% to 36%), and orofacial pain by 15% (95% CI: 12% to 18%). Girls were more affected than boys. The range of "severe" and "very severe" impairment lay between 8% (orofacial pain) and 22% (headache). The range of treatment demand was between 10% and 17% (orofacial pain: 15%), and the range for analgesic consumption between 18% and 24% (orofacial pain: 22%). The more pain experienced, the more impairment, doctor consultations, and analgesic consumption were reported (Chi2test: P < 0.05). Risk of orofacial pain was 60% higher for subjects with head, back, and/or abdominal pain (odds ratio: 1.6; 95% CI: 1.3 to 1.9). CONCLUSION: In children and adolescents, orofacial pain occurs about half as often as other pain complaints. However, relative to their prevalence the different pain complaints are similar regarding impairment and health care utilization.
Abdominal Pain↗
A model for conservative care of low back pain: back school, epidural blocks, mobilization.
Conservative care for low back pain can be an enjoyable and successful experience for the physician. It requires a bit more organization and assistance than other routine forms of orthopaedic practice. It begins with a systematic collection of historical and physical information. The most appropriate conservative treatment is selected specifically for the patient's diagnosis. The patient's participation is required in the conservative treatment, and he must be willing to take responsibility for his condition. Education and training are the mainstay of conservative treatment with the addition of injections, braces, mobilization, medication, or rest as temporary adjuncts.
Anti-Inflammatory Agents↗
Screening of lower back pain, low back pain clinic. The clinical experience.
Acute low back pain is a common complaint with high prevalence in society. Orthopaedic and specialist spinal services may be overwhelmed by large numbers of patients with low back pain who do not require investigation or surgical intervention. This phenomenon has led to the establishment of back pain screening clinics as a system of triage for those with acute low back pain. In March 2001, a back pain screening clinic was established in the Adelaide and Meath Hospitals incorporating the National Children's hospital. Six hundred and sixty-five patients were seen in the first year of this clinic. Of these, only ninety-six required referral to the orthopaedic spinal clinic. Just twenty-nine of these patients required surgical intervention. The introduction of this service resulted in a reduction in the waiting periods for the specialised spine clinic. We conclude that back pain screening clinics result in a clinical and economical improvement in the care of those suffering from acute low back pain. This is achieved by the systematic and efficient assessment, treatment and referral of patients afflicted with acute low back pain.
Adult↗
Back pain.
Back pain is ubiquitous and probably plagues almost everyone in all cultures and ethnic groups at some time (around 20% annually), and in up to 50% of these at least once a year. The WHO-COPCORD epidemiologic investigations have established its prevalence even in countries that had been unaware of its frequency in their populace, and factors involving type of work and training probably accounted for this misperception. Medical journals are replete with articles addressing diagnosis and treatment, but the majority fail to meet the standards needed for metaanalysis or comparison. A task force of the Agency for Health Care Policy and Research of the United States Department of Health and Human Services screened more than 10,000 abstracts, eliminated the majority of these studies and papers, and still was unable to recommend the best approach even to acute back pain; the problem of subacute and chronic back pain is even more formidable. Yet back pain has been identified as perhaps the major cause of disability and absenteeism from the workplace worldwide. WHO chiefly addressed subacute back pain, as most acute back pain is self-limited and ends spontaneously, almost regardless of the treatment. Subacute pain is the intermediate stage toward chronic pain, which defies most treatments. Specific causes for back pain, such as infections, tumors, osteoporosis, spondyloarthropathies, and trauma, actually represent a minority of such pain syndromes, qualifying for specific therapeutic approaches. A major problem in defining the burden of disease for back pain has been a dearth of agreed-upon outcome measures by which to judge the various interventions, and this was the task that the WHO Low Back Pain Initiative took upon itself. Among measures recommended to be included in all studies, so that valid comparisons could be made, were measurement of pain by visual analog scales, somatic perception, the Oswestry disability and modified Zung questionnaires, and a modified Schober test of spinal mobility. These measures are needed for studies, not for diagnosis or treatment of individual patients. They have been translated into various major languages and validated by back-translations, and applied in comparative studies in various cultures to medical, chiropractic, and other common interventions. The importance of such scientifically sound studies cannot be overemphasized, as the costs of health care are mounting everywhere and it therefore becomes imperative to develop cost-effective approaches. All the more so as conversion of acute back pain to chronic back pain is often iatrogenic, with strong psychosocial factors as well, so that not only what to do but also what not to do become important public health issues. The general lack of attention to back pain by governments and organizations probably results from the fact that it is perceived as a syndromic presentation with myriad causes rather than as a specific disease entity. Even if the "disease" names classify like presentations but are not necessarily etiologically discrete, syndromic diagnoses that subsume a variety of causes receive less attention; international rankings of common disabilities and public health problems tend to emphasize the named disorders rather than the grouped disorders. Moreover, back pain is often self-treated with nonprescription medications or alternative therapies, and by nonmedical practitioners or treatments in many parts of the world. Validation of outcomes therefore not only reduces invalidism and direct costs but also reduces the indirect costs of absenteeism and medical care.
Back Pain↗
Acupuncture as complementary therapy for back pain.
Back pain affects more than 9 million people in the United States and accounts for 25% of disability in all work-related injuries. It has a lifetime prevalence of 60%-90% and it costs more than $50 billion annually to manage back pain. The incidence of back pain in nurses is over 80% and accounts for more than 150 million working days per year being lost. Western treatment of back pain is controversial and often ineffective. Acupuncture as a therapeutic intervention is practiced widely in the United States. Research has demonstrated that acupuncture may benefit those who suffer from back pain when they have failed to respond to previous treatment by drugs, bed rest, epidural injection, physiotherapy, osteopathy, chiropractics, and surgery. Acupuncture is a powerful and complementary therapy for back pain.
Accidents, Occupational↗
Phantom pain, residual limb pain, and back pain in amputees: results of a national survey.
OBJECTIVES: To describe the prevalence of amputation-related pain; to ascertain the intensity and affective quality of phantom pain, residual limb pain, back pain, and nonamputated limb pain; and to identify the role that demographics, amputation-related factors, and depressed mood may contribute to the experience of pain in the amputee. DESIGN: Cross-sectional survey. SETTING: A sample of persons who contacted the Amputee Coalition of America from 1998 to 2000 were interviewed by telephone. PARTICIPANTS: A stratified sample by etiology of 914 persons with limb loss. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Prevalence, intensity, and bothersomeness of residual, phantom, and back pain, depressed mood as measured by the Center for Epidemiologic Study Depression Scale, characteristics of the amputation, prosthetic use, and sociodemographic characteristics of the amputee. RESULTS: Nearly all (95%) amputees surveyed reported experiencing 1 or more types of amputation-related pain in the previous 4 weeks. Phantom pain was reported most often (79.9%), with 67.7% reporting residual limb pain and 62.3% back pain. A large proportion of persons with phantom pain and stump pain reported experiencing severe pain (rating 7-10). Across all pain types, a quarter of those with pain reported their pain to be extremely bothersome. Identifiable risk factors for intensity and bothersomeness of amputation-related pain varied greatly by pain site. However, across all pain types, depressive symptoms were found to be a significant predictor of level of pain intensity and bothersomeness. CONCLUSIONS: Chronic pain is highly prevalent among persons with limb loss, regardless of time since amputation. A common predictor of an increased level of intensity and bothersomeness among all pain sites was the presence of depressive symptoms. Further studies are needed to elucidate the relationship between pain and depressive symptoms among amputees.
Age Factors↗
Managing acute low back pain.
Back pain is very common. In the UK, there were about 14 million GP consultations for back pain in 1993 and around 60-80% of the population will have had it at some time during their lives. Many attacks resolve quickly but some patients go on to develop chronic back pain and a few develop severe, long-term disability. Here we discuss the natural history, diagnosis and management of acute low back pain, focusing on simple low back pain, in which the pain is uncomplicated by nerve root involvement or serious spinal pathology.
Acute Disease↗
Nigerian back school model: development and effect on industrial workers' knowledge of back pain and back care.
Back schools are health education programmes on back pain. Many back schools have been developed for different populations since 1969 when the first one was developed in Sweden, but none for the Nigerian setting. The need to develop a back school that would be appropriate for the Nigerian environment was therefore identified. As a step towards its development, this preliminary study was carried out to determine the effect of a back school model (BSM) on some Nigerian industrial workers' knowledge of low back pain and back care. The subjects were 110 workers of a soap industry in Lagos, Nigeria. Apre-test, post-test quasi-experimental design was used. The BSM consisted of two 45 minute teaching sessions on structure and functions of the back, epidemiology and causes of back pain, correct postures and demonstration of exercises that may prevent/alleviate back pain. Data on demographic information, low back pain (LBP) experience, knowledge of back structure and back care were collected using a questionnaire with closed ended questions, which was completed before, immediately after and 8-weeks after BSM administration. The results showed that the subjects' mean knowledge score increased significantly from an initial value of 16.1 + 5.3 to 24.0 + 5.6 (p < 0.05) immediately after and 23.1 + 3.9 (p < 0.05) 8 weeks after BSM administration. Educational attainment had no influence on subjects' knowledge scores before or 8 weeks after BSM administration. Reported experience of LBP and duration on the job had no significant influence on subjects' knowledge scores before, immediately or 8-weeks following BSM administration. It was concluded that the BSM was effective in improving the workers' knowledge of LBP and back care. We believe that this findingjustifies the effort to develop the Nigerian model of back school.
Adult↗
Identification and management of pregnancy-related low back pain.
Back pain is a common complaint of women during pregnancy. It is frequently dismissed as trivial and inevitable. This article gives an overview of recent research on pregnancy-related back pain that documents the impact of this pain on women's lives, during and beyond the childbearing year. It argues for a more active approach to the prevention and management of back pain during pregnancy. Two common back pain types, lumbar pain and posterior pelvic pain, are described and basic management techniques for the woman and her primary caregiver are suggested. Red flag findings that necessitate specialist referral are also highlighted, as are suggestions for further research.
Female↗
Conservative management of low back pain.
Back pain is prevalent worldwide, but back pain disability has reached epidemic proportions in many industrialised societies. Few patients have serious medical pathology or direct neurological involvement requiring surgery. Although the causes remain unclear, physical stress and its consequences on discs, facet joints and supporting soft tissues at work or leisure are important, sometimes aggravated by adverse psychosocial factors. Modern management emphasises the role of self-care, beginning in primary care with the first episode. Without root compression, bed rest should not exceed 48 hours. Emphasis is on encouraging a rapid return to physical fitness and other activities, including employment, acknowledging that returning to a normal life may require working through pain. Medication facilitates this. No one should remain in pain beyond six weeks without being referred to a specialist service for a physical and psychosocial assessment by appropriately trained professionals and with consultant support for investigation, pain management and rehabilitation when needed.
Anti-Inflammatory Agents, Non-Steroidal↗
Relationship between muscle fiber composition and functional capacity of back muscles in healthy subjects and patients with back pain.
Back muscles are important to the stability of the lumbar spine. Muscle fiber composition may give some indication of the functional capacity of these muscles. This review explores the relationship between muscle fiber composition and functional capacity of back muscles. The reference values for the type and size of the muscle fibers found in the back musculature of healthy subjects and patients with back pain are also presented. A high percentage of type I fibers, which are larger in size than type II fibers, has been found in back muscles at the thoracic and lumbar levels. This is in accordance with the postural function of these muscles. The diameter of type II fibers is smaller in females than males, which may partly explain the lesser strength and greater endurance capacity of back muscles in females. Due to the limited amount of pertinent data, no conclusive evidence is available regarding age-related changes in muscle fiber composition in the musculature of the back. In patients with lumbar disorders, pathological changes and selective atrophy of type II fibers are seen, and these can be changed with adequate exercises. Further research is suggested to address issues related to gender, age, back pain, and exercise and their effects on the apparent back muscle fiber composition.
Aging↗
[Therapeutic approaches in chronic back pain].
Back pain is a common disease causing tremendous costs for treatment, work loss and pension payments. The reasons of back pain vary considerably and often remain doubtful. The effectiveness of common treatment concepts has not yet been proved significantly. Active treatment procedures should be preferred. In chronic pain patients only multimodal concepts of treatment seem to be successful as far as they take care of somatic, psychosocial, ergonomic and sport physiological aspects.
Analgesics↗