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Sample records for acute low-back pain

  1. Low back pain - acute

    MedlinePlus

    Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back strain - new ... lower back supports most of your body's weight. Low back pain is the number two reason that Americans see ...

  2. [Management of acute low back pain].

    PubMed

    Marty, Marc

    2008-02-15

    Acute low back pain is evolving for less than 4 or 6 weeks. The diagnostic stake in front of an acute low back pain is not to ignore a condition requiring a specific treatment (vertebral fracture, tumours, infections, inflammatory diseases...). Signs of alerts from patient history are to be looked for to enable it. Once the diagnosis of non specific low back pain has been confirmed and in absence of neurological complications, the therapeutic stake is to avoid chronicity by a treatment adapted to every patient. Numerous scientific quality data questioned the interest of the bed rest for non specific acute low back pain and the beneficial role of the preservation of the activities to avoid chronicity. The interest to inform and to reassure the patient on his future is also an important condition of the care. PMID:18536202

  3. Acute and Chronic Low Back Pain.

    PubMed

    Patrick, Nathan; Emanski, Eric; Knaub, Mark A

    2016-01-01

    Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function.

  4. Acute and Chronic Low Back Pain.

    PubMed

    Patrick, Nathan; Emanski, Eric; Knaub, Mark A

    2016-01-01

    Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function. PMID:26614726

  5. Acute and chronic low back pain.

    PubMed

    Patrick, Nathan; Emanski, Eric; Knaub, Mark A

    2014-07-01

    Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function. PMID:24994051

  6. Acute low back pain: a comprehensive review.

    PubMed

    Della-Giustina, D; Kilcline, B A

    2000-01-01

    Low back pain is commonly seen in the primary care setting. Although the majority of patients have a benign etiology for their symptoms, one must approach these patients in a systematic fashion, looking for "red flags" of serious disease. PMID:10984818

  7. Psychological Evaluation of Acute Low Back Pain in Hospital Workers

    PubMed Central

    Lamontagne, Yves; Bousquet, Pierre; Elie, Robert; Courtois, Monique

    1983-01-01

    Personality, anxiety and depression were assessed in 62 hospital workers divided in three experimental groups: those with acute organic low back pain, those with acute functional low back pain, and asymptomatic control subjects. Results showed no statistical differences between groups in the evaluation of personality. Asymptomatic subjects had significantly lower scores for trait anxiety and depression than did patients suffering from low back pain. Patients with pain of organic origin were also more depressed than were patients with pain of functional origin. Anxiety and depression are two psychological variables which must be examined in acute back pain problems. Further studies should be conducted to develop more accurate psychological instruments to evaluate the large population of patients suffering from low back pain. PMID:21283394

  8. Acute low back pain: systematic review of its prognosis

    PubMed Central

    Pengel, Liset H M; Herbert, Robert D; Maher, Chris G; Refshauge, Kathryn M

    2003-01-01

    Objectives To describe the course of acute low back pain and sciatica and to identify clinically important prognostic factors for these conditions. Design Systematic review. Data sources Searches of Medline, Embase, Cinahl, and Science Citation Index and iterative searches of bibliographies. Main outcome measures Pain, disability, and return to work. Results 15 studies of variable methodological quality were included. Rapid improvements in pain (mean reduction 58% of initial scores), disability (58%), and return to work (82% of those initially off work) occurred in one month. Further improvement was apparent until about three months. Thereafter levels for pain, disability, and return to work remained almost constant. 73% of patients had at least one recurrence within 12 months. Conclusions People with acute low back pain and associated disability usually improve rapidly within weeks. None the less, pain and disability are typically ongoing, and recurrences are common. PMID:12907487

  9. Acute low back pain: diagnostics and treatment.

    PubMed

    Becker, F C

    2001-03-01

    How many times have you heard from a patient or groaned yourself "Oh, my aching back?" Innocuous movements such as reaching, stooping, or leaning are halted mid-performance as you sense "something" give, catch, snap, grab, or slide in your lower back. Such subjective complaints may also include sensations of discomfort described as stabbing, sharp, dull, hot/burning, tingling, or numbing. In practice, you will be required to assess these subjective symptoms, effectively document objective data, formulate a diagnosis, and plan appropriate treatment for your patients. Careful attention to history, associated symptoms, and following a systematic approach to back pain can make the rule-in/out differentials less taxing on both the practitioner and the patient.

  10. Lumbar Disc Screening Using Back Pain Questionnaires: Oswestry Low Back Pain Score, Aberdeen Low Back Pain Scale, and Acute Low Back Pain Screening Questionnaire

    PubMed Central

    Kim, Do Yeon; Oh, Chang Hyun; Park, Hyung Chun; Park, Chong Oon

    2012-01-01

    Objective To evaluate the usefulness of back pain questionnaires for lumbar disc screening among Korean young males. Methods We carried out a survey for lumbar disc screening through back pain questionnaires among the volunteers with or without back pain. Three types of back pain questionnaire (Oswestry Low Back Pain Score, Aberdeen Low Back Pain Scale, and Acute Low Back Pain Screeing Questionnaire) were randomly assigned to the examinees. The authors reviewed lumbar imaging studies (simple lumbar radiographs, lumbar computed tomography, and magnetic resolutional images), and the severity of lumbar disc herniation was categorized according to the guidelines issued by the Korean military directorate. We calculated the relationship between the back pain questionnaire scores and the severity of lumbar disc herniation. Results The scores of back pain questionnaires increased according to the severity of lumbar disc herniation. But, the range of scores was very vague, so it is less predictable to detect lumbar disc herniation using only back pain questionnaires. The sensitivity between the back pain questionnaires and the presence of lumbar disc herniation was low (16-64%). Conclusion Screening of lumbar disc herniation using only back pain questionnaires has limited value. PMID:25983807

  11. Backfire: AHCPR practice guideline for acute low back pain.

    PubMed

    de Jong, R H

    1995-11-01

    The AHCPR "Guideline for Acute Low Back Problems in Adults" is a must-read for every South Carolina physician treating low back pain. The 25-page pamphlet excels as a practical guide for swiftly triaging acute low back problems into the 90 percent majority who recover within a month, from the few "red flag" and "red herring" serious back problems requiring urgent attention. But the Guideline panel overstepped its policymaking mandate by venturing into the quicksand of treatment by committee edict, rather than by on-the-spot caretakers. The rumbling backfire is that U. S. Government document, intended as practice guideline for routine acute back care, will come to haunt us as a practice standard for all back care. One-size-fits-all proposals for the majority short-change the few with more demanding healthcare resource requirements. Be sure to read the pamphlet; your patients, insurers, providers, administrators, journalists and attorneys will! PMID:8544439

  12. Effects of Acute Low Back Pain on Postural Control

    PubMed Central

    Sohn, Min Kyun; Lee, Sang Sook

    2013-01-01

    Objective To evaluate the changes in static and dynamic postural control after the development of acute low back pain. Methods Thirty healthy right-handed volunteers were divided into three groups; the right back pain group, the left back pain group, and the control group. 0.5 mL of 5% hypertonic saline was injected into L4-5 paraspinal muscle for 5 seconds to cause muscle pain. The movement of the center of gravity (COG) during their static and dynamic postural control was measured with their eyes open and with their eyes closed before and 2 minutes after the injection. Results The COGs for the healthy adults shifted to the right quadrant and the posterior quadrant during their static and dynamic postural control test (p<0.05). The static and dynamic instability index while they had their eyes closed was significantly increased than when they had their eyes open with and without acute back pain. After pain induction, their overall and anterior/posterior instability was increased in both the right back pain group and the left back pain group during the static postural control test (p<0.05). A right deviation and a posterior deviation of the COG still remained, and the posterior deviation was greater in the right back pain group (p<0.05). Conclusion The static instability, particularly the anterior/posterior instability was increased in the presence of acute low back pain, regardless of the visual information and the location of pain. PMID:23526750

  13. Psychological aspects of acute low back pain in general practice

    PubMed Central

    Gilchrist, Iain C.

    1983-01-01

    A prospective controlled study of acute low back pain in general practice was carried out. The presence of psychiatric illness was measured by use of the general health questionnaire (GHQ), by clinical assessment, and personality factors by use of the Eysenck personality inventory (EPI). It was found that overall the amount of psychiatric illness did not differ between patients with back pain and their controls at the time of presentation, although there was a higher prevalence of previous psychiatric illness in the back-pain group. The only difference in the personality factors measured was a higher degree of extraversion in the back-pain patients. PMID:6224930

  14. Persistence behavior of chronic low back pain patients in an acute pain situation.

    PubMed

    Schmidt, A J; Brands, A M

    1986-01-01

    The test behavior of 24 chronic low back pain patients was compared with the behavior of 24 healthy control Ss., matched for age and sex, in an experimental, acute pain situation (cold pressor-test). Chronic low back pain patients showed poorer persistence behavior and reported more pain. Thus, elements of typical chronic low back pain behavior were also present in an acute pain situation. These findings are discussed within the framework of stimulus-generalization theory. In addition, the effect of different coping strategies on pain tolerance was reconfirmed. The chronic low back pain group and the control group did not cope differently.

  15. Low-back pain.

    PubMed

    Violante, Francesco S; Mattioli, Stefano; Bonfiglioli, Roberta

    2015-01-01

    Low-back pain is one of the most common painful conditions experienced by humans throughout their life. Some occupational risk factors (namely, heavy manual material handling) may also contribute to the development of low-back pain: due to the high prevalence of both low-back pain and manual material handling in the adult working population, it has been estimated that low-back pain is probably the most common occupational disorder worldwide. Lifetime prevalence of low-back pain has been reported to be as high as 84%, depending on the case definition used, and no age group is spared, even children. Although low-back pain is not a lethal condition, it was estimated at the third rank among all diseases by disability-adjusted life-years in 2010 in the USA, after ischemic heart disease and chronic obstructive pulmonary disease, and at the first rank by years lived with disability. It also ranked high (13th) globally for the same year, in disability-adjusted life-years. Low-back pain is currently classified as nonspecific/specific as to putative cause and as acute (lasting less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks) according to duration of symptoms. The distinction between nonspecific/specific and acute/subacute/chronic low-back pain is useful not only for epidemiologic studies, but also (mainly) for choosing the appropriate strategy for the diagnosis and treatment of the disorder. Workplace risk factors for low-back pain include manual lifting and whole-body vibration exposure. This chapter will provide an overview of modern concepts of low-back pain (in general) and will then outline some distinctive features of work-related low-back pain. PMID:26563799

  16. Low-back pain.

    PubMed

    Violante, Francesco S; Mattioli, Stefano; Bonfiglioli, Roberta

    2015-01-01

    Low-back pain is one of the most common painful conditions experienced by humans throughout their life. Some occupational risk factors (namely, heavy manual material handling) may also contribute to the development of low-back pain: due to the high prevalence of both low-back pain and manual material handling in the adult working population, it has been estimated that low-back pain is probably the most common occupational disorder worldwide. Lifetime prevalence of low-back pain has been reported to be as high as 84%, depending on the case definition used, and no age group is spared, even children. Although low-back pain is not a lethal condition, it was estimated at the third rank among all diseases by disability-adjusted life-years in 2010 in the USA, after ischemic heart disease and chronic obstructive pulmonary disease, and at the first rank by years lived with disability. It also ranked high (13th) globally for the same year, in disability-adjusted life-years. Low-back pain is currently classified as nonspecific/specific as to putative cause and as acute (lasting less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks) according to duration of symptoms. The distinction between nonspecific/specific and acute/subacute/chronic low-back pain is useful not only for epidemiologic studies, but also (mainly) for choosing the appropriate strategy for the diagnosis and treatment of the disorder. Workplace risk factors for low-back pain include manual lifting and whole-body vibration exposure. This chapter will provide an overview of modern concepts of low-back pain (in general) and will then outline some distinctive features of work-related low-back pain.

  17. [Acute low back pain--assessment and management].

    PubMed

    Gautschi, O P; Hildebrandt, G; Cadosch, D

    2008-01-23

    Acute low back pain is a very common symptom. Up to 90% of all adults suffer at least once in their life from a low back pain episode, in the majority of cases a nonspecific lumbago. They are, with or without sciatica, usually self-limited and have no serious underlying pathology and subside in 80-90% of the concerned patients within six weeks. Beside a sufficient pain medication and physiotherapy, reassurance about the overall benign character and the favourable prognosis of the medical condition should be in the centre of the therapeutic efforts. A more thorough assessment is required for selected patients with warning signs, so called "red flags" findings, because they are associated with an increased risk of cauda equina syndrome, cancer, infection, or fracture. These patients also require a closer follow-up and, in some cases, an urgent surgical intervention. Among patients with acute nonspecific mechanical low back pain, imaging diagnostic can be delayed for at least four to six weeks, which usually allows the medical condition to improve. From a therapeutic viewpoint, there is enough evidence for the effectiveness of paracetamol, nonsteroidal anti-inflammatory drugs, skeletal muscle relaxants, heat therapy, physiotherapy, and the advice to stay "active". A complete relief and protection represent an out-dated concept, because the deconditioning is stimulated and the return to the workplace is needlessly delayed. Spinal manipulative therapy may provide short-term benefits in certain patients. In a multimodal therapeutic concept, the patient education should focus on the natural history of an acute back pain episode, the overall good prognosis, and recommendations for an effective treatment.

  18. Predicting Outcome in Acute Low-Back Pain

    PubMed Central

    Singer, Joel; Gilbert, J.R.; Hutton, Tim; Taylor, D.W.

    1987-01-01

    Patients presenting to their family physician with acute low-back pain were studied prospectively. Demographic factors and patient history at the initial visit were assessed to determine important predictors of selected clinical outcomes, including time to resumption of normal activities and time to relief from pain. While several predictors were significantly correlated with each of the outcomes assessed, the most consistent predictor of outcome proved to be the reported pain intensity at the initial visit. Baseline levels of pain intensity were related to expected time of recovery and probability of periodic pain in the future. Data collected in the initial history and physical examination of patients permit an assessment of factors that may be useful in establishing prognosis for relevant clinical outcomes. PMID:21263854

  19. Evaluation and treatment of acute low back pain.

    PubMed

    Kinkade, Scott

    2007-04-15

    Acute low back pain with or without sciatica usually is self-limited and has no serious underlying pathology. For most patients, reassurance, pain medications, and advice to stay active are sufficient. A more thorough evaluation is required in selected patients with "red flag" findings associated with an increased risk of cauda equina syndrome, cancer, infection, or fracture. These patients also require closer follow-up and, in some cases, urgent referral to a surgeon. In patients with nonspecific mechanical low back pain, imaging can be delayed for at least four to six weeks, which usually allows the pain to improve. There is good evidence for the effectiveness of acetaminophen, nonsteroidal anti-inflammatory drugs, skeletal muscle relaxants, heat therapy, physical therapy, and advice to stay active. Spinal manipulative therapy may provide short-term benefits compared with sham therapy but not when compared with conventional treatments. Evidence for the benefit of acupuncture is conflicting, with higher-quality trials showing no benefit. Patient education should focus on the natural history of the back pain, its overall good prognosis, and recommendations for effective treatments. PMID:17477101

  20. Low back pain.

    PubMed

    Golob, Anna L; Wipf, Joyce E

    2014-05-01

    Low back pain is a common, frequently recurring condition that often has a nonspecific cause. Most nonspecific acute low back pain will improve within several weeks with or without treatment. The diagnostic workup should focus on evaluation for evidence of systemic or pathologic causes. Psychosocial distress, poor coping skills, and high initial disability increase the risk for a prolonged disability course. All patients with acute or chronic low back pain should be advised to remain active. The treatment of chronic nonspecific low back pain involves a multidisciplinary approach targeted at preserving function and preventing disability. Surgical referral is indicated in the presence of severe or progressive neurologic deficits or signs and symptoms of cauda equina syndrome. PMID:24758954

  1. Low back pain.

    PubMed

    Golob, Anna L; Wipf, Joyce E

    2014-05-01

    Low back pain is a common, frequently recurring condition that often has a nonspecific cause. Most nonspecific acute low back pain will improve within several weeks with or without treatment. The diagnostic workup should focus on evaluation for evidence of systemic or pathologic causes. Psychosocial distress, poor coping skills, and high initial disability increase the risk for a prolonged disability course. All patients with acute or chronic low back pain should be advised to remain active. The treatment of chronic nonspecific low back pain involves a multidisciplinary approach targeted at preserving function and preventing disability. Surgical referral is indicated in the presence of severe or progressive neurologic deficits or signs and symptoms of cauda equina syndrome.

  2. Low Back Pain

    PubMed Central

    Reuler, James B.

    1985-01-01

    Low back pain is one of the most common and costly afflictions of our Society. The majority of adults will have at least one episode of acute low back pain that will likely resolve regardless of treatment. Lumbar spine radiographs are overused and there is little scientific support for many of the therapeutic interventions advocated. Even for those patients with symptomatic herniated disc, only a small fraction will ultimately require surgical intervention. PMID:2930949

  3. Diagnosis and treatment of acute low back pain.

    PubMed

    Casazza, Brian A

    2012-02-15

    Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare cases of serious underlying pathology. Certain red flags should prompt aggressive treatment or referral to a spine specialist, whereas others are less concerning. Serious red flags include significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis), major or progressive motor or sensory deficit, new-onset bowel or bladder incontinence or urinary retention, loss of anal sphincter tone, saddle anesthesia, history of cancer metastatic to bone, and suspected spinal infection. Without clinical signs of serious pathology, diagnostic imaging and laboratory testing often are not required. Although there are numerous treatments for nonspecific acute low back pain, most have little evidence of benefit. Patient education and medications such as nonsteroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants are beneficial. Bed rest should be avoided if possible. Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain and need for health care services. Spinal manipulation and chiropractic techniques are no more effective than established medical treatments, and adding them to established treatments does not improve outcomes. No substantial benefit has been shown with oral steroids, acupuncture, massage, traction, lumbar supports, or regular exercise programs. PMID:22335313

  4. Low Back Pain

    MedlinePlus

    ... Low Back Pain Overview What is low back pain? Low back pain is a common problem for many people. It can be caused by many ... lift and exercise correctly. Symptoms When is low back pain serious? Call your family doctor if: Pain goes ...

  5. Low back pain: pharmacologic management.

    PubMed

    Miller, Susan M

    2012-09-01

    Adequate treatment of low back pain is essential, but has been challenging for many primary care physicians. Most patients with low back pain can be treated in the primary care environment, provided the physician has enough knowledge of the medications used to treat low back pain. The main treatment goal for acute low back pain is to control the pain and maintain function. For patients with chronic back pain, the goal is continual pain management and prevention of future exacerbations. This article reviews current pharmacological options for the treatment of low back pain, and possible future innovations. PMID:22958559

  6. Low back pain, radiculopathy.

    PubMed

    Selkirk, Stephen M; Ruff, Robert

    2016-01-01

    Low back pain is a pervasive problem in the adult population. Most patients with low back pain will not require imaging as spontaneous recovery within 12 weeks is the rule. However, a small percentage of patients with low back pain will have serious underlying pathology requiring more intensive investigation. This chapter delineates the signs and symptoms related to potential serious underlying causes and discusses appropriate imaging modalities that should be utilized in patients with low back pain. PMID:27430456

  7. Prognosis of acute low back pain: design of a prospective inception cohort study

    PubMed Central

    Henschke, Nicholas; Maher, Christopher G; Refshauge, Kathryn M; Herbert, Robert D; Cumming, Robert G; Bleasel, Jane; York, John; Das, Anurina; McAuley, James H

    2006-01-01

    Background Clinical guidelines generally portray acute low back pain as a benign and self-limiting condition. However, evidence about the clinical course of acute low back pain is contradictory and the risk of subsequently developing chronic low back pain remains uncertain. There are few high quality prognosis studies and none that have measured pain, disability and return to work over a 12 month period. This study aims to provide the first estimates of the one year prognosis of acute low back pain (pain of less than 2 weeks duration) in patients consulting primary care practitioners. A secondary aim is to identify factors that are associated with the prognosis of low back pain. Methods/Design The study is a prospective inception cohort study. Consecutive patients consulting general medical practitioners, physiotherapists and chiropractors in the Sydney metropolitan region will complete a baseline questionnaire regarding their back pain. Subsequently these patients will be followed up by telephone 6 weeks, 3 months and 12 months after the initial consultation. Patients will be considered to have recovered from the episode of back pain if they have no pain and no limitation of activity, and have returned to pre-injury work status. Life tables will be generated to determine the one year prognosis of acute low back pain. Prognostic factors will be assessed using Cox regression. Discussion This study will provide the first estimates of the one year prognosis of acute low back pain in a representative sample of primary care patients. PMID:16790069

  8. Trajectories of acute low back pain: a latent class growth analysis.

    PubMed

    Downie, Aron S; Hancock, Mark J; Rzewuska, Magdalena; Williams, Christopher M; Lin, Chung-Wei Christine; Maher, Christopher G

    2016-01-01

    Characterising the clinical course of back pain by mean pain scores over time may not adequately reflect the complexity of the clinical course of acute low back pain. We analysed pain scores over 12 weeks for 1585 patients with acute low back pain presenting to primary care to identify distinct pain trajectory groups and baseline patient characteristics associated with membership of each cluster. This was a secondary analysis of the PACE trial that evaluated paracetamol for acute low back pain. Latent class growth analysis determined a 5 cluster model, which comprised 567 (35.8%) patients who recovered by week 2 (cluster 1, rapid pain recovery); 543 (34.3%) patients who recovered by week 12 (cluster 2, pain recovery by week 12); 222 (14.0%) patients whose pain reduced but did not recover (cluster 3, incomplete pain recovery); 167 (10.5%) patients whose pain initially decreased but then increased by week 12 (cluster 4, fluctuating pain); and 86 (5.4%) patients who experienced high-level pain for the whole 12 weeks (cluster 5, persistent high pain). Patients with longer pain duration were more likely to experience delayed recovery or nonrecovery. Belief in greater risk of persistence was associated with nonrecovery, but not delayed recovery. Higher pain intensity, longer duration, and workers' compensation were associated with persistent high pain, whereas older age and increased number of episodes were associated with fluctuating pain. Identification of discrete pain trajectory groups offers the potential to better manage acute low back pain.

  9. Trajectories of acute low back pain: a latent class growth analysis.

    PubMed

    Downie, Aron S; Hancock, Mark J; Rzewuska, Magdalena; Williams, Christopher M; Lin, Chung-Wei Christine; Maher, Christopher G

    2016-01-01

    Characterising the clinical course of back pain by mean pain scores over time may not adequately reflect the complexity of the clinical course of acute low back pain. We analysed pain scores over 12 weeks for 1585 patients with acute low back pain presenting to primary care to identify distinct pain trajectory groups and baseline patient characteristics associated with membership of each cluster. This was a secondary analysis of the PACE trial that evaluated paracetamol for acute low back pain. Latent class growth analysis determined a 5 cluster model, which comprised 567 (35.8%) patients who recovered by week 2 (cluster 1, rapid pain recovery); 543 (34.3%) patients who recovered by week 12 (cluster 2, pain recovery by week 12); 222 (14.0%) patients whose pain reduced but did not recover (cluster 3, incomplete pain recovery); 167 (10.5%) patients whose pain initially decreased but then increased by week 12 (cluster 4, fluctuating pain); and 86 (5.4%) patients who experienced high-level pain for the whole 12 weeks (cluster 5, persistent high pain). Patients with longer pain duration were more likely to experience delayed recovery or nonrecovery. Belief in greater risk of persistence was associated with nonrecovery, but not delayed recovery. Higher pain intensity, longer duration, and workers' compensation were associated with persistent high pain, whereas older age and increased number of episodes were associated with fluctuating pain. Identification of discrete pain trajectory groups offers the potential to better manage acute low back pain. PMID:26397929

  10. Psychometric properties of the Brazilian version of the Pain Catastrophizing Scale for acute low back pain.

    PubMed

    Lopes, Renata Antunes; Dias, Rosângela Corrêa; Queiroz, Bárbara Zille de; Rosa, Nayza Maciel de Britto; Pereira, Leani de Souza Máximo; Dias, João Marcos Domingues; Magalhães, Lívia de Castro

    2015-05-01

    Measurement instruments of pain catastrophizing for middle-aged and elderly individuals are needed to understand its impact on low back pain. The goals were to cross-culturally adapt the Pain Catastrophizing Scale, assess the construct validity through Rasch analysis, and verify reliability and convergent validity of pain catastrophizing with psychosocial factors. 131 individuals aged 55 years and older with acute low back pain were interviewed . The intra-rater reliability was Kp = 0.80 and interrater Kp = 0.75. The Rasch analysis found adequate reliability coefficients (0.95 for items and 0.90 for individuals ). The separation index for the elderly was 2.95 and 4.59 items. Of the 13 items, one did not fit the model, which was justified in the sample evaluated. The pain catastrophizing correlated with most psychosocial factors. The instrument proved to be clinically useful. Subsequent studies should carry out the same analysis in different populations. PMID:26017211

  11. Development and validation of a screening tool to predict the risk of chronic low back pain in patients presenting with acute low back pain: a study protocol

    PubMed Central

    Traeger, Adrian; Henschke, Nicholas; Hübscher, Markus; Williams, Christopher M; Kamper, Steven J; Maher, Chris G; Moseley, G Lorimer; McAuley, James H

    2015-01-01

    Introduction Around 40% of people presenting to primary care with an episode of acute low back pain develop chronic low back pain. In order to reduce the risk of developing chronic low back pain, effective secondary prevention strategies are needed. Early identification of at-risk patients allows clinicians to make informed decisions based on prognostic profile, and researchers to select appropriate participants for secondary prevention trials. The aim of this study is to develop and validate a prognostic screening tool that identifies patients with acute low back pain in primary care who are at risk of developing chronic low back pain. This paper describes the methods and analysis plan for the development and validation of the tool. Methods/analysis The prognostic screening tool will be developed using methods recommended by the Prognosis Research Strategy (PROGRESS) Group and reported using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement. In the development stage, we will use data from 1248 patients recruited for a prospective cohort study of acute low back pain in primary care. We will construct 3 logistic regression models to predict chronic low back pain according to 3 definitions: any pain, high pain and disability at 3 months. In the validation stage, we will use data from a separate sample of 1643 patients with acute low back pain to assess the performance of each prognostic model. We will produce validation plots showing Nagelkerke R2 and Brier score (overall performance), area under the curve statistic (discrimination) and the calibration slope and intercept (calibration). Ethics and dissemination Ethical approval from the University of Sydney Ethics Committee was obtained for both of the original studies that we plan to analyse using the methods outlined in this protocol (Henschke et al, ref 11-2002/3/3144; Williams et al, ref 11638). PMID:26179647

  12. Availability of services to treat patients with acute low back pain.

    PubMed Central

    Underwood, M R; Vickers, M R; Barnett, A G

    1997-01-01

    Guidelines for the management of acute low back pain were published in 1994. This national survey, conducted soon after, showed that the availability of services for general practitioners (GPs) to treat acute back pain fell short of the guideline recommendations. A repeat survey will be performed to measure the impact of guideline publication and dissemination. PMID:9302790

  13. Incidence and risk factors for acute low back pain in active duty infantry.

    PubMed

    Ernat, Justin; Knox, Jeffrey; Orchowski, Joseph; Owens, Brett

    2012-11-01

    Although much research has been performed on occupational risk factors for low back pain, little has been published on low back pain among infantrymen. This purpose of this study is to evaluate the incidence of acute low back pain amongst active duty infantrymen as compared to a matched control population. The Defense Medical Epidemiology Database was searched and incidence rates were calculated and compared between infantry and noninfantry soldiers. Data was stratified and controlled for age, race, marital status, rank, and branch of service using the Poisson multivariate regression analysis. Significantly lower rates of acute low back pain were discovered in active duty infantrymen when compared to matched controls (32.9 versus 49.5 cases per 1,000 person-years). Additionally, significantly lower rates were identified in the Marines versus the Army, and among junior enlisted compared to senior enlisted service members. PMID:23198512

  14. Low back pain.

    PubMed Central

    Ehrlich, George E.

    2003-01-01

    Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. Acute back pain is the most common presentation and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong psychological overlay: work dissatisfaction, boredom, and a generous compensation system contribute to it. Among the diagnoses offered for chronic pain is fibromyalgia, an urban condition (the diagnosis is not made in rural settings) that does not differ materially from other instances of widespread chronic pain. Although disc protrusions detected on X-ray are often blamed, they rarely are responsible for the pain, and surgery is seldom successful at alleviating it. No single treatment is superior to others; patients prefer manipulative therapy, but studies have not demonstrated that it has any superiority over others. A WHO Advisory Panel has defined common outcome measures to be used to judge the efficacy of treatments for studies. PMID:14710509

  15. Usefulness of the Pain Tracking Technique in Acute Mechanical Low Back Pain

    PubMed Central

    Bravo Acosta, Tania; Martín Cordero, Jorge E.; Hernández Tápanes, Solangel; Pedroso Morales, Isis; Fernández Cuesta, José Ignacio; Leyva Serrano, Maritza

    2015-01-01

    Objective. To evaluate the usefulness of the pain tracking technique in acute mechanical low back pain. Method. We performed an experimental prospective (longitudinal) explanatory study between January 2011 and September 2012. The sample was randomly divided into two groups. Patients were assessed at the start and end of the treatment using the visual analogue scale and the Waddell test. Treatment consisted in applying the pain tracking technique to the study group and interferential current therapy to the control group. At the end of treatment, cryotherapy was applied for 10 minutes. The Wilcoxon signed-rank test and the Mann Whitney test were used. They were performed with a predetermined significance level of p ≤ 0.05. Results. Pain was triggered by prolonged static posture and intense physical labor and intensified through trunk movements and when sitting and standing. The greatest relief was reported in lateral decubitus position and in William's position. The majority of the patients had contracture. Pain and disability were modified with the rehabilitation treatment in both groups. Conclusions. Both the pain tracking and interferential current techniques combined with cryotherapy are useful treatments for acute mechanical low back pain. The onset of analgesia is faster when using the pain tracking technique. PMID:26240758

  16. Usefulness of the Pain Tracking Technique in Acute Mechanical Low Back Pain.

    PubMed

    Bravo Acosta, Tania; Martín Cordero, Jorge E; Hernández Tápanes, Solangel; Pedroso Morales, Isis; Fernández Cuesta, José Ignacio; Leyva Serrano, Maritza

    2015-01-01

    Objective. To evaluate the usefulness of the pain tracking technique in acute mechanical low back pain. Method. We performed an experimental prospective (longitudinal) explanatory study between January 2011 and September 2012. The sample was randomly divided into two groups. Patients were assessed at the start and end of the treatment using the visual analogue scale and the Waddell test. Treatment consisted in applying the pain tracking technique to the study group and interferential current therapy to the control group. At the end of treatment, cryotherapy was applied for 10 minutes. The Wilcoxon signed-rank test and the Mann Whitney test were used. They were performed with a predetermined significance level of p ≤ 0.05. Results. Pain was triggered by prolonged static posture and intense physical labor and intensified through trunk movements and when sitting and standing. The greatest relief was reported in lateral decubitus position and in William's position. The majority of the patients had contracture. Pain and disability were modified with the rehabilitation treatment in both groups. Conclusions. Both the pain tracking and interferential current techniques combined with cryotherapy are useful treatments for acute mechanical low back pain. The onset of analgesia is faster when using the pain tracking technique. PMID:26240758

  17. Myofascial low back pain.

    PubMed

    Ramsook, Ryan R; Malanga, Gerard A

    2012-10-01

    Low back pain is a common condition that is encountered by both primary care physicians as well as various specialists, which include: orthopedic surgeons, physical medicine and rehabilitation specialists, neurologists, rheumatologists, and pain management specialists. Associated muscular pain is very common and often a reactive response from nociception from other structures. Myofascial pain may arise, which is characterized by the presence of myofascial trigger points (MTrPs) that are located in fascia, tendons, and/or muscle. This article reviews the current evidence regarding the pathophysiology, assessment, and recommended treatment options for myofascial low back pain.

  18. Management Patterns in Acute Low Back Pain: the Role of Physical Therapy

    PubMed Central

    Gellhorn, Alfred Campbell; Chan, Leighton; Martin, Brook; Friedly, Janna

    2010-01-01

    Study Design Retrospective cohort study. Objective To evaluate the relationship between early physical therapy (PT) for acute low back pain and subsequent use of lumbosacral injections, lumbar surgery, and frequent physician office visits for low back pain. Summary of Background Data Wide practice variations exist in the treatment of acute low back pain. Physical Therapy (PT) has been advocated as an effective treatment in this setting though disagreement exists regarding its purported benefits. Methods A national 20% sample of the Centers for Medicare & Medicaid Services physician outpatient billing claims was analyzed. Patients were selected who received treatment for low back pain between 2003 and 2004 (n=439,195). To exclude chronic low back conditions, patients were excluded if they had a prior visit for back pain, lumbosacral injection, or lumbar surgery within the previous year. Main outcome measures were rates of lumbar surgery, lumbosacral injections, and frequent physician office visits for low back pain over the following year. Results Based on logistic regression analysis, the adjusted odds ratio for undergoing surgery in the group of enrollees that received PT in the acute phase (<4 weeks) compared to those receiving PT in the chronic phase (>3 months) was 0.38 (95% CI, 0.36 to 0.41), adjusting for age, gender, diagnosis, treating physician specialty, and comorbidity. The adjusted OR for receiving a lumbosacral injection in the group receiving PT in the acute phase was 0.46 (95% CI, 0.44 to 0.49), and the adjusted OR for frequent physician office usage in the group receiving PT in the acute phase was 0.47 (95% CI, 0.44 to 0.50). Conclusions There was a lower risk of subsequent medical service usage among patients who received PT early after an episode of acute low back pain relative to those who received PT at later times. Medical specialty variations exist regarding early use of PT, with potential underutilization among generalist specialties. PMID

  19. Clinical decision support and acute low back pain: evidence-based order sets.

    PubMed

    Forseen, Scott E; Corey, Amanda S

    2012-10-01

    Low back pain is one of the most common reasons for visits to physicians in the ambulatory care setting. Estimated medical expenditures related to low back pain have increased disproportionately relative to the more modest increase in the prevalence of self-reported low back pain in the past decade. The increase in spine care expenditures has not been associated with improved patient outcomes. Evidence-based order templates presented in this article are designed to assist practitioners through the process of managing patients with acute low back pain. A logical method of choosing, developing, and implementing clinical decision support interventions is presented that is based on the best available scientific evidence. These templates may be reasonably expected to improve patient care, decrease inappropriate imaging utilization, reduce the inappropriate use of steroids and narcotics, and potentially decrease the number of inappropriate invasive procedures. PMID:23025864

  20. Acute Low Back Pain and Primary Care: How to Define Recovery and Chronification?

    PubMed Central

    Mehling, Wolf E.; Gopisetty, Viranjini; Acree, Michael; Pressman, Alice; Carey, Tim; Goldberg, Harley; Hecht, Frederick; Avins, Andrew L

    2011-01-01

    Study Design Prospective cohort study Objective to establish outcome measures for recovery and chronic pain for studies with patients that present with recent-onset acute low back pain in primary care Summary of Background Data Among back pain researchers, no consensus exists about outcome definitions or how to identify primary-care patients as not-recovered from an episode of low back pain. Cut points for outcome scales have mostly been arbitrarily chosen. Theoretical models for establishing minimal important change (MIC) values in studies of patients with low back pain have been proposed and need to be applied to real data. Methods In a sample of 521 patients which presented with acute low back pain (<4 weeks) in primary care clinics and were followed for 6 months, scores for pain and disability were compared with ratings on a global perceived effect scale. Using multiple potential “gold standards” as anchors (reference standards), the receiver operating characteristics method was used to determine optimal cut points for different ways of defining non-recovery from acute low back pain. Results MIC values and upper limits for pain and disability scores as well as minimal important percent changes are presented for five different definitions of recovery. A previously suggested 30% change from baseline scores does not accurately discriminate between recovered and not recovered patients in patients presenting with acute low back pain in primary care. Conclusions Outcome definitions that combine ratings from perceived recovery scales with pain and disability measures provide the highest accuracy in discriminating recovered from non-recovered patients. PMID:21311400

  1. Avoidance of affective pain stimuli predicts chronicity in patients with acute low back pain.

    PubMed

    Sharpe, Louise; Haggman, Sonia; Nicholas, Michael; Dear, Blake F; Refshauge, Kathryn

    2014-01-01

    This prospective study of acute and sub-acute low back pain (LBP) patients was conducted to assess whether attentional biases predicted chronic pain status 3 and 6 months later. The attentional biases of 100 LBP patients were assessed within 3 months of developing pain and 6 months later. Participants also completed measures associated with outcome at 3 assessment points: baseline, 3 and 6 months later. Current pain status was assessed at follow-ups. Patients were classified as those that met standard criteria for chronic pain or those who did not (i.e., the comparison group). At baseline, participants demonstrated a bias toward sensory pain words. However, biases toward sensory pain words did not differentiate those who subsequently developed chronic pain and those who did not at either follow-up. The same bias was observed 6 months later, but again it failed to distinguish between the chronic pain and comparison groups. However, subjects who developed chronic pain at both 3 (n=22) and 6 (n=21) months demonstrated biases away from affective pain words at baseline but not 6 months later, in comparison to other participants. These results remained significant in multivariate analyses. These findings are consistent with patterns observed in the previous research, and suggest that avoidance of emotionally laden pain-related stimuli (i.e., affective pain words) is associated with negative outcomes for LBP patients in the acute and sub-acute phase. This research suggests that attentional biases in relation to pain-related stimuli are important for the development of chronic pain, but are more complex than initially thought. PMID:24028848

  2. Ultrasound guided, painful electrical stimulation of lumbar facet joint structures: an experimental model of acute low back pain.

    PubMed

    O'Neill, Søren; Graven-Nielsen, Thomas; Manniche, Claus; Arendt-Nielsen, Lars

    2009-07-01

    Quantitative sensory testing has indicated generalized muscle hyperalgesia in patients with chronic low back pain. The temporal development of such hyperalgesia is not well understood. The aim of the present study was to demonstrate whether generalized muscle hyperalgesia can develop within minutes of acute low back pain using a new experimental model of lumbar facet joint pain. Thirteen healthy volunteers were included and baseline pressure pain thresholds were assessed at eight separate sites, outside the area of evoked low back and referred pain. Using ultrasonography, two electrode needles were placed either side of a lumbar facet joint (right L3-4) and used to induce experimental low back pain for 10 min with continuous stimulation. Thresholds, stimulus-response relationships, distribution and quality of the electrically induced pain were recorded. Electrical facet joint stimulation induced low back pain and pain referral into the anterior leg, ipsilaterally, proximal to the knee, similar to what is observed clinically. Pressure pain thresholds did not change significantly before, during and after facet joint stimulation. In conclusion, we describe a novel model of acute experimental low back pain and demonstrate that generalized hyperalgesia did not develop within minutes of acute low back pain. PMID:19376652

  3. A Study on Factors Affecting Low Back Pain and Safety and Efficacy of NSAIDs in Acute Low Back Pain in a Tertiary Care Hospital of Western Nepal

    PubMed Central

    Bhattarai, Srijana; Chhetri, Himal Paudel; Alam, Kadir; Thapa, Pabin

    2013-01-01

    Introduction: Low back pain is characterized by a range of symptoms which include pain, muscle tension or stiffness, and is localized between the shoulder blades and the folds of the buttocks, with or without spreading to the legs. Non-Steroidal Anti Inflammatory Drugs (NSAIDs) are the drugs of choice which provide an analgesic effect for acute low back pain. Aim: To study the factors affecting low back pain, efficacy and safety of different non-steroidal anti-inflammatory drugs (aceclofenac, diclofenac, naproxen and nimesulide) in low back pain. Methodology: Data collection form and numeric pain rating scale were used as study tools for studying patients’ demographies and severities of pain respectively. Patients prescribed with aceclofenac 100 mg , diclofenac 100 mg, naproxen 500 mg and nimesulide 100 mg for acute low back pain at Orthopaedics Outpatients Department of Manipal Teaching Hospital, Nepal, were enrolled in this study. The decrease in pain scores was recorded on 5th and 10th days of follow-up and pain scores were calculated. Descriptive statistics and Kruskal Wallis non parametric test were used for analysis. Results: Among 150 patients, 67.3% were females (n=101). Low back pain was more prevalent (24.7%) in age-group of 59-68 years and a positive correlation was seen. Similarly, low back pain was found to be high among people involved in agriculture, heavy weight lifters and non smokers. The decrease in average pain scores was more in the patients treated with aceclofenac (4.83 ± 0.537), followed by that in those who were treated with naproxen (4.13 ± 0.067) and diclofenac (3.84 ± 0.086). The decrease in pain scores was found to be lowest among patients who were treated with nimesulide (2.11 ± 0.148). Nimesulide presented more number of side-effects than the comparative drugs. Conclusion: Different factors affect low back pain, such as age, gender, personal habit, posture, occupation, weight lifting. Aceclofenac showed greater decrease in pain

  4. Natural course of acute neck and low back pain in the general population: the HUNT study.

    PubMed

    Vasseljen, Ottar; Woodhouse, Astrid; Bjørngaard, Johan Håkon; Leivseth, Linda

    2013-08-01

    In this prospective cohort study we aimed to describe the natural course of acute neck and low back pain in a general population of Norway. We screened 9056 subjects aged 20-67 years who participated in a general health survey for a new episode of neck or low back pain the previous month. The screening identified 219 subjects who formed the cohort for this study. Pain intensity was reported on a numeric rating scale (0-10) at 1, 2, 3, 6, and 12 months after start of the new pain episode. The course of pain was described for neck and low back pain, different baseline pain levels, age groups, and number of pain sites at baseline. Use of medication and health care was described and associations between pain intensity and seeking health care were estimated. Pain declined rapidly within 1 month after a new pain episode, with a reduction of 0.91 (95% confidence interval [CI] 0.50-1.32) for neck pain and 1.40 (95% CI 0.82-1.99) for low back pain with little change thereafter. However, pain remained unchanged over the follow-up year for those with equal pain in the neck and low back areas at baseline and for those reporting 4 or more pain sites at baseline. Only 1 in 5 sought health care for their complaints. Still, the course of pain was comparable to effect sizes reported in interventional studies. This study thus contributes natural course reference data for comparisons of pain outcome in clinical trials and practice.

  5. Routine primary care management of acute low back pain: adherence to clinical guidelines.

    PubMed

    González-Urzelai, Violeta; Palacio-Elua, Loreto; López-de-Munain, Josefina

    2003-12-01

    One of the major challenges for general practitioners is to manage individuals with acute low back pain appropriately to reduce the risk of chronicity. A prospective study was designed to assess the actual management of acute low back pain in one primary care setting and to determine whether existing practice patterns conform to published guidelines. Twenty-four family physicians from public primary care centers of the Basque Health Service in Bizkaia, Basque Country (Spain), participated in the study. A total of 105 patients aged 18-65 years presenting with acute low back pain over a 6-month period were included. Immediately after consultation, a research assistant performed a structured clinical interview. The patients' care provided by the general practitioner was compared with the Agency for Health Care Policy and Research (AHCPR) guidelines and guidelines issued by the Royal College of General Practitioners. The diagnostic process showed a low rate of appropriate use of history (27%), physical examination (32%), lumbar radiographs (31%), and referral to specialized care (33%). Although the therapeutic process showed a relatively high rate of appropriateness in earlier mobilization (77%) and educational advice (65%), only 23% of patients were taught about the benign course of back pain. The study revealed that management of acute low back pain in the primary care setting is far from being in conformance with published clinical guidelines. PMID:14605973

  6. Discogenic low back pain.

    PubMed

    Simon, Jeremy; McAuliffe, Matthew; Shamim, Fehreen; Vuong, Nancy; Tahaei, Amir

    2014-05-01

    Most lumbar disk herniations improve over time with or without medical treatment. Disk herniations and annular tears may not be symptomatic and are shown to exist in patients without any symptoms. In some patients, chronic low back pain may result from the syndrome of internal disk disruption. Treatment of chronic pain of diskal cause can be challenging and have varying results in terms of success. The diagnosis, cause, and treatment options are reviewed in this article. PMID:24787335

  7. The Relationship of Depression to Work Status during the Acute Period of Low Back Pain.

    ERIC Educational Resources Information Center

    Beaudet, Joanne; Rasch, John

    1988-01-01

    Investigated relationship of Beck Depression Inventory (BDI) scores to employment status and time since injury among persons with acute low back pain. Work status was unrelated to BDI scores. Participants 5 to 6 months post-injury scored higher than participants l month post-injury; participants working 5 to 6 months post-injury scored higher than…

  8. Evaluating and Managing Acute Low Back Pain in the Primary Care Setting

    PubMed Central

    Atlas, Steven J; Deyo, Richard A

    2001-01-01

    Acute low back pain is a common reason for patient calls or visits to a primary care clinician. Despite a large differential diagnosis, the precise etiology is rarely identified, although musculoligamentous processes are usually suspected. For most patients, back symptoms are nonspecific, meaning that there is no evidence for radicular symptoms or underlying systemic disease. Because episodes of acute, nonspecific low back pain are usually self-limited, many patients treat themselves without contacting their primary care clinician. When patients do call or schedule a visit, evaluation and management by primary care clinicians is appropriate. The history and physical examination usually provide clues to the rare but potentially serious causes of low back pain, as well as to identify patients at risk for prolonged recovery. Diagnostic testing, including plain x-rays, is often unnecessary during the initial evaluation. For patients with acute, nonspecific low back pain, the primary emphasis of treatment should be conservative care, time, reassurance, and education. Current recommendations focus on activity as tolerated (though not active exercise while pain is severe) and minimal if any bed rest. Referral for physical treatments is most appropriate for patients whose symptoms are not improving over 2 to 4 weeks. Specialty referral should be considered for patients with a progressive neurologic deficit, failure of conservative therapy, or an uncertain or serious diagnosis. The prognosis for most patients is good, although recurrence is common. Thus, educating patients about the natural history of acute low back pain and how to prevent future episodes can help ensure reasonable expectations. PMID:11251764

  9. Patients’ expectations of acute low back pain management: implications for evidence uptake

    PubMed Central

    2013-01-01

    Background In many countries, general practitioner (GP) care of acute low back pain often does not adhere to evidence-based clinical guidelines. There has been little exploration of this deviation from evidence-based care from the patients’ perspective, particularly in relation to patients’ care expectations. The aim of this study was to explore the care expectations in patients who present to their GP with acute low back pain, influences on expectation development, and congruence of these expectations with clinical guideline recommendations. Methods Qualitative study in an inner urban general practice in Brisbane, Australia. Semi-structured interviews were conducted with 11 patients who presented to their GP with acute low back pain. Results Patients had a biomechanical understanding of back pain, how it should be tested and treated, and a poor understanding of its natural history. Most expected x-rays, believing they were necessary to identify the “cause of the pain” without belief of any downsides to x-rays. Patients’ expectations were primarily influenced by the experiences of family and friends, their own previous experiences of low back pain care, and comments from other health professionals they were consulting. The GP-patient relationship was important in influencing patient satisfaction of care provided. Most patient expectations, and some of the care that they reported receiving, were incongruent with guideline recommendations. Conclusions A biomechanical approach to management rather than an awareness of empirical evidence was evident in patients’ expectations. Communication and education by the GP that includes specifically enquiring about patients’ expectations, provides an opportunity to correct misperceptions, explain acute low back pain natural history, and the rationale for test and treatment recommendations. PMID:23297840

  10. Chiropractic Care of Acute Low Back Pain and Incidental Spina Bifida Occulta: A Case Report

    PubMed Central

    Cofano, Gregory P.; Anderson, Benjamin C.; Stumpff, Eric R.

    2014-01-01

    Objective The purpose of this case report is to describe chiropractic care of an adolescent with acute low back pain and incidental finding of spina bifida occulta managed with high-velocity low-amplitude manipulation. Clinical Features A 10-year-old boy was referred for chiropractic care by his pediatrician for the management of low back pain after a fall 3 days prior. Examination and medical records revealed the patient also had spina bifida occulta at the level of L5. Intervention and Outcome High-velocity low-amplitude treatment for lower back pain showed resolution of patient's pain after 6 visits. No adverse effects were reported. Conclusion An adolescent patient with lower back pain and incidental finding of spina bifida occulta improved with a course of care that included with high-velocity low-amplitude manipulation therapy. PMID:25435841

  11. Unusual cause of acute low-back pain: sudden annulus fibrosus rupture

    PubMed Central

    Ozer, Ali Fahir; Oktenoglu, Tunc; Sasani, Mehdi; Kaner, Tuncay; Ercelen, Omur; Canbulat, Nazan

    2012-01-01

    Low-back pain is a common problem in neu-rosurgery practice, and an algorithm has been developed for assessing these cases. However, one subgroup of these patients shares several clinical features and these individuals are not easy to categorize and diagnose. We present our observations for 8 of these patients, individuals with low-back pain caused by atypical annulus fibrosus rupture (AAR). The aim of this study is to show the consequences of overlooked annular tears on acute onset of low back pain. Eight patients with acute-onset severe low-back pain were admitted. Physical examinations were normal and each individual was examined neurologically and assessed with neuroradiologic studies [plain x-rays, magnetic resonance imaging (MRI), discography and computed tomography (CT) discography]. AAR was ultimately diagnosed with provocative discography. In all cases, MRI showed a healthy disc or mild degeneration, whereas discography and CT discography demonstrated disc disease. Anterior interbody cage implantation was performed in 3 of the 8 cases and posterior dynamic stabilization was carried out in 3 cases. The other 2 individuals refused surgery, and we were informed that one of them developed disc herniation at the affected level 1 year after our diagnosis. Clinical and radiological outcomes were evaluated. In cases where AAR is suspected, MRI, discography, and CT discography should be performed in addition to routine neuroradiologic studies. PMID:22802990

  12. Unusual cause of acute low-back pain: sudden annulus fibrosus rupture.

    PubMed

    Ozer, Ali Fahir; Oktenoglu, Tunc; Sasani, Mehdi; Kaner, Tuncay; Ercelen, Omur; Canbulat, Nazan

    2012-05-01

    Low-back pain is a common problem in neu-rosurgery practice, and an algorithm has been developed for assessing these cases. However, one subgroup of these patients shares several clinical features and these individuals are not easy to categorize and diagnose. We present our observations for 8 of these patients, individuals with low-back pain caused by atypical annulus fibrosus rupture (AAR). The aim of this study is to show the consequences of overlooked annular tears on acute onset of low back pain. Eight patients with acute-onset severe low-back pain were admitted. Physical examinations were normal and each individual was examined neurologically and assessed with neuroradiologic studies [plain x-rays, magnetic resonance imaging (MRI), discography and computed tomography (CT) discography]. AAR was ultimately diagnosed with provocative discography. In all cases, MRI showed a healthy disc or mild degeneration, whereas discography and CT discography demonstrated disc disease. Anterior interbody cage implantation was performed in 3 of the 8 cases and posterior dynamic stabilization was carried out in 3 cases. The other 2 individuals refused surgery, and we were informed that one of them developed disc herniation at the affected level 1 year after our diagnosis. Clinical and radiological outcomes were evaluated. In cases where AAR is suspected, MRI, discography, and CT discography should be performed in addition to routine neuroradiologic studies. PMID:22802990

  13. Fear of movement/(re)injury, disability and participation in acute low back pain.

    PubMed

    Swinkels-Meewisse, Ilse E J; Roelofs, Jeffrey; Verbeek, André L M; Oostendorp, Rob A B; Vlaeyen, Johan W S

    2003-09-01

    Fear of movement/(re)injury and its associated avoidance behavior have shown to be strongly associated with functional disability in chronic low back pain. In acute low back pain disability, the role of pain-related fear has received little research attention so far. Measures of pain-related fear such as the Tampa Scale for Kinesiophobia (TSK) are increasingly being used in primary care. The aim of the present study was: (1). to further investigate the factor structure of the TSK in a population of acute low back pain (LBP) patients in primary care by means of a confirmatory factor analysis (CFA); (2). to examine the relationship between fear of movement/(re)injury and disability, as well as participation in daily and social life activities in 615 acute LBP patients seen by general practitioners and physical therapists in primary care settings; and (3). to examine whether disability mediates the association between pain-related fear and participation. CFA, and a subsequent explorative factor analysis on the TSK revealed a two-factor model. The factors consisted of items associated with 'harm', and items representing the 'avoidance of activity'. Both constructs were significantly associated with disability and participation. Additionally, and in contrast to what is often observed in chronic pain, disability, and to a lesser degree participation, were also associated with pain intensity. Finally, the association between pain-related fear, pain intensity and participation was indeed mediated by disability. The results suggest that early on in the development of LBP disability, the successful reduction of pain-related fear and disability might foster increased participation in daily and social life activities. PMID:14499456

  14. Manipulative therapy and/or NSAIDs for acute low back pain: design of a randomized controlled trial [ACTRN012605000036617

    PubMed Central

    Hancock, Mark J; Maher, Christopher G; Latimer, Jane; McLachlan, Andrew J; Cooper, Chris W; Day, Richard O; Spindler, Megan F; McAuley, James H

    2005-01-01

    Background Acute low back pain is a common condition resulting in pain and disability. Current national and international guidelines advocate general practitioner care including advice and paracetamol (4 g daily in otherwise well adults) as the first line of care for people with acute low back pain. Non-steroidal anti-inflammatory drugs (NSAIDs) and spinal manipulative therapy (SMT) are advocated in many guidelines as second line management options for patients with acute low back pain who are not recovering. No studies have explored the role of NSAIDs and/or SMT in addition to first line management for acute low back pain. The primary aim of this study is to investigate if NSAIDs and/or SMT in addition to general practitioner advice and paracetamol results in shorter recovery times for patients with acute low back pain. The secondary aims of the study are to evaluate whether the addition of SMT and/or NSAIDs influences pain, disability and global perceived effect at 1, 2, 4 and 12 weeks after onset of therapy for patients with significant acute low back pain. Methods/design This paper presents the rationale and design of a randomised controlled trial examining the addition of NSAIDs and/or SMT in 240 people who present to their general practitioner with significant acute low back pain. PMID:16280089

  15. [Therapeutic algorithm for low back pain].

    PubMed

    Illés, T S; Schiopu, D; Ouahes, R; Penders, W; Reynders, P F

    2015-09-01

    Low back pain (LBP) has become one of the greatest public health problems. The differentiation between specific and non-specific low back pain is mandatory. In the specific low back pain are classified all diseases whose etiology is well defined, quick and accurate diagnosis is required for specific treatment. Other types of low back pain can be considered non-specific. The management of acute low back pain is mainly based on analgesic treatment and early mobilization. Maintaining activity can prevent chronicity of LBP. Chronicity factors are multiple, mainly psycho-social and professional. The chronic low back pain treatment goals are the reduction of pain and better activity/participation to achieve the prevention of disability and maintaining work ability. Multidisciplinary treatment programs including personalized and guided physical therapy, cognitive behavioral therapy and short-term training programs will help to improve, restore and maintain the function in chronic low back pain. PMID:26591318

  16. [Therapeutic algorithm for low back pain].

    PubMed

    Illés, T S; Schiopu, D; Ouahes, R; Penders, W; Reynders, P F

    2015-09-01

    Low back pain (LBP) has become one of the greatest public health problems. The differentiation between specific and non-specific low back pain is mandatory. In the specific low back pain are classified all diseases whose etiology is well defined, quick and accurate diagnosis is required for specific treatment. Other types of low back pain can be considered non-specific. The management of acute low back pain is mainly based on analgesic treatment and early mobilization. Maintaining activity can prevent chronicity of LBP. Chronicity factors are multiple, mainly psycho-social and professional. The chronic low back pain treatment goals are the reduction of pain and better activity/participation to achieve the prevention of disability and maintaining work ability. Multidisciplinary treatment programs including personalized and guided physical therapy, cognitive behavioral therapy and short-term training programs will help to improve, restore and maintain the function in chronic low back pain.

  17. Systematic reviews of bed rest and advice to stay active for acute low back pain.

    PubMed Central

    Waddell, G; Feder, G; Lewis, M

    1997-01-01

    BACKGROUND: In the United Kingdom (UK), 9% of adults consult their doctor annually with back pain. The treatment recommendations are based on orthopaedic teaching, but the current management is causing increasing dissatisfaction. Many general practitioners (GPs) are confused about what constitutes effective advice. AIM: To review all randomized controlled trials of bed rest and of medical advice to stay active for acute back pain. METHOD: A systematic review based on a search of MEDLINE and EMBASE from 1966 to April 1996 with complete citation tracking for randomized controlled trials of bed rest or medical advice to stay active and continue ordinary daily activities. The inclusion criteria were: primary care setting, patients with low back pain of up to 3 months duration, and patient-centred outcomes (rate of recovery from the acute attack, relief of pain, restoration of function, satisfaction with treatment, days off work and return to work, development of chronic pain and disability, recurrent attacks, and further health care use). RESULTS: Ten trials of bed rest and eight trials of advice to stay active were identified. Consistent findings showed that bed rest is not an effective treatment for acute low back pain but may delay recovery. Advice to stay active and to continue ordinary activities results in a faster return to work, less chronic disability, and fewer recurrent problems. CONCLUSION: A simple but fundamental change from the traditional prescription of bed rest to positive advice about staying active could improve clinical outcomes and reduce the personal and social impact of back pain. PMID:9474831

  18. Implementation of RCGP guidelines for acute low back pain: a cluster randomised controlled trial.

    PubMed Central

    Dey, Paola; Simpson, Carl W R; Collins, Stuart I; Hodgson, G; Dowrick, Christopher F; Simison, A J M; Rose, M J

    2004-01-01

    BACKGROUND: The Royal College of General Practitioners (RCGP) has produced guidelines for the management of acute low back pain in primary care. AIM: To investigate the impact on patient management of an educational strategy to promote these guidelines among general practitioners (GPs). DESIGN OF STUDY: Group randomised controlled trial, using the health centre as the unit of randomisation. SETTING: Primary care teams in north-west England. METHOD: Twenty-four health centres were randomly allocated to an intervention or control arm. Practices in the intervention arm were offered outreach visits to promote national guidelines on acute low back pain, as well as access to fast-track physiotherapy and to a triage service for patients with persistent symptoms. RESULTS: Twenty-four centres were randomised. Two thousand, one hundred and eighty-seven eligible patients presented with acute low back pain during the study period: 1049 in the intervention group and 1138 in the control group. There were no significant differences between study groups in the proportion of patients who were referred for X-ray, issued with a sickness certificate, prescribed opioids or muscle relaxants, or who were referred to secondary care, but significantly more patients in the intervention group were referred to physiotherapy or the back pain unit (difference in proportion = 12.2%, 95% confidence interval [CI] = 2.8% to 21.6%). CONCLUSION: The management of patients presenting with low back pain to primary care was mostly unchanged by an outreach educational strategy to promote greater adherence to RCGP guidelines among GPs. An increase in referral to physiotherapy or educational programmes followed the provision of a triage service. PMID:14965404

  19. Randomized Controlled Trial of Education and Feedback for Implementation of Guidelines for Acute Low Back Pain

    PubMed Central

    Schectman, Joel M; Schroth, W Scott; Verme, Dante; Voss, John D

    2003-01-01

    OBJECTIVE The effect of clinical guidelines on resource utilization for complex conditions with substantial barriers to clinician behavior change has not been well studied. We report the impact of a multifaceted guideline implementation intervention on primary care clinician utilization of radiologic and specialty services for the care of acute low back pain. DESIGN Physician groups were randomized to receive guideline education and individual feedback, supporting patient education materials, both, or neither. The impact on guideline adherence and resource utilization was evaluated during the 12-month period before and after implementation. PARTICIPANTS Fourteen physician groups with 120 primary care physician and associate practitioners from 2 group model HMO practices. INTERVENTIONS Guideline implementation utilized an education/audit/feedback model with local peer opinion leaders. The patient education component included written and videotaped materials on the care of low back pain. MAIN RESULTS The clinician intervention was associated with an absolute increase in guideline-consistent behavior of 5.4% in the intervention group versus a decline of 2.7% in the control group (P = .04). The patient education intervention produced no significant change in guideline-consistent behavior, but was poorly adopted. Patient characteristics including duration of pain, prior history of low back pain, and number of visits during the illness episode were strong predictors of service utilization and guideline-consistent behavior. CONCLUSIONS Implementation of an education and feedback-supported acute low back pain care guideline for primary care clinicians was associated with an increase in guideline-consistent behavior. Patient education materials did not enhance guideline effectiveness. Implementation barriers could limit the utility of this approach in usual care setttings. PMID:14521638

  20. MRI and low back pain

    MedlinePlus

    Backache - MRI; Low back pain - MRI; Lumbar pain - MRI; Back strain - MRI; Lumbar radiculopathy - MRI; Herniated intervertebral disk - MRI; Prolapsed intervertebral disk - MRI; Slipped disk - MRI; Ruptured ...

  1. Does 48 hours' bed rest influence the outcome of acute low back pain?

    PubMed Central

    Wilkinson, M J

    1995-01-01

    BACKGROUND. Bed rest is a traditional treatment for back pain, yet only in recent years has the therapeutic benefit of this been questioned. AIM. The aim of this pilot study was to ascertain whether or not 48 hours' bed rest had an effect on the outcome of acute low back pain. METHOD. The study was conducted as a randomized controlled trial to compare a prescription of 48 hours' strict bed rest with controls; the control subjects were encouraged to remain mobile and to have no daytime rest. Nine general practitioners from practices in the West Midlands recruited patients in the age range 16-60 years who presented with low back pain of less than seven days' duration, with or without pain radiation. The outcome measures assessed were: change in straight leg raise and lumbar flexion after seven days, Oswestry and Roland-Morris disability scores after seven days and 28 days, and time taken from work. RESULTS. Forty two patients were recruited: 20 were allocated to bed rest and 22 as controls. Compared with the bed rest group the control group had statistically better Roland-Morris scores at day seven (P < 0.05) but not at day 28. At day seven, there were no statistically significant differences between groups in straight leg raise or lumbar flexion measurements although the control group had a better mean lumbar flexion than the bed rest group. The improvement in disability scores at day seven compared with day one was similar for the two groups but more of the control group had fully recovered (defined as scores of one or zero on the Roland-Morris disability scale and five or less on the Oswestry disability scale) by day seven. Remaining mobile did not appear to cause any adverse effects. The number of days lost from work in both groups was equal. A large number of self-remedies and physical therapies were recorded by subjects from both groups. CONCLUSION. The results of this pilot study did not indicate whether bed rest or remaining mobile was superior for the

  2. Acupuncture in patients with acute low back pain: a multicentre randomised controlled clinical trial.

    PubMed

    Vas, Jorge; Aranda, José Manuel; Modesto, Manuela; Benítez-Parejo, Nicolás; Herrera, Antonia; Martínez-Barquín, Dulce María; Aguilar, Inmaculada; Sánchez-Araujo, Max; Rivas-Ruiz, Francisco

    2012-09-01

    Reviews of the efficacy of acupuncture as a treatment for acute low back pain have concluded that there is insufficient evidence for its efficacy and that more research is needed to evaluate it. A multicentre randomized controlled trial was conducted at 4 primary-care centres in Spain to evaluate the effects of acupuncture in patients with acute nonspecific low back pain in the context of primary care. A total of 275 patients with nonspecific acute low back pain (diagnosed by their general practitioner) were recruited and assigned randomly to 4 different groups: conventional treatment either alone or complemented by 5 sessions over a 2-week period of true acupuncture, sham acupuncture, or placebo acupuncture per patient. Patients were treated from February 2006 to January 2008. The primary outcome was the reduction in Roland Morris Disability Questionnaire scores of 35% or more after 2weeks' treatment. The patients in the 3 types of acupuncture groups were blinded to the treatments, but those who received conventional treatment alone were not. In the analysis adjusted for the total sample (true acupuncture relative risk 5.04, 95% confidence interval 2.24-11.32; sham acupuncture relative risk 5.02, 95% confidence interval 2.26-11.16; placebo acupuncture relative risk 2.57 95% confidence interval 1.21-5.46), as well as for the subsample of occupationally active patients, all 3 modalities of acupuncture were better than conventional treatment alone, but there was no difference among the 3 acupuncture modalities, which implies that true acupuncture is not better than sham or placebo acupuncture. PMID:22770838

  3. Patterns and Determinants of Multiple Provider Use in Patients with Acute Low Back Pain

    PubMed Central

    Sundararajan, Vijaya; Konrad, Thomas R; Garrett, Joanne; Carey, Timothy

    1998-01-01

    OBJECTIVE To describe the patterns of provider use associated with an acute episode of nonspecific low back pain and their impact on cost. METHODS The analysis is based on a prospective cohort study of patients with acute low back pain followed until they recovered completely or to 6 months. Patients were followed after an initial visit to one of four provider types: private primary care physician, chiropractor, orthopedic surgeon, or HMO primary care physician. Follow-up interviews were conducted at baseline, 2, 4, 8, 12, and 24 weeks; 1,580 (97%) of the participants completed the 6-month follow-up. MAIN RESULTS Seventy-nine percent of patients saw only the initial provider who began their care for low back pain. Logistic regression revealed that duration of pain prior to initial visit, sciatica, higher Roland disability score, days to functional recovery, interval to complete recovery, referral by initial provider, disk attribution, satisfaction, and the type of index provider were significantly (p < .05) associated with seeking care from multiple provider types. Age, race, gender, and education were not significant. The adjusted proportions of multiple provider type use were 14% (95% confidence interval [CI] 11%, 17%) for the private primary care provider stratum; 19% (95% CI 16%, 23%) for the chiropractic stratum; 30% (95% CI 23%, 37%) for the orthopedic stratum; and 9% (95% CI 5%, 14%) for the HMO primary care physician stratum. Cost of seeing only the index provider was $439 (95% CI $404, $475), and cost of seeing multiple provider types was $1,137 (95% CI $1,064, $1,211) based on the adjusted model. CONCLUSIONS Use of multiple provider types, is associated with several factors, one of which is the initial provider type. The cost of such use is significant. PMID:9734789

  4. Myofascial low back pain treatment.

    PubMed

    Sharan, Deepak; Rajkumar, Joshua Samuel; Mohandoss, Mathankumar; Ranganathan, Rameshkumar

    2014-09-01

    Myofascial pain is a common musculoskeletal problem, with the low back being one of the commonest affected regions. Several treatments have been used for myofascial low back pain through physical therapies, pharmacologic agents, injections, and other such therapies. This review will provide an update based on recently published literature in the field of myofascial low back pain along with a brief description of a sequenced, multidisciplinary treatment protocol called Skilled Hands-on Approach for the Release of myofascia, Articular, Neural and Soft tissue mobilization (SHARANS) protocol. A comprehensive multidisciplinary approach is recommended for the successful management of individuals with myofascial low back pain.

  5. Myofascial low back pain treatment.

    PubMed

    Sharan, Deepak; Rajkumar, Joshua Samuel; Mohandoss, Mathankumar; Ranganathan, Rameshkumar

    2014-09-01

    Myofascial pain is a common musculoskeletal problem, with the low back being one of the commonest affected regions. Several treatments have been used for myofascial low back pain through physical therapies, pharmacologic agents, injections, and other such therapies. This review will provide an update based on recently published literature in the field of myofascial low back pain along with a brief description of a sequenced, multidisciplinary treatment protocol called Skilled Hands-on Approach for the Release of myofascia, Articular, Neural and Soft tissue mobilization (SHARANS) protocol. A comprehensive multidisciplinary approach is recommended for the successful management of individuals with myofascial low back pain. PMID:25091133

  6. Effects of Biofreeze and chiropractic adjustments on acute low back pain: a pilot study☆

    PubMed Central

    Zhang, John; Enix, Dennis; Snyder, Brian; Giggey, Kristan; Tepe, Rodger

    2008-01-01

    Abstract Objective This randomized controlled study was designed to determine the pain-relieving effect of Biofreeze (Performance Health Inc., Export, PA) body surface application and chiropractic adjustments on subjects with acute low back pain (LBP). Methods The data were collected at the baseline, 2 weeks after treatment, and 4 weeks after treatment for final analyses. Diversified manual adjustments were provided by licensed chiropractors twice a week for 4 weeks to both control and experimental groups. Biofreeze was applied to the lower back area 3 times a day for 4 weeks in the experimental group. Outcome assessments included visual analog scale, Roland Morris Disability Questionnaire, heart rate variability for stress, and electromyography for low back muscle activity. Results A total of 36 subjects were recruited in the study (25 male). The average age was 34 years. Significant pain reduction was found after each week of treatment in the experimental group (P < .05). The Roland Morris Disability Questionnaire did not show significant changes in both groups. There were no significant differences for pain reduction in the control group. Heart rate variability analysis showed no significant change (P > .05) in the experimental group after 4 weeks of Biofreeze and chiropractic adjustments. There were no statistically significant changes in the electromyography readings between the 2 groups. Conclusion Biofreeze combined with chiropractic adjustment showed significant reduction in LBP. PMID:19674721

  7. Acute low back pain: patients' perceptions of pain four weeks after initial diagnosis and treatment in general practice

    PubMed Central

    Chavannes, A.W.; Gubbels, J.; Post, D.; Rutten, G.; Thomas, S.

    1986-01-01

    In a nationwide study of the treatment of acute low back pain with and without radiation in general practice in the Netherlands the subjective well-being of patients was evaluated by means of a short questionnaire sent to patients four weeks after the initial contact with their general practitioner. After this period pain had disappeared in 28% of the patients, was diminished in 47%, was unchanged in 2% and was aggravated in 4%. There was no difference in the pain score of patients with and without follow-up encounters with their general practitioner. In all instances patients with low back pain without radiation fared significantly better than those with radiation. Radiation of pain was not constant — during the four-week follow-up period it developed in 19% of the patients originally without radiation and it disappeared in 44% of the patients originally suffering radiation. PMID:2945009

  8. Depression impacts the course of recovery in patients with acute low-back pain.

    PubMed

    Melloh, Markus; Elfering, Achim; Käser, Anja; Salathé, Cornelia Rolli; Barz, Thomas; Aghayev, Emin; Röder, Christoph; Theis, Jean-Claude

    2013-01-01

    Little is known about the course of recovery of acute low back pain (LBP) patients as a function of depression. In a prospective study, 286 acute LBP patients were assessed at baseline and followed up over 6 months. Recovery was defined as improvement in the Oswestry Disability Index (ODI). Repeated-measures analysis of covariance was employed with ODI as repeated factor, age, sex, and body mass index as covariates, depression and all other potential prognostic factors as between-subject factors. Of study participants, 18% were classified as depressive (>33 points on the Zung Self-Rating Depression Scale). Of 286 participants, 135 were lost to follow-up. In the longitudinal sample of 151 patients the course of recovery was slower in depressive patients. Depression was associated with LBP especially after 6 weeks and should therefore be included in screening instruments for acute LBP patients to identify those at risk of delayed recovery at an early stage. PMID:23930900

  9. COOP-WONCA charts: a suitable functional status screening instrument in acute low back pain?

    PubMed Central

    Andres, E; Temme, M; Raderschatt, B; Szecsenyi, J; Sandholzer, H; Kochen, M M

    1995-01-01

    BACKGROUND: Functional status is considered an important measure of health status in primary care. The COOP-WONCA charts, which comprise six single-item scales, have mainly been used to determine functional ability in chronically ill patients. AIM: A study was carried out to determine whether the charts are able to measure the degree of functional impairment associated with acute illness and the improvement in functional ability accompanying the process of recovery. METHOD: A total of 95 patients presenting with acute low back pain were recruited from 15 single-handed general practices in northern Germany. At presentation and at two-week follow up, these patients completed self-administered questionnaires which included the COOP-WONCA charts. The charts ask patients to use the timescale of the past two weeks when rating their condition. Baseline and follow-up measurements of the charts were compared and correlations of chart scores with patients' measurements of pain intensity on a visual analogue scale, general practitioners' ratings of impairment and patients' measurements of recovery were analysed. RESULTS: Only the chart measuring change in health revealed a deterioration in functional ability associated with the onset of pain and an improvement in functional status at follow up. Two of the other charts indicated a deterioration at follow up. Only the chart measuring change in health was correlated with ratings of pain and impairment at baseline. At follow up, strong correlations were found between general practitioners' assessments of impairment, patients' ratings of pain and patients' ratings of recovery for all scales except for those measuring social activities and daily activities. The patients interpreted the instructions for using the COOP-WONCA charts differently; some included the period of acute back pain while others did not. CONCLUSION: Of the six charts only the change in health chart proved to be a suitable scale for measuring short-term changes

  10. Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice.

    PubMed Central

    Coste, J.; Delecoeuillerie, G.; Cohen de Lara, A.; Le Parc, J. M.; Paolaggi, J. B.

    1994-01-01

    OBJECTIVE--To describe the natural course of recent acute low back pain in terms of both morbidity (pain, disability) and absenteeism from work and to evaluate the prognostic factors for these outcomes. DESIGN--Inception cohort study. SETTING--Primary care. PATIENTS--103 patients with acute localised non-specific back pain lasting less than 72 hours. MAIN OUTCOME MEASURES--Complete recovery (disappearance of both pain and disability) and return to work. RESULTS--90% of patients recovered within two weeks and only two developed chronic low back pain. Only 49 of 100 patients for whom data were available had bed rest and 40% of 75 employed patients lost no time from work. Proportional hazards regression analysis showed that previous chronic episodes of low back pain, initial disability level, initial pain worse when standing, initial pain worse when lying, and compensation status were significantly associated with delayed episode recovery. These factors were also related to absenteeism from work. Absenteeism from work was also influenced by job satisfaction and gender. CONCLUSIONS--The recovery rate from acute low back pain was much higher than reported in other studies. Those studies, however, did not investigate groups of patients enrolled shortly after the onset of symptoms and often mixed acute low back pain patients with patients with exacerbations of chronic pain or sciatica. Several sociodemographic and clinical factors were of prognostic value in acute low back pain. Factors which influenced the outcome in terms of episode recovery (mainly physical severity factors) were only partly predictive of absenteeism from work. Time off work and return to work depended more on sociodemographic and job related influences. PMID:8148683

  11. Mesotherapy versus Systemic Therapy in the Treatment of Acute Low Back Pain: A Randomized Trial

    PubMed Central

    Costantino, Cosimo; Marangio, Emilio; Coruzzi, Gabriella

    2011-01-01

    Pharmacological therapy of back pain with analgesics and anti-inflammatory drugs is frequently associated with adverse effects, particularly in the elderly. Aim of this study was to compare mesotherapic versus conventional systemic administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in patients with acute low back pain. Eighty-four patients were randomized to receive anti-inflammatory therapy according to the following protocols: (a) mesotherapy group received the 1st and 4th day 2% lidocaine (1 mL) + ketoprofen 160 mg (1 mL) + methylprednisolone 40 mg (1 mL), then on 7th, 10th, and 13th day, 2% lidocaine (1 mL) + ketoprofen 160 mg (1 mL) + methylprednisolone 20 mg (1 mL) (b) conventional therapy group received ketoprofen 80 mg × 2/die and esomeprazole 20 mg/die orally for 12 days, methylprednisolone 40 mg/die intramuscularly for 4 days, followed by methylprednisolone 20 mg/die for 3 days, and thereafter, methylprednisolone 20 mg/die at alternate days. Pain intensity and functional disability were assessed at baseline (T0), at the end of treatment (T1), and 6 months thereafter (T2) by using visual analogic scale (VAS) and Roland-Morris disability questionnaire (RMDQ). In both groups, VAS and RMDQ values were significantly reduced at the end of drug treatment and after 6 months, in comparison with baseline. No significant differences were found between the two groups. This suggests that mesotherapy may be a valid alternative to conventional therapy in the treatment of acute low back pain with corticosteroids and NSAIDs. PMID:20953425

  12. Low Back Pain

    MedlinePlus

    ... focuses on their pain as well as their perception of its severity. Pain that becomes chronic also ... that stimulating the nervous system can modify the perception of pain. Early studies of TENS suggested that ...

  13. The Efficacy of Thermotherapy and Cryotherapy on Pain Relief in Patients with Acute Low Back Pain, A Clinical Trial Study

    PubMed Central

    Dehghan, Morteza

    2014-01-01

    Introduction: Acute low back pain is one of the most common health problems especially in industrialized countries where 75 per cent of the population develop it at least once during their life. This study examined the efficacy of thermotherapy and cryotherapy, alongside a routine pharmacologic treatment, on pain relief in patients with acute low back pain referring an orthopedic clinic in Shahrekord, Iran. Materials and Methods: This clinical trial study was conducted on 87 patients randomly assigned to three (thermotherapy and cryotherapy as intervention, and naproxen as control) groups of 29 each. The first (thermotherapy) group underwent treatment with hot water bag and naproxen, the second (cryotherapy) group was treated with ice and naproxen, and the naproxen group was only treated with naproxen, all for one week. All patients were examined on 0, 3rd, 8th, and 15th day after the first visit and the data gathered by McGill Pain Questionnaire. The data were analyzed by SPSS software using paired t-test, ANOVA, and chi-square. Results: In this study, mean age of the patients was 34.48 (20–50) years and 51.72 per cent were female. Thermotherapy patients reported significantly less pain compared to cryotherapy and control (p≤0.05). In thermotherapy and cryotherapy groups, mean pain in the first visit was 12.70±3.7 and 12.06±2.6, and on the 15th day after intervention 0.75±0.37 and 2.20±2.12, respectively. Conclusion: The results indicated that the application of thermo–therapy and cryotherapy accompanied with a pharmacologic treatment could relieve pain in the patients with acute low back pain. PMID:25386469

  14. Acute epigastric and low back pain during amiodarone infusion; is it the drug or the vehicle to blame?

    PubMed

    Petrou, Emmanouil; Iakovou, Ioannis; Boutsikou, Maria; Girasis, Chrysafios; Mavrogeni, Sophie; Pavlides, Gregory

    2014-01-01

    Amiodarone is a Class III antiarrhythmic agent used for cardioversion and prevention of recurrences of atrial fibrillation. However, its use is limited due to its side-effects resulting from the drug's long-term administration. We have described acute epigastric pain following treatment with intravenous amiodarone for atrial fibrillation in a previous report. Hereby, we describe a second patient who suffered acute epigastric pain, as well as one who suffered acute low back pain. Intravenous amiodarone has been related to a series of minor and major adverse reactions, indicating other constituents of the intravenous solution as the possible cause, possibly polysorbate-80. A possible correlation between acute epigastric and low back pain after intravenous amiodarone loading is unproven; however it is of crucial importance for clinicians to be aware of this phenomenon, and especially since an acute epigastric pain is implicated in the differential diagnosis of cardiac ischemia. PMID:24239300

  15. MRI assessment of paraspinal muscles in patients with acute and chronic unilateral low back pain

    PubMed Central

    Wan, Q; Lin, C; Li, X; Zeng, W

    2015-01-01

    Objective: To investigate the changes in paraspinal muscle cross-sectional area (CSA) and composition, using the digital data from lumbar spine MRIs of patients with acute and chronic low back pain (LBP). Methods: In total, 178 patients with unilateral LBP who had lumbar MRI examination were recruited. The data were obtained by a retrospective documentation audit. The CSAs and mean signal intensities of the bilateral paraspinal muscles [psoas major (PM), quadratus lumborum, multifidus (MF) and erector spinae (ES)] were measured, and the percentage of fat infiltration was calculated. The data between the painful side and non-painful side were compared, and between-group comparisons were tested. 42 patients with chronic unilateral LBP could indicate the problem level, and the CSA and mean signal intensity of the MF muscle were analysed at the problem level, and one vertebral above and one vertebral level below the problem level. Results: The CSAs of the PM and ES muscles were significantly decreased in the acute LBP group, while in the chronic LBP group, significant reduction in CSA was found in the MF and ES muscles on the painful side compared with the non-painful side. The mean signal intensity and fat content of the ES muscle on the painful side in the chronic LBP group was significantly higher than that on the painful side in the acute LBP group. The significant decrease of CSA in the MF muscle was found at multiple levels on the painful side. Conclusion: The present findings show that there is selective ipsilateral atrophy of paraspinal muscles, specific to the symptomatic side, in patients with acute and chronic LBP. The reduction of the muscle CSA and increased fatty infiltration occurred synchronously, and the extent of change is significantly greater in chronic LBP in the ES muscle. Atrophy of the MF muscle appears to be at multiple levels but side specific in relation to symptoms in patients with chronic LBP, and the decreased muscle CSA may occur prior to

  16. Improving the coordination of care for low back pain patients by creating better links between acute and community services.

    PubMed

    Staiger, Petra K; Serlachius, Anna; Macfarlane, Susie; Anderson, Sharron; Chan, Thomas; Young, Greg

    2010-05-01

    This paper reports on the development of a care-pathway to improve service linkages between the acute setting and community health services in the treatment of low back pain. The pathway was informed by two processes: (1) a literature review based on best-practice guidelines in the assessment, treatment and continuity of care for low back pain patients; and (2) consultation with staff and key stakeholders. Stakeholders from both the acute and community sectors comprised the Working Group, who identified central areas of concern to be addressed in the care-pathway, with the goal of preventing chronicity of low back pain and reducing emergency department presentations. The main outcomes achieved include: the development of a new care-coordinator role, which would support a greater focus on integration between acute and community sectors for low back pain patients; identifying the need to screen at-risk patients; implementation of the SCTT (Service Coordination Tool Templates) tool as a system of referral across the acute and community settings; and agreement on the need to develop an evidence-based self-management program to be offered to low back pain patients. The benefits and challenges of implementing this care pathway are discussed. PMID:20497725

  17. Pharmacological management of low back pain.

    PubMed

    Chou, Roger

    2010-03-01

    Low back pain is one of the most common conditions encountered in clinical practice and medications are the most commonly used type of treatment. In most patients, low back pain is nonspecific, in that the pain cannot be reliably attributed to a specific condition or abnormality in the back. Although a number of medications are available to treat nonspecific low back pain, selecting a therapy can be a challenge because each one is associated with a unique set of benefits and harms. In addition, the evidence supporting the use of different medications varies, and issues such as costs and patient preferences may also affect treatment choices. A guideline published in 2007 from the American Pain Society and the American College of Physicians on diagnosis and treatment of low back pain includes recommendations on the use of medications, based on the quality of supporting evidence and the estimated magnitude of benefits relative to harms. For most patients with low back pain, regardless of the duration of symptoms, paracetamol (acetaminophen) and NSAIDs are first-line options for pain relief. Opioids are more potent analgesics, but are not a first-line option due to their abuse potential. Skeletal muscle relaxants and benzodiazepines can be used as adjunctive medications for acute low back pain, but have a high incidence of sedation. Tricyclic antidepressants may be an option for chronic low back pain, but their effects on pain appear small or uncertain. Nonetheless, depression is common in patients with low back pain and should be treated appropriately. When choosing medications for treatment of low back pain, practice guidelines provide a useful starting point for making decisions, but clinicians should base therapeutic choices on individualized consideration and discussion with patients regarding the potential benefits and risks. PMID:20205483

  18. Does weather affect daily pain intensity levels in patients with acute low back pain? A prospective cohort study.

    PubMed

    Duong, Vicky; Maher, Chris G; Steffens, Daniel; Li, Qiang; Hancock, Mark J

    2016-05-01

    The aim of this study was to investigate the influence of various weather parameters on pain intensity levels in patients with acute low back pain (LBP). We performed a secondary analysis using data from the PACE trial that evaluated paracetamol (acetaminophen) in the treatment of acute LBP. Data on 1604 patients with LBP were included in the analysis. Weather parameters (precipitation, temperature, relative humidity, and air pressure) were obtained from the Australian Bureau of Meteorology. Pain intensity was assessed daily on a 0-10 numerical pain rating scale over a 2-week period. A generalised estimating equation analysis was used to examine the relationship between daily pain intensity levels and weather in three different time epochs (current day, previous day, and change between previous and current days). A second model was adjusted for important back pain prognostic factors. The analysis did not show any association between weather and pain intensity levels in patients with acute LBP in each of the time epochs. There was no change in strength of association after the model was adjusted for prognostic factors. Contrary to common belief, the results demonstrated that the weather parameters of precipitation, temperature, relative humidity, and air pressure did not influence the intensity of pain reported by patients during an episode of acute LBP.

  19. Does weather affect daily pain intensity levels in patients with acute low back pain? A prospective cohort study.

    PubMed

    Duong, Vicky; Maher, Chris G; Steffens, Daniel; Li, Qiang; Hancock, Mark J

    2016-05-01

    The aim of this study was to investigate the influence of various weather parameters on pain intensity levels in patients with acute low back pain (LBP). We performed a secondary analysis using data from the PACE trial that evaluated paracetamol (acetaminophen) in the treatment of acute LBP. Data on 1604 patients with LBP were included in the analysis. Weather parameters (precipitation, temperature, relative humidity, and air pressure) were obtained from the Australian Bureau of Meteorology. Pain intensity was assessed daily on a 0-10 numerical pain rating scale over a 2-week period. A generalised estimating equation analysis was used to examine the relationship between daily pain intensity levels and weather in three different time epochs (current day, previous day, and change between previous and current days). A second model was adjusted for important back pain prognostic factors. The analysis did not show any association between weather and pain intensity levels in patients with acute LBP in each of the time epochs. There was no change in strength of association after the model was adjusted for prognostic factors. Contrary to common belief, the results demonstrated that the weather parameters of precipitation, temperature, relative humidity, and air pressure did not influence the intensity of pain reported by patients during an episode of acute LBP. PMID:26759130

  20. Spinal Manipulative Therapy for Acute Low Back Pain: A Clinical Perspective

    PubMed Central

    Hancock, Mark J.; Maher, Christopher G.; Latimer, Jane

    2008-01-01

    Low back pain (LBP) is an extremely common cause of pain and disability. While many treatments for acute LBP exist, one of the most widely used, but also most controversial, is spinal manipulative therapy (SMT). This therapy includes both high-velocity manipulative techniques and low-velocity mobilization techniques. The literature regarding the use of SMT is often conflicting, which explains the difference in recommendations regarding SMT in international LBP guidelines. The lack of a clear tissue diagnosis in the majority of patients with LBP combined with the unknown mechanism of action of SMT adds to the difficulty for clinicians in providing SMT in a logical and effective manner. Despite these limitations, the existing literature does provide some assistance to clinicians on when to provide SMT and how to provide it in an optimal way. This review aims to summarize the key research literature investigating SMT in LBP in order to help clinicians make informed decisions about the use of SMT for their patients with acute LBP. PMID:19771190

  1. Low back pain - chronic

    MedlinePlus

    ... Medical problems, such as fibromyalgia or rheumatoid arthritis Piriformis syndrome, a pain disorder involving a muscle in the buttocks called the piriformis muscle You are at greater risk for low ...

  2. Factors impacting on doctors' management of acute low back pain: a systematic review.

    PubMed

    Fullen, Brona M; Baxter, G David; O'Donovan, Barry G G; Doody, Catherine; Daly, Leslie E; Hurley, Deirdre A

    2009-10-01

    The aim of this review was to determine the factors that impact on doctors' management of patients with acute low back pain. A methodological assessment of databases (Medline, EMBASE, Psychinfo, BIOSIS, CINAHL, and the Cochrane Central Register of Controlled Trials) identified papers which were screened for inclusion criteria by two independent reviewers. Data were extracted from accepted papers, and the internal validity and strength of the evidence were determined using valid and reliable scales. The search generated a total of 28 papers [quantitative (n=27), qualitative (n=1) methodologies]. Themes were identified from the accepted papers: education (n=18), knowledge of clinical guidelines and impact on management (n=7), and doctors' demographics (n=4). There was consistent evidence that doctors did not adhere to clinical guidelines when performing a spinal assessment. There was inconsistent evidence that education increased adherence with acute LBP guideline recommendations in terms of referral rates to physiotherapy, for investigations, to secondary care and for maintaining patients at work. Strategies to address the factors impacting on doctors' management of acute LBP are required; these would lead to improvement in patient outcomes and reduce healthcare costs. PMID:19110456

  3. Promoting Best Practices for Managing Acute Low Back Pain in an Occupational Environment.

    PubMed

    Slaughter, Amanda Lynn; Frith, Karen; O'Keefe, Louise; Alexander, Susan; Stoll, Regina

    2015-09-01

    Providers treating low back pain must be confident and knowledgeable in evidence-based practice (EBP) to provide the best outcomes. An online education course was created in an effort to increase knowledge and confidence in EBP and clinical practice guidelines specific to low back pain in an occupational setting. There were 80 participants who completed the pre-test and post-test. The results showed a statistically significant improvement in knowledge and confidence scores after completion of the course. An online education course was shown to be a cost-effective, accessible tool to increase knowledge and confidence of EBP for different health care providers. PMID:26290452

  4. Promoting Best Practices for Managing Acute Low Back Pain in an Occupational Environment.

    PubMed

    Slaughter, Amanda Lynn; Frith, Karen; O'Keefe, Louise; Alexander, Susan; Stoll, Regina

    2015-09-01

    Providers treating low back pain must be confident and knowledgeable in evidence-based practice (EBP) to provide the best outcomes. An online education course was created in an effort to increase knowledge and confidence in EBP and clinical practice guidelines specific to low back pain in an occupational setting. There were 80 participants who completed the pre-test and post-test. The results showed a statistically significant improvement in knowledge and confidence scores after completion of the course. An online education course was shown to be a cost-effective, accessible tool to increase knowledge and confidence of EBP for different health care providers.

  5. Guideline update: what's the best approach to acute low back pain?

    PubMed

    Bach, Son M; Holten, Keith B

    2009-12-01

    GRADE A RECOMMENDATIONS (based on good-quality patient-oriented evidence): Advise patients to stay active and continue ordinary activity within the limits permitted by pain, avoid bed rest, and return to work early, which is associated with less disability. Consider McKenzie exercises, which are helpful for pain radiating below the knee. Recommend acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) if medication is necessary. COX-2 inhibitors, muscle relaxants, and opiate analgesics have not been shown to be more effective than NSAIDs for acute low back pain. Consider imaging if patients have no improvement after 6 weeks, although diagnostic tests or imaging is not usually required. GRADE B RECOMMENDATIONS (based on inconsistent or limited-quality patient-oriented evidence): Reassure patients that 90% of episodes resolve within 6 weeks-regardless of treatment. Advise patients that minor flares-ups may occur in the subsequent year. Consider a plain lumbosacral spine x-ray if there is suspicion of spinal fracture or compression. Consider a bone scan after 10 days, if fracture is still suspected or the patient has multiple sites of pain. Suspect cauda equina syndrome or severe or progressive neurological deficit if red flags are present. Obtain complete blood count, urinalysis, and sedimentation rate if cancer or infection are possibilities. If still suspicious, consider referral or perform other studies. Remember that a negative plain film x-ray does not rule out disease. GRADE C RECOMMENDATIONS (based on consensus, usual practice, opinion, disease-oriented evidence, or case series): Recommend ice for painful areas and stretching exercises. Discuss the use of proper body mechanics and safe back exercises for injury prevention. Refer for goal-directed manual physical therapy if there is no improvement in 1 to 2 weeks, not modalities such as heat, traction, ultrasound, or transcutaneous electrical nerve stimulation. Do not refer for surgery in the absence of

  6. Acute and Chronic Low Back Pain: Cognitive, Affective, and Behavioral Dimensions.

    ERIC Educational Resources Information Center

    Hadjistavropoulos, Heather D.; Craig, Kenneth D.

    1994-01-01

    Divided 90 chronic low back pain patients into those who demonstrated signs that were congruent or incongruent with underlying anatomical and physiological principles. Low socioeconomic status, compensation claims, use of opiate analgesics, greater disability, catastrophizing cognitions, stronger emotionality, and passive coping were more…

  7. [The use of nimesulide in the treatment of acute low back pain].

    PubMed

    Shikhkerimov, R K

    2016-01-01

    The objective is to study the efficacy and safety of nimesulide (nemulex) in the treatment of acute low back pain (LBP). The medical documentation of 54 patients with primary syndrome of LBP, which were treated in a polyclinic with nemulex at a dose of 200 mg per day had been studied. The assessment of patients' condition and efficacy and safety of the treatment was conducted based on the information after three visits (1-st, 5-th and 10-th day). The analysis took into account the data of clinical-neurological examination and the assessment of pain intensity at rest and at movement according to the visual analogue scale (VAS) and the severity of Lasegue symptom and limitation of movements in the lumbar spine. Safety of the therapy was evaluated on the basis of accounting of undesirable side reactions and data analysis and physical examination and laboratory testing. Cardiovascular safety was assessed by blood pressure and blood lipid profile on day 10. The use of nemulex at a dose of 200 mg per day resulted in relief of pain and increase of mobility in the lumbar spine on the 5th day of treatment that indicates the effectiveness of anti-inflammatory therapy to restore the previous functional status of patients with LBP. The use of nemulex was accompanied not only by statistically significant analgesic effect (0,78±0,14 points alone; 1,12±0,18 points when moving by VAS on the 10th day of the treatment) and high security (only 1 of the 54 patients was recorded to have elevation of hepatic transaminases; and 2 patients with dyspepsia without endoscopic changes of gastrointestinal tract). PMID:27240177

  8. Yellow flag scores in a compensable New Zealand cohort suffering acute low back pain

    PubMed Central

    Grimmer-Somers, Karen; Prior, Mathew; Robertson, Jim

    2008-01-01

    Background Despite its high prevalence, most acute low back pain (ALBP) is nonspecific, self-limiting with no definable pathology. Recurrence is prevalent, as is resultant chronicity. Psychosocial factors (yellow flags comprising depression and anxiety, negative pain beliefs, job dissatisfaction) are associated with the development of chronic LBP. Methods A national insurer (Accident Compensation Corporation, New Zealand [NZ]), in conjunction with a NZ primary health organization, piloted a strategy for more effective management of patients with ALBP, by following the NZ ALBP Guideline. The guidelines recommend the use of a psychosocial screening instrument (Yellow Flags Screening Instrument, a derivative of Örebro Musculoskeletal Pain Questionnaire). This instrument was recommended for administration on the second visit to a general medical practitioner (GP). This paper tests whether published cut-points of yellow flag scores to predict LBP claims length and costs were valid in this cohort. Results Data was available for 902 claimants appropriately enrolled into the pilot. 25% claimants consulted the GP once only, and thus were not requested to provide a yellow flag score. Yellow flag scores were provided by 48% claimants who consumed two or more GP services. Approximately 60% LBP presentations resolved within five GP visits. Yellow flag scores were significantly and positively associated with treatment costs and service use, although the association was nonlinear. Claimants with moderate yellow flag scores were similarly likely to incur lengthy claims as claimants with at-risk scores. Discussion Capturing data on psychosocial factors for compensable patients with ALBP has merit in predicting lengthy claims. The validity of the published yellow flag cut-points requires further testing. PMID:21197284

  9. [The use of nimesulide in the treatment of acute low back pain].

    PubMed

    Shikhkerimov, R K

    2016-01-01

    The objective is to study the efficacy and safety of nimesulide (nemulex) in the treatment of acute low back pain (LBP). The medical documentation of 54 patients with primary syndrome of LBP, which were treated in a polyclinic with nemulex at a dose of 200 mg per day had been studied. The assessment of patients' condition and efficacy and safety of the treatment was conducted based on the information after three visits (1-st, 5-th and 10-th day). The analysis took into account the data of clinical-neurological examination and the assessment of pain intensity at rest and at movement according to the visual analogue scale (VAS) and the severity of Lasegue symptom and limitation of movements in the lumbar spine. Safety of the therapy was evaluated on the basis of accounting of undesirable side reactions and data analysis and physical examination and laboratory testing. Cardiovascular safety was assessed by blood pressure and blood lipid profile on day 10. The use of nemulex at a dose of 200 mg per day resulted in relief of pain and increase of mobility in the lumbar spine on the 5th day of treatment that indicates the effectiveness of anti-inflammatory therapy to restore the previous functional status of patients with LBP. The use of nemulex was accompanied not only by statistically significant analgesic effect (0,78±0,14 points alone; 1,12±0,18 points when moving by VAS on the 10th day of the treatment) and high security (only 1 of the 54 patients was recorded to have elevation of hepatic transaminases; and 2 patients with dyspepsia without endoscopic changes of gastrointestinal tract).

  10. Patient Expectations as Predictors of Outcome In Patients with Acute Low Back Pain

    PubMed Central

    Phillips, Russell S.; Davis, Roger B.; Cherkin, Daniel C.; Legedza, Anna; Kaptchuk, Ted J.; Hrbek, Andrea; Buring, Julie E.; Post, Diana; Connelly, Maureen T.; Eisenberg, David M.

    2007-01-01

    BACKGROUND Few studies have evaluated the association between patient expectations for recovery and clinical outcomes, and no study has evaluated whether asking patients to choose their therapy modifies such an association. OBJECTIVE To evaluate the association between patients’ expectations and functional recovery in patients with acute low back pain (LBP), and to determine whether that association is affected by giving patients choice of therapy. DESIGN AND PARTICIPANTS A secondary analysis of a randomized controlled trial comparing usual care alone to usual care plus choice of chiropractic, acupuncture, or massage in 444 adults with acute LBP, lasting less than 21 days. MEASUREMENTS AND MAIN RESULTS Primary outcome was functional disability (Roland score) at 5 and 12 weeks. Patients’ general expectations for improvement were associated with improvement in functional status (β = 0.96, 95% CI = 0.56, 1.36). A 1-point increase in general expectations was associated with a 0.96-point improvement in Roland score. The association of expectation with outcome was 2–3 times greater in the usual care group than the choice group. However, these differences did not reach statistical significance. CONCLUSIONS In patients with acute LBP, higher expectations for recovery are associated with greater functional improvement. Eliciting patient expectations for improvement may be a simple way to identify patients with the highest (or lowest) likelihood of experiencing functional improvement. Incorporating questions about patient expectations in future trials may clarify the role of this important correlate of clinical outcomes. PMID:18066631

  11. Doctors' attitudes and beliefs regarding acute low back pain management: A systematic review.

    PubMed

    Fullen, B M; Baxter, G D; O'Donovan, B G G; Doody, C; Daly, L; Hurley, D A

    2008-06-01

    The aim of this systematic review was to determine the attitudes and beliefs of doctors to acute low back pain, and the factors that influence these. The review comprised three phases: a methodological assessment of databases (Medline, EMBASE, Psychinfo, BIOSIS, CINAHL, and the Cochrane Central Register of Controlled Trials) identified potential papers; these were screened for inclusion criteria by two independent reviewers, the extraction of data and the rating of internal validity and strength of the evidence, using valid and reliable scales from accepted papers. Themes were then identified from the accepted literature. The search generated a total of 15 papers of both qualitative (n=3) and quantitative (n=12) methodologies. Themes that emerged included doctors' attitudes and beliefs, and four factors that influenced attitudes and beliefs: doctors' specialty, demographic factors, personal beliefs and education. There was consistent evidence that doctors' specialty impacted their attitudes and beliefs: lack of consensus regarding the natural history of LBP, around treatment options, and issues regarding work. There was inconsistent evidence that demographic factors (age) and level of education impacted doctors' attitudes and beliefs. Strategies to address/ modify these attitudes and beliefs are required, as in some cases they are at odds with guideline recommendations. Long term, these changes in these areas have the potential to maximise patient-care, and reduce costs to health services. PMID:18395982

  12. Rapidity and Modality of Imaging for Acute Low Back Pain in Elderly Patients

    PubMed Central

    Pham, Hoangmai H.; Landon, Bruce E.; Reschovsky, James D.; Wu, Beny; Schrag, Deborah

    2010-01-01

    Background Most quality metrics focus on underuse of services, leaving unclear the factors associated with potential overuse. Objective To assess associations between physician and patient characteristics, and the rapidity and modality of imaging for uncomplicated low back pain (LBP) Setting Fee-for-service Medicare Population 35,039 beneficiaries with acute LBP and treated by one of 4,567 primary care physicians (PCPs) responding to the 2000-2001 or 2004-2005 Community Tracking Study Physician Surveys. Methods We analyzed Medicare claims from 2000-2002 and 2004-2006. We modified a measure of inappropriate imaging developed by the National Committee on Quality Assurance. Without assessing appropriateness of imaging for specific cases, we characterized the rapidity (within 28 days, within 29-180 days, none within 180 days) and modality of imaging (CT/MRI, only radiograph, no imaging). We used ordered logit models to assess relationships between imaging and patient demographics, and physician/practice characteristics including exposure to financial incentives based on patient satisfaction, clinical quality, cost profiling, or productivity. Results 28.8% of 35,039 beneficiaries with LBP were imaged within 28 days, and an additional 4.6% between 28-180 days. Among imaged patients, 88.2% had a radiograph, while 11.8% had CT/MRI as their initial study. White patients received higher levels of imaging than black patients or those of other races [29.7%, 24.8%, 18.9% (p<0.001) for imaging within 28 days and 10.8%, 9.1%, 7.2% (p<0.05) for CT/MRI, respectively]. Medicaid patients received less rapid or advanced imaging than other patients. Patients had more rapid imaging and advanced imaging if their PCP worked in large practices. Compared to no incentives, clinical quality-based incentives were associated with less advanced imaging (10.5% vs. 1.4% for within 28 days, respectively, p<0.001), while incentive combinations including satisfaction measures were associated with

  13. Management of people with acute low-back pain: a survey of Australian chiropractors

    PubMed Central

    2011-01-01

    Introduction Chiropractors commonly provide care to people with acute low-back pain (LBP). The aim of this survey was to determine how chiropractors intend to support and manage people with acute LBP and if this management is in accordance with two recommendations from an Australian evidence-based acute LBP guideline. The two recommendations were directed at minimising the use of plain x-ray and encouraging the patient to stay active. Methods This is a cross sectional survey of chiropractors in Australia. This paper is part of the ALIGN study in which a targeted implementation strategy was developed to improve the management of acute LBP in a chiropractic setting. This implementation strategy was subsequently tested in a cluster randomised controlled trial. In this survey phase of the ALIGN study we approached a random sample of 880 chiropractors in three States of Australia. The mailed questionnaire consisted of five patient vignettes designed to represent people who would typically present to chiropractors with acute LBP. Four vignettes represented people who, according to the guideline, would not require a plain lumbar x-ray, and one vignette represented a person with a suspected vertebral fracture. Respondents were asked, for each vignette, to indicate which investigation(s) they would order, and which intervention(s) they would recommend or undertake. Results Of the 880 chiropractors approached, 137 were deemed ineligible to participate, mostly because they were not currently practising, or mail was returned to sender. We received completed questionnaires from 274 chiropractors (response rate of 37%). Male chiropractors made up 66% of respondents, 75% practised in an urban location and their mean number of years in practice was 15. Across the four vignettes where an x-ray was not indicated 68% (95% Confidence Intervals (CI): 64%, 71%) of chiropractors responded that they would order or take an x-ray. In addition 51% (95%CI: 47%, 56%) indicated they would give

  14. Low Back Pain in Athletes

    PubMed Central

    Mortazavi, Javad; Zebardast, Jayran; Mirzashahi, Babak

    2015-01-01

    Context: Low Back Pain (LBP) in athletes is common and has a broad spectrum of differential diagnoses that must be taken in to account when a clinician approaches the patient with LBP. The physicians should take into account spinal and extra spinal causes of low back pain in athletes. Evidence Acquistion: A literature review was performed for the years 1951 through 2013. Keywords used were Low Back Pain and Athletes. We searched MEDLINE, EMBASE, OVID, PUBMED, the Cochrane Library, ELSEVIER, and the references of reviewed articles, for English-language of Low Back Pain in Athletes. Results: The two most common causes of LBP arising from spine in athletes are degenerative disc disease and spondylolysis with or without listhesis. Although most athletes, respond well to conservative treatment, surgical treatment is indicated when conservative treatment failes. Conclusions: The major concern in athletes with LBP is return to play and previous level of their activity after treatment. There is insufficient evidence regarding this issue in literature to define the optimal time of return to play following treatment. PMID:26448841

  15. Physicians' Initial Management of Acute Low Back Pain Versus Evidence-Based Guidelines

    PubMed Central

    Webster, Barbara S; Courtney, Theodore K; Huang, Yueng-Hsiang; Matz, Simon; Christiani, David C

    2005-01-01

    Background Little information is available on physician characteristics and patient presentations that may influence compliance with evidence-based guidelines for acute low back pain. Objective To assess whether physicians' management decisions are consistent with the Agency for Health Research Quality's guideline and whether responses varied with the presentation of sciatica or by physician characteristics. Design Cross-sectional study using a mailed survey. Participants Participants were randomly selected from internal medicine, family practice, general practice, emergency medicine, and occupational medicine specialties. Measurements A questionnaire asked for recommendations for 2 case scenarios, representing patients without and with sciatica, respectively. Results Seven hundred and twenty surveys were completed (response rate=25%). In cases 1 (without sciatica) and 2 (with sciatica), 26.9% and 4.3% of physicians fully complied with the guideline, respectively. For each year in practice, the odds of guideline noncompliance increased 1.03 times (95% confidence interval [CI]=1.01 to 1.05) for case 1. With occupational medicine as the referent specialty, general practice had the greatest odds of noncompliance (3.60, 95% CI=1.75 to 7.40) in case 1, followed by internal medicine and emergency medicine. Results for case 2 reflected the influence of sciatica with internal medicine having substantially higher odds (vs case 1) and the greatest odds of noncompliance of any specialty (6.93, 95% CI=1.47 to 32.78), followed by family practice and emergency medicine. Conclusions A majority of primary care physicians continue to be noncompliant with evidence-based back pain guidelines. Sciatica dramatically influenced clinical decision-making, increasing the extent of noncompliance, particularly for internal medicine and family practice. Physicians' misunderstanding of sciatica's natural history and belief that more intensive initial management is indicated may be factors

  16. Reorganised motor control strategies of trunk muscles due to acute low back pain.

    PubMed

    Hirata, R P; Salomoni, S E; Christensen, S W; Graven-Nielsen, T

    2015-06-01

    This study assessed how the low back motor control strategies were affected by experimental pain. In twelve volunteers the right m. longissimus was injected by hypertonic and isotonic (control) saline. The pain intensity was assessed on a visual analog scale (VAS). Subjects were seated on a custom-designed chair including a 3-dimensional force sensor adjusted to the segmental height of T1. Electromyography (EMG) was recorded bilaterally from longissimus, multifidus, rectus abdominis, and external oblique muscles. Isometric trunk extensions were performed before, during, and after the saline injections at 5%, 10%, and 20% of maximum voluntary contraction force. Visual feedback of the extension force was provided whereas the tangential force components were recorded. Compared with isotonic saline, VAS scores were higher following hypertonic saline injections (P<.01). Experimental low back pain reduced the EMG activity bilaterally of the rectus abdominis muscles during contractions at 10% and 20% MVC (P<.01) although force accuracy and tangential force variability was not affected. Increased variability in the tangential force composition was found during pain compared with the non-painful condition (P<.05). The immediate adaptation to pain was sufficient to maintain the quality of the task performance; however the long-term consequence of such adaptation is unknown and may overload other structures.

  17. Reorganised motor control strategies of trunk muscles due to acute low back pain.

    PubMed

    Hirata, R P; Salomoni, S E; Christensen, S W; Graven-Nielsen, T

    2015-06-01

    This study assessed how the low back motor control strategies were affected by experimental pain. In twelve volunteers the right m. longissimus was injected by hypertonic and isotonic (control) saline. The pain intensity was assessed on a visual analog scale (VAS). Subjects were seated on a custom-designed chair including a 3-dimensional force sensor adjusted to the segmental height of T1. Electromyography (EMG) was recorded bilaterally from longissimus, multifidus, rectus abdominis, and external oblique muscles. Isometric trunk extensions were performed before, during, and after the saline injections at 5%, 10%, and 20% of maximum voluntary contraction force. Visual feedback of the extension force was provided whereas the tangential force components were recorded. Compared with isotonic saline, VAS scores were higher following hypertonic saline injections (P<.01). Experimental low back pain reduced the EMG activity bilaterally of the rectus abdominis muscles during contractions at 10% and 20% MVC (P<.01) although force accuracy and tangential force variability was not affected. Increased variability in the tangential force composition was found during pain compared with the non-painful condition (P<.05). The immediate adaptation to pain was sufficient to maintain the quality of the task performance; however the long-term consequence of such adaptation is unknown and may overload other structures. PMID:25879794

  18. Motion style acupuncture treatment (MSAT) for acute low back pain with severe disability: a multicenter, randomized, controlled trial protocol

    PubMed Central

    2011-01-01

    Background Acupuncture is widely-used to treat patients with low back pain, despite insufficient evidence of the technique's efficacy for acute back pain. Motion style acupuncture treatment (MSAT) is a non-traditional acupuncture treatment requiring a patient to exercise while receiving acupuncture. In Korea, MSAT is used to reduce musculoskeletal pain and improve functional status. The study aims to evaluate the effect of MSAT on acute low back pain with severe disability. Methods/Design This study is a multicenter, randomized, active-controlled trial with two parallel arms. Participants with acute low back pain and severe functional disability, defined as an Oswestry Disability Index (ODI) value > 60%, will be randomly allocated to the acupuncture group and the nonsteroidal anti-inflammatory drug (NSAID) injection group. The acupuncture group will receive MSAT and the NSAID injection group will receive an intramuscular injection of diclofenac. All procedures will be limited to one session and the symptoms before and after treatment will be measured by assessors blinded to treatment allocation. The primary outcome will be measured at 30 minutes after treatment using the numerical rating scale (NRS) of low back pain while the patient is moving. Secondary outcomes will be measured at 30 minutes after treatment using the NRS of leg pain, ODI, patient global impression of change, range of motion (ROM) of the lumbar spine, and degrees of straight leg raising (SLR). Post-treatment follow-up will be performed to measure primary and secondary outcomes with the exception of ROM and SLR at 2, 4, and 24 weeks after treatment. Discussion The results of this trial will be discussed. Trial Registration ClinicalTrial.gov NCT01315561 PMID:22151475

  19. Clinical decision rule for primary care patient with acute low back pain at risk of developing chronic pain

    PubMed Central

    Mehling, Wolf E.; Ebell, Mark H.; Avins, Andrew L.; Hecht, Frederick M.

    2015-01-01

    Background Context Primary care clinicians need to identify candidates for early interventions to prevent patients with acute pain from developing chronic pain. Purpose We conducted a 2-year prospective cohort study of risk factors for the progression to chronic pain and developed and internally validated a clinical decision rule (CDR) that stratifies patients into low, medium and high-risk groups for chronic pain. Study Design/Setting Prospective cohort study in primary care. Patient Sample Patients with acute low back pain (LBP; ≤30 days duration) Outcome measures Self-reported perceived non-recovery and chronic pain. Methods Patients were surveyed at baseline, 6 months and 2 years. We conducted bivariate and multivariate regression analyses of demographic, clinical and psychosocial variables for chronic pain outcomes, developed a CDR and assessed its performance by calculating the bootstrapped areas under the receiver operating characteristic curve (AUC) and likelihood ratios. This study was supported by NIH/NCCAM grants K23 AT002298, R21 AT004467, NIH/NCCAM K24 AT007827, the Research Evaluation and Allocation Committee (REAC) of the University of California San Francisco, and the Mount Zion Health Fund, San Francisco. The funding agencies played no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The authors report no conflict of interests. Results 605 patients enrolled. 13% had chronic pain at 6 months, 19% at 2 years. An eight-item CDR was most parsimonious for classifying patients into three risk levels. Bootstrapped AUC was 0.76 (0.70–0.82) for the 6-month CDR. Each 10-point score increase (60-point range) was associated with an odds ratio of 11.1 (10.8–11.4) for developing chronic pain. Using a <5% probability of chronic pain as the cutoff for low risk and a >40% probability for high risk, likelihood ratios were 0.26 (0.14–0.48) and 4

  20. Trunk Motor Control Deficits in Acute and Subacute Low Back Pain are Not Associated with Pain or Fear of Movement

    PubMed Central

    Sung, Won; Abraham, Mathew; Plastaras, Christopher; Silfies, Sheri P.

    2015-01-01

    Background Context A subgroup of patients with acute/sub-acute low back pain (LBP) presenting with trunk movement control deficits, pain provocation with segmental testing, and segmental hypermobility have been clinically identified as having movement coordination impairments (MCI) of the trunk. It is hypothesized that these patients have proprioceptive, postural and movement control impairments of the trunk associated with LBP. While, trunk control impairments have been identified in patients with chronic LBP, they have not been investigated in this subgroup or closer to symptom onset. Purpose To identify trunk motor control (postural control and movement precision) impairments in a subgroup of patients with acute/sub-acute LBP who have been clinically identified to have MCI and determine association of these impairments with pain and fear of movement. Study Design/Setting Observational design; University biomechanics lab and clinical practice. Patient Sample Thirty-three patients with acute/sub-acute LBP identified with trunk MCI and 33 gender, age, and BMI matched healthy controls. Outcome Measures Self-report Measures Numeric Pain Rating Scale, Oswestry Disability Questionnaire, Fear Avoidance Beliefs Questionnaire. Physiologic Measures Postural control, Movement precision Methods Center of pressure movement was measured while subjects attempted to volitionally control trunk posture and movement while sitting on a platform with a hemisphere mounted underneath. This created an unstable surface that required coordinated trunk control to maintain an upright-seated posture. Postural control was tested using eyes-open and eyes-closed balance protocols. Movement precision was tested with a dynamic control test requiring movement of the center of pressure along a discrete path. Group trunk motor control performance was compared with ANOVA and t-Test. Performance association with pain and fear of movement were assessed with Pearson’s Correlations. Funding for this

  1. Does adherence to treatment mediate the relationship between patients' treatment outcome expectancies and the outcomes of pain intensity and recovery from acute low back pain?

    PubMed

    Haanstra, Tsjitske M; Kamper, Steven J; Williams, Christopher M; Spriensma, Alette S; Lin, Chung-Wei Christine; Maher, Christopher G; de Vet, Henrica C W; Ostelo, Raymond W J G

    2015-08-01

    It is believed that patients' expectancies about the effectiveness of treatment influence their treatment outcomes, but the working mechanism is rarely studied in patients with low back pain. Theoretical models suggest that adherence to treatment may be an important pathway. The aim of this study was to assess the mediating role of adherence to treatment in the relationship between expectancies and the outcomes of recovery and pain intensity in patients with acute low back pain. This study used data from a randomized placebo-controlled trial of paracetamol for acute low back pain. Expectancies were measured with the Credibility Expectancy Questionnaire. Adherence was measured with a medication diary. Pain intensity was recorded daily in a diary on a 0 to 10 pain scale, and recovery was defined as the first of 7 consecutive days scoring 0 or 1 on a 6-point pain scale. Cox regression (dependent variable: recovery) and linear mixed-model analyses (dependent variable: daily pain intensity scores) were performed. The "difference in coefficients" approach was used to establish mediation. A total of 1573 participants were included in current analyses. There was a small but highly significant relationship between expectancies and outcomes; 3.3% of the relationship between expectancies and recovery and 14.2% of the relationship between expectancies and pain intensity were mediated by adherence to treatment. This study does not convincingly support the theory that adherence is a key pathway in the relationship between treatment outcome expectancies and recovery and pain intensity in this acute low back pain population.

  2. Chronic Low Back Pain: A Personal Approach

    PubMed Central

    Lefort, Paul E.

    1989-01-01

    Sooner or later, all family physicians will face patients with chronic low back pain. This disorder does not result from the same causes and does not respond to the same treatment as acute back pain. A thorough assessment is the key to efficient treatment and should include data about familial, social, and occupational environments. The treatment should be multimodal and tailored to the patient's type of personality and to the causes of the syndrome. PMID:21249069

  3. Epidemiology of occupational low back pain.

    PubMed

    Shelerud, Randy A

    2006-01-01

    There have been significant advances in our understanding of occupational low back pain over the last decade largely because of a noteworthy improvement in the number and quality of prospective trials. More recent work confirms that genetic factors may drive a large portion of thr risk factors. The importance of physical fitness and spine support muscle fitness is believed to protect against future occurrences. Psychosocial factors can play a role in increasing the risk of future low back pain and acute pain in becoming chronic. Some of the psychological influence may be through a muscular pain component. It is arguable that an emphasis should be placed on resources, education, and support to allow workers to be productive whether suffering from back pain or not. PMID:16963373

  4. Acute low back pain is marked by variability: An internet-based pilot study

    PubMed Central

    2011-01-01

    Background Pain variability in acute LBP has received limited study. The objectives of this pilot study were to characterize fluctuations in pain during acute LBP, to determine whether self-reported 'flares' of pain represent discrete periods of increased pain intensity, and to examine whether the frequency of flares was associated with back-related disability outcomes. Methods We conducted a cohort study of acute LBP patients utilizing frequent serial assessments and Internet-based data collection. Adults with acute LBP (lasting ≤3 months) completed questionnaires at the time of seeking care, and at both 3-day and 1-week intervals, for 6 weeks. Back pain was measured using a numerical pain rating scale (NPRS), and disability was measured using the Oswestry Disability Index (ODI). A pain flare was defined as 'a period of increased pain lasting at least 2 hours, when your pain intensity is distinctly worse than it has been recently'. We used mixed-effects linear regression to model longitudinal changes in pain intensity, and multivariate linear regression to model associations between flare frequency and disability outcomes. Results 42 of 47 participants (89%) reported pain flares, and the average number of discrete flare periods per patient was 3.5 over 6 weeks of follow-up. More than half of flares were less than 4 hours in duration, and about 75% of flares were less than one day in duration. A model with a quadratic trend for time best characterized improvements in pain. Pain decreased rapidly during the first 14 days after seeking care, and leveled off after about 28 days. Patients who reported a pain flare experienced an almost 3-point greater current NPRS than those not reporting a flare (mean difference [SD] 2.70 [0.11]; p < 0.0001). Higher flare frequency was independently associated with a higher final ODI score (ß [SE} 0.28 (0.08); p = 0.002). Conclusions Acute LBP is characterized by variability. Patients with acute LBP report multiple distinct flares

  5. Use of Therapeutic Neuroscience Education to address psychosocial factors associated with acute low back pain: a case report.

    PubMed

    Zimney, Kory; Louw, Adriaan; Puentedura, Emilio J

    2014-04-01

    Acute low back pain (LBP) from injuries is prevalent in the work place. It has been shown that patients with psychosocial factors often progress with persistent pain and lead to significant workers compensation costs. Therapeutic Neuroscience Education (TNE) has been shown to be beneficial in changing a patient's cognition regarding their pain state, which may result in decrease fear, anxiety and catastrophization. A 19-year-old female who developed LBP from a work injury was the patient for this case report. A physical examination, Numeric Pain Rating Scale (NRPS), Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire (FABQ), Keele STarT Back Screening Tool (Keele SBST) and Acute Low Back Pain Screening (ALBPS) Questionnaires were assessed during initial physical therapy visit and discharge. Treatment consisted of use of TNE, manual therapy and exercises. She attended five total visits over a 2-week period prior to full discharge. During the initial visit the patient reported NRPS = 3/10, ODI = 36%, FABQ-PA = 23, FABQ-W = 30, Keele SBST = 4/9, ALBPS = 101. At discharge the patient reported a 0 on all outcome questionnaires with ability to return to full work and no pain complaints. PMID:24252071

  6. Effects of tai chi on pain and muscle activity in young males with acute low back pain.

    PubMed

    Cho, YongHo

    2014-05-01

    [Purpose] This study was to examine the effects of tai chi on low back pain in young males. [Subjects and Methods] Forty males in their 20s with low back pain were randomly assigned to two groups. Tai chi was applied to one group, and stretching was applied to the other group. The subjects conducted exercise for one hour, three times per week for four weeks. They performed warm-up exercises for 10 min at the beginning and end of the sessions and conducted the main exercise for 40 minutes. Wireless surface electromyography (sEMG) and a visual analogue scale (VAS) were employed to measure muscle activity and pain, respectively. [Results] There were significant differences between the two groups in pain and muscle activity. The tai chi group's VAS decreased from 3.1 to 2.1, and its muscle activity decreased from 21.5% maximum voluntary isomeric contraction (MVIC) to 16.4% MVIC. The stretching group's VAS decreased from 3.4 to 2.8, and its muscle activity decreased from 24.1% MVIC to 22.1% MVIC. [Conclusion] Tai chi is more effective for low back pain in males in their 20s than stretching. Tai chi can be considered an effective method to reduce low back pain in males in their 20s.

  7. Effects of Tai Chi on Pain and Muscle Activity in Young Males with Acute Low Back Pain

    PubMed Central

    Cho, YongHo

    2014-01-01

    [Purpose] This study was to examine the effects of tai chi on low back pain in young males. [Subjects and Methods] Forty males in their 20s with low back pain were randomly assigned to two groups. Tai chi was applied to one group, and stretching was applied to the other group. The subjects conducted exercise for one hour, three times per week for four weeks. They performed warm-up exercises for 10 min at the beginning and end of the sessions and conducted the main exercise for 40 minutes. Wireless surface electromyography (sEMG) and a visual analogue scale (VAS) were employed to measure muscle activity and pain, respectively. [Results] There were significant differences between the two groups in pain and muscle activity. The tai chi group’s VAS decreased from 3.1 to 2.1, and its muscle activity decreased from 21.5% maximum voluntary isomeric contraction (MVIC) to 16.4% MVIC. The stretching group’s VAS decreased from 3.4 to 2.8, and its muscle activity decreased from 24.1% MVIC to 22.1% MVIC. [Conclusion] Tai chi is more effective for low back pain in males in their 20s than stretching. Tai chi can be considered an effective method to reduce low back pain in males in their 20s. PMID:24926131

  8. Effects of tai chi on pain and muscle activity in young males with acute low back pain.

    PubMed

    Cho, YongHo

    2014-05-01

    [Purpose] This study was to examine the effects of tai chi on low back pain in young males. [Subjects and Methods] Forty males in their 20s with low back pain were randomly assigned to two groups. Tai chi was applied to one group, and stretching was applied to the other group. The subjects conducted exercise for one hour, three times per week for four weeks. They performed warm-up exercises for 10 min at the beginning and end of the sessions and conducted the main exercise for 40 minutes. Wireless surface electromyography (sEMG) and a visual analogue scale (VAS) were employed to measure muscle activity and pain, respectively. [Results] There were significant differences between the two groups in pain and muscle activity. The tai chi group's VAS decreased from 3.1 to 2.1, and its muscle activity decreased from 21.5% maximum voluntary isomeric contraction (MVIC) to 16.4% MVIC. The stretching group's VAS decreased from 3.4 to 2.8, and its muscle activity decreased from 24.1% MVIC to 22.1% MVIC. [Conclusion] Tai chi is more effective for low back pain in males in their 20s than stretching. Tai chi can be considered an effective method to reduce low back pain in males in their 20s. PMID:24926131

  9. PACE – the first placebo controlled trial of paracetamol for acute low back pain: statistical analysis plan

    PubMed Central

    2013-01-01

    Background Paracetamol (acetaminophen) is recommended in most clinical practice guidelines as the first choice of treatment for low back pain, however there is limited evidence to support this recommendation. The PACE trial is the first placebo controlled trial of paracetamol for acute low back pain. This article describes the statistical analysis plan. Results PACE is a randomized double dummy placebo controlled trial that investigates and compares the effect of paracetamol taken in two regimens for the treatment of low back pain. The protocol has been published. The analysis plan was completed blind to study group and finalized prior to initiation of analyses. All data collected as part of the trial were reviewed, without stratification by group, and classified by baseline characteristics, process of care and trial outcomes. Trial outcomes were classified as primary and secondary outcomes. Appropriate descriptive statistics and statistical testing of between-group differences, where relevant, have been planned and described. Conclusions A standard analysis plan was developed for the results of the PACE study. This plan comprehensively describes the data captured and pre-determined statistical tests of relevant outcome measures. The plan demonstrates transparent and verifiable use of the data collected. This a priori plan will be followed to ensure rigorous standards of data analysis are strictly adhered to. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12609000966291 PMID:23937999

  10. Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial.

    PubMed

    Cui, J Z; Geng, Z S; Zhang, Y H; Feng, J Y; Zhu, P; Zhang, X B

    2016-03-01

    Intracutaneous sterile water injection (ISWI) is used for relief of low back pain during labor, acute attacks of urolithiasis, chronic neck and shoulder pain following whiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief of acute low back pain (aLBP). A total of 68 patients (41 females and 27 males) between 18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an 11-point visual analogue scale [VAS]) were recruited and randomly assigned to receive either ISWIs (n=34) or intracutaneous isotonic saline injections (placebo treatment; n=34). The primary outcome was improvement in pain intensity using the VAS at 10, 45, and 90 min and 1 day after treatment. The secondary outcome was functional improvement, which was assessed using the Patient-Specific Functional Scale (PSFS) 1 day after treatment. The mean VAS score was significantly lower in the ISWI group than in the control group at 10, 45, and 90 min, and 1 day after injection (P<0.05, t-test). The mean increment in PSFS score of the ISWI group was 2.9±2.2 1 day after treatment, while that in the control group was 0.9±2.2. Our study showed that ISWI was effective for relieving pain and improving function in aLBP patients at short-term follow-up. ISWI might be an alternative treatment for aLBP patients, especially in areas where medications are not available, as well as in specific patients (e.g., those who are pregnant or have asthma), who are unable to receive medications or other forms of analgesia because of side effects. PMID:26840703

  11. Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial

    PubMed Central

    Cui, J.Z.; Geng, Z.S.; Zhang, Y.H.; Feng, J.Y.; Zhu, P.; Zhang, X.B.

    2016-01-01

    Intracutaneous sterile water injection (ISWI) is used for relief of low back pain during labor, acute attacks of urolithiasis, chronic neck and shoulder pain following whiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief of acute low back pain (aLBP). A total of 68 patients (41 females and 27 males) between 18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an 11-point visual analogue scale [VAS]) were recruited and randomly assigned to receive either ISWIs (n=34) or intracutaneous isotonic saline injections (placebo treatment; n=34). The primary outcome was improvement in pain intensity using the VAS at 10, 45, and 90 min and 1 day after treatment. The secondary outcome was functional improvement, which was assessed using the Patient-Specific Functional Scale (PSFS) 1 day after treatment. The mean VAS score was significantly lower in the ISWI group than in the control group at 10, 45, and 90 min, and 1 day after injection (P<0.05, t-test). The mean increment in PSFS score of the ISWI group was 2.9±2.2 1 day after treatment, while that in the control group was 0.9±2.2. Our study showed that ISWI was effective for relieving pain and improving function in aLBP patients at short-term follow-up. ISWI might be an alternative treatment for aLBP patients, especially in areas where medications are not available, as well as in specific patients (e.g., those who are pregnant or have asthma), who are unable to receive medications or other forms of analgesia because of side effects. PMID:26840703

  12. Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain.

    PubMed

    Swinkels-Meewisse, E J C M; Swinkels, R A H M; Verbeek, A L M; Vlaeyen, J W S; Oostendorp, R A B

    2003-02-01

    The transition from acute to chronic low back pain (LBP) is influenced by many interacting factors. Pain-related fear, as measured by the Tampa Scale for Kinesiophobia (TSK) and the Fear-Avoidance Beliefs Questionnaire (FABQ), is one of these factors. The objectives of this study were to investigate, in a population with acute LBP, the reliability of TSK and FABQ through evaluation of the internal consistency, the test-retest reliability, and the concurrent validity between TSK and FABQ. One hundred and Seventy-Six patients suffering LBP for no longer than 4 weeks completed a Visual Analogue Scale for pain (VAS), the TSK, the FABQ, and a socio-demographic questionnaire. Each patient completed the VAS, TSK, and FABQ twice within 24 h. Internal consistency of TSK and FABQ scores range from alpha=0.70 to 0.83. Test-retest reliability ranges from r(s)=0.64 to 0.80 (P<0.01). Concurrent validity is moderate, ranging from r(s) =0.33 to 0.59 (P<0.01). It may be concluded that in a population with acute LBP, both the TSK and the FABQ are reliable measures of pain-related fear. In the clinical setting they may provide the practitioner a means of identifying pain-related fear in a patient with acute LBP. PMID:12586559

  13. Does adherence to treatment mediate the relationship between patients' treatment outcome expectancies and the outcomes of pain intensity and recovery from acute low back pain?

    PubMed

    Haanstra, Tsjitske M; Kamper, Steven J; Williams, Christopher M; Spriensma, Alette S; Lin, Chung-Wei Christine; Maher, Christopher G; de Vet, Henrica C W; Ostelo, Raymond W J G

    2015-08-01

    It is believed that patients' expectancies about the effectiveness of treatment influence their treatment outcomes, but the working mechanism is rarely studied in patients with low back pain. Theoretical models suggest that adherence to treatment may be an important pathway. The aim of this study was to assess the mediating role of adherence to treatment in the relationship between expectancies and the outcomes of recovery and pain intensity in patients with acute low back pain. This study used data from a randomized placebo-controlled trial of paracetamol for acute low back pain. Expectancies were measured with the Credibility Expectancy Questionnaire. Adherence was measured with a medication diary. Pain intensity was recorded daily in a diary on a 0 to 10 pain scale, and recovery was defined as the first of 7 consecutive days scoring 0 or 1 on a 6-point pain scale. Cox regression (dependent variable: recovery) and linear mixed-model analyses (dependent variable: daily pain intensity scores) were performed. The "difference in coefficients" approach was used to establish mediation. A total of 1573 participants were included in current analyses. There was a small but highly significant relationship between expectancies and outcomes; 3.3% of the relationship between expectancies and recovery and 14.2% of the relationship between expectancies and pain intensity were mediated by adherence to treatment. This study does not convincingly support the theory that adherence is a key pathway in the relationship between treatment outcome expectancies and recovery and pain intensity in this acute low back pain population. PMID:25906348

  14. 15. Discogenic low back pain.

    PubMed

    Kallewaard, Jan Willem; Terheggen, Michel A M B; Groen, Gerbrand J; Sluijter, Menno E; Derby, Richard; Kapural, Leonardo; Mekhail, Nagy; van Kleef, Maarten

    2010-01-01

    An estimated 40% of chronic lumbosacral spinal pain is attributed to the discus intervertebralis. Degenerative changes following loss of hydration of the nucleus pulposus lead to circumferential or radial tears within the annulus fibrosus. Annular tears within the outer annulus stimulate the ingrowth of blood vessels and accompanying nociceptors into the outer and occasionally inner annulus. Sensitization of these nociceptors by various inflammatory repair mechanisms may lead to chronic discogenic pain. The current criterion standard for diagnosing discogenic pain is pressure-controlled provocative discography using strict criteria and at least one negative control level. The strictness of criteria and the adherence to technical detail will allow an acceptable low false positive response rate. The most important determinants are the standardization of pressure stimulus by using a validated pressure monitoring device and avoiding overly high dynamic pressures by the slow injection rate of 0.05 mL/s. A positive discogram requires the reproduction of the patient's typical pain at an intensity of > 6/10 at a pressure of < 15 psi above opening pressure and at a volume less than 3.0 mL. Perhaps the most important and defendable response is the failure to confirm the discus is symptomatic by not meeting this strict criteria. Various interventional treatment strategies for chronic discogenic low back pain unresponsive to conservative care include reduction of inflammation, ablation of intradiscal nociceptors, lowering intranuclear pressure, removal of herniated nucleus, and radiofrequency ablation of the nociceptors. Unfortunately, most of these strategies do not meet the minimal criteria for a positive treatment advice. In particular, single-needle radiofrequency thermocoagulation of the discus is not recommended for patients with discogenic pain (2 B-). Interestingly, a little used procedure, radiofrequency ablation of the ramus communicans, does meet the (2 B+) level

  15. Investigational pharmacology for low back pain

    PubMed Central

    Bhandary, Avinash K; Chimes, Gary P; Malanga, Gerard A

    2010-01-01

    Study design: Review and reinterpretation of existing literature. Objective: This review article summarizes the anatomy and pathogenesis of disease processes that contribute to low back pain, and discusses key issues in existing therapies for chronic low back pain. The article also explains the scientific rationale for investigational pharmacology and highlights emerging compounds in late development. Results/conclusion: While the diverse and complex nature of chronic low back pain continues to challenge clinicians, a growing understanding of chronic low back pain on a cellular level has refined our approach to managing chronic low back pain with pharmacology. Many emerging therapies with improved safety profiles are currently in the research pipeline and will contribute to a multimodal therapeutic algorithm in the near future. With the heterogeneity of the patient population suffering from chronic low back pain, the clinical challenge will be accurately stratifying the optimal pharmacologic approach for each patient. PMID:21197321

  16. Common questions about chronic low back pain.

    PubMed

    Herndon, Christopher M; Zoberi, Kimberly Schiel; Gardner, Bruce J

    2015-05-15

    More than 30% of U.S. adults report having experienced low back pain within the preceding three months. Although most low back pain is nonspecific and self-limiting, a subset of patients develop chronic low back pain, defined as persistent symptoms for longer than three months. Low back pain is categorized as nonspecific low back pain without radiculopathy, low back pain with radicular symptoms, or secondary low back pain with a spinal cause. Imaging should be reserved for patients with red flags for cauda equina syndrome, recent trauma, risk of infection, or when warranted before treatment (e.g., surgical, interventional). Prompt recognition of cauda equina syndrome is critical. Patient education should be combined with evidence-guided pharmacologic therapy. Goals of therapy include reducing the severity of pain symptoms, pain interference, and disability, as well as maximizing activity. Validated tools such as the Oswestry Disability Index can help assess symptom severity and functional change in patients with chronic low back pain. Epidural steroid injections do not improve pain or disability in patients with spinal stenosis. Spinal manipulation therapy produces small benefits for up to six months. Because long-term data are lacking for spinal surgery, patient education about realistic outcome expectations is essential. PMID:25978200

  17. Common questions about chronic low back pain.

    PubMed

    Herndon, Christopher M; Zoberi, Kimberly Schiel; Gardner, Bruce J

    2015-05-15

    More than 30% of U.S. adults report having experienced low back pain within the preceding three months. Although most low back pain is nonspecific and self-limiting, a subset of patients develop chronic low back pain, defined as persistent symptoms for longer than three months. Low back pain is categorized as nonspecific low back pain without radiculopathy, low back pain with radicular symptoms, or secondary low back pain with a spinal cause. Imaging should be reserved for patients with red flags for cauda equina syndrome, recent trauma, risk of infection, or when warranted before treatment (e.g., surgical, interventional). Prompt recognition of cauda equina syndrome is critical. Patient education should be combined with evidence-guided pharmacologic therapy. Goals of therapy include reducing the severity of pain symptoms, pain interference, and disability, as well as maximizing activity. Validated tools such as the Oswestry Disability Index can help assess symptom severity and functional change in patients with chronic low back pain. Epidural steroid injections do not improve pain or disability in patients with spinal stenosis. Spinal manipulation therapy produces small benefits for up to six months. Because long-term data are lacking for spinal surgery, patient education about realistic outcome expectations is essential.

  18. Brain Network Response to Acupuncture Stimuli in Experimental Acute Low Back Pain: An fMRI Study

    PubMed Central

    Shi, Yu; Liu, Ziping; Zhang, Shanshan; Li, Qiang; Guo, Shigui; Yang, Jiangming; Wu, Wen

    2015-01-01

    Most neuroimaging studies have demonstrated that acupuncture can significantly modulate brain activation patterns in healthy subjects, while only a few studies have examined clinical pain. In the current study, we combined an experimental acute low back pain (ALBP) model and functional magnetic resonance imaging (fMRI) to explore the neural mechanisms of acupuncture analgesia. All ALBP subjects first underwent two resting state fMRI scans at baseline and during a painful episode and then underwent two additional fMRI scans, once during acupuncture stimulation (ACUP) and once during tactile stimulation (SHAM) pseudorandomly, at the BL40 acupoint. Our results showed that, compared with the baseline, the pain state had higher regional homogeneity (ReHo) values in the pain matrix, limbic system, and default mode network (DMN) and lower ReHo values in frontal gyrus and temporal gyrus; compared with the OFF status, ACUP yielded broad deactivation in subjects, including nearly all of the limbic system, pain status, and DMN, and also evoked numerous activations in the attentional and somatosensory systems; compared with SHAM, we found that ACUP induced more deactivations and fewer activations in the subjects. Multiple brain networks play crucial roles in acupuncture analgesia, suggesting that ACUP exceeds a somatosensory-guided mind-body therapy for ALBP. PMID:26161117

  19. Clinical Comparative Study: Efficacy and Tolerability of Tolperisone and Thiocolchicoside in Acute Low Back Pain and Spinal Muscle Spasticity

    PubMed Central

    Rao, Rajeev; Panghate, Atul; Chandanwale, Ajay; Sardar, Indrajeet; Ghosh, Mriganka; Roy, Modan; Banerjee, Bireswar; Goswami, Ankur

    2012-01-01

    Study Design We performed a multicentric, randomized, comparative clinical trial. Eligible patients were randomly assigned to receive 150 mg of Tolperisone thrice daily or 8 mg of Thiocolchicoside twice daily for 7 days. Purpose To assess the efficacy and tolerability of Tolperisone in comparison with Thiocolchicoside in the treatment of acute low back pain with spasm of spinal muscles. Overview of Literature No head on clinical trial of Tolperisone with Thiocolchicoside is available and so this study is done. Methods The assessment of muscle spasm was made by measuring the finger-to-floor distance (FFD), articular excursion in degrees on performing Lasegue's maneuver and modified Schober's test. Assessment of pain on movement and spontaneous pain (pain at rest) of the lumbar spine was made with the help of visual analogue scale score. Results The improvement in articular excursion on Lasegue's maneuver was significantly greater on day 3 (p = 0.017) and day 7 (p = 0.0001) with Tolperisone as compared to Thiocolchicoside. The reduction in FFD score was greater on day 7 (p = 0.0001) with Tolperisone. However there was no significant difference in improvement in Schober's test score on day 3 (p = 0.664) and day 7 (p = 0.192). The improvement in pain score at rest and on movement was significantly greater with Tolperisone (p = 0.0001). Conclusions Tolperisone is an effective and well tolerated option for treatment of patients with skeletal muscle spasm associated with pain. PMID:22708015

  20. Brain Network Response to Acupuncture Stimuli in Experimental Acute Low Back Pain: An fMRI Study.

    PubMed

    Shi, Yu; Liu, Ziping; Zhang, Shanshan; Li, Qiang; Guo, Shigui; Yang, Jiangming; Wu, Wen

    2015-01-01

    Most neuroimaging studies have demonstrated that acupuncture can significantly modulate brain activation patterns in healthy subjects, while only a few studies have examined clinical pain. In the current study, we combined an experimental acute low back pain (ALBP) model and functional magnetic resonance imaging (fMRI) to explore the neural mechanisms of acupuncture analgesia. All ALBP subjects first underwent two resting state fMRI scans at baseline and during a painful episode and then underwent two additional fMRI scans, once during acupuncture stimulation (ACUP) and once during tactile stimulation (SHAM) pseudorandomly, at the BL40 acupoint. Our results showed that, compared with the baseline, the pain state had higher regional homogeneity (ReHo) values in the pain matrix, limbic system, and default mode network (DMN) and lower ReHo values in frontal gyrus and temporal gyrus; compared with the OFF status, ACUP yielded broad deactivation in subjects, including nearly all of the limbic system, pain status, and DMN, and also evoked numerous activations in the attentional and somatosensory systems; compared with SHAM, we found that ACUP induced more deactivations and fewer activations in the subjects. Multiple brain networks play crucial roles in acupuncture analgesia, suggesting that ACUP exceeds a somatosensory-guided mind-body therapy for ALBP. PMID:26161117

  1. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain.

    PubMed

    Witenko, Corey; Moorman-Li, Robin; Motycka, Carol; Duane, Kevin; Hincapie-Castillo, Juan; Leonard, Paul; Valaer, Christopher

    2014-06-01

    For patients with low back pain, skeletal muscle relaxants are often initiated after failure of first-line analgesics. However, these medications (reviewed in this article) are controversial alternatives that carry risks of adverse effects and increased cost. PMID:25050056

  2. Efficacy and Safety of Acupuncture for Acute Low Back Pain in Emergency Department: A Pilot Cohort Study

    PubMed Central

    Liu, Yen-Ting; Chiu, Chih-Wen; Chang, Chin-Fu; Lee, Tsung-Chieh; Chen, Chia-Yun; Chang, Shun-Chang; Lee, Chia-Ying; Lo, Lun-Chien

    2015-01-01

    Introduction. Low back pain (LBP) is one of the most common complaints in the emergency department (ED). There are several research articles providing evidence for acupuncture for treating chronic LBP but few about treating acute LBP. This study assessed the efficacy and safety of acupuncture for the treatment of acute LBP in the ED. Materials and methods. A clinical pilot cohort study was conducted. 60 participants, recruited in the ED, were divided into experimental and control groups with 1 dropout during the study. Life-threatening conditions or severe neurological defects were excluded. The experimental group (n = 45) received a series of fixed points of acupuncture. The control group (n = 14) received sham acupuncture by pasting seed-patches near acupoints. Back pain was measured using the visual analog scale (VAS) at three time points: baseline and immediately after and 3 days after intervention as the primary outcome. The secondary outcomes were heart rate variability (HRV) and adverse events. Results. The VAS demonstrated a significant decrease (P value <0.001) for the experimental group after 15 minutes of acupuncture. The variation in HRV showed no significant difference in either group. No adverse event was reported. Conclusion. Acupuncture might provide immediate effect in reducing the pain of acute LBP safely. PMID:26346626

  3. Lumbar manipulation and exercise for the treatment of acute low back pain in adolescents: a randomized controlled trial

    PubMed Central

    Selhorst, Brittany

    2015-01-01

    Objectives Low back pain (LBP) is a common condition in adolescents. Although much has been written about the efficacy of lumbar manipulation for adults with LBP, little is known about its effectiveness in adolescents. This study had two primary aims: (1) to assess the efficacy of adding lumbar manipulation to an exercise program in adolescents with acute (<90 days) LBP and (2) to report and assess any adverse reactions associated with lumbar manipulation noted in this study. Methods Patients were randomly assigned to receive lumbar manipulation or sham manipulation. All patients performed 4 weeks of physical therapy exercise. Pain, patient-specific functional scale (PSFS), and global rating of change (GROC) scores were measured at evaluation, 1 week, 4 weeks, and 6 months. Relative risk was calculated for adverse reactions noted. Results We recruited 35 consecutive patients with acute LBP. One patient was excluded after being diagnosed with a spondylolysis, 34 patients remained for analysis. Both groups experienced significant improvement over time in all measures. There were no differences between groups for pain, PSFS, or GROC scores. No increased risk of adverse reaction from lumbar manipulation was noted. Discussion The addition of lumbar manipulation to exercise did not benefit adolescents with acute LBP. There was not an increased risk of an adverse reaction noted in this study from lumbar manipulation performed on adolescents. Further research needs to be done to identify factors that predict positive outcomes following lumbar manipulation in adolescents. PMID:26917941

  4. Efficacy and Safety of Acupuncture for Acute Low Back Pain in Emergency Department: A Pilot Cohort Study.

    PubMed

    Liu, Yen-Ting; Chiu, Chih-Wen; Chang, Chin-Fu; Lee, Tsung-Chieh; Chen, Chia-Yun; Chang, Shun-Chang; Lee, Chia-Ying; Lo, Lun-Chien

    2015-01-01

    Introduction. Low back pain (LBP) is one of the most common complaints in the emergency department (ED). There are several research articles providing evidence for acupuncture for treating chronic LBP but few about treating acute LBP. This study assessed the efficacy and safety of acupuncture for the treatment of acute LBP in the ED. Materials and methods. A clinical pilot cohort study was conducted. 60 participants, recruited in the ED, were divided into experimental and control groups with 1 dropout during the study. Life-threatening conditions or severe neurological defects were excluded. The experimental group (n = 45) received a series of fixed points of acupuncture. The control group (n = 14) received sham acupuncture by pasting seed-patches near acupoints. Back pain was measured using the visual analog scale (VAS) at three time points: baseline and immediately after and 3 days after intervention as the primary outcome. The secondary outcomes were heart rate variability (HRV) and adverse events. Results. The VAS demonstrated a significant decrease (P value <0.001) for the experimental group after 15 minutes of acupuncture. The variation in HRV showed no significant difference in either group. No adverse event was reported. Conclusion. Acupuncture might provide immediate effect in reducing the pain of acute LBP safely. PMID:26346626

  5. PACE - The first placebo controlled trial of paracetamol for acute low back pain: design of a randomised controlled trial

    PubMed Central

    2010-01-01

    Background Clinical practice guidelines recommend that the initial treatment of acute low back pain (LBP) should consist of advice to stay active and regular simple analgesics such as paracetamol 4 g daily. Despite this recommendation in all international LBP guidelines there are no placebo controlled trials assessing the efficacy of paracetamol for LBP at any dose or dose regimen. This study aims to determine whether 4 g of paracetamol daily (in divided doses) results in a more rapid recovery from acute LBP than placebo. A secondary aim is to determine if ingesting paracetamol in a time-contingent manner is more effective than paracetamol taken when required (PRN) for recovery from acute LBP. Methods/Design The study is a randomised double dummy placebo controlled trial. 1650 care seeking people with significant acute LBP will be recruited. All participants will receive advice to stay active and will be randomised to 1 of 3 treatment groups: time-contingent paracetamol dose regimen (plus placebo PRN paracetamol), PRN paracetamol (plus placebo time-contingent paracetamol) or a double placebo study arm. The primary outcome will be time (days) to recovery from pain recorded in a daily pain diary. Other outcomes will be pain intensity, disability, function, global perceived effect and sleep quality, captured at baseline and at weeks 1, 2, 4 and 12 by an assessor blind to treatment allocation. An economic analysis will be conducted to determine the cost-effectiveness of treatment from the health sector and societal perspectives. Discussion The successful completion of the trial will provide the first high quality evidence on the effectiveness of the use of paracetamol, a guideline endorsed treatment for acute LBP. Trail registration ACTRN12609000966291. PMID:20650012

  6. The effects of t’ai chi on muscle activity, pain, and balance in females in their 20s with acute low back pain

    PubMed Central

    Jang, Jee-Hun; Cho, Tae-Yong; Cho, Yong-Ho

    2015-01-01

    [Purpose] This study was conducted in order to examine the effects of t’ai chi on females in their 20s with acute low back pain. The subjects were 30 females in their 20s with acute low back pain. [Subjects and Methods] They were equally and randomly divided into a t’ai chi group and a stretching group. The intervention was applied three times per week, one hour each time, for a total of eight weeks. During the one hour, the subjects conducted warm-up exercises for 10 min, primary exercises for 40 min, and cool-down exercises for 10 min. In order to examine changes in low back pain in the patients according to the intervention method, muscle activity, pain, and balance elements (left and right side movement distance, forward and backward movement distance) were measured. [Results] Muscle activity and the visual analog scale score significantly decreased in both the t’ai chi group and the stretching group. Regarding changes in balance elements, the t’ai chi group’s left and right side movement distance decreased, which was statistically significant. However, the t’ai chi group’s forward and backward movement distance and the stretching group’s forward and backward movement distance and left and right side movement distance did not change. [Conclusion] According to the results of this study, t’ai chi is considered an appropriate exercise program to reduce acute low back pain in females in their 20s. This is because when compared with stretching, it enables posture maintenance with lesser force due to decreased muscle activity, it is more helpful for improvements in balance ability, and it is effective in decreasing pain. PMID:25931717

  7. The effects of t'ai chi on muscle activity, pain, and balance in females in their 20s with acute low back pain.

    PubMed

    Jang, Jee-Hun; Cho, Tae-Yong; Cho, Yong-Ho

    2015-03-01

    [Purpose] This study was conducted in order to examine the effects of t'ai chi on females in their 20s with acute low back pain. The subjects were 30 females in their 20s with acute low back pain. [Subjects and Methods] They were equally and randomly divided into a t'ai chi group and a stretching group. The intervention was applied three times per week, one hour each time, for a total of eight weeks. During the one hour, the subjects conducted warm-up exercises for 10 min, primary exercises for 40 min, and cool-down exercises for 10 min. In order to examine changes in low back pain in the patients according to the intervention method, muscle activity, pain, and balance elements (left and right side movement distance, forward and backward movement distance) were measured. [Results] Muscle activity and the visual analog scale score significantly decreased in both the t'ai chi group and the stretching group. Regarding changes in balance elements, the t'ai chi group's left and right side movement distance decreased, which was statistically significant. However, the t'ai chi group's forward and backward movement distance and the stretching group's forward and backward movement distance and left and right side movement distance did not change. [Conclusion] According to the results of this study, t'ai chi is considered an appropriate exercise program to reduce acute low back pain in females in their 20s. This is because when compared with stretching, it enables posture maintenance with lesser force due to decreased muscle activity, it is more helpful for improvements in balance ability, and it is effective in decreasing pain. PMID:25931717

  8. A randomized, controlled trial of osteopathic manipulative treatment for acute low back pain in active duty military personnel

    PubMed Central

    Cruser, des Anges; Maurer, Douglas; Hensel, Kendi; Brown, Sarah K; White, Kathryn; Stoll, Scott T

    2012-01-01

    Objective Acute low back pain (ALBP) may limit mobility and impose functional limitations in active duty military personnel. Although some manual therapies have been reported effective for ALBP in military personnel, there have been no published randomized controlled trials (RCTs) of osteopathic manipulative treatment (OMT) in the military. Furthermore, current military ALBP guidelines do not specifically include OMT. Methods This RCT examined the efficacy of OMT in relieving ALBP and improving functioning in military personnel at Fort Lewis, Washington. Sixty-three male and female soldiers ages 18 to 35 were randomly assigned to a group receiving OMT plus usual care or a group receiving usual care only (UCO). Results The primary outcome measures were pain on the quadruple visual analog scale, and functioning on the Roland Morris Disability Questionnaire. Outcomes were measured immediately preceding each of four treatment sessions and at four weeks post-trial. Intention to treat analysis found significantly greater post-trial improvement in ‘Pain Now’ for OMT compared to UCO (P = 0·026). Furthermore, the OMT group reported less ‘Pain Now’ and ‘Pain Typical’ at all visits (P = 0·025 and P = 0·020 respectively). Osteopathic manipulative treatment subjects also tended to achieve a clinically meaningful improvement from baseline on ‘Pain at Best’ sooner than the UCO subjects. With similar baseline expectations, OMT subjects reported significantly greater satisfaction with treatment and overall self-reported improvement (P<0·01). Conclusion This study supports the effectiveness of OMT in reducing ALBP pain in active duty military personnel. PMID:23372389

  9. [Clinical management of low back pain in primary health care].

    PubMed

    Lie, H

    1999-06-10

    Diagnostic differentiation seems crucial in the treatment of patients with low back pain. We must try to distinguish between pain originating from the moving segments or the soft tissue in the columna, and differentiate between radicular pain and referred pain to the leg. Principles of treatment for the acute and recurrent low back pain attacks are dealt with, as well as the treatment of patients with acute chronic sciatica and spinal stenosis. The special problems concerning treatment of degenerative disc disease and patients with back pain caused by psychosocial problems are further discussed.

  10. Acute low back pain information online: an evaluation of quality, content accuracy and readability of related websites.

    PubMed

    Hendrick, Paul A; Ahmed, Osman H; Bankier, Shane S; Chan, Tze Jieh; Crawford, Sarah A; Ryder, Catherine R; Welsh, Lisa J; Schneiders, Anthony G

    2012-08-01

    The internet is increasingly being used as a source of health information by the general public. Numerous websites exist that provide advice and information on the diagnosis and management of acute low back pain (ALBP), however, the accuracy and utility of this information has yet to be established. The aim of this study was to establish the quality, content and readability of online information relating to the treatment and management of ALBP. The internet was systematically searched using Google search engines from six major English-speaking countries. In addition, relevant national and international low back pain-related professional organisations were also searched. A total of 22 relevant websites was identified. The accuracy of the content of the ALBP information was established using a 13 point guide developed from international guidelines. Website quality was evaluated using the HONcode, and the Flesch-Kincaid Grade level (FKGL) was used to establish readability. The majority of websites lacked accurate information, resulting in an overall mean content accuracy score of 6.3/17. Only 3 websites had a high content accuracy score (>14/17) along with an acceptable readability score (FKGL 6-8) with the majority of websites providing information which exceeded the recommended level for the average person to comprehend. The most accurately reported category was, "Education and reassurance" (98%) while information regarding "manipulation" (50%), "massage" (9%) and "exercise" (0%) were amongst the lowest scoring categories. These results demonstrate the need for more accurate and readable internet-based ALBP information specifically centred on evidence-based guidelines. PMID:22464886

  11. Standardized activities of daily living in presence of sub-acute low-back pain: a pilot study.

    PubMed

    Svendsen, Jacob H; Svarrer, Heine; Laessoe, Uffe; Vollenbroek-Hutten, Miriam; Madeleine, Pascal

    2013-02-01

    The aim of this pilot study was to investigate how sub-acute low-back pain (LBP) patients differed with respect to control in movements and muscle activation during standardized tasks representing daily living activities, and explore relationships between cognition and measured motor performance. Linear and nonlinear parameters were computed from kinetics, kinematics and muscle activity recorded for 12 sub-acute patients and 12 healthy matched controls during trunk flexion, sit-to-stand from a chair and lifting a box. Cognitive variables were collected to explore relationships with biomechanical parameters. For trunk flexion, left external abdominal oblique muscle activity level was lower for patients compared with controls (p < 0.05), whereas sample entropy (complexity) was higher (p < 0.05). Normalized mutual information was lower for patients compared with controls for left and right erector spinae (p < 0.05). Level of activity of left external abdominal oblique correlated negatively with cognitive ignoring and positively with catastrophizing (p ≤ 0.05), and catastrophizing also correlated positively with functional connectivity of abdominal muscles (p < 0.05). Signs of reorganization in muscle activation pointed towards different synergistic actions in trunk muscles in sub-acute LBP patients compared with controls. The interplay with maladaptive cognition suggested that in the subacute stage of LBP, both biomechanical and cognitive factors should be taken into account. PMID:22995335

  12. Mechanical therapy for low back pain.

    PubMed

    Guild, Donald Grant

    2012-09-01

    Physical therapy and manual medicine for low back pain encompass many different treatment modalities. There is a vast variety of techniques that physical therapists commonly use in the treatment of low back pain. Some of the therapies include, but are certainly not limited to, education, exercise, lumbar traction, manual manipulation, application of heat, cryotherapy, and ultrasonography. Many of these approaches are discussed specifically in this article.

  13. [Low back pain: when and what to do].

    PubMed

    Illés, S Tamás

    2015-08-16

    The low back pain has become one of the greatest public health problems worldwide. The author based on the current international standards summarizes the knowledge necessary for every day treatment of low back pain. In acute low back pain the author underlines the necessity of the rapid, accurate diagnosis and separation for specific and non-specific low back pain. In specific acute low back pain the treatment should focus on to eliminate the root causes. In non-specific cases pain killing treatment and early active mobilization is the choice for the therapeutic process. Beside analgesia, the primary goal of the treatment is to prevent becoming chronic the symptomatology. Objectives of the management of chronic low back pain are effective pain reduction, continuous maintainance of physical activity, prevention of permanent disability, and restoration of working ability. Analgesics, non steroid anti-inflammatory drugs, and muscle relaxants reduce pain, while multidisciplinary management programs, personalized and guided physiotherapy, cognitive behavioral therapy, as well as short training programs will help to restore function. Surgical treatment is only indicated in degenerative cases and only after the failure of conservative therapy. PMID:26256495

  14. [Low back pain: when and what to do].

    PubMed

    Illés, S Tamás

    2015-08-16

    The low back pain has become one of the greatest public health problems worldwide. The author based on the current international standards summarizes the knowledge necessary for every day treatment of low back pain. In acute low back pain the author underlines the necessity of the rapid, accurate diagnosis and separation for specific and non-specific low back pain. In specific acute low back pain the treatment should focus on to eliminate the root causes. In non-specific cases pain killing treatment and early active mobilization is the choice for the therapeutic process. Beside analgesia, the primary goal of the treatment is to prevent becoming chronic the symptomatology. Objectives of the management of chronic low back pain are effective pain reduction, continuous maintainance of physical activity, prevention of permanent disability, and restoration of working ability. Analgesics, non steroid anti-inflammatory drugs, and muscle relaxants reduce pain, while multidisciplinary management programs, personalized and guided physiotherapy, cognitive behavioral therapy, as well as short training programs will help to restore function. Surgical treatment is only indicated in degenerative cases and only after the failure of conservative therapy.

  15. Rehabilitation of Low Back Pain in Golfers

    PubMed Central

    Finn, Christopher

    2013-01-01

    Context: Low back injuries are the most common injury in golf. Best practice guidelines for rehabilitation and prevention of these injuries are helpful for health care professionals and all golfers. Objective: To establish a best practice clinical model for low back pain in golfers from diagnosis through treatment and rehabilitation to return to golf. Evidence Acquisition: The PubMed database and Google Scholar were searched from 1993 to 2012 with the following keywords: golf and low back injury, low back injury, golf and low back pain, golf injury prevention, golf modern swing, muscles in golf swing, low back rehabilitation, diaphragm, and core stability. All studies addressed in some manner the rehabilitation, prevention, or return to sport from low back injury, preferably in direct relation to golf, as well as muscle firing patterns used during the golf swing. Results: Best practice for rehabilitation and prevention of low back injury in golf appears to be through a multidisciplinary approach. Conclusion: Movement patterns, muscle imbalances, and type of swing utilized all have a direct effect on the forces applied to the spine during the golf swing and need to be assessed to prevent or rehabilitate injury. Understanding the golf swing and how the body works during the swing is necessary. PMID:24459546

  16. Adherence of Irish general practitioners to European guidelines for acute low back pain: a prospective pilot study.

    PubMed

    Fullen, Brona M; Maher, Thomas; Bury, Gerard; Tynan, Aodan; Daly, Leslie E; Hurley, Deirdre A

    2007-08-01

    There are no national low back pain (LBP) clinical guidelines in Ireland, and neither the level of adherence of General Practitioners (GPs) to the European guidelines, nor the cost of LBP to the patient and the state, have been investigated. A prospective pilot study was conducted on 54 consenting patients (18M, 36F: mean age (SD): 40.5 (14.3) years) with a new episode of acute LBP (<3 months) attending one of nine participating GPs. Baseline demographic, LBP classification [i.e. simple back ache (SBA), nerve root pain (NRP), serious spinal pathology (SSP)] and primary care management data were recorded over a three month period. Adherence and costs were estimated based on: medication prescription, referral for investigations, treatment or consultations, and wage replacement costs (time signed off work). For both SBA and NRP, medication prescriptions were consistent with European guideline recommendations, but not for referral for further treatment (39% of SBA patients were referred on first visit), secondary care (54% of NRP patients were referred on first visit), or discontinuation of work (50% NRP patients on first GP visit). The average total cost (direct and wage replacement) for a single episode of LBP over 12 weeks was 20,531 Euros (20,300-20,762). Direct costs accounted for 43% [8874.36 Euros, (8643.37-9105.37 Euros)] and wage replacement costs 57% (11,657 Euros). In conclusion, management of acute LBP in a cohort of GPs in Ireland was not consistent with European clinical guideline recommendations, and warrants higher levels of postgraduate education among GPs, as well as restructuring of primary care services, which should improve patient outcome and reduce costs.

  17. Coping with Low Back Pain.

    ERIC Educational Resources Information Center

    Kindig, L. E.; Mrvos, S. R.

    Guidelines are offered for the prevention and relief of lower back pain. The structure of the spine is described, and the functions and composition of spinal disks are explained. A list is included of common causes of abnormalities of the spinal column, and injuries which may cause the fracture of the vertebrae are described. Factors causing low…

  18. Randomized controlled trials in industrial low back pain relating to return to work. Part 1. Acute interventions.

    PubMed

    Scheer, S J; Radack, K L; O'Brien, D R

    1995-10-01

    Employers and insurers are interested in being able to use cost-effective interventions for returning injured workers to the workplace. Unfortunately, truly objective information is lacking. The purpose of this and two subsequent review articles was to perform thorough scrutiny and methodologic comparison among all obtainable, published randomized and controlled studies on low back pain (LBP) interventions leading to return to work. The study was confined to English language articles published from 1975 through 1993. Of more than 4,000 LBP citations, more than 500 were chosen for review. Of that number, 35 articles met the selection criteria of randomization, reasonable controls, and work return comparisons. This paper focuses on the 10 articles relating to interventions for acute (less than 4 weeks) LBP, and considers bed rest, exercise, spinal manipulation, back school, and case management. A 26-point quality system was used to compare the methodologic rigor of each article. This literature survey demonstrated the meager scientific foundations on which our industrial rehabilitation programs are based. PMID:7487440

  19. Diagnostic value of lasik test for detection of lumbar discopathy in patients attending emergency department with acute low back pain

    PubMed Central

    Aala, Alireza; Alizadeh Shahri, Saeid; Meshkini, Ali; Shams Vahdati, Samad

    2012-01-01

    Abstract: Background: Low back pain is one of the most important health problems. Disk herniation is one of the common causes of low back pain. Accurate examination is the best and simplest diagnostic methods. Physical examination, Straight leg raise (SLR) and neurologic tests as well as other tests are usually used to locate the exact place of herniation. Paraclinical studies such as magnetic resonance imaging (MRI) should be used because of the low diagnostic efficiency of physical examination. Methods: 100 patients attended the emergency unit because of back pain or radicular pain, were enrolled in the study. SLR, Reverse- SLR (R-SLR) and Crossed-SLR (C-SLR) tests were performed for all patients. Then, the patients were referred to the neurosurgery unit for treatment. Lumbar MRI was taken for all patients. Then, all patients were followed up and these data were collected. Results: Sensitivity and specificity of SLR test, C-SLR, and R-SLR tests was 77.52% and 36.36%, 29.21% and 90.9%, and 88.89% and 10.94%, respectively. There was no significant relationship between MRI and positive discopathy in the physical examination and SLR (P=0.11). Conclusions: SLR test has high sensitivity and low specificity. If the SLR test was accompanied by with physical examination the resulting sensitivity and specificity will increase. Findings of this study showed that SLR test has more sensitivity, while C-SLR has more specificity in low back pain diagnosis. Keywords: SLR test, Low Back Pain, Discopathy, Straight leg raise

  20. The effect of rest break schedule on acute low back pain development in pain and non-pain developers during seated work.

    PubMed

    Sheahan, Peter J; Diesbourg, Tara L; Fischer, Steven L

    2016-03-01

    A significant portion of the population (25-50%) is known to develop acute low back pain (LBP) within a bout of prolonged sitting. Previous research has supported the use of frequent rest breaks, from seated office work, in order to reduce self-reported LBP, however, there is limited consensus about the recommended frequency and duration of rest breaks. This may be due to the limited consideration of individual differences in acute LBP development. The purpose of this study was to examine the effect of three different standing rest-break conditions on a group of pain developers (PD) and non-pain developers (NPD) engaged in prolonged seated work. Twenty participants completed four one-hour-long bouts of seated typing: Condition A - no rest; Condition B - 5 min of standing rest every 30 min; Condition C - 2.5 min of standing rest every 15 min; Condition D - 50 s of standing rest every 5 min. Self-reported LBP, self-reported mental fatigue and 30-s samples of EMG were collected every 10 min throughout each session. Eight out of 20 participants (40%) reported LBP during Condition A (classified as PD). Only PD demonstrated clinically relevant increases in LBP across conditions where Conditions B, C, or D provided some relief, but did not restore pain scores to their original level, prior to sitting. PD and NPD developed mental fatigue equally, with Conditions B and D helping to reduce fatigue. No differences in productivity were observed between conditions or groups and no main effects were observed for muscle activity, median power frequency or co-contraction. These data suggests that frequent, short, standing rest breaks may help to reduce symptoms of LBP, however they are only a temporary solution as PD still developed clinically important LBP, even with frequent rest breaks.

  1. The effect of rest break schedule on acute low back pain development in pain and non-pain developers during seated work.

    PubMed

    Sheahan, Peter J; Diesbourg, Tara L; Fischer, Steven L

    2016-03-01

    A significant portion of the population (25-50%) is known to develop acute low back pain (LBP) within a bout of prolonged sitting. Previous research has supported the use of frequent rest breaks, from seated office work, in order to reduce self-reported LBP, however, there is limited consensus about the recommended frequency and duration of rest breaks. This may be due to the limited consideration of individual differences in acute LBP development. The purpose of this study was to examine the effect of three different standing rest-break conditions on a group of pain developers (PD) and non-pain developers (NPD) engaged in prolonged seated work. Twenty participants completed four one-hour-long bouts of seated typing: Condition A - no rest; Condition B - 5 min of standing rest every 30 min; Condition C - 2.5 min of standing rest every 15 min; Condition D - 50 s of standing rest every 5 min. Self-reported LBP, self-reported mental fatigue and 30-s samples of EMG were collected every 10 min throughout each session. Eight out of 20 participants (40%) reported LBP during Condition A (classified as PD). Only PD demonstrated clinically relevant increases in LBP across conditions where Conditions B, C, or D provided some relief, but did not restore pain scores to their original level, prior to sitting. PD and NPD developed mental fatigue equally, with Conditions B and D helping to reduce fatigue. No differences in productivity were observed between conditions or groups and no main effects were observed for muscle activity, median power frequency or co-contraction. These data suggests that frequent, short, standing rest breaks may help to reduce symptoms of LBP, however they are only a temporary solution as PD still developed clinically important LBP, even with frequent rest breaks. PMID:26674405

  2. Managing low back pain second edition

    SciTech Connect

    Kirkaldy-Willis, W.H. )

    1988-01-01

    This book contains 26 chapters. Some of the titles are: Magnetic resonance imaging of the lumbar spine; Diagnostic techniques; The site and nature of the lesion; The anatomy of the lumbosacral spine; The perception of pain; Differential diagnosis of low back pain; and A comprehensive outline of treatment.

  3. Efficacy and safety of acupuncture for the treatment of non-specific acute low back pain: a randomised controlled multicentre trial protocol [ISRCTN65814467

    PubMed Central

    Vas, Jorge; Perea-Milla, Emilio; Mendez, Camila; Silva, Luis Carlos; Herrera Galante, Antonia; Aranda Regules, Jose Manuel; Martinez Barquin, Dulce M; Aguilar, Inmaculada; Faus, Vicente

    2006-01-01

    Background Low back pain and its associated incapacitating effects constitute an important healthcare and socioeconomic problem, as well as being one of the main causes of disability among adults of working age. The prevalence of non-specific low back pain is very high among the general population, and 60–70% of adults are believed to have suffered this problem at some time. Nevertheless, few randomised clinical trials have been made of the efficacy and efficiency of acupuncture with respect to acute low back pain. The present study is intended to assess the efficacy of acupuncture for acute low back pain in terms of the improvement reported on the Roland Morris Questionnaire (RMQ) on low back pain incapacity, to estimate the specific and non-specific effects produced by the technique, and to carry out a cost-effectiveness analysis. Methods/Design Randomised four-branch controlled multicentre prospective study made to compare semi-standardised real acupuncture, sham acupuncture (acupuncture at non-specific points), placebo acupuncture and conventional treatment. The patients are blinded to the real, sham and placebo acupuncture treatments. Patients in the sample present symptoms of non specific acute low back pain, with a case history of 2 weeks or less, and will be selected from working-age patients, whether in paid employment or not, referred by General Practitioners from Primary Healthcare Clinics to the four clinics participating in this study. In order to assess the primary and secondary result measures, the patients will be requested to fill in a questionnaire before the randomisation and again at 3, 12 and 48 weeks after starting the treatment. The primary result measure will be the clinical relevant improvement (CRI) at 3 weeks after randomisation. We define CRI as a reduction of 35% or more in the RMQ results. Discussion This study is intended to obtain further evidence on the effectiveness of acupuncture on acute low back pain and to isolate the

  4. Aceclofenac–tizanidine in the treatment of acute low back pain: a double-blind, double-dummy, randomized, multicentric, comparative study against aceclofenac alone

    PubMed Central

    Chandurkar, Nitin; Chandanwale, A. S.; Ambade, Ratnakar; Gupta, Anil; Bartakke, Girish

    2009-01-01

    Tizanidine and aceclofenac individually have shown efficacy in the treatment of low back pain. The efficacy and tolerability of the combination have not yet been established. The objective of the study was to evaluate the efficacy and safety of aceclofenac-tizanidine fixed dose combination against aceclofenac alone in patients with acute low back pain. This double-blind, double-dummy, randomized, comparative, multicentric, parallel group study enrolled 197 patients of either sex in the age range of 18–70 years with acute low back pain. The patients were randomized to receive either aceclofenac (100 mg)–tizanidine (2 mg) b.i.d or aceclofenac (100 mg) alone b.i.d for 7 days. The primary efficacy outcomes were pain intensity (on movement, at rest and at night; on VAS scale) and pain relief (on a 5-point verbal rating scale). The secondary efficacy outcomes measures included functional impairment (modified Schober’s test and lateral body bending test) and patient’s and investigator’s global efficacy assessment. aceclofenac–tizanidine was significantly superior to aceclofenac for pain intensity (on movement, at rest and at night; P < 0.05) and pain relief (P = 0.00) on days 3 and 7. There was significant increase in spinal flexion in both the groups from baseline on days 3 and 7 with significant difference in favour of the combination group (P < 0.05). There were significantly more number of patients with excellent to good response for the aceclofenac–tizanidine treatment as compared to aceclofenac alone (P = 0.00). Both the treatments were well tolerated. In this study, aceclofenac–tizanidine combination was more effective than aceclofenac alone and had a favourable safety profile in the treatment of acute low back pain. PMID:19421791

  5. Pregnancy-related low back pain.

    PubMed

    Katonis, P; Kampouroglou, A; Aggelopoulos, A; Kakavelakis, K; Lykoudis, S; Makrigiannakis, A; Alpantaki, K

    2011-07-01

    Pregnancy related low back pain is a common complaint among pregnant women. It can potentially have a negative impact on their quality of life. The aim of this article is to present a current review of the literature concerning this issue.By using PubMed database and low back pain, pelvic girdle pain, pregnancy as keywords, abstracts and original articles in English investigating the diagnosis treatment of back pain during pregnancy were searched and analyzedLow back pain could present as either a pelvic girdle pain between the posterior iliac crest and the gluteal fold or as a lumbar pain over and around the lumbar spine. The source of the pain should be diagnosed and differentiated early.The appropriate treatment aims to reduce the discomfort and the impact on the pregnant womans quality of life. This article reveals the most common risk factors, as well as treatment methods, which may help to alleviate the pain. Some suggestions for additional research are also discussed.

  6. Pregnancy-related low back pain

    PubMed Central

    Katonis, P; Kampouroglou, A; Aggelopoulos, A; Kakavelakis, K; Lykoudis, S; Makrigiannakis, A; Alpantaki, K

    2011-01-01

    Pregnancy related low back pain is a common complaint among pregnant women. It can potentially have a negative impact on their quality of life. The aim of this article is to present a current review of the literature concerning this issue. By using PubMed database and low back pain, pelvic girdle pain, pregnancy as keywords, abstracts and original articles in English investigating the diagnosis treatment of back pain during pregnancy were searched and analyzed Low back pain could present as either a pelvic girdle pain between the posterior iliac crest and the gluteal fold or as a lumbar pain over and around the lumbar spine. The source of the pain should be diagnosed and differentiated early.The appropriate treatment aims to reduce the discomfort and the impact on the pregnant womans quality of life. This article reveals the most common risk factors, as well as treatment methods, which may help to alleviate the pain. Some suggestions for additional research are also discussed. PMID:22435016

  7. The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial

    PubMed Central

    2010-01-01

    Background Low back pain is a highly prevalent and disabling condition worldwide. Clinical guidelines for the management of patients with acute low back pain recommend first-line treatment consisting of advice, reassurance and simple analgesics. Exercise is also commonly prescribed to these patients. The primary aim of this study was to evaluate the short-term effect of adding the McKenzie method to the first-line care of patients with acute low back pain. Methods A multi-centre randomized controlled trial with a 3-month follow-up was conducted between September 2005 and June 2008. Patients seeking care for acute non-specific low back pain from primary care medical practices were screened. Eligible participants were assigned to receive a treatment programme based on the McKenzie method and first-line care (advice, reassurance and time-contingent acetaminophen) or first-line care alone, for 3 weeks. Primary outcome measures included pain (0-10 Numeric Rating Scale) over the first seven days, pain at 1 week, pain at 3 weeks and global perceived effect (-5 to 5 scale) at 3 weeks. Treatment effects were estimated using linear mixed models. Results One hundred and forty-eight participants were randomized into study groups, of whom 138 (93%) completed the last follow-up. The addition of the McKenzie method to first-line care produced statistically significant but small reductions in pain when compared to first-line care alone: mean of -0.4 points (95% confidence interval, -0.8 to -0.1) at 1 week, -0.7 points (95% confidence interval, -1.2 to -0.1) at 3 weeks, and -0.3 points (95% confidence interval, -0.5 to -0.0) over the first 7 days. Patients receiving the McKenzie method did not show additional effects on global perceived effect, disability, function or on the risk of persistent symptoms. These patients sought less additional health care than those receiving only first-line care (P = 0.002). Conclusions When added to the currently recommended first-line care of acute

  8. Low Back Pain in a Tennis Player.

    ERIC Educational Resources Information Center

    Bracker, Mark; And Others

    1988-01-01

    A group of physicians meet to discuss a case in which a middle-aged tennis player suffers from low back pain. The diagnosis, treatment and management of the case are discussed. The article is one in an occasional series. (JL)

  9. Emotional Disturbance and Chronic Low Back Pain.

    ERIC Educational Resources Information Center

    McCreary, Charles P.; And Others

    1980-01-01

    Patients high in alientation and distrust may be poor compliers. Because only the somatic concern dimension predicted outcome, a single scale that measures this characteristic may be sufficient for effective identification of the potential good v poor responders to conservative treatment of low back pain. (Author)

  10. Preclinical studies of low back pain

    PubMed Central

    2013-01-01

    Chronic low back pain is a major cause of disability and health care costs. Current treatments are inadequate for many patients. A number of preclinical models have been developed that attempt to mimic aspects of clinical conditions that contribute to low back pain. These involve application of nucleus pulposus material near the lumbar dorsal root ganglia (DRG), chronic compression of the DRG, or localized inflammation of the DRG. These models, which are primarily implemented in rats, have many common features including behavioral hypersensitivity of the hindpaw, enhanced excitability and spontaneous activity of sensory neurons, and locally elevated levels of inflammatory mediators including cytokines. Clinically, epidural injection of steroids (glucocorticoids) is commonly used when more conservative treatments fail, but clinical trials evaluating these treatments have yielded mixed results. There are relatively few preclinical studies of steroid effects in low back pain models. One preclinical study suggests that the mineralocorticoid receptor, also present in the DRG, may have pro-inflammatory effects that oppose the activation of the glucocorticoid receptor. Although the glucocorticoid receptor is the target of anti-inflammatory steroids, many clinically used steroids activate both receptors. This could be one explanation for the limited effects of epidural steroids in some patients. Additional preclinical research is needed to address other possible reasons for limited efficacy of steroids, such as central sensitization or presence of an ongoing inflammatory stimulus in some forms of low back pain. PMID:23537369

  11. Pharmacotherapy of neuropathic low back pain.

    PubMed

    Moskowitz, Michael H

    2003-06-01

    Neuropathic low back pain is examined from a structural standpoint, distinguishing processes that start from chronic inflammation and mechanical compromise and cross into the realm of neuropathy with primary neurogenic pathophysiology. The disease of chronic pain is discussed, examining peripheral and central changes in neuroanatomy, neurophysiology, and neuromolecular dynamics. The limitations of inadequate random controlled trials regarding long-term pharmacologic interventions are contrasted with excellent work in the basic science of chronic pain. Complex rational pharmacologic strategies for structural pathology, central pain processes, sites of medication action, and differing routes of administration are delineated.

  12. Challenges of the pregnant athlete and low back pain.

    PubMed

    Noon, Megan L; Hoch, Anne Z

    2012-01-01

    Low back pain during pregnancy is a common problem with a high prevalence among pregnant athletes. The etiology of pregnancy-related low back pain remains unclear, although more evidence is supporting a biomechanical/musculoskeletal origin. This article will review the causes of low back pain in athletes and pregnant women, differentiate low back from pelvic girdle pain, and discuss the treatment and prevention of pregnancy-related low back and pelvic girdle pain.

  13. [Low back pain in pregnant women].

    PubMed

    Majchrzycki, Marian; Mrozikiewicz, Przemysław M; Kocur, Piotr; Bartkowiak-Wieczorek, Joanna; Hoffmann, Marcin; Stryła, Wanda; Seremak-Mrozikiewicz, Agnieszka; Grześkowiak, Edmund

    2010-11-01

    Pain of lumbosacral segment of the vertebral column and the pelvis concerns about 45% of all pregnant women. The change of the body posture during pregnancy is the result of gravity centre relocation, which affects the musculosceletal system. Development of the joint, ligament and myofascial dysfunctions, as well as the pain in the lumbosacral segment and the pelvis, are the most common reasons of spine pain. The aim of this review is to present the current state of knowledge about lumbar spine pain in pregnant women with special focus on the pain connected with muscular, joint and ligament disorders. Pregnancy is a serious burden for the female osteo-skeletal system. Lumbar pain with different location and intensification is the negative consequence of the position changes during pregnancy. Pharmacotherapy could be useful only in cases of intensive low back pain, with possible application of small spectrum of drugs that are safe during pregnancy. Physical therapy including manual therapy exercises, massage and techniques of local anesthesia are alternative methods in case of low back pain in pregnant women.

  14. Evaluating the patient with low back pain.

    PubMed

    Shaikh, Maliha; Östör, Andrew J K

    2015-12-01

    In the UK, low back pain is the most common cause of disability in young adults and every year 6-9% of adults consult their GP about back pain. A thorough history and examination is required to exclude an alternative diagnosis, such as pain arising from the hip or trochanteric bursa and to categorise patients as having: serious spinal pathology, nerve root/radicular pain or non-specific back pain. Inflammatory back pain is often missed, particularly in the early stages when examination may be normal. The primary features are pain arising in patients under 40, thoracolumbar or sacroiliac pain and alternating buttock pain. Stiffness in the early morning and after rest is a hallmark of inflammatory back pain. There may also be peripheral joint involvement with evidence of inflammatory arthritis as well as extra-articular manifestations such as iritis, psoriasis and colitis. Sphincter disturbance leading to loss of bladder or bowel control should also be explored as it is a sign of spinal cord compression or cauda equina syndrome. Both of these are neurosurgical emergencies and need urgent referral for further investigation and possible intervention. The majority of patients with low back pain can be managed in primary care as the pain will usually be self-limiting. Patients with suspected inflammatory back pain should be referred to rheumatology as soon as possible in order to institute early management and prevent long-term deformity and disability. Patients with suspected serious spinal pathology should be referred urgently for further investigation. Red flag symptoms should raise concerns regarding a possible sinister cause such as malignancy and more than one red flag mandates urgent further investigation. PMID:26882775

  15. Low back pain in Hispanic residential carpenters☆

    PubMed Central

    Gilkey, David P.; Enebo, Brian A.; Keefe, Thomas J.; Vela Acosta, Martha Soledad; Hautaluoma, Jacob E.; Bigelow, Philip L.; Rosecrance, John; Herron, Robert E.

    2007-01-01

    Abstract Objective Low back pain (LBP) is a leading cause of lost work time and has been recognized as America's number one workplace safety challenge. Low back pain is occurring at epidemic proportions among construction workers, and minority populations have been underinvestigated for risk of back injury. This project investigated the multiple potential risk factors for occupational LBP among Hispanic residential carpenters. Methods This investigation evaluated 241 Hispanic residential framing carpenters. Data for this study were collected using a 91-question survey. End points of interest included point, annual, and lifetime prevalence of LBP. Results Nineteen percent of respondents reported they had an episode of LBP in their lifetime. Conclusions Hispanic residential carpenters reported less than expected prevalence of LBP compared with non-Hispanic counterparts in the same trade and location. Job tasks and personal and workplace risk factors, including psychological and morphological characteristics, affect the prevalence of LBP among Hispanic framing carpenters. PMID:19674688

  16. Economic Evaluation of Active Implementation versus Guideline Dissemination for Evidence-Based Care of Acute Low-Back Pain in a General Practice Setting

    PubMed Central

    Mortimer, Duncan; French, Simon D.; McKenzie, Joanne E.; O′Connor, Denise A.; Green, Sally E.

    2013-01-01

    Introduction The development and publication of clinical practice guidelines for acute low-back pain has resulted in evidence-based recommendations that have the potential to improve the quality and safety of care for acute low-back pain. Development and dissemination of guidelines may not, however, be sufficient to produce improvements in clinical practice; further investment in active implementation of guideline recommendations may be required. Further research is required to quantify the trade-off between the additional upfront cost of active implementation of guideline recommendations for low-back pain and any resulting improvements in clinical practice. Methods Cost-effectiveness analysis alongside the IMPLEMENT trial from a health sector perspective to compare active implementation of guideline recommendations via the IMPLEMENT intervention (plus standard dissemination) against standard dissemination alone. Results The base-case analysis suggests that delivery of the IMPLEMENT intervention dominates standard dissemination (less costly and more effective), yielding savings of $135 per x-ray referral avoided (-$462.93/3.43). However, confidence intervals around point estimates for the primary outcome suggest that – irrespective of willingness to pay (WTP) – we cannot be at least 95% confident that the IMPLEMENT intervention differs in value from standard dissemination. Conclusions Our findings demonstrate that moving beyond development and dissemination to active implementation entails a significant additional upfront investment that may not be offset by health gains and/or reductions in health service utilization of sufficient magnitude to render active implementation cost-effective. PMID:24146767

  17. Exercise therapy for chronic nonspecific low-back pain.

    PubMed

    van Middelkoop, Marienke; Rubinstein, Sidney M; Verhagen, Arianne P; Ostelo, Raymond W; Koes, Bart W; van Tulder, Maurits W

    2010-04-01

    Exercise therapy is the most widely used type of conservative treatment for low back pain. Systematic reviews have shown that exercise therapy is effective for chronic but not for acute low back pain. During the past 5 years, many additional trials have been published on chronic low back pain. This articles aims to give an overview on the effectiveness of exercise therapy in patients with low back pain. For this overview, existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria, and the search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. Studies were included if they fulfilled the following criteria: (1) randomised controlled trials,(2) adult (> or =18 years) population with chronic (> or =12 weeks) nonspecific low back pain and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias and outcomes at short-term, intermediate and long-term follow-up. The GRADE approach (GRADE, Grading of Recommendations Assessment, Development and Evaluation) was used to determine the quality of evidence. In total, 37 randomised controlled trials met the inclusion criteria and were included in this overview. Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. The authors conclude that evidence from randomised controlled trials demonstrated that exercise therapy is effective at reducing pain and function in the treatment of chronic low back pain. There is no evidence that one particular type of exercise therapy is clearly more effective than others. However, effects are small and it remains unclear which subgroups of patients benefit most from a specific type of treatment. PMID:20227641

  18. [Imaging indication for low back pain in the adult population].

    PubMed

    Mazzola Eusébio, O; Motamed, S

    2013-09-25

    Low back pain is a frequent symptom-related reason for visits to a general physician. In case of acute low back pain, the only situation that requires a radiologic exam is when are present. This article specifies which anamnestic symptoms and past medical events are to be considered as such, and suggests what kind of radiologic exam should be done depending on the situation. It also mentions the psycho-social factors that favour a chronicisation of the problem and that should be identified in order to be taken care of. When low back pain becomes a chronic condition, there is a lack of scientific evidences/evidence based medicine and the actual recommendations whether or not to ask for imaging studies are based upon experts opinions. Medical follow-up is essential. PMID:24163881

  19. Hypnosis treatment for chronic low back pain.

    PubMed

    Tan, Gabriel; Fukui, Tenley; Jensen, Mark P; Thornby, John; Waldman, Karen L

    2010-01-01

    Chronic low back pain (CLBP) is a significant healthcare problem, and many individuals with CLBP remain unresponsive to available interventions. Previous research suggests that hypnosis is effective for many chronic pain conditions; however, data to support its efficacy for CLBP are outdated and have been limited primarily to case studies. This pilot study indicated that a brief, 4-session standardized self-hypnosis protocol, combined with psycho-education, significantly and substantially reduced pain intensity and pain interference. Significant session-to-session improvements were also noted on pain ratings and mood states; however, follow-up data suggest that these benefits may not have been maintained across time in this sample. These findings need to be replicated and confirmed in a larger clinical trial, which could also assess the long-term effects of this treatment. PMID:20183738

  20. A comparison of spinal manipulation methods and usual medical care for acute and sub-acute low back pain: a randomized clinical trial

    PubMed Central

    Haas, Mitchell; Glick, Ronald; Stevans, Joel; Landsittel, Doug

    2014-01-01

    Study Design Randomized-controlled trial with follow-up to 6 months. Objective This was a comparative effectiveness trial of: manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC). Summary of Background Data Low back pain (LBP) is one of the most common conditions seen in primary care and physical medicine practice. MTM is a common treatment for LBP. Claims that MAM is an effective alternative to MTM have yet to be substantiated. There is also question about the effectiveness of manipulation in acute and sub-acute LBP, as compared to UMC. Methods 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: MTM; MAM; or UMC. Outcome measures included the Oswestry LBP disability index (0 to 100 scale) and numeric pain rating (0 to 10 scale). Participants in the manipulation groups were treated twice weekly over 4 weeks; subjects in UMC were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months and 6 months. Results Linear regression showed a statistically significant advantage of MTM at 4 weeks compared to MAM (disability = −8.1, p = .009; pain = −1.4, p = .002) and UMC (disability = −6.5, p = .032; pain = −1.7, p < .001). Responder analysis, defined as 30% and 50% reductions in Oswestry scores revealed a significantly greater proportion of responders at 4 weeks in MTM (76%; 50%) compared to MAM (50%; 16%) and UMC (48%; 39%).Similar between-group results were found for pain: MTM (94%; 76%); MAM (69%; 47%); and UMC (56%; 41%). No statistically significant group differences were found between MAM and UMC, and for any comparison at 3 or 6 months. Conclusions MTM provides greater short-term reductions in self-reported disability and pain scores compared to UMC or MAM. PMID:25423308

  1. Can We Identify People at Risk of Non-recovery after Acute Occupational Low Back Pain? Results of a Review and Higher-Order Analysis

    PubMed Central

    Agnello, Adrienne; Brown, Tim; Desroches, Sam; Welling, Uma

    2010-01-01

    ABSTRACT Purpose: To identify prognostic factors in the literature that may predict a poor recovery from acute occupational low back pain (LBP). Methods: Four international databases (Medline, CINAHL, EMBASE, and PsycINFO) were reviewed, searching all articles indexed up to November 2007 with the term low back pain combined with the terms prognostic, prospective, or cohort. Following application of inclusion criteria, 10 articles were found to be appropriate for data extraction. Each article was critically appraised by two independent reviewers. Statistical pooling was performed on any factor evaluated in at least three independent cohorts. Results: Seven cohorts were identified, with a total sample size of 2,484 subjects. Only three factors were followed in at least three cohorts and were therefore suitable for statistical pooling: female gender (OR=1.28, 95% CI: 1.03–1.58); pain radiation (OR=1.37, 95% CI: 0.79–2.39); and previous history of back pain (OR=0.91, 95% CI: 0.52–1.60). There was significant heterogeneity within the female gender factor; compensation of subjects for study participation appeared to moderate its effect. Conclusion: After statistical pooling, only female gender achieved statistical significance as a prognostic factor for prolonged recovery. Further research is necessary to determine prognostic factors for non-recovery in acute LBP. PMID:21197174

  2. Can acute low back pain result from segmental spinal buckling during sub-maximal activities? A review of the current literature.

    PubMed

    Preuss, Richard; Fung, Joyce

    2005-02-01

    This paper provides a review of the current literature supporting the hypothesis that segmental spine buckling resulting in tissue damage may be a primary cause of sudden onset low back pain, even during activities that are sub-maximal with respect to loading and muscle activation. While a temporal link exists, it is supported primarily by anecdotal and clinical reports. More pertinent to this review is the biological plausibility of segmental spine buckling as a mechanism of acute injury, supported by modelling studies as well as current knowledge of tissue mechanics and neurophysiology. One antithesis, however, is the low incidence of low back injuries reported during sub-maximal tasks. In order to account for this discrepancy, several predisposing factors are addressed, both constant and situation-dependent, which may contribute to the occurrence of segmental spinal buckling during sub-maximal activities. PMID:15681264

  3. Radiologic investigation of low back pain.

    PubMed Central

    Pelz, D M; Haddad, R G

    1989-01-01

    Low back pain is one of the commonest disorders, yet is the most confusing. The cost in work-time lost and in the search for and treatment of its many causes amounts to billions of dollars annually. The traditional techniques for anatomic visualization have been plain-film radiography and myelography, but they have limitations. The development of computed tomography and magnetic resonance imaging have substantially improved anatomic imaging. However, invasive procedures, such as discography, percutaneous nerve-root blocking and percutaneous facet injection, may be helpful in patients with disabling pain in whom noninvasive methods give negative findings, show abnormalities that do not correlate with the symptoms or identify multiple sites of disease. The invasive procedures are believed by some to be associated with too many complications. We have attempted to clarify the strengths and weaknesses of the currently available methods of investigating low back pain and the indications for their use. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:2521569

  4. Low Back Pain Exacerbated by Psychosocial Factors

    PubMed Central

    Derebery, V. Jane; Tullis, William H.

    1986-01-01

    Patients with low back pain can pose a considerable challenge when there is evidence of a nonorganic or functional overlay. These patients can become frustrating examples of chronicity if proper guidelines in diagnosis and management are not followed. An exploration into the psychosocial factors affecting a patient is essential. Several simple questions and tests can facilitate this process. Significant organic lesions should be ruled out with a minimum of appropriate diagnostic procedures. A supportive and conservative treatment regimen with the goal of returning patients to full functioning as soon as possible is recommended. Patients should be encouraged to take an active role in their own treatment. PMID:2940754

  5. Low Back Pain in Port Machinery Operators

    NASA Astrophysics Data System (ADS)

    BOVENZI, M.; PINTO, I.; STACCHINI, N.

    2002-05-01

    The occurrence of several types of low back pain (LBP) was investigated by a standardized questionnaire in a group of 219 port machinery operators exposed to whole-body vibration (WBV) and postural load and in a control group of 85 maintenance workers employed at the same transport company. The group of port machinery operators included 85 straddle carrier drivers, 88 fork-lift truck drivers, and 46 crane operators. The vector sum of the frequency-weighted r.m.s. acceleration of vibration measured on the seatpan of port vehicles and machines averaged 0·90 m/s2 for fork-lift trucks, 0·48 m/s2 for straddle carriers, 0·53 m/s2 for mobile cranes, and 0·22 m/s2 for overhead cranes. The 12-month prevalence of low back symptoms (LBP, sciatic pain, treated LBP, sick leave due to LBP) was significantly greater in the fork-lift truck drivers than in the controls and the other two groups of port machinery operators. After adjusting for potential confounders, the prevalence of low back symptoms was found to increase with the increase of WBV exposure expressed as duration of exposure (driving years), equivalent vibration magnitude (m/s2), or cumulative vibration exposure (yr m2/s4). An excess risk for lumbar disc herniation was observed in the port machinery operators with prolonged driving experience. In both the controls and the port machinery operators, low back complaints were strongly associated with perceived postural load assessed in terms of frequency and/or duration of awkward postures at work. Multivariate analysis showed that vibration exposure and postural load were independent predictors of LBP. Even though the cross-sectional design of the present study does not permit firm conclusions on the relationship between WBV exposure and low back disorders, the findings of this investigation provide additional epidemiological evidence that seated WBV exposure combined with non-neutral trunk postures, as while driving, is associated with an increased risk of long

  6. To evaluate efficacy and safety of fixed dose combination of aceclofenac + paracetamol + thiocolchicoside (acenac-MR) in the treatment of acute low back pain.

    PubMed

    Lahoti, Govind

    2012-01-01

    Low back pain is very common complaint in all age groups. Paracetamol, non-steroidal anti-inflammatory drugs and muscle relaxants are commonly prescribed in combination for the treatment of back pain. The aim of the study was to evaluate efficacy and safety of fixed dose combination of aceclofenac + paracetamol + thiocolchicoside (acenac-MR) in the treatment of acute low back pain. Thirty-five patients, age being 18 to 76 years suffering from acute low back pain were enrolled in the study. Study drug acenac-MR tablet, (Medley pharmaceutical, Mumbai) containing aceclofenac 100 mg + thiocolchicoside 4 mg + paracetamol 500 mg was prescribed twice daily for a duration of 7 days. Intensity of pain was evaluated at the start of the therapy and on day 3 and day 7 with the help of visual analogue scale. Mobility assessment in low back patients was evaluated at the start of the therapy and on day 3 and day 7. A simple graduated bar (0 value at floor) evaluated hand-to-floor distance. Tolerability and efficacy was evaluated based on the global assessment by the investigator based on a 3-point scale marked as excellent/good/poor. There were 20 males and 10 females who were included for final analysis, 5 patients lost to follow-up. Intensity of pain at rest (p< or =0.0014 at day 3, p< or =0.0001 at day 7), during movement (p< or =0.0001 at day 3, p< or =0.0001 at day 7) and at night (p< or =0.0001 at day 3, p< or =0.0001 at day 7) was significantly reduced by acenac-MR compared to baseline. The mobility assessment revealed a statistically significant improvement in hand-to-floor distance on the 3rd (< or =0.0001) and 7th day (< or =0.0001) as compared to baseline with acenac-MR. As per investigators' assessment about efficacy of trial drug, 70% of patients reported excellent, 26.66 % good and 3.33 % reported poor efficacy. As per investigators' assessment about tolerability, 60 % of patients reported excellent, 36.66 % good and 3.33 % reported poor tolerability. None of the

  7. Novel analgesic combination of tramadol, paracetamol, caffeine and taurine in the management of moderate to moderately severe acute low back pain

    PubMed Central

    Madhusudhan, Santhosh Kumar

    2013-01-01

    Background Acute low back pain is one the leading cause of doctor's visit in our country with innumerable medication for treatment. Finding an ideal analgesic medication with better efficacy and least adverse effects is always a challenging task to the treating doctor. Methods In this study we compared the efficacy and safety profile of a fixed dose combination of novel analgesic tramadol 37.5 mg/paracetamol 325 mg/caffeine 30 mg/taurine 250 mg with commonly used tramadol 37.5 mg/paracetamol 325 mg tablet in the treatment of moderate to moderately severe acute low back pain. Patients attending 50 clinics throughout India were enrolled in either of the above group and were asked to take one tablet every 6th hour for five consecutive days. The pain evaluation in both groups was done with verbal pain relief scale and pain intensity scale at end of treatment. Results Proportion of patients in novel combination group compared to tramadol/paracetamol only group responding to treatment based on treatment satisfaction (good and excellent) and mean pain intensity (no pain or mild pain), were 81% Vs 45%, (p < 0.001) and 83% Vs 66% (p < 0.001) respectively. Common expected adverse drug reaction like nausea, vomiting and dizziness occurred with far less frequency in patients under novel combination group. Conclusion We conclude that significantly more patients in novel combination drug group compared to tramadol/paracetamol only group had a superior analgesic effect with lesser adverse reactions. PMID:24396231

  8. Exercise and nonspecific low back pain: a literature review.

    PubMed

    Henchoz, Yves; Kai-Lik So, Alexander

    2008-10-01

    We reviewed the literature to clarify the effects of exercise in preventing and treating nonspecific low back pain. We evaluated several characteristics of exercise programs including specificity, individual tailoring, supervision, motivation enhancement, volume, and intensity. The results show that exercise is effective in the primary and secondary prevention of low back pain. When used for curative treatment, exercise diminishes disability and pain severity while improving fitness and occupational status in patients who have subacute, recurrent, or chronic low back pain. Patients with acute low back pain are usually advised to continue their everyday activities to the greatest extent possible rather than to start an exercise program. Supervision is crucial to the efficacy of exercise programs. Whether general or specific exercises are preferable is unclear, and neither is there clear evidence that one-on-one sessions are superior to group sessions. Further studies are needed to determine which patient subsets respond to specific characteristics of exercise programs and which exercise volumes and intensities are optimal. PMID:18801686

  9. Isolated septic facet joint arthritis as a rare cause of acute and chronic low back pain – a case report and literature review

    PubMed Central

    Klekot, Dominika; Zimny, Anna; Czapiga, Bogdan; Sąsiadek, Marek

    2012-01-01

    Summary Background: The most common cause of low back pain is degenerative disease of the intervertebral disc and other structures of the lumbar spine. However, in some cases other less frequent causes of such pain can be seen, for example septic facet joint arthritis. Until now, only 40 cases of such inflammatory changes within the spine have been reported in the literature. The disease is probably underestimated due to improper diagnostic pathway. Case Report: The authors describe a case of a 53-year-old woman who was repeatedly hospitalized during a five-month period because of an acute, severe low back pain, with sphincter dysfunction, partially resembling sciatic symptoms. Physical examinations revealed also focal tenderness in the area of the lumbar spine. Inflammatory markers (ESR – erythrocyte sedimentation rate, CRP – C-reactive protein) were elevated. Conservative analgetic treatment brought only partial and temporary relief of the pain and symptoms. The final accurate diagnosis of isolated septic facet joint arthritis at the level of L5/S1 was established after several months from the onset of the first symptoms, after performing various imaging examinations, including bone scintigraphy as well as CT and MRI of the lumbosacral spine. The patient fully recovered after antibiotic therapy and surgery, which was proven in several follow-up examinations showing no relevant pathology of the lumbar spine. The authors broadly describe the etiology and clinical symptoms of the septic facet joint arthritis as well as the significant role of imaging methods, especially MRI, in diagnostic process. The authors also discuss currently available treatment options, both conservative and surgical. Conclusions: The diagnostic procedure of septic facet joint arthritis requires several steps to be taken. Establishing a correct diagnosis may be difficult, that is why it is important to remember about rare causes of low back pain and to perform detailed physical

  10. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain.

    PubMed

    Borenstein, D G

    1999-03-01

    Low back pain continues to affect a significant proportion of the younger, working population between 35 and 45 years of age. An important study has correlated macroscopic and microscopic intervertebral disc alterations starting in the second decade of life with oxidative stress manifested by the presence of N-(carboxylmethyl)lysine. Job satisfaction remains a strong predictive factor for the identification of individuals with acute back pain who will develop chronic pain. Patients with pyogenic vertebral osteomyelitis may have an increase in their erythrocyte sedimentation rate during the first 2 weeks of antibiotic therapy without requiring surgical intervention. Magnetic resonance imaging enhancement of migrated disc fragments identifies individuals who are likely to resolve sciatica without surgical intervention. As many as 25% of individuals with low back pain are symptomatic at 12 months, in contradistinction to the dictum of resolution of pain in 2 months. Nonsteroidal anti-inflammatory drugs and muscle relaxants are a very effective combination for the effective treatment of acute low back pain. A majority of chiropractic manipulations are performed for inappropriate indications. PMID:10319220

  11. [Low back pain during pregnancy. Multidisciplinary approach].

    PubMed

    Gallo-Padilla, D; Gallo-Padilla, C; Gallo-Vallejo, F J; Gallo-Vallejo, J L

    2016-09-01

    After explaining that low back pain is considered the most common pregnancy complication, its pathogenesis, risk factors and the clinical characteristics of the very painful symptoms of this condition are described. As for its approach, it is stressed that it must be multidisciplinary, introducing very important preventive measures, including proper postural hygiene. For its treatment, the methods may be based on non-surgical or pharmacological interventions of a conservative non-invasive nature. Thus, physiotherapy, osteopathic manipulation, multimodal intervention (exercise and education), exercises performed in water environment, acupuncture, etc., have proven to be effective. Finally, it is emphasised that given the significant impact on their quality of life, different health professionals must be proactive and treat the lumbar disease in pregnant women. PMID:26239672

  12. [Low back pain during pregnancy. Multidisciplinary approach].

    PubMed

    Gallo-Padilla, D; Gallo-Padilla, C; Gallo-Vallejo, F J; Gallo-Vallejo, J L

    2016-09-01

    After explaining that low back pain is considered the most common pregnancy complication, its pathogenesis, risk factors and the clinical characteristics of the very painful symptoms of this condition are described. As for its approach, it is stressed that it must be multidisciplinary, introducing very important preventive measures, including proper postural hygiene. For its treatment, the methods may be based on non-surgical or pharmacological interventions of a conservative non-invasive nature. Thus, physiotherapy, osteopathic manipulation, multimodal intervention (exercise and education), exercises performed in water environment, acupuncture, etc., have proven to be effective. Finally, it is emphasised that given the significant impact on their quality of life, different health professionals must be proactive and treat the lumbar disease in pregnant women.

  13. A cost utility analysis of interdisciplinary early intervention versus treatment as usual for high-risk acute low back pain patients.

    PubMed

    Rogerson, Mark D; Gatchel, Robert J; Bierner, Samuel M

    2010-01-01

    Chronic pain is a costly and debilitating condition that has proven difficult to treat, solely with medical interventions, due to the complex interplay of biological, psychological, and social factors in its onset and persistence. Many studies have demonstrated the effectiveness of interdisciplinary treatment that includes psychosocial interventions for low back pain. Nevertheless, these interventions continue to be under-utilized due to concerns of cost and applicability. The present study utilized a cost utility analysis to evaluate effectiveness and associated costs of interdisciplinary early intervention for individuals with acute low back pain that was identified as high-risk for becoming chronic. Treatment effectiveness was evaluated using a standard pain measure and quality-adjusted life years, and associated medical and employment costs were gathered for 1 year. Results indicated that subjects improved significantly from pretreatment to 1-year follow-up, and that the early intervention group reported fewer health-care visits and missed workdays than the treatment as usual group. The majority of 1,000 bootstrapped samples demonstrated the dominance of the early intervention program as being both more effective and less costly from a societal perspective. The early intervention treatment was the preferred option in over 85% of samples within an established range of acceptable costs. These results are encouraging evidence for the cost-effectiveness of interdisciplinary intervention and the benefits of targeted early treatment. PMID:20384967

  14. The Prognosis of Acute Low Back Pain in Primary Care in the U.S. A 2-Year Prospective Cohort Study

    PubMed Central

    Mehling, Wolf E.; Gopisetty, Viranjini; Bartmess-LeVasseur, Elizabeth; Acree, Mike; Pressman, Alice; Goldberg, Harley; Hecht, Frederick M; Carey, Tim; Avins, Andrew L

    2011-01-01

    Study Design Prospective cohort study Objective to assess the prognosis of patients presenting with acute low back pain (LBP) in a primary care setting in the U.S. Summary of Background Data Practice guidelines for acute LBP based on return-to-work outcomes underestimate the development of chronic pain in the primary care setting. Due to differences in inclusion criteria, chronic pain definitions and national health systems, prognostic cohort studies have reported a wide range of results limiting interpretation and generalization. Current data from carefully designed prognostic studies of acute LBP are lacking for the U.S. primary care system. Methods Members of a large health service organization were enrolled after seeking medical care for acute LBP, with or without sciatica, of up to 30 days duration, with no prior episode in the past 12 months and no history of spine surgery. We conducted phone interviews at baseline, six months and two years. Based on receiver operating characteristic analyses, a combination of global perceived recovery with pain intensity was used as primary outcome for chronic pain. Recurrence and multiple secondary outcomes were assessed to allow for comparison with other studies. Results 605 patients had an average pain intensity of 5.6 (numeric rating scale 0–10) and disability of 15.8 (Roland Morris scale 0–24). Eight percent had declared sick leave between pain onset and baseline interview. 13% of 521 patients (86% follow-up) suffered from chronic pain at six months and 19% of 443 patients at 2 years. At six months, 54% had experienced at least one LBP recurrence, and 47% in the subsequent 18 months. Conclusion The prognosis of strictly-defined acute LBP, with or without sciatica, is less favorable than commonly stated in practice guidelines based on failure to return to work. Broad initiatives to develop new means for the primary and secondary prevention of recurrent and chronic LBP are urgently needed. PMID:22504516

  15. Cauda equina cavernous angioma presenting as acute low back pain and sciatica. A report of two cases and literature review.

    PubMed

    Khalatbari, M R; Hamidi, M; Moharamzad, Y; Taheri, B

    2011-08-31

    Spinal cavernous angiomas are rare vascular lesions occurring mainly in the vertebral bodies extending secondary into the extradural space. Only 3% of these lesions are intradural, usually localized within the spinal cord. Rarely, cavernous angioma has been reported to occur in the cauda equina. We describe clinical, diagnostic imaging, and surgical procedures of two cases of cavernous angioma of the cauda equina who presented with acute back pain and sciatica. The relevant literature is also reviewed. PMID:24059723

  16. Chronic low back pain among tobacco farmers in southern Brazil

    PubMed Central

    Meucci, Rodrigo D; Fassa, Anaclaudia G; Faria, Neice M X; Fiori, Nadia S

    2015-01-01

    Background: Despite tobacco farming involving intensive manual labor, chronic low back pain (CLBP) prevalence and associated factors are unknown among this occupational group. Methods: This was a cross-sectional study conducted in southern Brazil. A random sample of tobacco farmers was interviewed. Socioeconomic and individual characteristics, occupational tasks, workloads, and comorbidities were investigated. Chronic low back pain prevalence was described in relation to independent variables, and associations were examined with Poisson regression. Results: Chronic low back pain prevalence was 8·4%. Increasing age, rearing two or more species of livestock (PR 1·65), exposure to tasks that require heavy physical exertion (PR 2·00), working in awkward postures (PR 1·36), green tobacco sickness (GTS) (PR 1·63), pesticide poisoning (PR 2·37), and minor psychiatric disorders (PR 2·55) were associated with CLBP. Conclusions: This study found that CLBP is a relevant health problem among tobacco farmers and highlights understudied risk factors such as pesticide poisoning and GTS. Policies to minimize exposure to physiological and chemical workloads in tobacco planting to prevent CLBP are needed. Health professionals should be trained to diagnose and prevent acute low back pain episodes and thus prevent/minimize limitations and disabilities due to CLBP. PMID:25633930

  17. [Recommendations for a basic functional assessment of low back pain].

    PubMed

    Demoulin, C; Fauconnier, C; Vanderthommen, M; Henrotin, Y

    2005-01-01

    This article aims to recommend easy, reproducible and valid physical tests and questionnaires to allow a functional and physical assessment of sub-acute and chronic low back pain patients. We recommend the pain visual analogue scale, the French translation of the Roland-Morris Disability Questionnaire (EIFEL) and the Dallas questionnaire to appreciate pain intensity and its influence on patients' quality of life. Sorensen's test is recommended in order to assess trunk extensor muscles endurance. We suggest to measure pelvic and lumbar flexion mobility by means of the inclinometer technique. The test described by McQuade is recommended to assess abdominal muscles static endurance. PMID:16184742

  18. Improving the care for people with acute low-back pain by allied health professionals (the ALIGN trial): A cluster randomised trial protocol

    PubMed Central

    2010-01-01

    Background Variability between clinical practice guideline recommendations and actual clinical practice exists in many areas of health care. A 2004 systematic review examining the effectiveness of guideline implementation interventions concluded there was a lack of evidence to support decisions about effective interventions to promote the uptake of guidelines. Further, the review recommended the use of theory in the development of implementation interventions. A clinical practice guideline for the management of acute low-back pain has been developed in Australia (2003). Acute low-back pain is a common condition, has a high burden, and there is some indication of an evidence-practice gap in the allied health setting. This provides an opportunity to develop and test a theory-based implementation intervention which, if effective, may provide benefits for patients with this condition. Aims This study aims to estimate the effectiveness of a theory-based intervention to increase allied health practitioners' (physiotherapists and chiropractors in Victoria, Australia) compliance with a clinical practice guideline for acute non-specific low back pain (LBP), compared with providing practitioners with a printed copy of the guideline. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of acute non-specific LBP patients who are either referred for or receive an x-ray, and improving mean level of disability for patients three months post-onset of acute LBP. Methods The design of the study is a cluster randomised trial. Restricted randomisation was used to randomise 210 practices (clusters) to an intervention or control group. Practitioners in the control group received a printed copy of the guideline. Practitioners in the intervention group received a theory-based intervention developed to address prospectively identified barriers to practitioner compliance with the guideline. The intervention primarily consisted of

  19. Chronic Low Back Pain due to Retroperitoneal Cystic Lymphangioma.

    PubMed

    Fattahi, Asieh Sadat; Maddah, Godratollah; Motamedolshariati, Mohammad; Ghiasi-Moghadam, Taghi

    2014-03-01

    Abdominal cystic lymphangioma is a rare benign neoplasm. Less than 1% of lymphangiomas is in the retroperitoneum. Lymphangioma is mostly asymptomatic. Chronic symptoms were reported in retroperitoneal type more than others. Acute symptoms due to complications like infection, cyst rupture or hemorrhage may occur. We report an 18-years-old girl with low back pain from 6 months ago with huge pelvic mass and diagnosis of retroperitoneal cystic lymphangioma.

  20. Muscle functional magnetic resonance imaging and acute low back pain: a pilot study to characterize lumbar muscle activity asymmetries and examine the effects of osteopathic manipulative treatment

    PubMed Central

    Clark, Brian C; Walkowski, Stevan; Conatser, Robert R; Eland, David C; Howell, John N

    2009-01-01

    Background Muscle functional magnetic resonance imaging (mfMRI) measures transverse relaxation time (T2), and allows for determination of the spatial pattern of muscle activation. The purposes of this pilot study were to examine whether MRI-derived T2 or side-to-side differences in T2 (asymmetries) differ in low back muscles between subjects with acute low back pain (LBP) compared to asymptomatic controls, and to determine if a single osteopathic manipulative treatment (OMT) session alters these T2 properties immediately and 48-hours after treatment. Methods Subjects with non-specific acute LBP (mean score on 1-10 visual analog score = 3.02 ± 2.81) and asymptomatic controls (n = 9/group) underwent an MRI, and subsequently the LBP subjects received OMT and then underwent another MRI. The LBP subjects reported back for an additional MRI 48-hours following their initial visit. T2 and T2 asymmetry were calculated from regions of interest for the psoas, quadratus lumborum (QL), multifidus, and iliocostalis lumborum/longissimus thoracis (IL/LT) muscles. Results No differences were observed between the groups when T2 was averaged for the left and right side muscles. However, the QL displayed a significantly greater T2 asymmetry in LBP subjects when compared to controls (29.1 ± 4.3 vs. 15.9 ± 4.1%; p = 0.05). The psoas muscle also displayed a relatively large, albeit non-significant, mean difference (22.7 ± 6.9 vs. 9.5 ± 2.8%; p = 0.11). In the subjects with LBP, psoas T2 asymmetry was significantly reduced immediately following OMT (25.3 ± 6.9 to 6.1 ± 1.8%, p = 0.05), and the change in LBP immediately following OMT was correlated with the change in psoas T2 asymmetry (r = 0.75, p = 0.02). Conclusion Collectively, this pilot work demonstrates the feasibility of mfMRI for quantification and localization of muscle abnormalities in patients with acute low back pain. Additionally, this pilot work provides insight into the mechanistic actions of OMT during acute LBP, as

  1. Estimating the Risk of Chronic Pain: Development and Validation of a Prognostic Model (PICKUP) for Patients with Acute Low Back Pain

    PubMed Central

    Traeger, Adrian C.; Henschke, Nicholas; Hübscher, Markus; Williams, Christopher M.; Kamper, Steven J.; Maher, Christopher G.; Moseley, G. Lorimer; McAuley, James H.

    2016-01-01

    Background Low back pain (LBP) is a major health problem. Globally it is responsible for the most years lived with disability. The most problematic type of LBP is chronic LBP (pain lasting longer than 3 mo); it has a poor prognosis and is costly, and interventions are only moderately effective. Targeting interventions according to risk profile is a promising approach to prevent the onset of chronic LBP. Developing accurate prognostic models is the first step. No validated prognostic models are available to accurately predict the onset of chronic LBP. The primary aim of this study was to develop and validate a prognostic model to estimate the risk of chronic LBP. Methods and Findings We used the PROGRESS framework to specify a priori methods, which we published in a study protocol. Data from 2,758 patients with acute LBP attending primary care in Australia between 5 November 2003 and 15 July 2005 (development sample, n = 1,230) and between 10 November 2009 and 5 February 2013 (external validation sample, n = 1,528) were used to develop and externally validate the model. The primary outcome was chronic LBP (ongoing pain at 3 mo). In all, 30% of the development sample and 19% of the external validation sample developed chronic LBP. In the external validation sample, the primary model (PICKUP) discriminated between those who did and did not develop chronic LBP with acceptable performance (area under the receiver operating characteristic curve 0.66 [95% CI 0.63 to 0.69]). Although model calibration was also acceptable in the external validation sample (intercept = −0.55, slope = 0.89), some miscalibration was observed for high-risk groups. The decision curve analysis estimated that, if decisions to recommend further intervention were based on risk scores, screening could lead to a net reduction of 40 unnecessary interventions for every 100 patients presenting to primary care compared to a “treat all” approach. Limitations of the method include the model being

  2. Self-reported assessment of disability and performance-based assessment of disability are influenced by different patient characteristics in acute low back pain

    PubMed Central

    Chiffelle, Lara A.; O’Connell, Neil Edward; McAuley, James Henry; DeSouza, Lorraine Hilary

    2009-01-01

    For an individual, the functional consequences of an episode of low back pain is a key measure of their clinical status. Self-reported disability measures are commonly used to capture this component of the back pain experience. In non-acute low back pain there is some uncertainty of the validity of this approach. It appears that self-reported assessment of disability and direct measurements of functional status are only moderately related. In this cross-sectional study, we investigated this relationship in a sample of 94 acute low back pain patients. Both self-reported disability and a performance-based assessment of disability were assessed, along with extensive profiling of patient characteristics. Scale consistency of the performance-based assessment was investigated using Cronbach’s alpha, the relationship between self-reported and performance-based assessment of disability was investigated using Pearson’s correlation. The relationship between clinical profile and each of the disability measures were examined using Pearson’s correlations and multivariate linear regression. Our results demonstrate that the battery of tests used are internally reliable (Cronbach’s alpha = 0.86). We found only moderate correlations between the two disability measures (r = 0.471, p < 0.001). Self-reported disability was significantly correlated with symptom distribution, medication use, physical well-being, pain intensity, depression, somatic distress and anxiety. The only significant correlations with the performance-based measure were symptom distribution, physical well-being and pain intensity. In the multivariate analyses no psychological measure made a significant unique contribution to the prediction of the performance-based measure, whereas depression made a unique contribution to the prediction of the self-reported measure. Our results suggest that self-reported and performance-based assessments of disability are influenced by different patient characteristics

  3. Does a patient’s physical activity predict recovery from an episode of acute low back pain? A prospective cohort study

    PubMed Central

    2013-01-01

    Background Advice to remain active and normalisation of activity are commonly prescribed in the management of low back pain (LBP). However, no research has assessed whether objective measurements of physical activity predict outcome and recovery in acute low back pain. Method The aims of this study were to assess the predictive relationship between activity and disability at 3 months in a sub-acute LBP population. This prospective cohort study recruited 101 consenting patients with sub-acute LBP (< 6 weeks) who completed the Roland Morris Disability Questionnaire (RMDQ), the Visual Analogue Scale, and resumption of full ‘normal’ activity question (Y/N), at baseline and 3 months. Physical activity was measured for 7 days at both baseline and at 3 months with an RT3 accelerometer and a recall questionnaire. Results Observed and self-reported measures of physical activity at baseline and change in activity from baseline to 3 months were not independent predictors of RMDQ (p > 0.05) or RMDQ change (p > 0.05) over 3 months. A self-report of a return to full ‘normal’ activities was significantly associated with greater RMDQ change score at 3 months (p < 0.001). Paired t-tests found no significant change in activity levels measured with the RT3 (p = 0.57) or the recall questionnaire (p = 0.38) from baseline to 3 months. Conclusions These results question the predictive role of physical activity in LBP recovery, and the assumption that activity levels change as LBP symptoms resolve. The importance of a patient’s perception of activity limitation in recovery from acute LBP was also highlighted. Trial registration Clinical Trial Registration Number, ACTRN12609000282280 PMID:23560880

  4. IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT): Cluster randomised controlled trial study protocol

    PubMed Central

    McKenzie, Joanne E; French, Simon D; O'Connor, Denise A; Grimshaw, Jeremy M; Mortimer, Duncan; Michie, Susan; Francis, Jill; Spike, Neil; Schattner, Peter; Kent, Peter M; Buchbinder, Rachelle; Green, Sally E

    2008-01-01

    Background Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidence-based clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access

  5. Low back pain during labor and related factors.

    PubMed

    Tzeng, Ya-Ling; Su, Tsann-Juu

    2008-09-01

    A substantial proportion of women in labor suffer from low back pain, yet this issue has only been specifically evaluated in a few Western studies. The purpose of this research was to (1) describe the following characteristics of low back pain during labor: prevalence, anatomic region(s) affected, type, pattern, intensity trend, effective interventions, and exacerbating factors; (2) identify the factors relating to intrapartum low back pain in Taiwan women. A correlational design with repeated measures was used to conduct this investigation. Ninety-three low-risk women in labor were recruited from a medical center in central Taiwan. Low back pain was repeatedly measured during the latent phase (cervix dilated 2-4 cm), early active phase (cervix dilated 5-7 cm), and late active phase (cervix dilated 8-10 cm) of labor. Data were analyzed using descriptive statistics, repeated measurement ANOVA, and logistic regression. The results showed as many as 75.3% of the participants suffered episodes of low back pain during labor. The mean pain scores were 36.66-76.20 in the various stages of labor. Pain intensified as labor progressed. The location of the pain also changed with the progression of labor. The type of low back pain in 54.29% of women in labor was "muscle soreness and pain"; The pattern of pain in 45.71% women was continuous. Massage was chosen as the most effective intervention to alleviate low back pain by 65.3% of women. The women in labor who suffered from low back pain during pregnancy (OR = 3.23; p < .01) and had greater body weight when hospitalized (OR = 1.13; p = .02) were most likely to be in the low back pain group. In conclusion, our study demonstrates low back pain intensified with the progression of labor, suggesting early prevention is necessary, especially in the case of women who had low back pain during pregnancy and heavier body weight when hospitalized.

  6. Low back pain and lumbar angles in Turkish coal miners

    SciTech Connect

    Sarikaya, S.; Ozdolap, S.; Gumustas, S.; Koc, U.

    2007-02-15

    This study was designed to assess the incidence of low back pain among Turkish coal miners and to investigate the relationship between angles of the lumbar spine and low back pain in coal miners. Fifty underground workers (Group I) and 38 age-matched surface workers (Group II) were included in the study. All the subjects were asked about low back pain in the past 5 years. The prevalence of low back pain was higher in Group I than in Group II (78.0%, 32.4%, respectively, P {lt} 0.001). The results of the study showed that low back pain occurred in 78.0% of Turkish coal miners. Although the nature of the occupation may have influenced coal miners' lumbar spinal curvature, lumbar angles are not a determinant for low back pain in this population. Further extensive studies involving ergonomic measurements are needed to validate our results for Turkish coal mining industry.

  7. Subgrouping Patients With Low Back Pain

    PubMed Central

    Hebert, Jeffrey J.; Koppenhaver, Shane L.; Walker, Bruce F.

    2011-01-01

    Context: Low back pain (LBP) is a prevalent condition imposing a large socioeconomic burden. Despite intensive research aimed at the efficacy of various therapies for patients with LBP, most evidence has failed to identify a superior treatment approach. One proposed solution to this dilemma is to identify subgroups of patients with LBP and match them with targeted therapies. Among the subgrouping approaches, the system of treatment-based classification (TBC) is promoted as a means of increasing the effectiveness of conservative interventions for patients with LBP. Evidence acquisition: MEDLINE and PubMed databases were searched from 1985 through 2010, along with the references of selected articles. Results: TBC uses a standardized approach to categorize patients into 1 of 4 subgroups: spinal manipulation, stabilization exercise, end-range loading exercise, and traction. Although the TBC subgroups are in various stages of development, recent research lends support to the effectiveness of this approach. Conclusions: While additional research is required to better elucidate this method, the TBC approach enhances clinical decision making, as evidenced by the improved clinical outcomes experienced by patients with LBP. PMID:23016055

  8. Prevalence of chronic low back pain: systematic review

    PubMed Central

    Meucci, Rodrigo Dalke; Fassa, Anaclaudia Gastal; Faria, Neice Muller Xavier

    2015-01-01

    OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex. METHODS We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex. RESULTS The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%. CONCLUSIONS Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level. PMID:26487293

  9. The impact of a guideline-driven computer charting system on the emergency care of patients with acute low back pain.

    PubMed Central

    Day, F.; Hoang, L. P.; Ouk, S.; Nagda, S.; Schriger, D. L.

    1995-01-01

    Federal guidelines for the treatment of acute low back pain were locally modified and made more specific. These guidelines were then programmed into a rule-based computer charting system which provides real-time advice regarding documentation, testing, treatment, and disposition of emergency department patients with this condition. In a time-series off-on experiment the system was shown to significantly improve documentation of the medical record and discharge instructions. There was little effect on the appropriateness of testing and treatment and the cost of care. These findings contrast with our previous experiment using a similar program for the care of health care workers exposed to body fluids. In that study both the appropriateness of care and the cost-effectiveness of care were substantially improved. PMID:8563351

  10. Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature

    PubMed Central

    Steenstra, I; Verbeek, J; Heymans, M; Bongers, P

    2005-01-01

    Background: The percentages of patients with acute low back pain (LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. Aims: To evaluate the evidence for prognostic factors for return to work among workers sick listed with acute LBP. Methods: Systematic literature search with a quality assessment of studies, assessment of levels of evidence for all factors, and pooling of effect sizes. Results: Inclusion of studies in the review was restricted to inception cohort studies of workers with LBP on sick leave for less than six weeks, with the outcome measured in absolute terms, relative terms, survival curve, or duration of sick leave. Of the studies, 18 publications (14 cohorts) fulfilled all inclusion criteria. One low quality study, four moderate quality studies, and nine high quality studies were identified; 79 prognostic factors were studied and grouped in eight categories for which the evidence was assessed. Conclusions: Specific LBP, higher disability levels, older age, female gender, more social dysfunction and more social isolation, heavier work, and receiving higher compensation were identified as predictors for a longer duration of sick leave. A history of LBP, job satisfaction, educational level, marital status, number of dependants, smoking, working more than 8 hour shifts, occupation, and size of industry or company do not influence duration of sick leave due to LBP. Many different constructs were measured to identify psychosocial predictors of long term sick leave, which made it impossible to determine the role of these factors. PMID:16299094

  11. Double-blind, randomized, double-dummy clinical trial comparing the efficacy of ketorolac trometamol and naproxen for acute low back pain

    PubMed Central

    Plapler, Pérola Grinberg; Scheinberg, Morton Aaron; Ecclissato, Christina da Cunha; Bocchi de Oliveira, Monalisa Fernanda; Amazonas, Roberto Bleuel

    2016-01-01

    Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common type of medication used in the treatment of acute pain. Ketorolac trometamol (KT) is a nonnarcotic, peripherally acting nonsteroidal anti-inflammatory drug with analgesic effects comparable to certain opioids. Objective The aim of this study was to compare the efficacy of KT and naproxen (NA) in the treatment of acute low back pain (LBP) of moderate-to-severe intensity. Patients and methods In this 10-day, Phase III, randomized, double-blind, double-dummy, noninferiority trial, participants with acute LBP of moderate-to-severe intensity as determined through a visual analog scale (VAS) were randomly assigned in a 1:1 ratio to receive sublingual KT 10 mg three times daily or oral NA 250 mg three times daily. From the second to the fifth day of treatment, if patient had VAS >40 mm, increased dosage to four times per day was allowed. The primary end point was the reduction in LBP as measured by VAS. We also performed a post hoc superiority analysis. Results KT was not inferior to NA for the reduction in LBP over 5 days of use as measured by VAS scores (P=0.608 for equality of variance; P=0.321 for equality of means) and by the Roland–Morris Disability Questionnaire (P=0.180 for equality of variance test; P=0.446 for equality of means) using 95% confidence intervals. The percentage of participants with improved pain relief 60 minutes after receiving the first dose was higher in the KT group (24.2%) than in the NA group (6.5%; P=0.049). The most common adverse effects were heartburn, nausea, and vomiting. Conclusion KT is not inferior in efficacy and delivers faster pain relief than NA. PMID:27382251

  12. Double-blind, randomized, double-dummy clinical trial comparing the efficacy of ketorolac trometamol and naproxen for acute low back pain

    PubMed Central

    Plapler, Pérola Grinberg; Scheinberg, Morton Aaron; Ecclissato, Christina da Cunha; Bocchi de Oliveira, Monalisa Fernanda; Amazonas, Roberto Bleuel

    2016-01-01

    Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common type of medication used in the treatment of acute pain. Ketorolac trometamol (KT) is a nonnarcotic, peripherally acting nonsteroidal anti-inflammatory drug with analgesic effects comparable to certain opioids. Objective The aim of this study was to compare the efficacy of KT and naproxen (NA) in the treatment of acute low back pain (LBP) of moderate-to-severe intensity. Patients and methods In this 10-day, Phase III, randomized, double-blind, double-dummy, noninferiority trial, participants with acute LBP of moderate-to-severe intensity as determined through a visual analog scale (VAS) were randomly assigned in a 1:1 ratio to receive sublingual KT 10 mg three times daily or oral NA 250 mg three times daily. From the second to the fifth day of treatment, if patient had VAS >40 mm, increased dosage to four times per day was allowed. The primary end point was the reduction in LBP as measured by VAS. We also performed a post hoc superiority analysis. Results KT was not inferior to NA for the reduction in LBP over 5 days of use as measured by VAS scores (P=0.608 for equality of variance; P=0.321 for equality of means) and by the Roland–Morris Disability Questionnaire (P=0.180 for equality of variance test; P=0.446 for equality of means) using 95% confidence intervals. The percentage of participants with improved pain relief 60 minutes after receiving the first dose was higher in the KT group (24.2%) than in the NA group (6.5%; P=0.049). The most common adverse effects were heartburn, nausea, and vomiting. Conclusion KT is not inferior in efficacy and delivers faster pain relief than NA. PMID:27382251

  13. Diagnostic evaluation of low back pain.

    PubMed

    Carragee, Eugene J; Hannibal, Matthew

    2004-01-01

    The diagnostic evaluation of chronic LBP is at best a complex and involved undertaking. The most important part of the process lies in the knowledge of the patient and a solid history and physical examination. From there, most of the serious and life-threatening causes of LBP can be elucidated and studies may be used for confirmation. Imaging studies are used most practically as confirmation studies once a working diagnosis is determined. MRI, although excellent at defining tumor, infection, and nerve compression, can be too sensitive with regard to degenerative disease findings and commonly displays pathology that is not responsible for the patient's symptoms. As an example, the high-intensity zones (HIZ) seen on MRI are reliable in determining annular defects in the disc but are not reliable in establishing internal disc disruption as the cause of LBP. Discography is the primary tool used by many physicians to determine the true pain generator when discogenic LBP is suspected. Because the reliability of the patient response is fundamental to discography, interpreting the test in different settings must be considered. In individuals with disc degeneration and annular defects, discography may elicit LBP with injection whether the patient is symptomatic with serious LBP or not. The pain response may be amplified in those subjects with issues of chronic pain, social stressors, such as secondary gain or litigation claims, or psychologic distress disorder. These factors have been shown experimentally to be associated with an increased risk for a false positive injection. The ability of an individual to differentiate the true site of LBP by the quality of sensation with disc injection (concordancy) of pain produced by the injected disc also may not be reliable. In fact, individuals may not have the neural discrimination to differentiate sclerotomal pain originating from different sites in the low back and pelvis. One may realize that chronic LBP illness may not stem

  14. The relative timing of trunk muscle activation is retained in response to unanticipated postural-perturbations during acute low back pain.

    PubMed

    Boudreau, S; Farina, D; Kongstad, L; Buus, D; Redder, J; Sverrisdóttir, E; Falla, D

    2011-04-01

    The purpose of this study was to assess the activation of the erector spinae (ES) and external oblique (EO) in response to unanticipated, bi-directional postural perturbations before and after the induction of acute low back pain (LBP) in healthy individuals. An experimental session consisted of a baseline, control, and an acute LBP condition. For the control and acute LBP condition, isotonic or hypertonic saline (HS), respectively, was injected into the right ES muscle. In each condition, participants stood on a moveable platform during which 32 randomized postural perturbations (8 repetitions of 4 perturbation types: 8 cm anterior slides, 8 cm posterior slides, 10° anterior tilts, and 10° posterior tilts) with varying inter-perturbation time intervals were performed over a period of 4-5 min. Bilateral surface electromyography (EMG) was recorded from the ES and EO in addition to subjective pain records. During the acute LBP condition: (1) the onset time of the ES and EO was delayed for the forward and backward sliding perturbations (P < 0.05); (2) EMG amplitude was reduced bilaterally for all perturbations (P < 0.05); (3) the order of activation and interval between the onset times of the ES and EO were unaltered and (4) ES, but not EO, activity was adjusted to account for the directional differences between the perturbations. This study revealed that re-establishment of posture and balance was a result of the individuals' ability to rapidly modulate ES with respect to EO activity and that the bi-directional postural responses, although shifted in time and amplitude, retained temporal features in the presence of acute LBP.

  15. Rehabilitation — a valuable consideration in acute and chronic neck and low back pain in addition to standard chiropractic management: a case study

    PubMed Central

    Mizel, Dennis H

    1999-01-01

    A case of chronic neck and low back pain, resistant to standard chiropractic management of manipulation/adjustment and verbal exercise instruction is presented. Identification of psychosocial factors and deconditioning, with a subsequent three month program of in-office rehabilitation including supervised progressive/resistance exercises and behavioural therapy was administered in conjunction with spinal manipulation/adjustment and passive modalities. The program proved effective in reducing the patient’s neck and low back pain. The beneficial effect of supervised exercises and behavioural therapy in patient management is illustrated.

  16. A clinical contrast: physical therapists with low back pain treating patients with low back pain.

    PubMed

    Louw, Adriaan; Puentedura, Emilio J; Zimney, Kory

    2015-01-01

    Patients with low back pain (LBP) often display faulty beliefs and cognitions regarding their pain experience. Pain neuroscience education (PNE) aims to alter the pain experience by targeting these faulty beliefs and cognitions. One PNE strategy aims specifically to reframe commonly held beliefs about tissues by patients with LBP as the single source of pain. In line with this reasoning, it is hypothesized that physical therapists (PT) treating patients with LBP may indeed experience similar, if not worse, pain experiences while treating a patient with LBP. To date, this assumption has never been studied. A PT LBP questionnaire was developed, validated and distributed to a convenience sample of attendees of an international PT conference. One-hundred and ten PTs completed the questionnaire for a 71% response rate. Ninety percent of the PTs reported having experienced LBP, with 27% at the conference experiencing LBP at the time. Of the PTs that have experienced LBP 75% reported not having received any imaging; 81% no formal diagnoses, 58% no treatment and 86% not having missed work due to LBP. Eighty-six percent of therapists reported having experienced LBP while treating a patient with LBP, with 50% convinced their LBP was higher than the LBP experienced by the patient they were treating. The results from this study indicate PTs often treat patients with LBP while suffering LBP. It is suggested that this knowledge may potentially help patients with LBP reconceptualize their LBP experience leading to expedited recovery.

  17. [Chronic low back pain and abdominal aortic aneurysm].

    PubMed

    Zúñiga Cedó, E; Vico Besó, L

    2013-10-01

    Abdominal aortic aneurysm has a population prevalence of 2-5% and mortality in case of rupture of 80%. Up to 91% of cases is accompanied with low back pain, so it is important to include aortic aneurysm in the differential diagnosis of chronic low back pain. Low back pain is one of the most frequent reasons for consultions in Services Emergency Hospital Emergency and Primary Care Services, with an estimated 80% of population having spinal pain at some point in their lives, with 90% of them having a benign course.

  18. Combination of Comfrey Root Extract Plus Methyl Nicotinate in Patients with Conditions of Acute Upper or Low Back Pain: A Multicentre Randomised Controlled Trial

    PubMed Central

    Pabst, Helmut; Schaefer, Axel; Staiger, Christiane; Junker-Samek, Marc; Predel, Hans-Georg

    2013-01-01

    This randomised, multicentre, double-blind, three-arm, placebo-controlled trial compared a topical combination of 35% comfrey root extract plus 1.2% methyl nicotinate versus a single preparation of methyl nicotinate or placebo cream for relief of acute upper or low back pain. 379 patients were randomly assigned to three groups (combination, n = 163; methyl nicotinate, n = 164; placebo, n = 52). They applied a 12 cm layer of cream three times daily for 5 days. The primary efficacy variable was the area under the curve (AUC) of the visual analogue scale (VAS) on active standardised movement values at visits 1 to 4. Secondary measures included back pain at rest, pressure algometry, consumption of analgesic medication, functional impairment measured with Oswestry Disability Index, and global assessment of response. The AUC of the VAS on active standardised movement was markedly smaller in the combination treatment group than in the methyl nicotinate and in the placebo group (ANOVA: p < 0.0001). The combination demonstrated superiority to the two other treatment arms, while methyl nicotinate displayed a considerable effect as well. Copyright © 2012 John Wiley & Sons, Ltd. PMID:22887778

  19. Combination of comfrey root extract plus methyl nicotinate in patients with conditions of acute upper or low back pain: a multicentre randomised controlled trial.

    PubMed

    Pabst, Helmut; Schaefer, Axel; Staiger, Christiane; Junker-Samek, Marc; Predel, Hans-Georg

    2013-06-01

    This randomised, multicentre, double-blind, three-arm, placebo-controlled trial compared a topical combination of 35% comfrey root extract plus 1.2% methyl nicotinate versus a single preparation of methyl nicotinate or placebo cream for relief of acute upper or low back pain. 379 patients were randomly assigned to three groups (combination, n = 163; methyl nicotinate, n = 164; placebo, n = 52). They applied a 12 cm layer of cream three times daily for 5 days. The primary efficacy variable was the area under the curve (AUC) of the visual analogue scale (VAS) on active standardised movement values at visits 1 to 4. Secondary measures included back pain at rest, pressure algometry, consumption of analgesic medication, functional impairment measured with Oswestry Disability Index, and global assessment of response. The AUC of the VAS on active standardised movement was markedly smaller in the combination treatment group than in the methyl nicotinate and in the placebo group (ANOVA: p < 0.0001). The combination demonstrated superiority to the two other treatment arms, while methyl nicotinate displayed a considerable effect as well.

  20. Low Back Pain and Pelvic Girdle Pain in Pregnancy.

    PubMed

    Casagrande, Danielle; Gugala, Zbigniew; Clark, Shannon M; Lindsey, Ronald W

    2015-09-01

    Pregnancy has a profound effect on the human body, particularly the musculoskeletal system. Hormonal changes cause ligamentous joint laxity, weight gain, and a shift in the center of gravity that leads to lumbar spine hyperlordosis and anterior tilting of the pelvis. In addition, vascular changes may lead to compromised metabolic supply in the low back. The most common musculoskeletal complaints in pregnancy are low back pain and/or pelvic girdle pain. They can be diagnosed and differentiated from each other by history taking, clinical examination, provocative test maneuvers, and imaging. Management ranges from conservative and pharmacologic measures to surgical treatment. Depending on the situation, and given the unique challenges pregnancy places on the human body and the special consideration that must be given to the fetus, an orthopaedic surgeon and the obstetrician may have to develop a plan of care together regarding labor and delivery or when surgical interventions are indicated.

  1. Chronic Low Back Pain: Toward an Integrated Psychosocial Assessment Model.

    ERIC Educational Resources Information Center

    Strong, Jenny; And Others

    1994-01-01

    Integrated six dimensions of chronic low back pain (pain intensity, functional disability, attitudes toward pain, pain coping strategies, depression, illness behavior) to provide multidimensional patient profile. Data from 100 patients revealed presence of three distinct patient groups: patients who were in control, patients who were depressed and…

  2. Adherence to clinical practice guidelines among three primary contact professions: a best evidence synthesis of the literature for the management of acute and subacute low back pain

    PubMed Central

    Amorin-Woods, Lyndon G.; Beck, Randy W.; Parkin-Smith, Gregory F.; Lougheed, James; Bremner, Alexandra P.

    2014-01-01

    Aim: To determine adherence to clinical practice guidelines in the medical, physiotherapy and chiropractic professions for acute and subacute mechanical low back pain through best-evidence synthesis of the healthcare literature. Methods: A structured best-evidence synthesis of the relevant literature through a literature search of relevant databases for peer-reviewed papers on adherence to clinical practice guidelines from 1995 to 2013. Inclusion of papers was based on selection criteria and appraisal by two reviewers who independently applied a modified Downs & Black appraisal tool. The appraised papers were summarized in tabular form and analysed by the authors. Results: The literature search retrieved 23 potentially relevant papers that were evaluated for methodological quality, of which 11 studies met the inclusion criteria. The main finding was that no profession in the study consistently attained an overall high concordance rating. Of the three professions examined, 73% of chiropractors adhered to current clinical practice guidelines, followed by physiotherapists (62%) and then medical practitioners (52%). Conclusions: This review showed that quality papers in this area of research are very limited. Notwithstanding, chiropractors appear to adhere to clinical practice guidelines more so than physiotherapists and medical practitioners, although there is scope for improvement across all three professions. PMID:25202150

  3. Treatment Options for Low Back Pain in Athletes

    PubMed Central

    Petering, Ryan C.; Webb, Charles

    2011-01-01

    Context: Low back pain is one of the most common medical presentations in the general population. It is a common source of pain in athletes, leading to significant time missed and disability. The general categories of treatment for low back pain are medications and therapies. Evidence acquisition: Relevant studies were identified through a literature search of MEDLINE and the Cochrane Database from 1990 to 2010. A manual review of reference lists of identified sources was also performed. Results: It is not clear whether athletes experience low back pain more often than the general public. Because of a aucity of trials with athlete-specific populations, recommendations on treatments must be made from reviews of treatments for the general population. Several large systemic reviews and Cochrane reviews have compiled evidence on different modalities for low back pain. Superficial heat, spinal manipulation, nonsteroidal anti-inflammatory medications, and skeletal muscle relaxants have the strongest evidence of benefit. Conclusions: Despite the high prevalence of low back pain and the significant burden to the athletes, there are few clearly superior treatment modalities. Superficial heat and spinal manipulation therapy are the most strongly supported evidence-based therapies. Nonsteroidal anti-inflammatory medications and skeletal muscle relaxants have benefit in the initial management of low back pain; however, both have considerable side effects that must be considered. Athletes can return to play once they have recovered full range of motion and have the strength to prevent further injury. PMID:23016058

  4. Gender-age environmental associates of adolescent low back pain.

    PubMed

    Grimmer, K; Williams, M

    2000-08-01

    This paper describes adolescent low back pain and tests its associations with environmental features of backpack load, time spent carrying loads, time sitting, and time playing sport, using data from 1269 adolescents in twelve volunteer high schools in Adelaide, South Australia. Backpacks were the preferred method of load carrying, two-thirds of wearers preferring to carry the load over two shoulders. The average load weighed 5.3 kg (approximating 10% of body weight). The youngest students carried approximately the same amount as the oldest students. Girls were more likely than boys to report recent low back pain, and there were gender- and age-specific associations between recent low back pain, the amount of time spent sitting, the backpack load and time spent carrying it, and time playing sport. Body mass was not a confounder of any association. These findings support ongoing concerns regarding environmental contributions to adolescent low back pain. PMID:10975661

  5. [Evolution of low back pain after bariatric surgery].

    PubMed

    Koulischer, S; Cadière, B; Cadière, G-B; Fabeck, L

    2015-01-01

    Although frequently called to mind by physicians, the relationship between overweight and low back pain is poorly understood and remains controversial. The present study aims to evaluate the evolution of low back pain in 65 patients planned for a bariatric surgery. The patients were enrolled prospectively. 54 patients (80%) could be evaluated 5 months after the procedure, and 47 patients (72%) were evaluated 22 months after surgery. Mean weight loss was 19 ± 9 kg (P < 0.001) at 22 months post-op. Patients demonstrated a statistically significant improvement of the NRS, Oswestry and SF-36 scores. This study suggests that low back pain might be reduced following bariatric surgery. However, the lack of dose-response effect is against a causal relationship between low back pain and obesity. Larger randomised controls are needed to determine a causal relationship.

  6. Study protocol of effectiveness of a biopsychosocial multidisciplinary intervention in the evolution of non-speficic sub-acute low back pain in the working population: cluster randomised trial

    PubMed Central

    2010-01-01

    Background Non-specific low back pain is a common cause for consultation with the general practitioner, generating increased health and social costs. This study will analyse the effectiveness of a multidisciplinary intervention to reduce disability, severity of pain, anxiety and depression, to improve quality of life and to reduce the incidence of chronic low back pain in the working population with non-specific low back pain, compared to usual clinical care. Methods/Design A Cluster randomised clinical trial will be conducted in 38 Primary Health Care Centres located in Barcelona, Spain and its surrounding areas. The centres are randomly allocated to the multidisciplinary intervention or to usual clinical care. Patients between 18 and 65 years old (n = 932; 466 per arm) and with a diagnostic of a non-specific sub-acute low back pain are included. Patients in the intervention group are receiving the recommendations of clinical practice guidelines, in addition to a biopsychosocial multidisciplinary intervention consisting of group educational sessions lasting a total of 10 hours. The main outcome is change in the score in the Roland Morris disability questionnaire at three months after onset of pain. Other outcomes are severity of pain, quality of life, duration of current non-specific low back pain episode, work sick leave and duration, Fear Avoidance Beliefs and Goldberg Questionnaires. Outcomes will be assessed at baseline, 3, 6 and 12 months. Analysis will be by intention to treat. The intervention effect will be assessed through the standard error of measurement and the effect-size. Responsiveness of each scale will be evaluated by standardised response mean and receiver-operating characteristic method. Recovery according to the patient will be used as an external criterion. A multilevel regression will be performed on repeated measures. The time until the current episode of low back pain takes to subside will be analysed by Cox regression. Discussion We hope

  7. Imaging-guided hyperstimulation analgesia in low back pain.

    PubMed

    Gorenberg, Miguel; Schwartz, Kobi

    2013-01-01

    Low back pain in patients with myofascial pain syndrome is characterized by painful active myofascial trigger points (ATPs) in muscles. This article reviews a novel, noninvasive modality that combines simultaneous imaging and treatment, thus taking advantage of the electrodermal information available from imaged ATPs to deliver localized neurostimulation, to stimulate peripheral nerve endings (Aδ fibers) and in turn, to release endogenous endorphins. "Hyperstimulation analgesia" with localized, intense, low-rate electrical pulses applied to painful ATPs was found to be effective in 95% patients with chronic nonspecific low back pain, in a clinical validation study.

  8. Imaging-guided hyperstimulation analgesia in low back pain.

    PubMed

    Gorenberg, Miguel; Schwartz, Kobi

    2013-01-01

    Low back pain in patients with myofascial pain syndrome is characterized by painful active myofascial trigger points (ATPs) in muscles. This article reviews a novel, noninvasive modality that combines simultaneous imaging and treatment, thus taking advantage of the electrodermal information available from imaged ATPs to deliver localized neurostimulation, to stimulate peripheral nerve endings (Aδ fibers) and in turn, to release endogenous endorphins. "Hyperstimulation analgesia" with localized, intense, low-rate electrical pulses applied to painful ATPs was found to be effective in 95% patients with chronic nonspecific low back pain, in a clinical validation study. PMID:23847430

  9. Imaging-guided hyperstimulation analgesia in low back pain

    PubMed Central

    Gorenberg, Miguel; Schwartz, Kobi

    2013-01-01

    Low back pain in patients with myofascial pain syndrome is characterized by painful active myofascial trigger points (ATPs) in muscles. This article reviews a novel, noninvasive modality that combines simultaneous imaging and treatment, thus taking advantage of the electrodermal information available from imaged ATPs to deliver localized neurostimulation, to stimulate peripheral nerve endings (Aδ fibers) and in turn, to release endogenous endorphins. “Hyperstimulation analgesia” with localized, intense, low-rate electrical pulses applied to painful ATPs was found to be effective in 95% patients with chronic nonspecific low back pain, in a clinical validation study. PMID:23847430

  10. Low-Back Pain: An Orthopedic Medicine Approach

    PubMed Central

    Ouellette, Jean-Paul

    1987-01-01

    Many patients suffering from low-back pain present to a family physician. This paper will deal specifically with the moving parts of the lumbar spine as the source of low-back pain: muscles, discs, ligaments, apophysial (facet) joints. A detailed systematic approach is suggested to facilitate the identification of the particular tissues involved. Various modes of treatment—manipulations, tractions, epidural injections and sclerotherapy—are discussed. PMID:21263859

  11. Myofascial low back pain: a review.

    PubMed

    Malanga, Gerard A; Cruz Colon, Eduardo J

    2010-11-01

    Myofascial pain syndrome is a common nonarticular local musculoskeletal pain syndrome caused by myofascial trigger points located at muscle, fascia, or tendinous insertions, affecting up to 95% of people with chronic pain disorders. Clinically, myofascial pain syndrome can present as painful restricted range of motion, stiffness, referred pain patterns, and autonomic dysfunction. The underlying cause is often related to muscular imbalances, and following a thorough physical examination the condition should be treated with a comprehensive rehabilitation program. Additional treatment options include pharmacologic, needling with or without anesthetic agents or nerve stimulation, and alternative medicine treatments such as massage or herbal medicines. Repeated trigger point injections should be avoided, and corticosteroids should not be injected into trigger points.

  12. Effects of motion style acupuncture treatment in acute low back pain patients with severe disability: a multicenter, randomized, controlled, comparative effectiveness trial.

    PubMed

    Shin, Joon-Shik; Ha, In-Hyuk; Lee, Jinho; Choi, Youngkwon; Kim, Me-Riong; Park, Byoung-Yoon; Shin, Byung-Cheul; Lee, Myeong Soo

    2013-07-01

    Reviews of the efficacy of acupuncture as a treatment for acute low back pain (aLBP) have shown that there is insufficient evidence for its effect and that more research is needed. Motion style acupuncture treatment (MSAT) is novel in that it requires a part of the patient's body to move passively or actively while acupuncture needles are retained. A multicenter, randomized, comparative effectiveness trial was conducted to evaluate the effects of MSAT in aLBP with severe disability. A total of 58 aLBP patients with severe functional disability (defined per Oswestry Disability Index [ODI] ⩾60%) were recruited and assigned randomly to receive 1 session of either conventional diclofenac injection (n=29) or MSAT (n=29). The primary outcome measured improvement in LBP using the 10-point numerical rating scale of LBP, and the secondary outcome assessed disability using the Oswestry Disability Index at 30minutes and at 2, 4, and 24weeks after treatment. Analyses were by intention to treat. The numerical rating scale of the MSAT group decreased 3.12 (95% confidence interval=2.26, 3.98; P<.0001) more than that of the injection group and the Oswestry Disability Index of the MSAT group decreased 32.95% (95% confidence interval=26.88, 39.03; P<.0001) more than that of the injection group, respectively. The difference between the 2 groups maintained statistical significance at 2 and 4weeks after treatment. These results suggest that MSAT has positive effects on immediate pain relief and the functional recovery of aLBP patients with severe disability. PMID:23639822

  13. [Low Back Pain in Pregnancy: Diagnosis, Treatment Options and Outcomes].

    PubMed

    Mühlemann, Daniel; Mühlemann, Malin B

    2015-05-20

    Low back pain in pregnancy is a common occurrence and is mainly caused by hormonal and biomechanical changes. Patients with pregnancy-induced low back pain (PILBP) frequently complain of moderate to severe and disabling pain often restricting their daily activities. In these cases, a “watch and wait” approach cannot be the best solution. On the basis of anamnesis and examination PILBP can be divided into three subgroups: pregnancy-related low back pain (PLBP), pelvic girdle pain (PGP) and the combination of PLBP and PGP. The three entities ask for different diagnostic workups and therapeutic modalities. There are many possible treatments for PLBP, however, only a few are based on sound evidence. Information and advice, exercise and training programs, acupuncture, stabilizing belts and analgesic medication can have a positive impact on pain and disability. PGP und PLBP respond well to chiropractic interventions.

  14. Acupuncture for low back pain: an overview of systematic reviews.

    PubMed

    Liu, Lizhou; Skinner, Margot; McDonough, Suzanne; Mabire, Leon; Baxter, George David

    2015-01-01

    Objective. As evidence of the effectiveness of acupuncture for low back pain (LBP) is inconsistent, we aimed to critically appraise the evidence from relevant systematic reviews. Methods. Systematic reviews of randomized controlled trials (RCTs) concerning acupuncture and LBP were searched in seven databases. Internal validity and external validity of systematic reviews were assessed. Systematic reviews were categorized and high quality reviews assigned greater weightings. Conclusions were generated from a narrative synthesis of the outcomes of subgroup comparisons. Results. Sixteen systematic reviews were appraised. Overall, the methodological quality was low and external validity weak. For acute LBP, evidence that acupuncture has a more favorable effect than sham acupuncture in relieving pain was inconsistent; it had a similar effect on improving function. For chronic LBP, evidence consistently demonstrated that acupuncture provides short-term clinically relevant benefits for pain relief and functional improvement compared with no treatment or acupuncture plus another conventional intervention. Conclusion. Systematic reviews of variable quality showed that acupuncture, either used in isolation or as an adjunct to conventional therapy, provides short-term improvements in pain and function for chronic LBP. More efforts are needed to improve both internal and external validity of systematic reviews and RCTs in this area. PMID:25821485

  15. Acupuncture for Low Back Pain: An Overview of Systematic Reviews

    PubMed Central

    Liu, Lizhou; Skinner, Margot; McDonough, Suzanne; Mabire, Leon; Baxter, George David

    2015-01-01

    Objective. As evidence of the effectiveness of acupuncture for low back pain (LBP) is inconsistent, we aimed to critically appraise the evidence from relevant systematic reviews. Methods. Systematic reviews of randomized controlled trials (RCTs) concerning acupuncture and LBP were searched in seven databases. Internal validity and external validity of systematic reviews were assessed. Systematic reviews were categorized and high quality reviews assigned greater weightings. Conclusions were generated from a narrative synthesis of the outcomes of subgroup comparisons. Results. Sixteen systematic reviews were appraised. Overall, the methodological quality was low and external validity weak. For acute LBP, evidence that acupuncture has a more favorable effect than sham acupuncture in relieving pain was inconsistent; it had a similar effect on improving function. For chronic LBP, evidence consistently demonstrated that acupuncture provides short-term clinically relevant benefits for pain relief and functional improvement compared with no treatment or acupuncture plus another conventional intervention. Conclusion. Systematic reviews of variable quality showed that acupuncture, either used in isolation or as an adjunct to conventional therapy, provides short-term improvements in pain and function for chronic LBP. More efforts are needed to improve both internal and external validity of systematic reviews and RCTs in this area. PMID:25821485

  16. A descriptive study of the usage of spinal manipulative therapy techniques within a randomized clinical trial in acute low back pain.

    PubMed

    Hurley, Deirdre A; McDonough, Suzanne M; Baxter, G David; Dempster, Martin; Moore, Ann P

    2005-02-01

    The majority of randomized clinical trials (RCTs) of spinal manipulative therapy have not adequately defined the terms 'mobilization' and 'manipulation', nor distinguished between these terms in reporting the trial interventions. The purpose of this study was to describe the spinal manipulative therapy techniques utilized within a RCT of manipulative therapy (MT; n = 80), interferential therapy (IFT; n = 80), and a combination of both (CT; n = 80) for people with acute low back pain (LBP). Spinal manipulative therapy was defined as any 'mobilization' (low velocity manual force without a thrust) or 'manipulation' (high velocity thrust) techniques of the spine described by Maitland and Cyriax. The 16 physiotherapists, all members of the Society of Orthopaedic Medicine, utilized three spinal manipulative therapy patterns in the RCT: Maitland Mobilization (40.4%, n = 59), Maitland Mobilization/Cyriax Manipulation (40.4%, n = 59) and Cyriax Manipulation (19.1%, n = 28). There was a significant difference between the MT and CT groups in their usage of spinal manipulative therapy techniques (chi2 = 9.178; df = 2; P = 0.01); subjects randomized to the CT group received three times more Cyriax Manipulation (29.2%, n = 21/72) than those randomized to the MT group (9.5%, n = 7/74; df = 1; P = 0.003). The use of mobilization techniques within the trial was comparable with their usage by the general population of physiotherapists in Britain and Ireland for LBP management. However, the usage of manipulation techniques was considerably higher than reported in physiotherapy surveys and may reflect the postgraduate training of trial therapists.

  17. Application of “less is more” to low back pain.

    PubMed

    Srinivas, Shubha V; Deyo, Richard A; Berger, Zackary D

    2012-07-01

    An initiative of the National Physicians Alliance, the project titled "Promoting Good Stewardship in Clinical Practice," developed a list of the top 5 activities in primary care for which changes in practice could lead to higher-quality care and better use of finite clinical resources. One of the top 5 recommendations was "Don't do imaging for low back pain within the first 6 weeks unless red flags are present." This article presents data that support this recommendation. We selectively reviewed the literature, including recent reviews, guidelines, and commentaries, on the benefits and risks of routine imaging in low back pain. In particular, we searched PubMed for systematic reviews or meta-analyses published in the past 5 years. We also assessed the cost of spine imaging using data from the National Ambulatory Medical Care Survey. One high-quality systematic review and meta-analysis focused on clinical outcomes in patients with low back pain and found no clinically significant difference in pain or function between those who received immediate lumbar spine imaging vs usual care. Published data also document harms associated with early imaging for low back pain, including patient "labeling," unneeded follow-up tests for incidental findings, irradiation exposure, unnecessary surgery, and significant cost. Routine imaging should not be pursued in acute low back pain. Not imaging patients with acute low back pain will reduce harms and costs, without affecting clinical outcomes. PMID:22664775

  18. Low back pain post partum - a case report.

    PubMed

    De Búrca, Neasa

    2012-12-01

    Sacral stress fracture is an unusual source of low back pain and can be easily confused with a number of other clinical conditions seen in physiotherapy clinics. The purpose of this case report is to describe the case of a patient presenting with low back pain post partum illustrating pertinent aspects of differential diagnosis and issues of management. A 31 year old female presented complaining of low back pain since the birth of her second child 11 months earlier. Subjective and objective examination led the Therapist to consider a diagnosis of sacral stress fracture. This diagnosis was confirmed by MRI. Three months after presenting to physiotherapy the patient was pain free and had returned to all aspects of her daily life without any difficulties. Clinicians must be aware of the less common pathologies in any hypotheses development. A careful history and physical examination and broad hypotheses generation will ensure that patients are accurately diagnosed and receive appropriate and effective treatments.

  19. Spinal Manipulation for Low-Back Pain: An Office Procedure

    PubMed Central

    Hollingworth, G.R.; Wood, W.E.

    1987-01-01

    In properly selected patients, spinal manipulation is an alternative to the standard conservative approach to low-back pain. In this paper, an approach to the patient with low-back pain emphasizes the importance of a thorough history, physical examination, and diagnosis prior to manipulation. In addition to listing indications and contraindications, the authors discuss the process of selecting patients for manipulation according to pain and range of motion. Two manipulative techniques which can be easily learned and performed in the office by the family physician are described. PMID:21263974

  20. Core strength training for patients with chronic low back pain.

    PubMed

    Chang, Wen-Dien; Lin, Hung-Yu; Lai, Ping-Tung

    2015-03-01

    [Purpose] Through core strength training, patients with chronic low back pain can strengthen their deep trunk muscles. However, independent training remains challenging, despite the existence of numerous core strength training strategies. Currently, no standardized system has been established analyzing and comparing the results of core strength training and typical resistance training. Therefore, we conducted a systematic review of the results of previous studies to explore the effectiveness of various core strength training strategies for patients with chronic low back pain. [Methods] We searched for relevant studies using electronic databases. Subsequently, we evaluated their quality by analyzing the reported data. [Results] We compared four methods of evaluating core strength training: trunk balance, stabilization, segmental stabilization, and motor control exercises. According to the results of various scales and evaluation instruments, core strength training is more effective than typical resistance training for alleviating chronic low back pain. [Conclusion] All of the core strength training strategies examined in this study assist in the alleviation of chronic low back pain; however, we recommend focusing on training the deep trunk muscles to alleviate chronic low back pain.

  1. Core strength training for patients with chronic low back pain

    PubMed Central

    Chang, Wen-Dien; Lin, Hung-Yu; Lai, Ping-Tung

    2015-01-01

    [Purpose] Through core strength training, patients with chronic low back pain can strengthen their deep trunk muscles. However, independent training remains challenging, despite the existence of numerous core strength training strategies. Currently, no standardized system has been established analyzing and comparing the results of core strength training and typical resistance training. Therefore, we conducted a systematic review of the results of previous studies to explore the effectiveness of various core strength training strategies for patients with chronic low back pain. [Methods] We searched for relevant studies using electronic databases. Subsequently, we evaluated their quality by analyzing the reported data. [Results] We compared four methods of evaluating core strength training: trunk balance, stabilization, segmental stabilization, and motor control exercises. According to the results of various scales and evaluation instruments, core strength training is more effective than typical resistance training for alleviating chronic low back pain. [Conclusion] All of the core strength training strategies examined in this study assist in the alleviation of chronic low back pain; however, we recommend focusing on training the deep trunk muscles to alleviate chronic low back pain. PMID:25931693

  2. Exercise and spinal manipulation in the treatment of low back pain.

    PubMed

    Twomey, L; Taylor, J

    1995-03-01

    Current research clearly indicates the importance of exercise and mobility in the treatment of low back pain and also that bed rest and inactivity should play a relatively small part in treatment. The use of intensive, physical exercise and "work hardening" routines have been shown to be necessary for treating chronic low back pain and returning individuals to work. Evidence derived from valid clinical studies of the use of manipulation in the treatment of low back pain shows a role for it in the acute treatment of "mechanical" low back disorders. These studies have demonstrated that manipulative procedures result in more rapid pain and functional relief compared with other conservative therapies. Over a longer time frame, this advantage disappears. PMID:7604333

  3. Evaluation of a Theory-Informed Implementation Intervention for the Management of Acute Low Back Pain in General Medical Practice: The IMPLEMENT Cluster Randomised Trial

    PubMed Central

    French, Simon D.; McKenzie, Joanne E.; O'Connor, Denise A.; Grimshaw, Jeremy M.; Mortimer, Duncan; Francis, Jill J.; Michie, Susan; Spike, Neil; Schattner, Peter; Kent, Peter; Buchbinder, Rachelle; Page, Matthew J.; Green, Sally E.

    2013-01-01

    Introduction This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice. Methods General practices were randomised to either access to a guideline for acute LBP (control) or facilitated interactive workshops (intervention). We measured behavioural predictors (e.g. knowledge, attitudes and intentions) and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP) level: behavioural simulation (clinical decision about vignettes) and rates of x-ray and CT-scan (medical administrative data). All those not involved in the delivery of the intervention were blinded to allocation. Results 47 practices (53 GPs) were randomised to the control and 45 practices (59 GPs) to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05) and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60). Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10) for x-ray or CT-scan. Conclusions The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant changes in actual

  4. Streamlining the Evaluation of Low Back Pain in Children

    PubMed Central

    Auerbach, Joshua D.; Ahn, Jaimo; Zgonis, Miltiadis H.; Reddy, Sudheer C.; Ecker, Malcolm L.

    2008-01-01

    The workup of low back pain in children often results in overimaging so as not to miss organic back pain. The primary goal of this study was to identify which combination of imaging modalities provides the most sensitive and specific screening protocol for children with low back pain. Medical records from 100 consecutive patients between 2 and 18 years of age presenting with low back pain, without night pain or constitutional symptoms, were evaluated. A hyperextension test combined with a radiograph showed a negative predictive value of 0.81 and sensitivity of 0.90. The addition of a bone scan was highly effective in achieving good negative predictive value and sensitivity. Bone scans had perfect negative predictive value and sensitivity when symptom duration was less than 6 weeks. We identified a set of factors that is highly predictive for distinguishing organic back pain from mechanical back pain. Painless hyperextension combined with negative anteroposterior, lateral, and oblique lumbar radiographs and magnetic resonance images predicts mechanical back pain. For patients with nonneurologic back pain of less than 6 weeks duration, bone scan is the most useful screening test because it is accurate, accessible, inexpensive, and unlikely to require sedation. Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18553213

  5. Multidisciplinary rehabilitation for chronic low back pain: systematic review

    PubMed Central

    Guzmán, Jaime; Esmail, Rosmin; Karjalainen, Kaija; Malmivaara, Antti; Irvin, Emma; Bombardier, Claire

    2001-01-01

    Objective To assess the effect of multidisciplinary biopsychosocial rehabilitation on clinically relevant outcomes in patients with chronic low back pain. Design Systematic literature review of randomised controlled trials. Participants A total of 1964 patients with disabling low back pain for more than three months. Main outcome measures Pain, function, employment, quality of life, and global assessments. Results Ten trials reported on a total of 12 randomised comparisons of multidisciplinary treatment and a control condition. There was strong evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration improves function when compared with inpatient or outpatient non-multidisciplinary treatments. There was moderate evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain when compared with outpatient non-multidisciplinary rehabilitation or usual care. There was contradictory evidence regarding vocational outcomes of intensive multidisciplinary biopsychosocial intervention. Some trials reported improvements in work readiness, but others showed no significant reduction in sickness leaves. Less intensive outpatient psychophysical treatments did not improve pain, function, or vocational outcomes when compared with non-multidisciplinary outpatient therapy or usual care. Few trials reported effects on quality of life or global assessments. Conclusions The reviewed trials provide evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain and improves function in patients with chronic low back pain. Less intensive interventions did not show improvements in clinically relevant outcomes. What is already known on this topicDisabling chronic pain is regarded as the result of interrelating physical, psychological, and social or occupational factors requiring multidisciplinary interventionTwo previous systematic reviews of

  6. Balneotherapy for chronic low back pain: a randomized, controlled study.

    PubMed

    Kesiktas, Nur; Karakas, Sinem; Gun, Kerem; Gun, Nuran; Murat, Sadiye; Uludag, Murat

    2012-10-01

    A large number of treatments were used for patients with chronic low back pain. Frequent episodes have been reported very high. Although balneotherapy was found effective in this disease, there are not well-designed studies. We aimed to determine the effectiveness of balneotherapy versus physical therapy in patients with chronic low back pain. Exercise was added to both treatment programs. Sixty patients with chronic low back pain were randomly divided into two groups. Physical modalities plus exercise were applied to group 1, and group 2 was received balneotherapy plus exercise for ten sessions. The following parameters were measured: visual analogue scale at rest and movement for pain, paracetamol dose, manual muscle test for lumber muscles, modified Schoeber' test, Oswestry disability index, and Short-Form 36 at the beginning and end of the therapies and at the 3 months follow-up. The statistical analyses were performed using the SPSS 10.0 program. Both groups achieved significant improvements within themselves. But balneotherapy groups were improved at back extensor muscle test (P < 0.05), modified Schoeber's test (P < 0.03), Oswestry disability index, and the some scores of SF 36 (energy vitality, social function, role limitations related to physical problems, and general health P < 0.05). Balneotherapy combined with exercise therapy had advantages than therapy with physical modalities plus exercise in improving quality of life and flexibility of patients with chronic low back pain.

  7. Reliability of Zygapophysial Joint Space Measurements Made from MRI Scans of Acute Low Back Pain Subjects: Comparison of Two Statistical Methods

    PubMed Central

    Cramer, Gregory D; Cantu, Joe A; Pocius, Judith D; Cambron, Jerrilyn A; McKinnis, Ray A

    2010-01-01

    Objective This purpose of this study was to assess the reliability of measurements made of the zygapophysial (Z) joint space from the MRI scans of subjects with acute low back pain (ALBP) using new equipment and 2 different methods of statistical analysis. If found reliable, the methods of Z joint measurement can be applied to scans taken before and after spinal manipulation in a larger study of ALBP subjects. Methods Three observers measured the central anterior-to-posterior distance of the left and right L4/L5 and L5/S1 Z joint space from 5 subject scans (20 digitizer measurements, rounded to 0.1mm) on two separate occasions separated by 4 weeks. Observers were blinded to each other and their previous work. Intra- and interobserver reliability was calculated by means of intra-class correlation coefficients (ICCs) and also by mean differences using the methods of Bland and Altman (1986). A mean difference of <±0.4 mm was considered clinically acceptable. Results ICCs showed intraobserver reliabilities of 0.95 (95%CI 0.87-0.98), 0.83 (0.62-0.92), and 0.92 (0.83-0.96) for each of the 3 observers; and interobserver reliabilities of 0.90 (0.82-0.95), 0.79 (0.61-0.90), and 0.84 (0.75-0.90) for the first and second measurements and overall reliability, respectively. The mean difference between the first and second measurements was -0.04 mm (±1.96 SD= -0.37 – 0.29), 0.23 (-0.48 – 0.94), 0.25 (-0.24 – 0.75), and 0.15 (-0.44 – 0.74) for each of the 3 observers and the overall agreement, respectively. Conclusions Both statistical methods were found to be useful and complementary and showed the measurements to be highly reliable. PMID:20350676

  8. Low back pain, intervertebral disc and occupational diseases.

    PubMed

    Petit, Audrey; Roquelaure, Yves

    2015-01-01

    Nonspecific low back pain and sciatica are prevalent diseases among working adults and have become a worrying occupational health issue because they sometimes affect continuation or resumption of employment. Epidemiological studies that based questionnaires on workers' healthcare consumption have shown a higher prevalence of these disorders in certain industrial sectors. Thus, low back disorders are usually more prevalent among workers exposed to cumulative lumbar load such as manual handling, awkward postures of the trunk and whole-body vibrations. In addition, morphological and biomechanical studies have compared disc space narrowing and the intensity of lumbar workload. Although debated, the relationship between disc degeneration and biomechanical work exposures seems to be usually accepted by most authors. In response to a considerable need of prevention and compensation for workers, low back pain and/or disc disease can be recognized as an occupational diseases in several countries but the criteria of recognition remains heterogeneous from one country to another. PMID:26327258

  9. Psychosocial Factors and Low Back Pain among College Students

    ERIC Educational Resources Information Center

    Kennedy, Catherine; Kassab, Osama; Gilkey, David; Linnel, Sheri; Morris, Debra

    2008-01-01

    Objective and Participants: The authors evaluated psychosocial factors of stress and their effects on the prevalence of low back pain (LBP) among a population of college students in a major university in Colorado. Methods: This was a nested cross-sectional study of 973 respondents who completed the National College Health Assessment survey. The…

  10. Core Strength: Implications for Fitness and Low Back Pain.

    ERIC Educational Resources Information Center

    Liemohn, Wendell; Pariser, Gina

    2002-01-01

    Presents information to promote understanding of the concept of core strength and stability, explain why this concept is important to spine health, and evaluate trunk training activities with respect to their contribution to core strength and stability, noting implications for physical fitness and low back pain. The paper reviews the anatomy and…

  11. Sex Differences in the Presentation of Chronic Low Back Pain

    ERIC Educational Resources Information Center

    Sheffer, Christine E.; Cassisi, Jeffrey E.; Ferraresi, Laurette M.; Lofland, Kenneth R.; McCracken, Lance M.

    2002-01-01

    Sex differences in 351 patients with chronic low back pain were examined. Biological, psychological, and psychosocial factors were considered. Sex differences in adaptive functioning were consistent with traditional gender roles. Significant interactions were found for sex and employment status, and sex and marital status. Retired women reported…

  12. Educational approaches to management of low back pain.

    PubMed

    Anderson, L

    1989-01-01

    With the high incidence of low back pain in adults, especially in the work place, industrial and health care professionals must work together to reduce the physical, emotional, and monetary cost of back pain. Conservative management can be effective when it includes therapy and patient education. This article discusses back schools and work hardening programs, two methods used to return employees to productive levels. PMID:2523529

  13. Which Patients With Low Back Pain Benefit From Deadlift Training?

    PubMed

    Berglund, Lars; Aasa, Björn; Hellqvist, Jonas; Michaelson, Peter; Aasa, Ulrika

    2015-07-01

    Recent studies have indicated that the deadlift exercise may be effective in decreasing pain intensity and increasing activity for most, but not all, patients with a dominating pattern of mechanical low back pain. This study aimed to evaluate which individual factors measured at baseline could predict activity, disability, and pain intensity in patients with mechanical low back pain after an 8-week training period involving the deadlift as a rehabilitative exercise. Thirty-five participants performed deadlift training under the supervision of a physical therapist with powerlifting experience. Measures of pain-related fear of movement, hip and trunk muscle endurance, and lumbopelvic movement control were collected at baseline. Measures of activity, disability, and pain intensity were collected at baseline and at follow-up. Linear regression analyses were used to create models to predict activity, disability, and pain intensity at follow-up. Results showed that participants with less disability, less pain intensity, and higher performance on the Biering-Sørensen test, which tests the endurance of hip and back extensor muscles, at baseline benefit from deadlift training. The Biering-Sørensen test was the most robust predictor because it was included in all predictive models. Pain intensity was the next best predictor as it was included in 2 predictive models. Thus, for strength and conditioning professionals who use the deadlift as a rehabilitative exercise for individuals with mechanical low back pain, it is important to ensure that clients have sufficient back extensor strength and endurance and a sufficiently low pain intensity level to benefit from training involving the deadlift exercise.

  14. Which Patients With Low Back Pain Benefit From Deadlift Training?

    PubMed

    Berglund, Lars; Aasa, Björn; Hellqvist, Jonas; Michaelson, Peter; Aasa, Ulrika

    2015-07-01

    Recent studies have indicated that the deadlift exercise may be effective in decreasing pain intensity and increasing activity for most, but not all, patients with a dominating pattern of mechanical low back pain. This study aimed to evaluate which individual factors measured at baseline could predict activity, disability, and pain intensity in patients with mechanical low back pain after an 8-week training period involving the deadlift as a rehabilitative exercise. Thirty-five participants performed deadlift training under the supervision of a physical therapist with powerlifting experience. Measures of pain-related fear of movement, hip and trunk muscle endurance, and lumbopelvic movement control were collected at baseline. Measures of activity, disability, and pain intensity were collected at baseline and at follow-up. Linear regression analyses were used to create models to predict activity, disability, and pain intensity at follow-up. Results showed that participants with less disability, less pain intensity, and higher performance on the Biering-Sørensen test, which tests the endurance of hip and back extensor muscles, at baseline benefit from deadlift training. The Biering-Sørensen test was the most robust predictor because it was included in all predictive models. Pain intensity was the next best predictor as it was included in 2 predictive models. Thus, for strength and conditioning professionals who use the deadlift as a rehabilitative exercise for individuals with mechanical low back pain, it is important to ensure that clients have sufficient back extensor strength and endurance and a sufficiently low pain intensity level to benefit from training involving the deadlift exercise. PMID:25559899

  15. [Therapeutic exercise for patients with chronic low-back pain].

    PubMed

    Grazio, Simeon; Grgurević, Lovorka; Vlak, Tonko; Perić, Porin; Nemčić, Tomislav; Vrbanić, Tea Schurrer Luke; Kadojić, Mira; Gnjidić, Zoja; Grubišić, Frane; Balen, Diana; Vuga, Katarina Lohman; Ćurković, Boždiar

    2014-01-01

    Low Back Pain (LBP) is a major medical and socio-economical problem in the industrialized countries. Exercise therapy is the keystone of conservative treatment for chronic low back pain (CLBP). Numerous randomized trials and clinical practice guidelines have supported that exercise diminishes disability and pain severity while improving fitness and occupational status in patients with CLBP, as well as decrease its recurrence rate. However, there is no significant evidence that one particular type of exercise is clearly more effective than others. Here we present a descriptive review of different types of exercise for therapeutic or prevention purposes in patients with CLBP. Studies suggest that individually tailored, supervised exercise programs are associated with the best outcomes. High quality clinical trials are needed to determine the effectiveness of specific interventions (type, time, intensity and other characteristics) aimed at individuals and/or specific target groups.

  16. [Rehabilitation on effort of low back pain. Functional restoration programs].

    PubMed

    Poiraudeau, Serge; Rannou, François; Lefevre Colau, Marie Martine; Boutron, Isabelle; Revel, Michel

    2004-03-27

    Mediocre functional prognosis In industrialised countries, chronic low back pain is the most common cause of disability and work stoppage. Conventional treatments have not reduced the impact of chronic low back pain. Hence new solutions have been searched for. FUNCTIONAL RESTORATION PROGRAMS: These programs consist in heavy and expensive multidisciplinary treatment schedules, lasting from 3 to 6 weeks. The key concepts of these programs are acceptance of pain, treatment of the problem by the patients themselves and a progression contract. POSITIVE RESULTS: Controlled studies published on the percentage of patients returning to work are positive. Maintenance of a job-attached status to the pre-injury employer is often best accomplished by the provision of suitable modified duties. Finally, results of functional restoration programs in term of return-to-work rate probably strongly depend on the social security system of the country in which such programs have been developed. PMID:15105788

  17. The Continuing and Growing Epidemic of Chronic Low Back Pain

    PubMed Central

    Gatchel, Robert J.

    2015-01-01

    Because of the great prevalence of chronic pain, it is not surprising that there have been a number of influential reports by the Institute of Medicine, National Institutes of Health, and the World Health Organization that have documented the medical, social and economic problems caused by it, and the need for better pain-management programs. The present article briefly reviews these reports, and then focuses on three important areas that need to be considered when addressing the continuing and growing epidemic of one of the most prevalent types of chronic pain [chronic low back pain (CLBP)]: the biopsychosocial model of chronic pain; the paradigm shift in medicine from a disease model to an illness model of CLBP; and a review of the treatment- and cost-effectiveness of interdisciplinary chronic pain management programs. This overview will serve as an important prelude to other topics related to low back pain included in this Special Issue of Healthcare. Topics covered will range from assessment and treatment approaches, to important psychosocial mediators/moderators such as coping and pain beliefs. PMID:27417800

  18. ACR Appropriateness Criteria Low Back Pain.

    PubMed

    Patel, Nandini D; Broderick, Daniel F; Burns, Judah; Deshmukh, Tejaswini K; Fries, Ian Blair; Harvey, H Benjamin; Holly, Langston; Hunt, Christopher H; Jagadeesan, Bharathi D; Kennedy, Tabassum A; O'Toole, John E; Perlmutter, Joel S; Policeni, Bruno; Rosenow, Joshua M; Schroeder, Jason W; Whitehead, Matthew T; Cornelius, Rebecca S; Corey, Amanda S

    2016-09-01

    Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

  19. ACR Appropriateness Criteria Low Back Pain.

    PubMed

    Patel, Nandini D; Broderick, Daniel F; Burns, Judah; Deshmukh, Tejaswini K; Fries, Ian Blair; Harvey, H Benjamin; Holly, Langston; Hunt, Christopher H; Jagadeesan, Bharathi D; Kennedy, Tabassum A; O'Toole, John E; Perlmutter, Joel S; Policeni, Bruno; Rosenow, Joshua M; Schroeder, Jason W; Whitehead, Matthew T; Cornelius, Rebecca S; Corey, Amanda S

    2016-09-01

    Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. PMID:27496288

  20. Altered spinal motion in low back pain associated with lumbar strain and spondylosis.

    PubMed

    Cheng, Joseph S; Carr, Christopher B; Wong, Cyrus; Sharma, Adrija; Mahfouz, Mohamed R; Komistek, Richard D

    2013-04-01

    Study Design We present a patient-specific computer model created to translate two-dimensional (2D) fluoroscopic motion data into three-dimensional (3D) in vivo biomechanical motion data. Objective The aim of this study is to determine the in vivo biomechanical differences in patients with and without acute low back pain. Current dynamic imaging of the lumbar spine consists of flexion-extension static radiographs, which lack sensitivity to out-of-plane motion and provide incomplete information on the overall spinal motion. Using a novel technique, in-plane and coupled out-of-plane rotational motions are quantified in the lumbar spine. Methods A total of 30 participants-10 healthy asymptomatic subjects, 10 patients with low back pain without spondylosis radiologically, and 10 patients with low back pain with radiological spondylosis-underwent dynamic fluoroscopy with a 3D-to-2D image registration technique to create a 3D, patient-specific bone model to analyze in vivo kinematics using the maximal absolute rotational magnitude and the path of rotation. Results Average overall in-plane rotations (L1-L5) in patients with low back pain were less than those asymptomatic, with the dominant loss of motion during extension. Those with low back pain also had significantly greater out-of-plane rotations, with 5.5 degrees (without spondylosis) and 7.1 degrees (with spondylosis) more out-of-plane rotational motion per level compared with asymptomatic subjects. Conclusions Subjects with low back pain exhibited greater out-of-plane intersegmental motion in their lumbar spine than healthy asymptomatic subjects. Conventional flexion-extension radiographs are inadequate for evaluating motion patterns of lumbar strain, and assessment of 3D in vivo spinal motion may elucidate the association of abnormal vertebral motions and clinically significant low back pain. PMID:24436694

  1. Reconceptualizing John F. Kennedy's chronic low back pain.

    PubMed

    Pinals, Robert S; Hassett, Afton L

    2013-01-01

    When the medical records for John Fitzgerald Kennedy were made public, it became clear that the 35th President of the United States suffered greatly from a series of medical illnesses from the time he was a toddler until his assassination in November of 1963. Aside from having Addison disease, no condition seemed to cause him more distress than did his chronic low back pain. A number of surgical procedures to address the presumed structural cause of the pain resulted in little relief and increased disability. Later, a conservative program, including trigger point injections and exercises, provided modest benefit. Herein, the mechanisms underlying his pain are evaluated based on more contemporary pain research. This reconceptualizing of John Fitzgerald Kennedy's pain could serve as a model for other cases where the main cause of the pain is presumed to be located in the periphery.

  2. Randomized controlled trials in industrial low back pain relating to return to work. Part 2. Discogenic low back pain.

    PubMed

    Scheer, S J; Radack, K L; O'Brien, D R

    1996-11-01

    The purpose of this review was to determine the efficacy of treatments for discogenic low back pain (LBP) by examining all randomized controlled trials (RCTs) of discogenic LBP published in the English language literature between 1975 and 1993 with "return to work" (RTW) as the end point. From more than 4,000 LBP citations, nearly 600 articles were initially reviewed; 35 studies met our selection criteria. Twenty-two studies were discussed in Part 1 (Acute Interventions) or will be discussed in Part 3 (Chronic Interventions). In this review, of 13 RCTs assessing interventions for LBP with sciatica, 9 were appropriate for their focus on, and radiologic confirmation of, discogenic LBP. The treatments assessed included chemonucleolysis, surgical discectomy, and epidural steroid injection. A 26-point system to assess the quality of methodologic rigor was used for each article. Our literature survey found a need for additional studies comparing surgery, conservative care, epidural steroids, traction, and other approaches to determine their individual effects for RTW after discogenic disease. PMID:8931535

  3. Using a CBT approach to manage low back pain.

    PubMed

    Richmond, Helen

    Low back pain is not only commonplace the world over, but also costly to treat. A training programme was developed so health professionals from many different specialties, from nursing to occupational health, can have a positive impact on patients with the condition, easing their disability and consequently also, the financial burden on healthcare institutions and systems. This article describes the programme and outlines how NHS nurses can train to use the programme no matter where they are based. PMID:27344895

  4. Kappa Delta Award. Low back pain and whole body vibration.

    PubMed

    Pope, M H; Magnusson, M; Wilder, D G

    1998-09-01

    The investigators describe their multifaceted approach to the study of the relationship between whole body vibration and low back pain. The epidemiologic study was a two center study of drivers and sedentary workers in the United States and Sweden. The vibration exposure was measured in the vehicles. It was found that the career vibration exposure was related to low back, neck, and shoulder pain. However, disability was related to job satisfaction. In vivo experiments, using percutaneous pin mounted accelerometers have shown that the natural frequency is at 4.5 Hz. The frequency response is affected by posture, seating, and seat back inclination. The response appears to be determined largely by the rocking of the pelvis. Electromyographic studies have shown that muscle fatigue occurs under whole body vibration. After whole body vibration exposure the muscle response to a sudden load has greater latency. Vehicle driving may be a reason for low back pain or herniated nucleus pulposus. Prolonged seating exposure, coupled with the whole body vibration, should be reduced for those recovering from these problems. Vibration attenuating seats and correct ergonomic layout of the cabs may reduce the risks of recurrence. PMID:9755785

  5. Low back pain: risk evaluation and preplacement screening.

    PubMed

    Himmelstein, J S; Andersson, G B

    1988-01-01

    As screening tests in a currently asymptomatic population, all of the available methods for predicting low back pain and disability have serious technical, ethical and legal limitations. From a technical point of view, none of the predictive tests appear to have sufficient sensitivity or specificity to justify routine usage. The most sensitive indicator (a past history of low back pain) lacks reliability and specificity. Muscle strength-testing may be predictive of future musculoskeletal injury as part of a well-designed program that considers specific job demands in relation to specific worker capabilities. Unfortunately, the conditions necessary for a well designed program--a large number of predictable high-risk jobs that have measurable specific demands that can be reproduced reliably in a testing situation--are rarely met. In the future, the use of computer-assisted multivariate models analogous to those used in the prediction of cardiovascular risk may be capable of integrating information about an individual's medical history, physical exam, physical capacity and other tests with specific job requirements to give us a more accurate prediction of the future risk of back pain and disability. If such predictive models are ever developed and verified, it would then be appropriate to examine various interventions and their effectiveness in modifying risks for the population and the individual worker. From a legal point of view, all of the techniques described hold potential for significant discrimination against legally protected groups. Making employment decisions with regard to a past history of low back pain or on the basis of an x-ray will lead to systematic age discrimination and discrimination against the handicapped. The use of muscle strength-testing will systematically discriminate against women and certain ethnic groups. The ethical implications of predictive screening for low back pain clearly depends on what is done with the information that is

  6. Comparison of pain, kinesiophobia and quality of life in patients with low back and neck pain

    PubMed Central

    Uluğ, Naime; Yakut, Yavuz; Alemdaroğlu, İpek; Yılmaz, Öznur

    2016-01-01

    [Purpose] The purpose of this study was to compare patients with low back and neck pain with respect to kinesiophobia, pain, and quality of life. [Subjects and Methods] Three-hundred patients with low back (mean age 43.2±11 years) and 300 with neck pain (mean age 42.8±10.2 years) were included in this study. Pain severity was evaluated by using the Short-Form McGill Pain Questionnaire, which includes a Visual Analogue Scale, quality of life by the Nottingham Health Profile, and kinesiophobia by the Tampa Scale for Kinesiophobia. [Results] Pain severity was similar in both groups, with a Visual Analogue Scale score of 6.7±2 in the low back pain and 6.8±2 in the neck pain group. Nottingham Health Profile pain [z=−4.132] and physical activity scores [z=−5.640] in the low back pain group were significantly higher. Kinesiophobia was also more severe in the low back pain group, with a mean 42.05±5.91 versus 39.7±6.0 Tampa Scale for Kinesiophobia score [z=−4.732]. [Conclusion] Patients with low back pain developed more severe kinesiophobia, regardless of the pain severity, and had greater pain perception and lower physical activity levels. Kinesiophobia adversely affects the quality of life and requires effective management of low back pain. PMID:27064399

  7. Comparison of pain, kinesiophobia and quality of life in patients with low back and neck pain.

    PubMed

    Uluğ, Naime; Yakut, Yavuz; Alemdaroğlu, İpek; Yılmaz, Öznur

    2016-01-01

    [Purpose] The purpose of this study was to compare patients with low back and neck pain with respect to kinesiophobia, pain, and quality of life. [Subjects and Methods] Three-hundred patients with low back (mean age 43.2±11 years) and 300 with neck pain (mean age 42.8±10.2 years) were included in this study. Pain severity was evaluated by using the Short-Form McGill Pain Questionnaire, which includes a Visual Analogue Scale, quality of life by the Nottingham Health Profile, and kinesiophobia by the Tampa Scale for Kinesiophobia. [Results] Pain severity was similar in both groups, with a Visual Analogue Scale score of 6.7±2 in the low back pain and 6.8±2 in the neck pain group. Nottingham Health Profile pain [z=-4.132] and physical activity scores [z=-5.640] in the low back pain group were significantly higher. Kinesiophobia was also more severe in the low back pain group, with a mean 42.05±5.91 versus 39.7±6.0 Tampa Scale for Kinesiophobia score [z=-4.732]. [Conclusion] Patients with low back pain developed more severe kinesiophobia, regardless of the pain severity, and had greater pain perception and lower physical activity levels. Kinesiophobia adversely affects the quality of life and requires effective management of low back pain.

  8. Efficacy of Coblation Annuloplasty in Discogenic Low Back Pain

    PubMed Central

    He, Liangliang; Hu, Xiangyu; Tang, Yuanzhang; Li, Xiuhua; Zheng, Shuyue; Ni, Jiaxiang

    2015-01-01

    Abstract In degenerative disc, the innervated outer annulus is confirmed to the major origin resulted in discogenic pain. To alleviate the discogenic pain, annuloplasty with electrothermal technology was proved to be effective, which mainly involves the thermal heating of the annulus to denature collagen fibers and denervate posterior annular nerve fibers. However, little is known that efficacy of annuloplasty with coblation technology in treating discogenic pain through directly interrupting nerves in outer annulus. The purpose of this study was to evaluate the clinical outcomes of coblation annuloplasty for the treatment of discogenic low back pain. In a clinical prospective observational study, 17 consecutive patients with discogenic low back pain underwent coblation annuloplasty under local anesthesia. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, and modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 6 months of follow-up. The preoperative pain VAS score was 6.5 ± 0.8(95% confidence interval [CI] 6.1–6.9) and the pain VAS score decreased to 2.9 ± 1.6 (95% CI 2.1–3.8), 2.9 ± 1.7 (95% CI 2.1–3.8), 3.2 ± 1.6 (95% CI 2.4–4.1), 3.2 ± 1.7 (95% CI 2.4–4.2) at 1 week and 1, 3 and 6 month postoperatively, respectively. 12 (70.6%), 11 (64.7%), 10 (58.8%) and 10 (58.8%) of patients reported significant pain relief at 1 week and 1, 3 and 6 months postoperatively. At 1, 3, and 6 months postoperatively, the numbers of patients with “excellent” or “good” ratings were 13 (76.5%), 11 (64.7%), and 10 (58.8%) according to the modified MacNab criteria. No serious complications were observed. The finds show that coblation annuloplasty is an effective, safe, and less uncomfortable procedure in managing discogenic low back pain. PMID:25984672

  9. Practice guidelines for the management of low back pain. Consensus Group of Practice Parameters to Manage Low Back Pain.

    PubMed

    Guevara-López, Uría; Covarrubias-Gómez, Alfredo; Elías-Dib, Jorge; Reyes-Sánchez, Alejandro; Rodríguez-Reyna, Tatiana Sofía

    2011-01-01

    It has been documented that pain in its diverse modalities is the most common cause of medical attention. In Mexico, an increase in its frequency has promoted its consideration in several health programs. On the other hand, inadequate pain management will cause severe physical, psychoaffective, and socioeconomic repercussions for patients, families, and public health services. Despite this panorama, there has not been an agreement to establish better diagnostic and therapeutic methods for the management of chronic pain. A consensus group was reunited and was integrated by medical experts from private and public institutions and from various states of the Mexican Republic. To assure the development of these practice guidelines, these experts had experience in the assessment and treatment of conditions causing pain. With the guidelines used by other consensus groups, meetings were held to analyze and discuss published literary evidence for the management of low back pain. The recommendations were classified according to their methodological strength. As a result of this meeting, consensus recommendations were based on evidence and operational conclusions of such proactive educational plans, institutional policies and diagnostic recommendations for pharmacological and nonpharmacological treatment in order for Mexican physicians to provide a better therapeutic approach to low back pain.

  10. Reflex receptive fields are enlarged in patients with musculoskeletal low back and neck pain.

    PubMed

    Biurrun Manresa, José A; Neziri, Alban Y; Curatolo, Michele; Arendt-Nielsen, Lars; Andersen, Ole K

    2013-08-01

    Pain hypersensitivity has been consistently detected in chronic pain conditions, but the underlying mechanisms are difficult to investigate in humans and thus poorly understood. Patients with endometriosis pain display enlarged reflex receptive fields (RRF), providing a new perspective in the identification of possible mechanisms behind hypersensitivity states in humans. The primary hypothesis of this study was that RRF are enlarged in patients with musculoskeletal pain. Secondary study end points were subjective pain thresholds and nociceptive withdrawal reflex (NWR) thresholds after single and repeated (temporal summation) electrical stimulation. Forty chronic neck pain patients, 40 chronic low back pain patients, and 24 acute low back pain patients were tested. Electrical stimuli were applied to 10 sites on the sole of the foot to quantify the RRF, defined as the area of the foot from where a reflex was evoked. For the secondary end points, electrical stimuli were applied to the cutaneous innervation area of the sural nerve. All patient groups presented enlarged RRF areas compared to pain-free volunteers (P<.001). Moreover, they also displayed lower NWR and pain thresholds to single and repeated electrical stimulation (P<.001). These results demonstrate that musculoskeletal pain conditions are characterized by enlarged RRF, lowered NWR and pain thresholds, and facilitated temporal summation, most likely caused by widespread spinal hyperexcitability. This study contributes to a better understanding of the mechanisms underlying these pain conditions, and it supports the use of the RRF and NWR as objective biomarkers for pain hypersensitivity in clinical and experimental pain research. PMID:23707309

  11. Prevalence of sleep disturbance in patients with low back pain.

    PubMed

    Alsaadi, Saad M; McAuley, James H; Hush, Julia M; Maher, Chris G

    2011-05-01

    Low back pain (LBP) is a common health condition that is often associated with disability, psychological distress and work loss. Worldwide, billions of dollars are expended each year trying to manage LBP, often with limited success. Recently, some researchers have reported that LBP patients also report sleep disturbance as a result of their LBP. However, as most of this evidence was obtained from highly selected groups of patients or from studies with small samples, high quality data on prevalence of sleep disturbance for patients with LBP are lacking. It is also unclear whether sleep disturbance is more likely to be reported by patients with recent-onset LBP than by patients with persistent LBP. Finally, it is not known whether high pain intensity, the most relevant condition-specific variable, is associated with higher rates of reported sleep disturbance. The present study aimed to determine the prevalence of reported sleep disturbance in patients with LBP. In addition, we aimed to determine whether sleep disturbance was associated with the duration of back pain symptoms and whether pain intensity was associated with reported sleep disturbance. Data from 1,941 patients obtained from 13 studies conducted by the authors or their colleagues between 2001 and 2009 were used to determine the prevalence of sleep disturbance. Logistic regression analyses explored associations between sleep disturbance, the duration of low back symptoms and pain intensity. The estimated prevalence of sleep disturbance was 58.7% (95% CI 56.4-60.7%). Sleep disturbance was found to be dependent on pain intensity, where each increase by one point on a ten-point visual analogue scale (VAS) was associated with a 10% increase in the likelihood of reporting sleep disturbance. Our findings indicate that sleep disturbance is common in patients with LBP. In addition, we found that the intensity of back pain was only weakly associated with sleep disturbance, suggesting that other factors contribute

  12. Pharmacists' views on implementing a disease state management program for low back pain.

    PubMed

    Abdel Shaheed, Christina; Maher, Christopher G; Williams, Kylie A; McLachlan, Andrew J

    2016-01-01

    Pharmacists have the potential to take a lead role in the primary care management of people with acute low back pain. The aim of this study was to investigate pharmacists' views on implementing a care program for people with acute low back pain in the community pharmacy. Recruitment of pharmacists for this study took place between July 2012 and March 2013. A convenience sample of 30 pharmacists who collaborated in recruiting participants for a low back pain clinical trial in Sydney (n=15 pharmacist recruiters and n=15 non-recruiters) completed an open-ended questionnaire. There was no marked variation in responses between the two groups. Participating pharmacists were receptive to the idea of implementing a care program for people with low back pain, highlighting the need for adequate reimbursement and adequate training of staff to ensure it is successful. Pharmacists identified that the follow up of people receiving such a service is dependent on several factors such as effective reminder systems and the proximity of patients to the pharmacy. PMID:25719762

  13. A longitudinal study of low back pain in student nurses.

    PubMed

    Klaber Moffett, J A; Hughes, G I; Griffiths, P

    1993-06-01

    Results from a longitudinal study of low back pain in 199 student nurses followed up for 20 months show that 37% reported back pain which lasted for at least 3 consecutive days. The first incidence peaked markedly between 9 and 12 months into training, and coincided with work on wards described by the nurses as "heavy". A combination of personal characteristics are also associated with back pain reports, within this group of nurses. These include attitudes to health as measured by the Health Locus of Control, low levels of trait anxiety, increased neuroticism, and emotional disturbance as measured by the General Health Questionnaire, the strength endurance of the thigh muscles (quadriceps), and height. Recommendations are made for: (1) the consideration of a modified training programme for lifting and handling; and (2) the need for a standardized system of recording back problems as suggested by the DHSS-commissioned Robens Institute (University of Surrey) Report.

  14. A systematic review of paracetamol for non-specific low back pain

    PubMed Central

    Davies, Reece A.; Hancock, Mark J.

    2008-01-01

    The objective of this study was to assess the efficacy of paracetamol (acetaminophen) in the treatment of pain and disability in patients with non-specific low back pain. We conducted a systematic review of randomized controlled trials to assess the efficacy of paracetamol in the treatment of pain and disability in patients with non-specific low back pain. A search for randomized controlled trials was conducted using the Medline, Embase and CINAHL databases. Trials were eligible if they were randomized controlled trials comparing paracetamol to no treatment, placebo or another treatment in patients with non-specific low back pain. Two of the authors independently assessed trials for methodological quality on the PEDro Scale and extracted data. Continuous pain and disability data were converted to a common 0–10 scale; ordinal data were dichotomized (e.g., no pain, pain). The data was analyzed using the MIX version 1.61 meta-analysis software. Out of 205 unique articles found in the searches, 7 eligible trials were identified. The trials enrolled a total of 676 participants with 5 investigating acute low back pain, 1 investigating chronic low back pain and 1 investigating both. No trial provided data comparing paracetamol to placebo and only one trial compared paracetamol to no treatment. In general the trials were small (only 1 trial had >25 subjects per group) and of low methodological quality (only 2 had a score above 6 on the quality scale). All but one of the trials provided imprecise estimates of the effects of treatment with confidence intervals spanning clinically important beneficial and also harmful effects of paracetamol. No trial reported a statistically significant difference in favor of paracetamol. There is insufficient evidence to assess the efficacy of paracetamol in patients with low back pain. There is a clear need for large, high quality randomized controlled trials evaluating paracetamol, to provide reliable evidence of paracetamol

  15. A systematic review of paracetamol for non-specific low back pain.

    PubMed

    Davies, Reece A; Maher, Christopher G; Hancock, Mark J

    2008-11-01

    The objective of this study was to assess the efficacy of paracetamol (acetaminophen) in the treatment of pain and disability in patients with non-specific low back pain. We conducted a systematic review of randomized controlled trials to assess the efficacy of paracetamol in the treatment of pain and disability in patients with non-specific low back pain. A search for randomized controlled trials was conducted using the Medline, Embase and CINAHL databases. Trials were eligible if they were randomized controlled trials comparing paracetamol to no treatment, placebo or another treatment in patients with non-specific low back pain. Two of the authors independently assessed trials for methodological quality on the PEDro Scale and extracted data. Continuous pain and disability data were converted to a common 0-10 scale; ordinal data were dichotomized (e.g., no pain, pain). The data was analyzed using the MIX version 1.61 meta-analysis software. Out of 205 unique articles found in the searches, 7 eligible trials were identified. The trials enrolled a total of 676 participants with 5 investigating acute low back pain, 1 investigating chronic low back pain and 1 investigating both. No trial provided data comparing paracetamol to placebo and only one trial compared paracetamol to no treatment. In general the trials were small (only 1 trial had >25 subjects per group) and of low methodological quality (only 2 had a score above 6 on the quality scale). All but one of the trials provided imprecise estimates of the effects of treatment with confidence intervals spanning clinically important beneficial and also harmful effects of paracetamol. No trial reported a statistically significant difference in favor of paracetamol. There is insufficient evidence to assess the efficacy of paracetamol in patients with low back pain. There is a clear need for large, high quality randomized controlled trials evaluating paracetamol, to provide reliable evidence of paracetamol

  16. Gynecological Surgery and Low Back Pain in Older Women

    PubMed Central

    Ericksen, Jeffery; Pidcoe, Peter E.; Ketchum-McKinney, Jessica M.; Burnet, Evie N.; Huang, Emily; Wilson, James C.; Hoogstad, Vincent

    2010-01-01

    Objective: To determine sacroiliac joint compliance characteristics and pelvic floor movements in older women relative to gynecological surgery history and back pain complaints. Design: Single-visit laboratory measurement. Setting: University clinical research center. Participants: Twenty-five women aged 65 years or older. Outcome Measures: Sacroiliac joint compliance measured by Doppler imaging of vibrations and ultrasound measures of pelvic floor motion during the active straight leg raise test. Results: Doppler imaging of vibrations demonstrated test reliability ranging from 0.701 to 0.898 for detecting vibration on the ilium and sacrum sides of the sacroiliac joint. The presence of low-back pain or prior gynecological surgery was not significantly associated with a difference in the compliance or laxity symmetry of the sacroiliac joints. No significant difference in pelvic floor movement was found during the active straight leg raise test between subject groups. All P values were ≥.4159. Conclusions: Prior gynecological surgery and low-back pain were not significantly associated with side-to-side differences in the compliance of the sacroiliac joints or in significant changes in pelvic floor movement during a loading maneuver in a group of older women. PMID:23569659

  17. Surface Electromyographic (SEMG) Biofeedback for Chronic Low Back Pain

    PubMed Central

    Neblett, Randy

    2016-01-01

    Biofeedback is a process in which biological information is measured and fed back to a patient and clinician for the purpose of gaining increased awareness and control over physiological domains. Surface electromyography (SEMG), a measure of muscle activity, allows both a patient and clinician to have direct and immediate access to muscle functioning that is not possible with manual palpation or visual observation. SEMG biofeedback can be used to help “down-train” elevated muscle activity or to “up-train” weak, inhibited, or paretic muscles. This article presents a historical and clinical overview of SEMG and its use in chronic low back pain assessment and biofeedback training. PMID:27417615

  18. Surface Electromyographic (SEMG) Biofeedback for Chronic Low Back Pain.

    PubMed

    Neblett, Randy

    2016-01-01

    Biofeedback is a process in which biological information is measured and fed back to a patient and clinician for the purpose of gaining increased awareness and control over physiological domains. Surface electromyography (SEMG), a measure of muscle activity, allows both a patient and clinician to have direct and immediate access to muscle functioning that is not possible with manual palpation or visual observation. SEMG biofeedback can be used to help "down-train" elevated muscle activity or to "up-train" weak, inhibited, or paretic muscles. This article presents a historical and clinical overview of SEMG and its use in chronic low back pain assessment and biofeedback training. PMID:27417615

  19. [Update on Current Care Guideline: Low back pain].

    PubMed

    Pohjolainen, Timo; Leinonen, Ville; Frantén, Janek; Haanpää, Maija; Jousimaa, Jukkapekka; Karppinen, Jaro; Kuukkanen, Tiina; Luoma, Katariina; Salmenkivi, Jyrki; Osterman, Heikki; Malmivaara, Antti

    2015-01-01

    Classification to severe diseases, sciatic symptoms or non-specific back pain is recommended. Radiography in acute or subacute non-specific back pain is not recommended in the primary health care. In specialized care magnetic resonance imaging is the main imaging modality. Importance of patient information is emphasized. In acute non-specific pain avoidance of bed rest, advice and paracetamol are recommended. Indications for an emergency referral should be considered. In disabling pain for 6 weeks, multidisciplinary measures are needed. Pain over 3 months indicates intensive multidisciplinary rehabilitation, and also surgery may be considered. PMID:26245063

  20. DNA methylation of SPARC and chronic low back pain

    PubMed Central

    2011-01-01

    Background The extracellular matrix protein SPARC (Secreted Protein, Acidic, Rich in Cysteine) has been linked to degeneration of the intervertebral discs and chronic low back pain (LBP). In humans, SPARC protein expression is decreased as a function of age and disc degeneration. In mice, inactivation of the SPARC gene results in the development of accelerated age-dependent disc degeneration concurrent with age-dependent behavioral signs of chronic LBP. DNA methylation is the covalent modification of DNA by addition of methyl moieties to cytosines in DNA. DNA methylation plays an important role in programming of gene expression, including in the dynamic regulation of changes in gene expression in response to aging and environmental signals. We tested the hypothesis that DNA methylation down-regulates SPARC expression in chronic LBP in pre-clinical models and in patients with chronic LBP. Results Our data shows that aging mice develop anatomical and behavioral signs of disc degeneration and back pain, decreased SPARC expression and increased methylation of the SPARC promoter. In parallel, we show that human subjects with back pain exhibit signs of disc degeneration and increased methylation of the SPARC promoter. Methylation of either the human or mouse SPARC promoter silences its activity in transient transfection assays. Conclusions This study provides the first evidence that DNA methylation of a single gene plays a role in chronic pain in humans and animal models. This has important implications for understanding the mechanisms involved in chronic pain and for pain therapy. PMID:21867537

  1. Study protocol of cost-effectiveness and cost-utility of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial

    PubMed Central

    2011-01-01

    Background Low back pain (LBP), with high incidence and prevalence rate, is one of the most common reasons to consult the health system and is responsible for a significant amount of sick leave, leading to high health and social costs. The objective of the study is to assess the cost-effectiveness and cost-utility analysis of a multidisciplinary biopsychosocial educational group intervention (MBEGI) of non-specific sub-acute LBP in comparison with the usual care in the working population recruited in primary healthcare centres. Methods/design The study design is a cost-effectiveness and cost-utility analysis of a MBEGI in comparison with the usual care of non-specific sub-acute LBP. Measures on effectiveness and costs of both interventions will be obtained from a cluster randomised controlled clinical trial carried out in 38 Catalan primary health care centres, enrolling 932 patients between 18 and 65 years old with a diagnosis of non-specific sub-acute LBP. Effectiveness measures are: pharmaceutical treatments, work sick leave (% and duration in days), Roland Morris disability, McGill pain intensity, Fear Avoidance Beliefs (FAB) and Golberg Questionnaires. Utility measures will be calculated from the SF-12. The analysis will be performed from a social perspective. The temporal horizon is at 3 months (change to chronic LBP) and 12 months (evaluate the outcomes at long term). Assessment of outcomes will be blinded and will follow the intention-to-treat principle. Discussion We hope to demonstrate the cost-effectiveness and cost-utility of MBEGI, see an improvement in the patients' quality of life, achieve a reduction in the duration of episodes and the chronicity of non-specific low back pain, and be able to report a decrease in the social costs. If the intervention is cost-effectiveness and cost-utility, it could be applied to Primary Health Care Centres. Trial registration ISRCTN: ISRCTN58719694 PMID:21859489

  2. Evidence-based risk assessment and recommendations for physical activity: arthritis, osteoporosis, and low back pain.

    PubMed

    Chilibeck, Philip D; Vatanparast, Hassanali; Cornish, Stephen M; Abeysekara, Saman; Charlesworth, Sarah

    2011-07-01

    We systematically reviewed the safety of physical activity (PA) for people with arthritis, osteoporosis, and low back pain. We searched PubMed, MEDLINE, Sport Discus, and the Cochrane Central Register of Controlled Trials (1966 through March 2008) for relevant articles on PA and adverse events. A total of 111 articles met our inclusion criteria. The incidence for adverse events during PA was 3.4%-11% (0.06%-2.4% serious adverse events) and included increased joint pain, fracture, and back pain for those with arthritis, osteoporosis, and low back pain, respectively. Recommendations were based on the Appraisal of Guidelines for Research and Evaluation, which applies Levels of Evidence based on type of study ranging from high-quality randomized controlled trials (Level 1) to anecdotal evidence (Level 4) and Grades from A (strong) to C (weak). Our main recommendations are that (i) arthritic patients with highly progressed forms of disease should avoid heavy load-bearing activities, but should participate in non-weight-bearing activities (Level 2, Grade A); and (ii) patients with osteoporosis should avoid trunk flexion (Level 2, Grade A) and powerful twisting of the trunk (Level 3, Grade C); (iii) patients with acute low back pain can safely do preference-based PA (i.e., PA that does not induce pain), including low back extension and flexion (Level 2, Grade B); (iv) arthritic patients with stable disease without progressive joint damage and patients with stable osteoporosis or low back pain can safely perform a variety of progressive aerobic or resistance-training PAs (Level 2, Grades A and B). Overall, the adverse event incidence from reviewed studies was low. PA can safely be done by most individuals with musculoskeletal conditions. PMID:21800948

  3. Prediction of low back pain with two expert systems.

    PubMed

    Sari, Murat; Gulbandilar, Eyyup; Cimbiz, Ali

    2012-06-01

    Low back pain (LBP) is one of the common problems encountered in medical applications. This paper proposes two expert systems (artificial neural network and adaptive neuro-fuzzy inference system) for the assessment of the LBP level objectively. The skin resistance and visual analog scale (VAS) values have been accepted as the input variables for the developed systems. The results showed that the expert systems behave very similar to real data and that use of the expert systems can be used to successfully diagnose the back pain intensity. The suggested systems were found to be advantageous approaches in addition to existing unbiased approaches. So far as the authors are aware, this is the first attempt of using the two expert systems achieving very good performance in a real application. In light of some of the limitations of this study, we also identify and discuss several areas that need continued investigation.

  4. Motor control and low back pain in dancers.

    PubMed

    Roussel, N; De Kooning, M; Schutt, A; Mottram, S; Truijen, S; Nijs, J; Daenen, L

    2013-02-01

    Professional dancers suffer a high incidence of injuries, especially to the spine and lower extremities. There is a lack of experimental research addressing low back pain (LBP) in dancers. The aim of this study is to compare lumbopelvic motor control, muscle extensibility and sacroiliac joint pain between dancers with and without a history of LBP. 40 pre-professional dancers (mean age of 20.3 years) underwent a clinical test battery, consisting of an evaluation of lumbopelvic motor control, muscle extensibility, generalized joint hypermobility, and sacroiliac joint pain provocation tests. Also self-reported measurements and standardized questionnaires were used. 41% of the dancers suffered from LBP during at least 2 consecutive days in the previous year. Only one dancer suffered from sacroiliac joint pain. Compared to dancers without a history of LBP, dancers with a history of LBP showed poorer lumbopelvic motor control (p<0.05). No differences in muscle extensibility or joint hypermobility were observed between dancers (p>0.05). Despite their young age, pre-professional dancers suffer from LBP frequently. Sacroiliac joint pain, generalized joint hypermobility or muscle extensibility appears unrelated to LBP in dancers. Motor control is decreased in those with a history of LBP. Further research should examine whether motor control is etiologically involved in LBP in dancers.

  5. [Effectiveness of manipulative therapy in low back pain: systematic literature reviews and guidelines are inconclusive].

    PubMed

    Assendelft, W J; Lankhorst, G J

    1998-03-28

    In the Dutch general practitioners' guidelines spinal manipulative therapy (SMT) is not recommended for treatment of acute low back pain. This is in contrast to the recent American and English guidelines, which explicitly recommend SMT for this indication. Randomized clinical trials (RCTs) on SMT are on average of low methodological quality. Most systematic reviews, however, lead to positive conclusions. The potential sources of discrepancy between the recommendations in the national guidelines are: interpretation of the available RCTs and systematic reviews, composition of the guideline-setting committee, values of the participants and appreciation of direct and indirect costs. Definite conclusions on the efficacy of SMT for (acute) low back pain cannot yet be drawn. Therefore, more RCTs in various settings and on different indications are clearly needed. PMID:9623139

  6. Diagnosis and Characters of Non-Specific Low Back Pain in Japan: The Yamaguchi Low Back Pain Study

    PubMed Central

    Suzuki, Hidenori; Kanchiku, Tsukasa; Imajo, Yasuaki; Yoshida, Yuichiro; Nishida, Norihiro; Taguchi, Toshihiko

    2016-01-01

    Study Design Cross sectional data from the Yamaguchi low back pain study conducted in Yamaguchi prefecture, Japan, was used for this analysis. Methods A total of 320 patients were recruited from walk-in orthopedic clinics in Yamaguchi Prefecture, Japan. Patients visited the clinics primarily for low back pain (LBP) and sought treatment between April and May 2015. A self-questionnaire was completed by patients, while radiographic testing and neurological and physical examination was performed by the orthopedist in each hospital. The cause and characters of LBP was determined following examination of the data, regional anesthesia and block injection. Results ‘Specific LBP’ was diagnosed in 250 (78%) patients and non-diagnosable, ‘non-specific LBP’ in 70 (22%) patients. The VAS scores of patients were: LBP, 5.8±0.18; leg pain, 2.9±0.18 and the intensity of leg numbness was 1.9±0.16. Item scores for SF-8 were: general health, 46.6±0.40; physical function, 43.5±0.51; physical limitations, 42.8±0.53; body pain, 42.1±0.52; vitality, 48.4±0.37; social function, 46.9±0.53; emotional problems, 48.9±0.43; mental health, 46.9±0.43. Conclusions The incidence of non-specific LBP in Japan was lower than previous reports from western countries, presumably because of variation in the diagnosis of LBP between different health care systems. In Japan, 78% of cases were classified as ‘specific LBP’ by orthopedists. Identification of the definitive cause of LBP should help to improve the quality of LBP treatment. PMID:27548658

  7. [Chiropractic in general and in low back pain].

    PubMed

    Myhrvold, K

    1999-05-30

    The practice of chiropractic was for many years regulated by "The Quack Act" in Norway, and the numbers of chiropractors decreased year by year. They are now authorized health care practitioners with academic training; most Norwegian students attending courses in chiropractic or clinical biomechanics go to European universities. An international council ensures reciprocity and a quality assured academic programme in all recognized colleges of chiropractic. Recent research have broadened our understanding of the biomechanical interrelationship between the nervous system, the musculature and the skeletal articulations. In the early 1990s, several studies documented favourable effect of chiropractic treatment of low back disorders. These studies are now substantiated by new studies, especially concerning cost-effectiveness. Several reports also give evidence that chiropractic manipulation is beneficial especially in combination with light exercise. There are conflicting results concerning the efficacy of varying types of exercise programmes. Patients may benefit from increased cooperation between medical doctors and chiropractors. Most acute low back syndromes should be assessed by the chiropractor in order to prevent chronic illness. PMID:10394283

  8. Motor skill acquisition strategies for rehabilitation of low back pain.

    PubMed

    Stevans, J; Hall, K G

    1998-09-01

    Evidence supporting the early use of exercise for the treatment of low back pain continues to grow. We must keep in mind, however, that motor skill learning and exercise are not synonymous. If rehabilitation goals are limited to the improvement of physical parameters (ie., strength, flexibility, endurance), the opportunity to help patients improve the performance of functional activities will be missed. The motor learning literature suggests several strategies for facilitating the acquisition of a motor skill: transfer-appropriate processing, the contextual interference effect, and repetitive self-evaluation. These techniques will cognitively challenge patients, helping them gain skills more quickly and retain them longer. By incorporating these methods into the rehabilitation program, patients will better transfer what they have learned from the rehabilitation environment to their everyday functional activities. PMID:9742473

  9. Questionnaire for low back pain in the garment industry workers.

    PubMed

    Bindra, Supreet; Sinha, A G K; Benjamin, A I

    2013-05-01

    Low back pain affects up to 90% of the world's population at some point in their lives. Until date no questionnaire has been designed for back pain in the garment industry workers. Therefore, the objective of this study is to design a questionnaire to determine the prevalence, risk factors, impact, health care service utilization and back pain features in the garment industry workers and gain preliminary experience of its use. The content validity and reliability of the questionnaire was established. Items showing acceptable internal consistency and moderate to high test re-test reliability were retained in the questionnaire. Items showing unacceptable internal consistency, low test re-test reliability or poor differentiation were reworded, redrafted and re-tested on the workers. It took 20 min to complete one interview schedule. Environmental factors such as the absence of the garment industry owner/supervisor or co-workers at the time of the interview and interview during leisure hours need to be standardized. Thus, final questionnaire is ready for use after necessary amendments and will be used on the larger sample size in the main study.

  10. Questionnaire for low back pain in the garment industry workers

    PubMed Central

    Bindra, Supreet; Sinha, A. G. K.; Benjamin, A. I.

    2013-01-01

    Low back pain affects up to 90% of the world's population at some point in their lives. Until date no questionnaire has been designed for back pain in the garment industry workers. Therefore, the objective of this study is to design a questionnaire to determine the prevalence, risk factors, impact, health care service utilization and back pain features in the garment industry workers and gain preliminary experience of its use. The content validity and reliability of the questionnaire was established. Items showing acceptable internal consistency and moderate to high test re-test reliability were retained in the questionnaire. Items showing unacceptable internal consistency, low test re-test reliability or poor differentiation were reworded, redrafted and re-tested on the workers. It took 20 min to complete one interview schedule. Environmental factors such as the absence of the garment industry owner/supervisor or co-workers at the time of the interview and interview during leisure hours need to be standardized. Thus, final questionnaire is ready for use after necessary amendments and will be used on the larger sample size in the main study. PMID:24421591

  11. Making Better Lives: Patient-Focused Care for Low Back Pain (LBP)

    ClinicalTrials.gov

    2016-08-05

    Chronic Low Back Pain; Hip Ostearthritis; Myofascial Pain Syndrome; Fibromyalgia; Depression; Maladaptive Coping; Lumbar Spinal Stenosis; Insomnia; Sacroiliac Joint Pain; Lateral Hip and Thigh Pain; Anxiety; Dementia; Recent Leg Length Discrepancy

  12. Low-Back Pain in Microgravity: Causes and Countermeasures

    NASA Astrophysics Data System (ADS)

    Snijders, C. J.; Richardson, C. A.

    2005-06-01

    Low-back pain (LBP) is common not only on Earth, but also in space.This is remarkable because, on Earth, LBP is ascribed mostly to heavy spinal loading.The Topical Team was established by ESA to answer the question "What is the aetiology of LBP during flight and what countermeasures may be developed?" The starting point for the Team's activities is a biomechanical model developed at the Erasmus Medical Centre in Rotterdam (NL) that describes the function of a deep-muscle corset to stabilise lumbar and pelvic joints. For spaceflight, the hypothesis was formulated that muscle atrophy and neuroplasticity in the absence of gravity loading destabilises the lumbopelvic area. The outcome of the Team activities is the development of a theory for the source of pain in microgravity that identifies in particular the iliolumbar ligaments.To help verify the theory,Team members were involved in the Berlin Bedrest Study and the Dutch Soyuz Mission. Based on the results of these studies, countermeasures can be developed and implemented.

  13. Risk factors associated with chronic low back pain in Syria

    PubMed Central

    Alhalabi, Mohammad Salem; Alhaleeb, Hassan; Madani, Sarah

    2015-01-01

    Background: We aimed to identify risk factors associated with chronic low back pain (C-LBP) in Syria. Materials and Methods: We conducted the study in a busy outpatient neurology clinic in Damascus city from October 2011 to August 2012. We enrolled all eligible adults presenting with C-LBP along with those who denied any back pain as a controls. We considered C-LBP any LBP lasting over 3 months. We developed our own questionnaire. A clinical nurse interviewed each person and filled in the results. Results: We had a total of 911 subjects; 513 patients and 398 controls. We found that C-LBP increased with age. Having a sibling with C-LBP was a strong predictor of C-LBP. In women obesity, but not overweight, was a risk factor. Number of children was a risk factor for mothers. Higher level of education decreased the chance of C-LBP in women. Sedentary job increased the risk of C-LBP. Conclusion: This study sheds some light on risk factors for C-LBP in our population and might help find possible preventive measures. PMID:26629465

  14. Impairment and disability rating in low back pain.

    PubMed

    Katz, R T

    2001-08-01

    LBP is one of the two most common forms of disability in Western society (mental illness is the other), and remains a thorny problem in the arena of disability evaluation. Disability evaluation after LBP differs whether the pain is work-related or not. If work-related, guidelines for disability evaluation differ by jurisdiction and type of employment (e.g., private vs. federal employee). When outside of the workplace, thresholds for disability differ between entitlement programs (Social Security Disability) and private insurance programs (long-term disability insurance). In the patient without obvious findings, the disability evaluating physician needs to be caring and compassionate and yet maintain an objective stance with the understanding that there may be significant psychosocial overlay in patients with nonobjective pain complaints. Although some would argue that objective independent medical evaluation is an oxymoron, psychiatrists have excellent training and perspective with which to do so. The patient suffering from catastrophic brain injury or spinal cord injury offers a useful contrast--on the most severe end of the disability spectrum--to the patient with persisting low back complaints but normal physical examination. As a society, we have to wisely manage the funds that comprise our social "safety net" in order to provide for persons with severe disability who cannot provide for themselves. It would then follow that patients with minor impairments/disabilities should receive minor (i.e., noninflated) ratings. Psychiatrists need to enable rather than disable their patients. PMID:11478198

  15. Limbus Vertebra Presenting with Inflammatory Low Back Pain: A Case Report

    PubMed Central

    Özdemir, Tayfun; Öz, Hande Ece

    2016-01-01

    Limbus vertebra is a condition characterized by marginal interosseous herniation of the nucleus pulposus, and causes non specific symptoms like low back pain, back pain, muscle spasms and radiculopathy. It is frequently confused with vertebral fracture, infection, schmorl nodule or tumour because it has not a spesific symptom. It usually causes mechanical low back pain rather than inflammatory low back pain. We reported a patient presented with inflammatory low back pain and diagnosed with anterior limbus vertebra because it is rare and the patient has atypical clinical presentation. PMID:27134989

  16. Limbus Vertebra Presenting with Inflammatory Low Back Pain: A Case Report.

    PubMed

    Tuna, Serpil; Özdemir, Tayfun; Öz, Hande Ece

    2016-03-01

    Limbus vertebra is a condition characterized by marginal interosseous herniation of the nucleus pulposus, and causes non specific symptoms like low back pain, back pain, muscle spasms and radiculopathy. It is frequently confused with vertebral fracture, infection, schmorl nodule or tumour because it has not a spesific symptom. It usually causes mechanical low back pain rather than inflammatory low back pain. We reported a patient presented with inflammatory low back pain and diagnosed with anterior limbus vertebra because it is rare and the patient has atypical clinical presentation. PMID:27134989

  17. Minimally-invasive Ultrasound Devices for Treating Low Back Pain

    NASA Astrophysics Data System (ADS)

    Nau, William; Diederich, C.; Shu, R.; Kinsey, A.; Lotz, J.; Ferrier, W.; Sutton, J.; Pellegrino, R.

    2006-05-01

    Catheter-based ultrasound is being investigated for the potential to deliver heat to disc tissue for the treatment of discogenic low back pain. Two ultrasound applicator design configurations were tested: an intradiscal (IDUS) applicator which can be implanted directly within the disc, and an extradiscal (EDUS) applicator which is placed adjacent to the disc. In vitro heating trials were performed in human lumbar cadaveric disc segments instrumented with 24 thermocouples to obtain detailed maps of the temperature distributions. A low temperature elevation heating protocol in which the maximum temperature measured 5 mm away from the applicator is controlled to 52° C for the treatment period, and a high temperature elevation protocol (maximum temperature controlled to >70° C) were evaluated in this study. In vivo experiments were performed in sheep cervical spine using both applicator configurations, and both heating protocols. Steady-state temperature maps, and thermal doses (t43) calculated from the transient temperature data were used to assess regions of thermal damage within the disc. During the in vitro human disc studies using the high temperature protocol, temperatures were maintained at 71.5° ± 0.4°C 5 mm from an IDUS applicator implanted within the annular wall, with a maximum temperature (Tmax) of 78.6°C (t43 > 4.85 × 1010 min) measured 2 mm from the applicator. For the EDUS applicator, the temperature was maintained at 78.7° °C 5 mm from the applicator, with a Tmax of 86.3°C within 1 mm of the applicator surface. In the in vivo sheep studies, steady-state temperatures were maintained at 49.4° ± 0.3°C (t43 = 8.74 × 102 min) and 73.2° ± 0.6°C (t43 = 1.34 × 1010 min) with the IDUS applicator for the low and high temperature protocols, respectively. Using the EDUS applicator, temperatures were maintained at 54.4° ± 3.2°C (t43 = 4.11 × 104 min) and 69.4° ± 2.8°C (t43 = 2.81 × 109 min) for the two protocols. Directional heating was

  18. Management of chronic low back pain: a comprehensive approach.

    PubMed

    Kriegler, J S; Ashenberg, Z S

    1987-12-01

    The treatment approach presented in this article is an obvious departure from ways physicians are typically trained to handle patients' pain complaints. Traditional medical training focuses primarily on the management of acute pain. Unfortunately, the treatment modalities appropriate for acute pain are not applicable to most chronic pain disorders. Since physicians' practices contain many chronic pain patients, it is important for them to develop a more comprehensive and effective approach to the management of CLBP. Through the use of case vignettes, this article has attempted to elucidate some common problems experienced by patients with CLBP. It is a complex disorder that requires that the physicians be sensitive to the biologic, psychologic, and social aspects of the illness. Simply handing a patient with CLBP a set of back exercises or prescriptions for narcotics and sedatives will not be beneficial. Rather, the patient must be educated about the pain and taught to take an active role in his own treatment. By working with patients and their families, physicians can teach patients with CLBP the self-management skills essential for the resumption of a normal, productive life. PMID:2972043

  19. Quality of sleep in patients with chronic low back pain: a case-control study.

    PubMed

    Marty, M; Rozenberg, S; Duplan, B; Thomas, P; Duquesnoy, B; Allaert, F

    2008-06-01

    Animal experiments and studies in humans clearly show that the relation between pain (acute and chronic) and sleep quality is two-way: sleep disorders can increase pain, which in turn may cause sleep disorders. Sleep disorders and chronic low back pain are frequent health problems and it is unsurprising that the two can co-exist. This study was conducted to evaluate if sleep disorders and chronic pain associated are more frequently than one would expect. The objective of the study was to compare sleep quality in a population of patients with chronic low back pain and a control population. Sleep quality was assessed in 101 patients with chronic low back pain (CLBP) and in 97 sex- and age-matched healthy control subjects using the Pittsburgh Sleep Quality Index [PSQI; score from 0 (no disorder) to 21]. The French version of the Dallas Pain Questionnaire (DPQ) was used to assess the impact of low back pain on patients' quality of life. This impact was taken as nil in the healthy controls. The patients with CLBP and the controls were comparable in age, sex, and height, but mean bodyweight was higher in the CLBP group (70.3 +/- 14.5 vs. 61.8 +/- 11.4 kg; P < 0.05). The patients with CLBP were also more frequently on sick leave than the controls (32.3%; n = 31 vs. 0.0% n = 0; P < 0.001). Coffee, tea, and cola intakes were comparable in the two groups. Patients with CLBP had statistically higher scores in all items of the PSQI than the healthy controls. The mean PSQI was 4.7 +/- 3.2 for the healthy controls and 10.9 +/- 7.9 for the patients with CLBP (P < 0.0001). Sleep disorders were greater when the impact of CLBP on daily life (the four aspects of the DPQ) was greater [P < 0.0001]). The sleep of the patients with CLBP was significantly altered compared with that of the healthy controls, in proportion to the impact of low back pain on daily life. Our findings do not indicate whether sleep disorders are a cause or a consequence of CLBP. PMID:18389288

  20. Immune Responses to Low Back Pain Risk Factors

    PubMed Central

    Splittstoesser, Riley E.; Marras, William S.; Best, Thomas M.

    2013-01-01

    Objective Investigate effects of interactions between biomechanical, psychosocial and individual risk factors on the body’s immune inflammatory responses. Background Current theories for low back pain causation do not fully account for the body’s response to tissue loading and tissue trauma. Methods Two groups possessing a preference for the sensor or intuitor personality trait performed repetitive lifting combined with high or low mental workload on separate occasions. Spinal loading was assessed using an EMG-assisted subject-specific biomechanical model and immune markers were collected before and after exposure. Results Mental workload was associated with a small decrease in AP shear. Both conditions were characterized by a regulated time-dependent immune response making use of markers of inflammation, tissue trauma and muscle damage. Intuitors’ creatine kinase levels were increased following low mental workload compared to that observed in Sensors with the opposite trend occurring for high mental workload. Conclusions A temporally regulated immune response to lifting combined with mental workload exists. This response is influenced by personality and mental workload. PMID:22317743

  1. Subclassification of low back pain: a cross-country comparison.

    PubMed

    Billis, Evdokia V; McCarthy, Christopher J; Oldham, Jacqueline A

    2007-07-01

    Various health professionals have attempted to classify low back pain (LBP) subgroups and have developed several LBP classification systems. Knowing that culture has an effect on LBP symptomatology, assessment findings and clinical decision making, the aim of this review is to perform a cross-country comparative review amongst the published classification systems, addressing each country's similarities and differences as well as exploring whether cultural factors have been incorporated into the subclassification process. A systematic search of databases limited to human adults was undertaken by Medline, Cinahl, AMED and PEDro databases between January 1980 and October 2005. Classification systems from nine countries were identified. Most studies were classified according to pathoanatomic and/or clinical features, whereas fewer studies utilized a psychosocial and even less, a biopsychosocial approach. Most studies were limited in use to the country of the system's developer. Very few studies addressed cultural issues, highlighting the lack of information on the impact of specific cultural factors on LBP classification procedures. However, there seem to be certain 'cultural trends' in classification systems within each country, which are discussed. Despite the plethora of classification studies, there is still no system which is internationally established, effective, reliable and valid. Future research should aim to develop a LBP classification system within a well identified cultural setting, addressing the multi-dimensional features of the LBP presentation.

  2. Some endurance measures in persons with chronic low back pain.

    PubMed

    Moffroid, M; Reid, S; Henry, S M; Haugh, L D; Ricamato, A

    1994-08-01

    Muscle fatigue and lack of endurance are complaints of persons with chronic low back pain, but there are no standard ways to assess endurance in this population. The purposes of this study were to examine three measures of endurance; to determine relationships of these measures to each other; and to describe effects of gender, obesity, smoking, and self-reported fitness on the clinical measures. The measures of endurance selected were not dependent on maximal voluntary muscular contractions. They were the Sorensen test, median frequency decline of selected muscles, and a submaximal bicycle ergometer test. Thirty-five consenting individuals who were referred for treatment answered questions about their daily exercise prior to being tested. Repeatability of the Sorensen test holding time and of the slope measure of decline in the median frequencies was acceptable for subjects who reported a higher activity level. The decline of the median frequency in the biceps femoris muscles correlated with holding time of the Sorensen test. Smoking, gender, or obesity level did not affect test results on any of the endurance measures. Subjects who reportedly were more active achieved significantly higher scores on the Sorensen test. The importance of controlling for self-perception of activity in physical testing is discussed.

  3. Mediators of yoga and stretching for chronic low back pain.

    PubMed

    Sherman, Karen J; Wellman, Robert D; Cook, Andrea J; Cherkin, Daniel C; Ceballos, Rachel M

    2013-01-01

    Although yoga is an effective treatment for chronic low back pain, little is known about the mechanisms responsible for its benefits. In a trial comparing yoga to intensive stretching and self-care, we explored whether physical (hours of back exercise/week), cognitive (fear avoidance, body awareness, and self-efficacy), affective (psychological distress, perceived stress, positive states of mind, and sleep), and physiological factors (cortisol, DHEA) mediated the effects of yoga or stretching on back-related dysfunction (Roland-Morris Disability Scale (RDQ)). For yoga, 36% of the effect on 12-week RDQ was mediated by increased self-efficacy, 18% by sleep disturbance, 9% by hours of back exercise, and 61% by the best combination of all possible mediators (6 mediators). For stretching, 23% of the effect was mediated by increased self-efficacy, 14% by days of back exercise, and 50% by the best combination of all possible mediators (7 mediators). In open-ended questions, ≥20% of participants noted the following treatment benefits: learning new exercises (both groups), relaxation, increased awareness, and the benefits of breathing (yoga), benefits of regular practice (stretching). Although both self-efficacy and hours of back exercise were the strongest mediators for each intervention, compared to self-care, qualitative data suggest that they may exert their benefits through partially distinct mechanisms. PMID:23690832

  4. A Model of Integrative Care for Low-Back Pain

    PubMed Central

    Buring, Julie E.; Hrbek, Andrea L.; Davis, Roger B.; Connelly, Maureen T.; Cherkin, Daniel C.; Levy, Donald B.; Cunningham, Mark; O'Connor, Bonnie; Post, Diana E.

    2012-01-01

    Abstract Objectives While previous studies focused on the effectiveness of individual complementary and alternative medical (CAM) therapies, the value of providing patients access to an integrated program involving multiple CAM and conventional therapies remains unknown. The objective of this study is to explore the feasibility and effects of a model of multidisciplinary integrative care for subacute low-back pain (LBP) in an academic teaching hospital. Design This was a pilot randomized trial comparing an individualized program of integrative care (IC) plus usual care to usual care (UC) alone for adults with LBP. Subjects Twenty (20) individuals with LPB of 3–12 weeks' duration were recruited from an occupational health clinic and community health center. Interventions Participants were randomized to 12 weeks of individualized IC plus usual care versus UC alone. IC was provided by a trained multidisciplinary team offering CAM therapies and conventional medical care. Outcome measures The outcome measures were symptoms (pain, bothersomeness), functional status (Roland-Morris score), SF-12, worry, and difficulty performing three self-selected activities. Results Over 12 weeks, participants in the IC group had a median of 12.0 visits (range 5–25). IC participants experienced significantly greater improvements at 12 weeks than those receiving UC alone in symptom bothersomeness (p=0.02) and pain (p=0.005), and showed greater improvement in functional status (p=0.08). Rates of improvement were greater for patients in IC than UC in functional status (p=0.02), bothersomeness (p=0.002), and pain scores (p=0.001). Secondary outcomes of self-selected most challenging activity, worry, and the SF-12 also showed improvement in the IC group at 12 weeks. These differences persisted at 26 weeks, but were no longer statistically significant. Conclusions It was feasible for a multidisciplinary, outpatient IC team to deliver coordinated, individualized intervention to patients

  5. Low back pain, radiculopathy, and bilateral proximal hamstring ruptures: a case report.

    PubMed

    Deren, Matthew E; DeFroda, Steven F; Mukand, Nita H; Mukand, Jon A

    2015-12-01

    Low back pain (LBP) is a common complaint in the United States, with an incidence of 6.3%-15.4% and yearly recurrence in 54%-90% of patients.1 Trends show more frequent diagnostic testing, opioid use, and surgical intervention as the incidence of LBP increases.2 LBP is defined as pain at and near the lumbosacral region that can vary with physical activity and time. LBP is usually related to pathology of muscles, ligaments, spinal column joints, nerve roots, and the spinal cord. During the assessment of LBP, practitioners must also consider less common causes of pain in that region. For instance, patients with indolent or nighttime pain may have infectious or malignant processes. Referred pain from injuries to pelvic musculature or abdominal contents should be considered, especially following a traumatic event. One of these injuries, which can present as acute low back pain, is rupture of the proximal hamstring tendon. On rare occasion, concomitant LBP, radiculopathy, and hamstring injuries can occur;. This diagnostic challenge is described in the following case. PMID:26623451

  6. A Novel Nitronyl Nitroxide with Salicylic Acid Framework Attenuates Pain Hypersensitivity and Ectopic Neuronal Discharges in Radicular Low Back Pain.

    PubMed

    Han, Wen-Juan; Chen, Lei; Wang, Hai-Bo; Liu, Xiang-Zeng; Hu, San-Jue; Sun, Xiao-Li; Luo, Ceng

    2015-01-01

    Evidence has accumulated that reactive oxygen species and inflammation play crucial roles in the development of chronic pain, including radicular low back pain. Nonsteroid anti-inflammatory drugs (NSAIDs), for example, salicylic acid, aspirin, provided analgesic effects in various types of pain. However, long-term use of these drugs causes unwanted side effects, which limits their implication. Stable nitronyl (NIT) nitroxide radicals have been extensively studied as a unique and interesting class of new antioxidants for protection against oxidative damage. The present study synthesized a novel NIT nitroxide radical with salicylic acid framework (SANR) to provide synergistic effect of both antioxidation and antiinflammation. We demonstrated for the first time that both acute and repeated SANR treatment exerted dramatic analgesic effect in radicular low back pain mimicked by chronic compression of dorsal root ganglion in rats. This analgesic potency was more potent than that produced by classical NSAIDs aspirin and traditional nitroxide radical Tempol alone. Furthermore, SANR-induced behavioral analgesia is found to be mediated, at least in partial, by a reduction of ectopic spontaneous discharges in injured DRG neurons. Therefore, the synthesized NIT nitroxide radical coupling with salicylic acid framework may represent a novel potential therapeutic candidate for treatment of chronic pain, including radicular low back pain. PMID:26609438

  7. A Novel Nitronyl Nitroxide with Salicylic Acid Framework Attenuates Pain Hypersensitivity and Ectopic Neuronal Discharges in Radicular Low Back Pain

    PubMed Central

    Han, Wen-Juan; Chen, Lei; Wang, Hai-Bo; Liu, Xiang-Zeng; Hu, San-Jue; Sun, Xiao-Li; Luo, Ceng

    2015-01-01

    Evidence has accumulated that reactive oxygen species and inflammation play crucial roles in the development of chronic pain, including radicular low back pain. Nonsteroid anti-inflammatory drugs (NSAIDs), for example, salicylic acid, aspirin, provided analgesic effects in various types of pain. However, long-term use of these drugs causes unwanted side effects, which limits their implication. Stable nitronyl (NIT) nitroxide radicals have been extensively studied as a unique and interesting class of new antioxidants for protection against oxidative damage. The present study synthesized a novel NIT nitroxide radical with salicylic acid framework (SANR) to provide synergistic effect of both antioxidation and antiinflammation. We demonstrated for the first time that both acute and repeated SANR treatment exerted dramatic analgesic effect in radicular low back pain mimicked by chronic compression of dorsal root ganglion in rats. This analgesic potency was more potent than that produced by classical NSAIDs aspirin and traditional nitroxide radical Tempol alone. Furthermore, SANR-induced behavioral analgesia is found to be mediated, at least in partial, by a reduction of ectopic spontaneous discharges in injured DRG neurons. Therefore, the synthesized NIT nitroxide radical coupling with salicylic acid framework may represent a novel potential therapeutic candidate for treatment of chronic pain, including radicular low back pain. PMID:26609438

  8. A Novel Nitronyl Nitroxide with Salicylic Acid Framework Attenuates Pain Hypersensitivity and Ectopic Neuronal Discharges in Radicular Low Back Pain.

    PubMed

    Han, Wen-Juan; Chen, Lei; Wang, Hai-Bo; Liu, Xiang-Zeng; Hu, San-Jue; Sun, Xiao-Li; Luo, Ceng

    2015-01-01

    Evidence has accumulated that reactive oxygen species and inflammation play crucial roles in the development of chronic pain, including radicular low back pain. Nonsteroid anti-inflammatory drugs (NSAIDs), for example, salicylic acid, aspirin, provided analgesic effects in various types of pain. However, long-term use of these drugs causes unwanted side effects, which limits their implication. Stable nitronyl (NIT) nitroxide radicals have been extensively studied as a unique and interesting class of new antioxidants for protection against oxidative damage. The present study synthesized a novel NIT nitroxide radical with salicylic acid framework (SANR) to provide synergistic effect of both antioxidation and antiinflammation. We demonstrated for the first time that both acute and repeated SANR treatment exerted dramatic analgesic effect in radicular low back pain mimicked by chronic compression of dorsal root ganglion in rats. This analgesic potency was more potent than that produced by classical NSAIDs aspirin and traditional nitroxide radical Tempol alone. Furthermore, SANR-induced behavioral analgesia is found to be mediated, at least in partial, by a reduction of ectopic spontaneous discharges in injured DRG neurons. Therefore, the synthesized NIT nitroxide radical coupling with salicylic acid framework may represent a novel potential therapeutic candidate for treatment of chronic pain, including radicular low back pain.

  9. Low back pain in car drivers: A review of studies published 1975 to 2005

    NASA Astrophysics Data System (ADS)

    Gallais, Lenka; Griffin, Michael J.

    2006-12-01

    This review investigates whether there is evidence of an association between car driving and low back pain, and evidence that whole-body vibration contributes to low back pain in car drivers. The evidence of an association between various physical, psychosocial and individual factors and low back pain in car drivers was also investigated. From 23 epidemiological studies of low back problems in groups that reported car driving, nine studies fulfilled simple criteria for detailed review: four cross-sectional studies, three case-control studies and two longitudinal studies. The definition of low back pain was often unclear and, mostly, the physiological mechanisms causing low back pain were not considered. Eight of the nine studies concluded that there was an increase in low back pain among car drivers but there was little consideration of the influence of the many physical factors, individual factors and psychosocial factors that might be associated with an increase in low back pain. Consequently, there is insufficient evidence to form a conclusion on whether whole-body vibration, postural stressors or other factors, specific or not specific to driving, are common causes of low back problems in car drivers.

  10. Low back pain predict sickness absence among power plant workers

    PubMed Central

    Murtezani, Ardiana; Hundozi, Hajrije; Orovcanec, Nikola; Berisha, Merita; Meka, Vjollca

    2010-01-01

    Background: Low back pain (LBP) remains the predominant occupational health problem in most industrialized countries and low-income countries. Both work characteristics and individual factors have been identified as risk factors. More knowledge about the predictors of sickness absence from LBP in the industry will be valuable in determining strategies for prevention. Objectives: The aim of this longitudinal study was to investigate whether individual, work-related physical risk factors were involved in the occurrence of LBP sickness absence. Methods: A follow-up study was conducted among 489 workers, aged 18–65 years, at Kosovo Energetic Corporation in Kosovo. This cross-sectional study used a self-administered questionnaire to collect data on individual and work-related risk factors and the occurrence of LBP sickness absence. Logistic regression models were used to determine associations between risk factors and the occurrence of sickness absence due to LBP. Results: Individual factors did not influence sickness absence, whereas work-related physical factors showed strong associations with sickness absence. The main risk factors for sickness absence due to LBP among production workers were extreme trunk flexion (OR = 1.71, 95% CI = 1.05–2.78) as well as very extreme trunk flexion (OR = 6.04, 95% CI = 1.12–32.49) and exposure to whole-body vibration (OR = 1.75, 95% CI = 1.04–2.95). Conclusion: Reducing sickness absence from LBP among power plant workers requires focusing on the working conditions of blue-collar workers and risk factors for LBP. Increasing social support in the work environment may have effects in reducing sickness absence from LBP. PMID:21120081

  11. Generic Preference-based Measures for Low Back Pain

    PubMed Central

    Finch, Aureliano Paolo; Dritsaki, Melina; Jommi, Claudio

    2016-01-01

    Study Design. Systematic review. Objective. This systematic review examines validity and responsiveness of three generic preference-based measures in patients with low back pain (LBP). Summary of Background Data. LBP is a very common incapacitating disease with a significant impact on health-related quality of life (HRQoL). Health state utility values can be derived from various preference-based HRQoL instruments, and among them the most widely ones are EuroQol 5 dimensions (EQ-5D), Short Form 6 Dimensions (SF-6D), and Health Utilities Index 3 (HUI III). The ability of these instruments to reflect HRQoL has been tested in various contexts, but never for LBP populations. Methods. A systematic search on electronic literature databases was undertaken to identify studies of patients with LBP where health state utility values were reported. Records were screened using a set of predefined eligibility criteria. Data on validity (correlations and known group methods) and responsiveness (effect sizes, standardized response means, tests of statistical significance) of instruments were extracted using a customized extraction template, and assessed using predefined criteria. Results. There were substantial variations in the 37 included papers identified in relation to study design and outcome measures used. EQ-5D demonstrated good convergent validity, as it was able to distinguish between known groups. EQ-5D was also able to capture changes of health states as results of different interventions. Evidence for SF-6D and HUI III was limited to allow an appropriate evaluation. Conclusion. EQ-5D performs well in LBP population and its scores seem to be suitable for economic evaluation of LBP interventions. However, the paucity of information on the other instruments makes it impossible to determine its relative validity and responsiveness compared with them. Level of Evidence: 2 PMID:26583478

  12. Synergistic effect of a rehabilitation program and treadmill exercise on pain and dysfunction in patients with chronic low back pain.

    PubMed

    Cho, Young-Ki; Kim, Dae-Young; Jung, Sun-Young; Seong, Jun-Hyuk

    2015-04-01

    [Purpose] The present study examined the influence of treadmill exercise added to a low back pain rehabilitation program on low back extensor strength, pain, and dysfunction in chronic low back pain patients. [Subjects and Methods] Twenty men aged 22-36 years with chronic low back pain were randomly divided into experimental and control groups of 10 patients each. Both groups underwent a low back pain rehabilitation program lasting 30 min each, thrice/week for 8 weeks. The experimental group was prescribed an additional 30 min of treadmill exercise without a slope at a speed of 3.0-3.5 km/h, at which patients could walk comfortably. Low back extensor strength was tested using the Medx lumbar extension machine, pain level was tested, using the visual analog scale, and dysfunction was tested, using the Oswestry Low Back Pain Disability Questionnaire. [Results] Changes in low back extensor strength by angle showed significant interaction effects between measurement time and group at 12°, 24°, and 36°. The results of the visual analog scale and Oswestry Questionnaire showed a decreasing trend after the experiment in both groups. However, there was no interaction effect of the additional treadmill exercise in the experimental group. [Conclusion] The combination of a low back pain rehabilitation program and treadmill exercise has a synergistic effect, to some extent, on the improvement of low back extensor strength and should be considered for treatment and rehabilitation of low back pain patients.

  13. Understanding and prevention of low back pain in care workers.

    PubMed

    Minematsu, Akira

    2007-01-01

    The aim of this study was to investigate the actual situation of low back pain (LBP) prevention in care workers with questionnaires, and this data were used to clarify and decrease LBP factors. Subjects were 52 care workers (30.7 ± 10.0 years old) in a nursing home who filled out two kinds of questionnaires about LBP, one about the prevalence of LBP (QN1) and the other about LBP control measures (QN2). They had either license of certified care worker, 1st or 2nd class care worker. The data were collected for the purpose of finding differences in age and career (QN1) and differences in LBP control measures (QN2) between subjects with and without LBP. The average career of the subjects was 19.1 ± 12.5 months, and the prevalence of LBP among them was 46.2% (24 care workers), of which 66.7% began having LBP after starting work as care workers. Moreover, 75.0% of these subjects began having LBP within a year after starting work. Further, of the 24 care workers with LBP, 66.7% reported constantly experiencing LBP. The major risk factors given for LBP in care work were transfer, the replacement of diapers, and movement in a half-sitting posture. Compared with LBP subjects, rates of taking preventative steps in the non-LBP group were low. More than 80% of the subjects with LBP engaged in prevention methods such as using body mechanics, learning the proper way to perform care activities, using LBP support belts, and increasing their skills and knowledge with regard to their job responsibilities. Most subjects began to engage in such prevention methods after the onset of LBP. The results of this investigation indicated that most subjects did not engage in measures to counter their LBP until after it had already started, and that they selected prevention methods which were easy to perform and effective. It is important for care workers to learn the best ways to inhibit pain and prevent the occurrence, or recurrence, of LBP. It is necessary for physical therapists to grasp

  14. An epidemiological study of low back pain in professional drivers

    NASA Astrophysics Data System (ADS)

    Bovenzi, Massimo; Rui, Francesca; Negro, Corrado; D'Agostin, Flavia; Angotzi, Giuliano; Bianchi, Sandra; Bramanti, Lucia; Festa, GianLuca; Gatti, Silvana; Pinto, Iole; Rondina, Livia; Stacchini, Nicola

    2006-12-01

    The prevalence of low back pain (LBP) was investigated in 598 Italian professional drivers exposed to whole-body vibration (WBV) and ergonomic risk factors (drivers of earth moving machines, fork-lift truck drivers, truck drivers, bus drivers). The control group consisted of a small sample of 30 fire inspectors not exposed to WBV. Personal, occupational and health histories were collected by means of a structured questionnaire. Vibration measurements were performed on representative samples of the machines and vehicles used by the driver groups. From the vibration magnitudes and exposure durations, alternative measures of vibration dose were estimated for each subject. Daily vibration exposure, expressed in terms of 8-h energy-equivalent frequency-weighted acceleration, A(8), averaged 0.28-0.61 (range 0.10-1.18) m s -2 rms in the driver groups. Duration of exposure to WBV ranged between 1 and 41 years. The 7-day and 12-month prevalence of LBP was greater in the driver groups than in the controls. In the professional drivers, the occurrence of 12-month LBP, high intensity of LBP (Von Korff pain scale score ⩾5), and LBP disability (Roland & Morris disability scale score ⩾12) significantly increased with increasing cumulative vibration exposure. Even though several alternative measures of vibration exposure were associated with LBP outcomes, nevertheless a more regular trend of association with LBP was found for vibration dose expressed as ∑ a vit i (m s -2 h), in which the frequency-weighted acceleration, a v, and lifetime exposure duration, t, were given equal weight. In multivariate data analysis, individual characteristics (e.g. age, body mass index) and a physical load index (derived from combining manual materials handling and awkward postures) were significantly associated with LBP outcomes, while psychosocial work factors (e.g. job decision, job support) showed a marginal relation to LBP. This study tends to confirm that professional driving in industry

  15. What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis

    PubMed Central

    Minkalis, Amy L.; Vining, Robert D.

    2015-01-01

    Background: Low back pain is a common symptom arising from many possible sources and includes the possibility of the contribution of remote pathology. This report describes a patient with bilateral osteonecrosis of the femoral heads presenting with a primary symptom of low back pain. Case presentation: A 37-year-old male presented for evaluation of dominant pain that existed for approximately 6–12 months and was located in the right low back. Milder pain was also reported in the right hip. Low back and hip pain were both aggravated by weight-bearing activities. An evidence-based diagnostic evaluation revealed little indication for a primary pain source originating from low back structures. Radiographs revealed bilateral osteonecrosis with evidence of left femoral head collapse. Conclusion: Hip osteonecrosis may have contributed to an atypical presentation of low back pain due to aberrant localization of pain and/or combined with altered biomechanical loading of musculoskeletal structures. PMID:26500365

  16. Low back pain affects trunk as well as lower limb movements during walking and running.

    PubMed

    Müller, Roy; Ertelt, Thomas; Blickhan, Reinhard

    2015-04-13

    Up to now, most gait analyses on low back pain concentrate on changes in trunk coordination during walking on a treadmill. Locomotion on uneven ground as well as lower limb changes receives little attention in association with low back pain. The present study focuses on how chronic non-specific low back pain causes modifications in lower limb and trunk movements, in level and uneven walking and running. We found that trunk as well as lower limb movement was influenced by chronic non-specific low back pain. A consistent finding across all gaits and ground level changes is that patients with chronic non-specific low back pain show less pelvis and unchanged thorax rotation as compared to healthy controls. Furthermore, in chronic non-specific low back pain patients the trunk rotation decreased only during level and uneven running whereas the sagittal trunk inclination at touchdown increased only during uneven walking as compared to healthy controls. Besides significant changes in the upper body, in chronic non-specific low back pain patients the knee joint angle at touchdown was more extended during level walking but also during uneven walking and running as compared to healthy controls. We assume that trunk movements interact with lower limb movements or vice versa. Therefore, we recommend that further investigations on low back pain should consider both trunk (primarily pelvis) and lower limb (primarily knee) movements.

  17. Special Section: Complementary and Alternative Medicine (CAM): Low Back Pain and CAM

    MedlinePlus

    ... massage might be useful for low back pain. Yoga is more effective than a self-care book for improving function and reducing pain. The benefits persist for at least several months. Recently, the ...

  18. Foot posture, foot function and low back pain: the Framingham Foot Study

    PubMed Central

    Menz, Hylton B.; Dufour, Alyssa B.; Riskowski, Jody L.; Hillstrom, Howard J.

    2013-01-01

    Objective. Abnormal foot posture and function have been proposed as possible risk factors for low back pain, but this has not been examined in detail. The objective of this study was to explore the associations of foot posture and foot function with low back pain in 1930 members of the Framingham Study (2002–05). Methods. Low back pain, aching or stiffness on most days was documented on a body chart. Foot posture was categorized as normal, planus or cavus using static weight-bearing measurements of the arch index. Foot function was categorized as normal, pronated or supinated using the centre of pressure excursion index derived from dynamic foot pressure measurements. Sex-specific multivariate logistic regression models were used to examine the associations of foot posture, foot function and asymmetry with low back pain, adjusting for confounding variables. Results. Foot posture showed no association with low back pain. However, pronated foot function was associated with low back pain in women [odds ratio (OR) = 1.51, 95% CI 1.1, 2.07, P = 0.011] and this remained significant after adjusting for age, weight, smoking and depressive symptoms (OR = 1.48, 95% CI 1.07, 2.05, P = 0.018). Conclusion. These findings suggest that pronated foot function may contribute to low back symptoms in women. Interventions that modify foot function, such as orthoses, may therefore have a role in the prevention and treatment of low back pain. PMID:24049103

  19. The effects of lumbar stabilization exercise with thoracic extension exercise on lumbosacral alignment and the low back pain disability index in patients with chronic low back pain.

    PubMed

    Woo, Seong-Dae; Kim, Tae-Ho

    2016-01-01

    [Purpose] To determine the effects of lumbar stabilization exercise with thoracic extension exercise on chronic low back pain patients. [Subjects and Methods] Thirty patients with chronic low back pain were randomly divided into a lumbar stabilization exercise group (group A) and a lumbar stabilization exercise with thoracic extension exercise group (group B). Group B did 15 min of lumbar stabilization exercises and 15 min of thoracic extension exercises, while group A did 30 min of lumbar stabilization exercises five times a week for 4 weeks. For assessing lumbosacral alignment, the lordotic angle, lumbosacral angle, and sacral angle were evaluated. The Oswestry disability index was used for assessment of disability due to low back pain. [Results] Both groups showed improvement in lumbosacral alignment and in the disability index. Group B showed greater changes in the lordotic angle and in the Oswestry disability index than group A, although the differences were not statistically significant. [Conclusion] Lumbar stabilization exercise with thoracic extension exercise can be recommended for improvement of chronic low back pain, although the improvements seen in lumbosacral alignment and low back pain disability index in this study did not achieve statistical significance.

  20. Postural control and low back pain in elite athletes comparison of static balance in elite athletes with and without low back pain.

    PubMed

    Oyarzo, Claudio A; Villagrán, Claudio R; Silvestre, Rony E; Carpintero, Pedro; Berral, Francisco J

    2014-01-01

    Although current research findings suggest that postural control or static balance is impaired in subjects with low back pain, few studies have specifically addressed the effect of low back pain on static balance in elite athletes. Forty-four athletes belonging to Chilean national teams took part in this study; 20 had low back pain and the remaining 24 were healthy controls. Displacement of the centre of pressure was analyzed by computerized platform posturography, using a standardized protocol; subjects were required to stand upright on both feet, with eyes first open then closed. The results showed that, athletes with low back pain used significantly more energy (p< 0.0182) and had a greater displacement of the centre of pressure (p< 0.005) with open eyes to control posture than healthy athletes. It may be concluded that static balance is impaired in elite athletes with low back pain and that analysis of two-footed stance provides a sensitive assessment of static balance in athletes.

  1. The effects of lumbar stabilization exercise with thoracic extension exercise on lumbosacral alignment and the low back pain disability index in patients with chronic low back pain

    PubMed Central

    Woo, Seong-Dae; Kim, Tae-Ho

    2016-01-01

    [Purpose] To determine the effects of lumbar stabilization exercise with thoracic extension exercise on chronic low back pain patients. [Subjects and Methods] Thirty patients with chronic low back pain were randomly divided into a lumbar stabilization exercise group (group A) and a lumbar stabilization exercise with thoracic extension exercise group (group B). Group B did 15 min of lumbar stabilization exercises and 15 min of thoracic extension exercises, while group A did 30 min of lumbar stabilization exercises five times a week for 4 weeks. For assessing lumbosacral alignment, the lordotic angle, lumbosacral angle, and sacral angle were evaluated. The Oswestry disability index was used for assessment of disability due to low back pain. [Results] Both groups showed improvement in lumbosacral alignment and in the disability index. Group B showed greater changes in the lordotic angle and in the Oswestry disability index than group A, although the differences were not statistically significant. [Conclusion] Lumbar stabilization exercise with thoracic extension exercise can be recommended for improvement of chronic low back pain, although the improvements seen in lumbosacral alignment and low back pain disability index in this study did not achieve statistical significance. PMID:27065563

  2. Pilot data: association between gluteus medius weakness and low back pain during pregnancy.

    PubMed

    Bewyer, Kathryn J; Bewyer, Dennis C; Messenger, Dana; Kennedy, Colleen M

    2009-01-01

    This cross-sectional study examines whether there is an association between gluteus medius weakness in the presence of low back pain in pregnant women at any stage of gestation. Prevalence of low back pain during pregnancy is high, and identifying potential etiologies and targeted interventions is lacking. Thus, identification of an association between specific muscle weakness and pain would have clinical relevance. Initial pilot data suggests that weakness of the gluteus medius is strongly associated with the presence of low back pain during pregnancy.

  3. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care

    PubMed Central

    van Tulder, Maurits; Lin, Chung-Wei Christine; Macedo, Luciana G.; McAuley, James; Maher, Chris

    2010-01-01

    The aim of this study was to present and compare the content of (inter)national clinical guidelines for the management of low back pain. To rationalise the management of low back pain, evidence-based clinical guidelines have been issued in many countries. Given that the available scientific evidence is the same, irrespective of the country, one would expect these guidelines to include more or less similar recommendations regarding diagnosis and treatment. We updated a previous review that included clinical guidelines published up to and including the year 2000. Guidelines were included that met the following criteria: the target group consisted mainly of primary health care professionals, and the guideline was published in English, German, Finnish, Spanish, Norwegian, or Dutch. Only one guideline per country was included: the one most recently published. This updated review includes national clinical guidelines from 13 countries and 2 international clinical guidelines from Europe published from 2000 until 2008. The content of the guidelines appeared to be quite similar regarding the diagnostic classification (diagnostic triage) and the use of diagnostic and therapeutic interventions. Consistent features for acute low back pain were the early and gradual activation of patients, the discouragement of prescribed bed rest and the recognition of psychosocial factors as risk factors for chronicity. For chronic low back pain, consistent features included supervised exercises, cognitive behavioural therapy and multidisciplinary treatment. However, there are some discrepancies for recommendations regarding spinal manipulation and drug treatment for acute and chronic low back pain. The comparison of international clinical guidelines for the management of low back pain showed that diagnostic and therapeutic recommendations are generally similar. There are also some differences which may be due to a lack of strong evidence regarding these topics or due to differences in local

  4. Design factors in epidemiologic cohort studies of work-related low back injury or pain.

    PubMed

    Kraus, J F; Gardner, L; Collins, J; Sorock, G; Volinn, E

    1997-08-01

    The connection between work-related exposures and the onset of back injury or pain is complex and not clearly understood. This paper raises design issues related to the planning and conduct of cohort studies of industrial low back pain (or injury)(LBP), with care given to definition and measurement of exposure and outcome events. These issues include sample size, outcome definition, study biases, and practical considerations when seeking and maintaining company collaboration with a research effort. Without resolving these issues, the authors conclude: (1) cohort studies of worksite-based LBP are needed to elucidate the causal associations between work tasks and LBP onset, (2) both acute and cumulative exposures should be assessed as risk factors for low back injury or pain, and (3) attention should be paid to the planning of such studies and minimization of potential biases that can limit the validity of the results. These design issues will benefit researchers and companies engaged in the planning and conduct of cohort studies of industrial LBP.

  5. Low Back Pain in 17 Countries, a Rasch Analysis of the ICF Core Set for Low Back Pain

    ERIC Educational Resources Information Center

    Roe, Cecilie; Bautz-Holter, Erik; Cieza, Alarcos

    2013-01-01

    Previous studies indicate that a worldwide measurement tool may be developed based on the International Classification of Functioning Disability and Health (ICF) Core Sets for chronic conditions. The aim of the present study was to explore the possibility of constructing a cross-cultural measurement of functioning for patients with low back pain…

  6. Nonsteroidal anti-inflammatory drugs in the treatment of low back pain.

    PubMed

    Kuritzky, Louis; Samraj, George P

    2012-01-01

    Low back pain (LBP) is amongst the top ten most common conditions presenting to primary care clinicians in the ambulatory setting. Further, it accounts for a significant amount of health care expenditure; indeed, over one third of all disability dollars spent in the United States is attributable to low back pain. In most cases, acute low back pain is a self-limiting disease. There are many evidence-based guidelines for the management of LBP. The most common risk factor for development of LBP is previous LBP, heavy physical work, and psychosocial risk factors. Management of LBP includes identification of red flags, exclusion of specific secondary causes, and comprehensive musculoskeletal/neurological examination of the lower extremities. In uncomplicated LBP, imaging is unnecessary unless symptoms become protracted. Reassurance that LBP will likely resolve and advice to maintain an active lifestyle despite LBP are the cornerstones of management. Medications are provided not because they change the natural history of the disorder, but rather because they enhance the ability of the patient to become more active, and in some cases, to sleep better. The most commonly prescribed medications include nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants. Although NSAIDs are a chemically diverse class, their similarities, efficacy, tolerability, and adverse effect profile have more similarities than differences. The most common side effects of NSAIDs are gastrointestinal. Agents with cyclo-oxygenase 2 selectivity are associated with reduced gastrointestinal bleeding, but problematic increases in adverse cardiovascular outcomes continue to spark concern. Fortunately, short-term use of NSAIDs for LBP is generally both safe and effective. This review will focus on the role of NSAIDs in the management of LBP. PMID:23271922

  7. Nonsteroidal anti-inflammatory drugs in the treatment of low back pain

    PubMed Central

    Kuritzky, Louis; Samraj, George P

    2012-01-01

    Low back pain (LBP) is amongst the top ten most common conditions presenting to primary care clinicians in the ambulatory setting. Further, it accounts for a significant amount of health care expenditure; indeed, over one third of all disability dollars spent in the United States is attributable to low back pain. In most cases, acute low back pain is a self-limiting disease. There are many evidence-based guidelines for the management of LBP. The most common risk factor for development of LBP is previous LBP, heavy physical work, and psychosocial risk factors. Management of LBP includes identification of red flags, exclusion of specific secondary causes, and comprehensive musculoskeletal/neurological examination of the lower extremities. In uncomplicated LBP, imaging is unnecessary unless symptoms become protracted. Reassurance that LBP will likely resolve and advice to maintain an active lifestyle despite LBP are the cornerstones of management. Medications are provided not because they change the natural history of the disorder, but rather because they enhance the ability of the patient to become more active, and in some cases, to sleep better. The most commonly prescribed medications include nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants. Although NSAIDs are a chemically diverse class, their similarities, efficacy, tolerability, and adverse effect profile have more similarities than differences. The most common side effects of NSAIDs are gastrointestinal. Agents with cyclo-oxygenase 2 selectivity are associated with reduced gastrointestinal bleeding, but problematic increases in adverse cardiovascular outcomes continue to spark concern. Fortunately, short-term use of NSAIDs for LBP is generally both safe and effective. This review will focus on the role of NSAIDs in the management of LBP. PMID:23271922

  8. Entrapment of middle cluneal nerves as an unknown cause of low back pain

    PubMed Central

    Aota, Yoichi

    2016-01-01

    Entrapment of middle cluneal nerves induces low back pain and leg symptoms. The middle cluneal nerves can become spontaneously entrapped where this nerve pass under the long posterior sacroiliac ligament. A case of severe low back pain, which was completely treated by release of the middle cluneal nerve, was presented. Entrapment of middle cluneal nerves is possibly underdiagnosed cause of low-back and/or leg symptoms. Spinal surgeons should be aware of this clinical entity and avoid unnecessary spinal surgeries and sacroiliac fusion. This paper is to draw attention by pain clinicians in this unrecognized etiology. PMID:27004164

  9. Improvement in Automatic Postural Coordination Following Alexander Technique Lessons in a Person With Low Back Pain

    PubMed Central

    Cacciatore, Timothy W; Horak, Fay B; Henry, Sharon M

    2006-01-01

    Background and Purpose The relationship between abnormal postural coordination and back pain is unclear. The Alexander Technique (AT) aims to improve postural coordination by using conscious processes to alter automatic postural coordination and ongoing muscular activity, and it has been reported to reduce low back pain. This case report describes the use of the AT with a client with low back pain and the observed changes in automatic postural responses and back pain. Case Description The client was a 49-year-old woman with a 25-year history of left-sided, idiopathic, lumbrosacral back pain. Automatic postural coordination was measured using a force plate during horizontal platform translations and one-legged standing. Outcomes The client was tested monthly for 4 months before AT lessons and for 3 months after lessons. Before lessons, she consistently had laterally asymmetric automatic postural responses to translations. After AT lessons, the magnitude and asymmetry of her responses and balance improved and her low back pain decreased. Discussion Further research is warranted to study whether AT lessons improve low back pain–associated abnormalities in automatic postural coordination and whether improving automatic postural coordination helps to reduce low back pain. [Cacciatore TW, Horak FB, Henry SM. Improvement in automatic postural coordination following Alexander Technique lessons in a person with low back pain. PMID:15921477

  10. The effectiveness of walking as an intervention for low back pain: a systematic review.

    PubMed

    Hendrick, P; Te Wake, A M; Tikkisetty, A S; Wulff, L; Yap, C; Milosavljevic, S

    2010-10-01

    As current low back pain (LBP) guidelines do not specifically advocate walking as an intervention, this review has explored for the effectiveness of walking in managing acute and chronic LBP. CINAHL, Medline, AMED, EMBASE, PubMed, Cochrane and Scopus databases, as well as a hand search of reference lists of retrieved articles, were searched. The search was restricted to studies in the English language. Studies were included when walking was identified as an intervention. Four studies met inclusion criteria, and were assessed with a quality checklist. Three lower ranked studies reported a reduction in LBP from a walking intervention, while the highest ranked study observed no effect. Heterogeneity of study design made it difficult to draw comparisons between studies. There is only low-moderate evidence for walking as an effective intervention strategy for LBP. Further investigation is required to investigate the strength of effect for walking as a primary intervention in the management of acute and chronic LBP. PMID:20414688

  11. Occupational, personal and psychosocial resources for preventing persistent low back pain.

    PubMed

    Melloh, Markus; Salathé, Cornelia Rolli; Elfering, Achim; Käser, Anja; Barz, Thomas; Aghayev, Emin; Röder, Christoph; Theis, Jean-Claude

    2013-01-01

    The aim of this prospective cohort study was to identify modifiable protective factors of the progression of acute/subacute low back pain (LBP) to the persistent state at an early stage to reduce the socioeconomic burden of persistent LBP. Patients attending a health practitioner for acute/subacute LBP were assessed at baseline addressing occupational, personal and psychosocial factors, and followed up over 12 weeks. Pearson correlations were calculated between these baseline factors and the presence of nonpersistent LBP at 12-week follow-up. For those factors found to be significant, multivariate logistic regression analyses were performed. The final 3-predictor model included job satisfaction, mental health and social support. The accuracy of the model was 72%, with 81% of nonpersistent and 60% of persistent LBP patients correctly identified. Further research is necessary to confirm the role of different types of social support regarding their prognostic influence on the development of persistent LBP. PMID:23498709

  12. The effectiveness of walking as an intervention for low back pain: a systematic review

    PubMed Central

    Hendrick, P.; Te Wake, A. M.; Tikkisetty, A. S.; Wulff, L.; Yap, C.

    2010-01-01

    As current low back pain (LBP) guidelines do not specifically advocate walking as an intervention, this review has explored for the effectiveness of walking in managing acute and chronic LBP. CINAHL, Medline, AMED, EMBASE, PubMed, Cochrane and Scopus databases, as well as a hand search of reference lists of retrieved articles, were searched. The search was restricted to studies in the English language. Studies were included when walking was identified as an intervention. Four studies met inclusion criteria, and were assessed with a quality checklist. Three lower ranked studies reported a reduction in LBP from a walking intervention, while the highest ranked study observed no effect. Heterogeneity of study design made it difficult to draw comparisons between studies. There is only low–moderate evidence for walking as an effective intervention strategy for LBP. Further investigation is required to investigate the strength of effect for walking as a primary intervention in the management of acute and chronic LBP. PMID:20414688

  13. Chiropractic Management of Low Back Pain in a 75-Year-Old Man With Bilateral Developmental Hip Dysplasia

    PubMed Central

    Murray, Kelvin J.; Azari, Michael F.

    2015-01-01

    Objective The purpose of this case report is to describe chiropractic management of an elderly man with untreated bilateral hip joint dysplasia presenting with mild acute mechanical low back pain. Clinical Features A 75-year-old man presented with an insidious-onset intermittent low back pain of 3 days’ duration. Physical examination findings supported a mechanical cause for mild acute low back pain. Plain radiography revealed dysplasia of hip joints with absence of femoral heads and necks and bilateral high dislocation. Intervention and Outcome Chiropractic management included vibration, mobilization, light drop-piece adjustments of the lower lumbar and sacroiliac joints, and recommendation of the use of heat at home. Treatments were given 3 times over the course of 1 week. The low back pain intensity over this period dropped from 5 to 0 on an 11-point numerical rating scale, and the patient was discharged. Conclusion This patient with substantial postural and gait abnormalities as a result of severe bilateral hip dysplasia associated with an unusual pattern of osteoarthritic change in the spine responded favorably to a short course of chiropractic care. PMID:26644785

  14. The role of exercise and alternative treatments for low back pain.

    PubMed

    Carneiro, Kevin A; Rittenberg, Joshua D

    2010-11-01

    The determination of whether a patient should pursue an active or passive treatment program is often made by medical practitioners. Knowledge about all forms of treatment, including complementary and alternative (CAM) treatments, is essential in the treatment of low back pain. Medical practitioner-directed active treatments that have been shown to be effective for the treatment of low back pain include physical therapy-directed exercise programs such as core stabilization and mechanical diagnosis and therapy (MDT). Based on the current literature, it appears that yoga is the most effective nonphysician-directed active treatment approach to nonspecific low back pain when comparing other CAM treatments. Acupuncture is a medical practitioner-directed passive treatment that has been shown to be a good adjunct treatment. More randomized controlled studies are needed to support both CAM treatments and exercise in the treatment of low back pain.

  15. Comparison of static postural balance between healthy subjects and those with low back pain

    PubMed Central

    Braga, Alice Bernardi; Rodrigues, Ana Carolina de Mello Alves; de Lima, Giliane Vanessa Moraes Pereira; de Melo, Larissa Rabello; de Carvalho, Alberito Rodrigo; Bertolini, Gladson Ricardo Flor

    2012-01-01

    Objective To compare the static postural balance between women suffering from chronic low back pain and healthy subjects, by moving the center of pressure. Methods The study included 15 women with low back pain (LBP group) and 15 healthy women (healthy group). They were instructed to remain in standing on the force platform for 30 seconds. We analyzed the area and the speed of displacement of center of pressure of both groups. Data analysis was performed using the Student's t-test, with significance of 5%. Results Individuals with chronic low back pain showed a larger area of displacement of the center of pressure relative to the healthy ones but there was no significant difference in the speed of displacement of the center of pressure. Conclusion Individuals with chronic low back pain had alterations in static balance with respect to healthy ones. Level of Evidence III, Prognostic Studies. PMID:24453604

  16. Ignoring the sacroiliac joint in chronic low back pain is costly

    PubMed Central

    Polly, David W; Cher, Daniel

    2016-01-01

    Background Increasing evidence supports minimally invasive sacroiliac joint (SIJ) fusion as a safe and effective treatment for SIJ dysfunction. Failure to include the SIJ in the diagnostic evaluation of low back pain could result in unnecessary health care expenses. Design Decision analytic cost model. Methods A decision analytic model calculating 2-year direct health care costs in patients with chronic low back pain considering lumbar fusion surgery was used. Results The strategy of including the SIJ in the preoperative diagnostic workup of chronic low back pain saves an expected US$3,100 per patient over 2 years. Cost savings were robust to reasonable ranges for costs and probabilities, such as the probability of diagnosis and the probability of successful surgical treatment. Conclusion Including the SIJ as part of the diagnostic strategy in preoperative patients with chronic low back pain is likely to be cost saving in the short term. PMID:26855595

  17. Psychological Disturbance and Life Event Differences Among Patients With Low Back Pain.

    ERIC Educational Resources Information Center

    Leavitt, Frank; And Others

    1980-01-01

    Results of this study emphasized the importance of considering psychological disturbance in assessing functional components of low back pain. Psychologically disturbed patients had higher life-event scores regardless of organic pathology. (Author/BEF)

  18. Development and Psychometric Evaluation of Nursing Low Back Pain Predictor Questionnaire Focusing on Nurses Suffering from Chronic Low Back Pain in Iran

    PubMed Central

    Ghadyani, Leila; Kazemnejad, Anoshirvan; Wagner, Joan

    2016-01-01

    Study Design Development and psychometric evaluation. Purpose Design and psychometric assessment of the Nursing Low Back Pain Predictor Questionnaire addressing nurses suffering from chronic low back pain in Iran. Overview of Literature Low back pain is the most prevalent behavior-related health problem among nurses, and it needs to be assessed through a validated multi-factorial questionnaire, using the premises of the social cognitive theory. Methods This was a cross-sectional study carried out in Tehran, Iran from April 17, 2014 to July 16, 2014. A 50-item questionnaire based on the social cognitive theory was generated. The questionnaire was distributed among 500 nurses working in hospitals located in different geographically areas in Tehran. Exploratory factor analysis was used to determine the factors and their related items. Cronbach's alpha was calculated to assess reliability. Results The exploratory factor analysis loaded six factors, named observational learning, outcome expectations, self-efficacy, self-regulation, and self-efficacy in overcoming impediments in the working environment and emotional coping. All factors were jointly accounted for 67.12% of behavior change variance. The Cronbach's alpha coefficient showed excellent internal consistency (alpha=0.91). Test and retest analysis with 2-week intervals indicated an appropriate stability for the questionnaire (intraclass correlation coefficient=0.94). Conclusions According the results, the developed questionnaire is a reliable and validated theory-based instrument, which can be used to predict the work, related factors for low back pain among nurses. PMID:27559450

  19. Low Back Pain in Children and Adolescents: an Algorithmic Clinical Approach

    PubMed Central

    Kordi, Ramin; Rostami, Mohsen

    2011-01-01

    Low back pain (LBP) is common among children and adolescents. In younger children particularly those under 3, LBP should be considered as an alarming sign for more serious underlying pathologies. However, similar to adults, non specific low back pain is the most common type of LBP among children and adolescents. In this article, a clinical algorithmic approach to LBP in children and adolescents is presented. PMID:23056800

  20. Orthotic insoles do not prevent physical stress-induced low back pain.

    PubMed

    Mattila, Ville M; Sillanpää, Petri; Salo, Tuula; Laine, Heikki-Jussi; Mäenpää, Heikki; Pihlajamäki, Harri

    2011-01-01

    Orthotic insoles are suggested to prevent low back pain. This randomized controlled study assessed if customised orthotic insoles prevent low back pain. Healthy military conscripts (n = 228; mean age 19 years, range 18-29) were randomly assigned to use either customised orthotic insoles (treatment group, n = 73) or nothing (control group, n = 147). The main outcome measure was low back pain requiring a physician visit and resulting in minimum 1 day suspension from military duty. Twenty-four (33%) treated subjects and 42 (27%) control subjects were suspended from duty due to low back pain (p = 0.37; risk difference 4.3%; 95% CI: -8.7 to 17.3%). Mean suspension duration was 2 days (range 1-7) in both groups. Four (5%) treated subjects and eight (5%) control subjects were released from duty due to persistent low back pain (p = 0.92; risk difference 0%; 95% CI: -6 to 6%). Use of orthotic insoles is therefore not recommended to prevent physical stress-related low back pain.

  1. Effects of long-term corset wearing on chronic low back pain.

    PubMed

    Sato, Naoto; Sekiguchi, Miho; Kikuchi, Shinichi; Shishido, Hiroaki; Sato, Katsuhiko; Konno, Shinichi

    2012-01-01

    There are few studies of the therapeutic effects of long-term corset wearing in patients with chronic low back pain. The aim of this study was to evaluate the effects of long-term corset wearing on chronic low back pain and to examine the myoelectrical activities of the paravertebral muscles. Forty subjects with chronic low back pain were enrolled and randomly divided into two groups: a group wearing corsets for 6 months (CW) group and a group not wearing corsets (NW). The treatment effects were measured using the Japanese Orthopaedic Association (JOA) score. Muscle endurance was evaluated during the Biering-Sorensen test (S-test), and the degree of muscle fatigue was evaluated by the change in percent mean power frequency (%MPF) of the paravertebral muscles. Corset treatment for chronic low back pain improved low back pain and increased muscle endurance for a short period of time. Paravertebral muscle fatigue was not increased by long-term corset wearing for chronic low back pain, and weakening of the paravertebral muscles was not observed up to 6 months after the start of corset wearing.

  2. Managing Low-Back Pain: Steps To Optimize Function and Hasten Return to Activity.

    ERIC Educational Resources Information Center

    Drezner, Jonathan A.; Herring, Stanley A.

    2001-01-01

    Low-back pain (LBP) in active people is common and recurrent. This paper describes: the natural history and clinical course of LBP; anatomy and biomechanics of LBP; what causes pain; diagnosis; initial treatment (e.g., pain and inflammation control, bed rest, and exercises); rehabilitation (e.g., lumbar stabilization exercises, conditioning, and…

  3. Pelvic girdle pain and low back pain in pregnancy: a review.

    PubMed

    Vermani, Era; Mittal, Rajnish; Weeks, Andrew

    2010-01-01

    Pregnancy-related pelvic girdle pain (PGP) and pregnancy-related low back pain (PLBP) are common problems with significant physical, psychological, and socioeconomic implications. There are several management options that are underutilized because of lack of comprehensive knowledge by health-care professionals and fear of harmful effects of treatment on the developing fetus. Interventions such as patient education, the use of pelvic belts, acupuncture, and aquatic and tailored postpartum exercises can be of some benefit to these patients. This article will focus on the diagnosis and management of PGP and PLBP, with discussion of terminology, epidemiology, risk factors, pathophysiology, and prognosis.

  4. Does a 'tight' hamstring predict low back pain reporting during prolonged standing?

    PubMed

    Raftry, Sean M; Marshall, Paul W M

    2012-06-01

    The purpose of this study was to investigate the relationship between hamstring passive stiffness and extensibility in asymptomatic individuals with the reporting of low back pain during 2-h prolonged standing. Twenty healthy participants with no history of low back pain (mean±SD, age 22.6±2.7 years, height 1.74±0.09 m, weight 76.2±14.8 kg). Low back pain (VAS score; mm) was continuously monitored during 2-h prolonged standing. Hamstring extensibility, passive stiffness, and stretch tolerance were measured before and after prolonged standing using an instrumented straight leg raise (iSLR). Ten participants reported a clinically relevant increase (Δ VAS>10mm) in low back pain during prolonged standing. Hamstring extensiblity (leg°(max)), passive stiffness (Nm.°(-1)), and stretch tolerance (VAS; mm) were no different between pain developers and non-pain developers. No changes in hamstring measures were observed following 2-h prolonged standing. No relationship was observed in this study between measures of hamstring extensibility and the reporting of low back pain during prolonged standing. There is no evidence to recommend hamstring extensibility interventions (i.e. passive stretching) as a means of reducing pain reporting in occupations requiring prolonged standing.

  5. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society.

    PubMed

    Chou, Roger; Qaseem, Amir; Snow, Vincenza; Casey, Donald; Cross, J Thomas; Shekelle, Paul; Owens, Douglas K

    2007-10-01

    before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. RECOMMENDATION 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits-for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence). PMID:17909209

  6. Improvement in chronic low back pain in an obese patient with topiramate use.

    PubMed

    Gupta, Anita; Kulkarni, Archana; Ramanujam, Vendhan; Zheng, Lu; Treacy, Erin

    2015-06-01

    The objective of this study was to demonstrate efficacy, benefit, and potential use of topiramate in treating obese patients with chronic low back pain. This is a case report from an outpatient academic pain multidisciplinary clinical center. The patient was a 30-year-old morbidly obese (body mass index [BMI]: 61.4 kg/m(2)) female suffering from chronic low back pain. With a known association between obesity and chronic low back pain, and a possible role of topiramate in treating both simultaneously, the patient was started on a therapeutic trial of topiramate. Over a period of a 12-week topiramate therapy, the patient experienced clinically meaningful and significant weight loss as well as improvement in her chronic low back pain and functionality. With more substantial evidence, pain physicians may start considering using topiramate in the multimodal management of obesity-related chronic low back pain based on their thoughtful consideration of the drug's efficacy and side effects and the patient's comorbidities and preferences.

  7. Does anterior trunk pain predict a different course of recovery in chronic low back pain?

    PubMed

    Panagopoulos, John; Hancock, Mark J; Kongsted, Alice; Hush, Julia; Kent, Peter

    2014-05-01

    Patient characteristics associated with the course and severity of low back pain (LBP) and disability have been the focus of extensive research, however, known characteristics do not explain much of the variance in outcomes. The relationship between anterior trunk pain (ATP) and LBP has not been explored, though mechanisms for visceral referred pain have been described. Study objectives were: (1) determine prevalence of ATP in chronic LBP patients, (2) determine whether ATP is associated with increased pain and disability in these patients, and (3) evaluate whether ATP predicts the course of pain and disability in these patients. In this study, spinal outpatient department patients mapped the distribution of their pain and patients describing pain in their chest, abdomen or groin were classified with ATP. Generalized estimating equations were performed to investigate the relationship between ATP and LBP outcomes. A total of 2974 patients were included and 19.6% of patients reported ATP. At all time points, there were significant differences in absolute pain intensity and disability in those with ATP compared with those without. The presence of ATP did not affect the clinical course of LBP outcomes. The results of this study suggest that patients who present with LBP and ATP have higher pain and disability levels than patients with localised LBP. Visceral referred pain mechanisms may help to explain some of this difference. PMID:24502844

  8. Does anterior trunk pain predict a different course of recovery in chronic low back pain?

    PubMed

    Panagopoulos, John; Hancock, Mark J; Kongsted, Alice; Hush, Julia; Kent, Peter

    2014-05-01

    Patient characteristics associated with the course and severity of low back pain (LBP) and disability have been the focus of extensive research, however, known characteristics do not explain much of the variance in outcomes. The relationship between anterior trunk pain (ATP) and LBP has not been explored, though mechanisms for visceral referred pain have been described. Study objectives were: (1) determine prevalence of ATP in chronic LBP patients, (2) determine whether ATP is associated with increased pain and disability in these patients, and (3) evaluate whether ATP predicts the course of pain and disability in these patients. In this study, spinal outpatient department patients mapped the distribution of their pain and patients describing pain in their chest, abdomen or groin were classified with ATP. Generalized estimating equations were performed to investigate the relationship between ATP and LBP outcomes. A total of 2974 patients were included and 19.6% of patients reported ATP. At all time points, there were significant differences in absolute pain intensity and disability in those with ATP compared with those without. The presence of ATP did not affect the clinical course of LBP outcomes. The results of this study suggest that patients who present with LBP and ATP have higher pain and disability levels than patients with localised LBP. Visceral referred pain mechanisms may help to explain some of this difference.

  9. Systematic review on the safety of Harpagophytum preparations for osteoarthritic and low back pain.

    PubMed

    Vlachojannis, J; Roufogalis, B D; Chrubasik, S

    2008-02-01

    Harpagophytum products are a treatment option for osteoarthritic and low back pain. The aim of this study was to review the safety of treatment with Harpagophytum procumbens. The databases OVID(MEDLINE), PUBMED and COCHRANE COLLABORATION LIBRARY were searched back to 1985 for studies with Harpagophytum procumbens. Twenty-eight clinical trials were identified of which 20 stated adverse events. In none of the double-blind studies was the incidence of adverse events during treatment with Harpagophytum procumbens higher than during placebo treatment. Minor adverse events occurred in around 3% of the patients, mainly gastrointestinal adverse events. A few reports of acute toxicity were found but there were no reports on chronic toxicity. Since the dosage used in most of the studies is at the lower limit and since long-term treatment with Harpagophytum products is advisable, more safety data are urgently needed. PMID:18236448

  10. Effect of General Health Status on Chronicity of Low Back Pain in Industrial Workers.

    PubMed

    Seyedmehdi, Seyed Mohammad; Dehghan, Faezeh; Ghaffari, Mostafa; Attarchi, Mirsaeed; Khansari, Bahareh; Heidari, Bijan; Yazdanparast, Taraneh; Norouzi Javidan, Abbas; Emami Razavi, Seyed Hassan

    2016-03-01

    Recognizing patients at a higher risk of developing chronic low back pain (LBP) is important in industrial medicine. This study aimed to assess the power and quality of General Health Questionnaire (GHQ) for prediction of the odds of chronicity of acute LBP. This study was conducted on industrial workers. All subjects with acute LBP who met the inclusion criteria were enrolled. Demographic characteristics, occupational, physical, and mental parameters and the general health status of subjects were evaluated;  they were followed up for developing chronic LBP for one year. Cigarette smoking, high body mass index, job stress, physical load and high GHQ scores were found to be the risk factors for the progression of acute LBP to chronic LBP (P<0.05). Standing position while working, age, work experience, exercise, level of education, weekly work hours and shift work were not the risk factors for chronic LBP (P>0.05). High GHQ score can be a risk factor for progression of acute LBP to chronic LBP. The GHQ in combination with the Job Content Questionnaire can be used as a quick and simple screening tool for detection of subjects at high risk of chronic LBP when evaluating acute LBP in an occupational setting. PMID:27107527

  11. Computer assisted treatment prediction of low back pain pathologies.

    PubMed

    Gal, Norbert; Stoicu-Tivadar, Vasile; Andrei, Diana; Nemeş, Dan Ion; Nădăşan, Emanuela

    2014-01-01

    The paper presents a fuzzy inference system based prediction with the role to determine the appropriate action for patients that presents lower back pain. If not treated correctly lower back pain can degenerate in various diseases. The system infers three possible actions: (1) spinal cord surgery, (2) medication combined with exercises and (3) no action needed. The system takes in consideration the age and sex of the patient, a pain intensity parameter, the metabolic rate of the patient and mobility parameters from the Zebris Mobility device. In total 243 rules have been formulated but only 21% of the rules suggests surgery. The initial results are promising; there is a correlation of 0.83% between the control results and the results from the system. PMID:24743076

  12. Scientific Basis for the Treatment of Low Back Pain

    PubMed Central

    Mulholland, RC

    2007-01-01

    Disc degeneration causes back pain because the function of the disc as a load transferring structure is abnormal, producing abnormal patterns of load which cause pain. Fusion has been unpredictable because it only fortuitously addresses loading. A fusion may be in such a position that it takes load from the disc, and this may be reflected in the way the fusion models, demonstrating a weight bearing pattern, but this is unpredictable. Recognition that we are dealing with a problem of load transfer allows us to design any surgical implant to solve this problem, without stopping movement. PMID:17959004

  13. Low BACK PAIN BELIEFS AND THEIR RELATIONSHIPS WITH Low BACK PAIN-RELATED DISABILITY IN NURSES WORKING IN MAINLAND CHINA AND IN AUSTRALIA.

    PubMed

    Tan, Boon-Kiang; Smith, Anne; O'Sullivan, Peter; Chen, Gang; Burnett, Angus

    2015-01-01

    Beliefs held about low back pain (LBP) can influence treatment outcomes and the development of LBP-related disability. Beliefs are shaped by cultural norms but few cross-cultural studies have been done. This cross-sectional study investigated the back pain beliefs and their associations with disability in 109 Chinese nurses and 165 Australian Caucasian nurses. Chinese nurses held more pessimistic views about the consequences of LBP than the Australian and those with LBP held higher level of fear avoidance beliefs and had higher disability than the Australian nurses with LBP. In both groups, more negativeback pain beliefs were significantly associated with higher disability.

  14. Prevalence of low back pain among handloom weavers in West Bengal, India

    PubMed Central

    Durlov, Santu; Chakrabarty, Sabarni; Chatterjee, Arijit; Das, Tamal; Dev, Samrat; Gangopadhyay, Somnath; Haldar, Prasun; Maity, Santi Gopal; Sarkar, Krishnendu; Sahu, Subhashis

    2014-01-01

    Background: Handloom is one of the oldest industries in India, particularly in West Bengal, where a considerable number of rural people are engaged in weaving. Objectives: The purpose of this study was to evaluate the prevalence of low back pain among the handloom weavers in India. Methods: A modified Nordic Musculoskeletal Disorder Questionnaire and Oswestry Low Back Pain Disability Questionnaire along with a body part discomfort scale were administered to handloom weavers (n = 175). Working posture of the participants was assessed using the Ovako Working Posture Analysis System (OWAS). Results: Sixty eight per cent of the participants reported suffering from low back pain, making it the most prevalent disorder in our sample. Analysis of the Oswestry Low Back Pain Disability Questionnaire data revealed that among those with low back pain (n = 119), 2% had severe disabilities, 46% had moderate disabilities, and 52% had minimal disabilities. Statistical analyses revealed a positive significant association between the intensity of pain in the lower back and an increased number of years of work experience (P<0.05). Conclusions: The study underlines the need for further research regarding the postural strain of weavers and also suggests the implementation of ergonomic design into weaver workstations to minimize the adverse effect of their current working postures. Improving upon the weaver’s work-posture could improve their quality of life. PMID:25224808

  15. Low-Dose Tramadol and Non-Steroidal Anti-Inflammatory Drug Combination Therapy Prevents the Transition to Chronic Low Back Pain

    PubMed Central

    Orita, Sumihisa; Yamauchi, Kazuyo; Suzuki, Takane; Suzuki, Miyako; Sakuma, Yoshihiro; Kubota, Go; Oikawa, Yasuhiro; Sainoh, Takeshi; Sato, Jun; Fujimoto, Kazuki; Shiga, Yasuhiro; Abe, Koki; Kanamoto, Hirohito; Inoue, Masahiro; Kinoshita, Hideyuki; Takahashi, Kazuhisa; Ohtori, Seiji

    2016-01-01

    Study Design Retrospective study. Purpose To determine whether low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy could prevent the transition of acute low back pain to chronic low back pain. Overview of Literature Inadequately treated early low back pain transitions to chronic low back pain occur in approximately 30% of affected individuals. The administration of non-steroidal anti-inflammatory drugs is effective for treatment of low back pain in the early stages. However, the treatment of low back pain that is resistant to non-steroidal anti-inflammatory drugs is challenging. Methods Patients who presented with acute low back pain at our hospital were considered for inclusion in this study. After the diagnosis of acute low back pain, non-steroidal anti-inflammatory drug administration was started. Forty patients with a visual analog scale score of >5 for low back pain 1 month after treatment were finally enrolled. The first 20 patients were included in a non-steroidal anti-inflammatory drug group, and they continued non-steroidal anti-inflammatory drug therapy for 1 month. The next 20 patients were included in a combination group, and they received low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy for 1 month. The incidence of adverse events and the improvement in the visual analog scale score at 2 months after the start of treatment were analyzed. Results No adverse events were observed in the non-steroidal anti-inflammatory drug group. In the combination group, administration was discontinued in 2 patients (10%) due to adverse events immediately following the start of tramadol administration. At 2 months, the improvement in the visual analog scale score was greater in the combination group than in the non-steroidal anti-inflammatory drug group (p<0.001). Conclusions Low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy might decrease the incidence of adverse events and prevent

  16. Post-partum low-back pain of an uncommon origin: a case report.

    PubMed

    Sansone, Valerio; McCleery, Jocelyn; Bonora, Cristina

    2013-01-01

    Low-back pain is a common complaint during pregnancy and the post-partum period, and it may be due to a variety of conditions. Among these, a frequently overlooked cause is a sacral fracture. We report the case of a 37 year old woman, suffering from post-partum low-back pain which had not responded to treatment. Though rare, a sacral stress fracture must be considered in cases of prolonged low-back or sacral pain in pregnant or post-partum women. Plain radiographs are frequently inconclusive and MRI is the imaging technique of choice. Capacitive coupling electric fields (CCEF) seemed to be effective in treating pain and in reducing the patient's recovery time.

  17. 25 Years Old Women With Inflammatory Low Back Pain

    PubMed Central

    Soltani, Zahra; Davatchi, Fereydon

    2016-01-01

    Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most frequent histological type of malignant lymphomas (approximately 30% of cases). DLBCL is highly curable through chemotherapy. Rituximab in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy as the most frequent of care for first - DLBCL therapy, improves long-term survival of patients effectively. Case report: A young female (25 years old) complained about pain in her right back for two years. She was suffering from backache with priority in the right and contracture in mornings. Sacroiliac joint seemed normal but lytic and sclerotic lesions and also density changing of L5 and humerus head was revealed by CT scan. Biopsy was taken from the iliac bone and diffuse large B cell lymphoma was diagnosed. Conclusion: Chronic pains especially in axial skeleton, pelvis area and main joints must be taken seriously and examined by CT scan and MRI. If no particular issue was reported primarily while the pain was remained, a complete diagnosis BMB associated with PET must be applied. Despite of dependency on diagnosis the treatment by CHOP in association with rituximab is the most recommended chemotherapy alternative for patients with DLBCL. PMID:27594751

  18. Chronic Low Back Pain: Perception and Coping With Pain in the Presence of Psychiatric Comorbidity.

    PubMed

    Ciaramella, Antonella; Poli, Paolo

    2015-08-01

    This retrospective study investigated the influence of psychiatric comorbidity on pain perception and coping with pain in tertiary pain clinic patients, 427 treated for chronic low back pain (CLBP) and 629 for other forms of chronic pain (CG). No differences in psychosomatic dimensions were found between the two groups, but Italian Pain Questionnaire dimensions and intensity scores (t = 7.35; p < 0.0001) were higher in CLBP than in CG subjects. According to the Mini-International Neuropsychiatric Interview, CLBP patients also had a higher prevalence of lifetime major depressive episodes (χ2 = 4.96; p < 0.05), dysthymic disorder (χ2 = 4.64; p < 0.05), suicide risk (χ2 = 10.43; p < 0.01), and agoraphobia (χ2 = 6.31; p < 0.05) than CG patients did. The Multidimensional Pain Inventory showed a close association between CLBP and both agoraphobia (χ2 = 3.74; p < 0.05) and dysfunctional coping style (χ2 = 8.25; p < 0.01), which increased disability. Both agoraphobia and lifetime depression were associated with an overall increase in dimensions and pain intensity in CLBP, but not in CG. PMID:26153889

  19. Attribution of Responsibility and Hiring Recommendations for Job Applicants with Low Back Pain.

    ERIC Educational Resources Information Center

    Bordieri, James E.; And Others

    1988-01-01

    Supervisors and managers (N=108) reviewed cover letter and resume of job applicant with low back pain (source of which was systematically manipulated) and job description for simulated position. Found that, regardless of qualifications and source of injury, participants made more negative hiring recommendations for applicants with pain than for…

  20. Effectiveness of Behavioral Therapy for Chronic Low Back Pain: A Component Analysis.

    ERIC Educational Resources Information Center

    Turner, Judith A.; And Others

    1990-01-01

    Evaluated effects of group behavioral therapy including aerobic exercise, behavioral therapy alone, and aerobic exercise alone on pain and physical and psychological disability among mildly disabled chronic low-back-pain patients (n=96). The combined behavioral therapy and exercise group improved significantly more pretreatment to posttreatment…

  1. Value of Consensual Ratings in Differentiating Organic and Functional Low Back Pain.

    ERIC Educational Resources Information Center

    Donham, Greg W.; And Others

    1984-01-01

    Evaluated 40 low back pain patients by a multidisciplinary team to identify the behavioral characteristics associated with functional and organic determinants of pain. Results indicated that behavioral observations of the orthopedists and the nursing staff revealed contrasting patterns of behavior for those patients classified as organic or…

  2. Chronic non-specific low back pain – sub-groups or a single mechanism?

    PubMed Central

    Wand, Benedict Martin; O'Connell, Neil Edward

    2008-01-01

    Background Low back pain is a substantial health problem and has subsequently attracted a considerable amount of research. Clinical trials evaluating the efficacy of a variety of interventions for chronic non-specific low back pain indicate limited effectiveness for most commonly applied interventions and approaches. Discussion Many clinicians challenge the results of clinical trials as they feel that this lack of effectiveness is at odds with their clinical experience of managing patients with back pain. A common explanation for this discrepancy is the perceived heterogeneity of patients with chronic non-specific low back pain. It is felt that the effects of treatment may be diluted by the application of a single intervention to a complex, heterogeneous group with diverse treatment needs. This argument presupposes that current treatment is effective when applied to the correct patient. An alternative perspective is that the clinical trials are correct and current treatments have limited efficacy. Preoccupation with sub-grouping may stifle engagement with this view and it is important that the sub-grouping paradigm is closely examined. This paper argues that there are numerous problems with the sub-grouping approach and that it may not be an important reason for the disappointing results of clinical trials. We propose instead that current treatment may be ineffective because it has been misdirected. Recent evidence that demonstrates changes within the brain in chronic low back pain sufferers raises the possibility that persistent back pain may be a problem of cortical reorganisation and degeneration. This perspective offers interesting insights into the chronic low back pain experience and suggests alternative models of intervention. Summary The disappointing results of clinical research are commonly explained by the failure of researchers to adequately attend to sub-grouping of the chronic non-specific low back pain population. Alternatively, current approaches

  3. Physical therapists’ treatment choices for non-specific low back pain in Florida: an electronic survey

    PubMed Central

    Ladeira, Carlos E; Samuel Cheng, M; Hill, Cheryl J

    2015-01-01

    Objectives: No study has described low back pain (LBP) treatment choices among physical therapists (PTs) in the United States (US) in the new millennium. Intervention for LBP in the new millennium is largely based on evidence-based practice (EBP) recommendations. The purpose of this study was twofold: (a) to describe PTs' preferences for treating acute and subacute non-specific LBP in Florida and to compare these preferences to EBP guideline recommendations and (b) to compare outpatient musculoskeletal therapist (MSPT) choices for management of acute and subacute LBP to non-outpatient musculoskeletal therapist (NMSPT) choices. Methods: The data were collected with an electronic survey. Study participants selected treatment choices for acute and subacute LBP clinical vignettes. Results: A total of 327 PTs participated in the study, of which 128 worked in outpatient musculoskeletal settings. The most common treatment choices for acute and subacute LBP were home exercise program, exercise in the clinic, back care education, joint mobilization, ice/heat, and interferential current. The EBP adherence rate for acute LBP was 30% for MSPTs and 15% for NMSPTs. Thirty-seven percent (37%) of MSPTs and 30% of NMSPTs adhered to EBP guidelines for subacute LBP. Discussion: The EBP adherence rate for management of acute and subacute LBP was low. Spinal manipulation was underutilized for management of acute LBP, and passive therapeutic procedures were overutilized for subacute LBP. Physical Therapy schools and professional associations should reemphasize the benefits of spinal manipulation to manage non-specific acute LBP and active interventional procedures to manage subacute LBP. PMID:26109832

  4. The effect of chronic low back pain on tactile suppression during back movements.

    PubMed

    Van Damme, Stefaan; Van Hulle, Lore; Danneels, Lieven; Spence, Charles; Crombez, Geert

    2014-10-01

    The aim of the present study was to examine whether tactile suppression, the phenomenon whereby tactile perception is suppressed during movement, would occur in the context of back movements. Of particular interest, it was investigated if tactile suppression in the back would be attenuated in those suffering from chronic low back pain. Individuals with chronic low back pain (N = 30) and a matched control group (N = 24) detected tactile stimuli on three possible locations (back, arm, chest) while performing a back or arm movement, or no movement. We hypothesized that the movements would induce tactile suppression, and that this effect would be largest for low-intense stimuli on the moving body part. We further hypothesized that, during back movements, tactile suppression on the back would be less pronounced in the chronic low back pain group than in the control group. The results showed the expected general tactile suppression effects. The hypothesis of back-specific attenuation of tactile suppression in the chronic low back pain group was not supported. However, back-specific tactile suppression in the chronic low back pain group was less pronounced in those who performed the back movements more slowly.

  5. A Novel Tool for the Assessment of Pain: Validation in Low Back Pain

    PubMed Central

    Scholz, Joachim; Mannion, Richard J.; Hord, Daniela E.; Griffin, Robert S.; Rawal, Bhupendra; Zheng, Hui; Scoffings, Daniel; Phillips, Amanda; Guo, Jianli; Laing, Rodney J. C.; Abdi, Salahadin; Decosterd, Isabelle; Woolf, Clifford J.

    2009-01-01

    Background Adequate pain assessment is critical for evaluating the efficacy of analgesic treatment in clinical practice and during the development of new therapies. Yet the currently used scores of global pain intensity fail to reflect the diversity of pain manifestations and the complexity of underlying biological mechanisms. We have developed a tool for a standardized assessment of pain-related symptoms and signs that differentiates pain phenotypes independent of etiology. Methods and Findings Using a structured interview (16 questions) and a standardized bedside examination (23 tests), we prospectively assessed symptoms and signs in 130 patients with peripheral neuropathic pain caused by diabetic polyneuropathy, postherpetic neuralgia, or radicular low back pain (LBP), and in 57 patients with non-neuropathic (axial) LBP. A hierarchical cluster analysis revealed distinct association patterns of symptoms and signs (pain subtypes) that characterized six subgroups of patients with neuropathic pain and two subgroups of patients with non-neuropathic pain. Using a classification tree analysis, we identified the most discriminatory assessment items for the identification of pain subtypes. We combined these six interview questions and ten physical tests in a pain assessment tool that we named Standardized Evaluation of Pain (StEP). We validated StEP for the distinction between radicular and axial LBP in an independent group of 137 patients. StEP identified patients with radicular pain with high sensitivity (92%; 95% confidence interval [CI] 83%–97%) and specificity (97%; 95% CI 89%–100%). The diagnostic accuracy of StEP exceeded that of a dedicated screening tool for neuropathic pain and spinal magnetic resonance imaging. In addition, we were able to reproduce subtypes of radicular and axial LBP, underscoring the utility of StEP for discerning distinct constellations of symptoms and signs. Conclusions We present a novel method of identifying pain subtypes that we

  6. Yoga attitudes in chronic low back pain: Roles of catastrophizing and fear of movement.

    PubMed

    Combs, Martha A; Thorn, Beverly E

    2015-08-01

    Chronic low back pain is a significant public health problem and, although underused, yoga may be an effective complementary treatment. The current study examined associations of pain catastrophizing and fear of movement with attitudes toward yoga in adults with chronic low back pain. Participants completed three quantitative questionnaires assessing specific constructs: beliefs about yoga, fear of movement, and pain catastrophizing. A semi-structured in-person interview was then conducted to obtain specific pain-related information. Hierarchical regression and mediational analyses were used to test hypotheses. Consistent with the fear-avoidance model of chronic pain, catastrophizing and fear of movement were negatively associated with yoga attitudes. Specifically, fear of movement was a mediator between catastrophizing and attitudes toward yoga. Individuals with higher levels of catastrophizing and fear of movement may be less likely to consider a pain treatment involving physical movement.

  7. [Low back pain and associated factors in children and adolescents in a private school in Southern Brazil].

    PubMed

    Lemos, Adriana Torres de; Santos, Fábio Rosa Dos; Moreira, Rodrigo Baptista; Machado, Débora Teixeira; Braga, Fernando Cesar Camargo; Gaya, Adroaldo Cezar Araujo

    2013-11-01

    Studies have shown that children and adolescents with low back pain are also similarly affected when they reach adulthood, thus highlighting the importance of investigating causes of low back pain in school-age children. The study examined low back pain and associated factors in 770 schoolchildren 7 to 17 years of age in a private school in Porto Alegre, Rio Grande do Sul State, Brazil. Low back pain was defined as pain or discomfort in the lumbar region in the previous month, assessed by a questionnaire. Low back pain was found in 31.6% of the subjects and was more prevalent in girls (41.9%) than boys (21.4%). Factors associated with lumbar pain were female gender, age 9 to 17 years, hyperactivity (borderline and abnormal categories), and emotional symptoms (abnormal category). Mapping the occurrence of low back pain and associated factors is important for identifying children and adolescents at risk and for developing effective programs for primary prevention.

  8. Prospective cohort study of predictors of incident low back pain in nurses.

    PubMed Central

    Smedley, J.; Egger, P.; Cooper, C.; Coggon, D.

    1997-01-01

    OBJECTIVE: To assess the impact of handling patients and indicators of individual susceptibility on risk of low back pain in nurses. DESIGN: Prospective cohort study with follow up by repeated self administered every three months over two years. SETTING: NHS university hospital trust. SUBJECTS: 961 female nurses who had been free from low back pain for at least one month at the time of completing a baseline questionnaire. MAIN OUTCOME MEASURES: Incidence of new low back pain during follow up and of pain leading to absence from work. RESULTS: Of 838 women who provided data suitable for analysis, 322 (38%) developed low back pain during follow up (mean 18.6 months), including 93 (11%) whose pain led to absence from work. The strongest predictor of new low back pain was earlier history of the symptom, and risk was particularly high if previous pain had lasted for over a month in total and had occurred within the 12 months before entry to the study (incidence during follow up 66%). Frequent low mood at baseline was strongly associated with subsequent absence from work for back pain (odds ratio 3.4; 95% confidence interval 1.4 to 8.2). After adjustment for earlier history of back pain and other potential confounders, risk was higher in nurses who reported frequent manual transfer of patients between bed and chair, manual repositioning of patients on the bed, and lifting patients in or out of the bath with a hoist. CONCLUSIONS: Of the indicators of individual susceptibility that were examined, only history of back trouble was sufficiently predictive to justify selective exclusion of some applicants for nursing posts. The main route to prevention of back disorders among nurses is likely to lie in improved ergonomics. PMID:9154024

  9. Radiofrequency ablation for chronic low back pain: A systematic review of randomized controlled trials

    PubMed Central

    Leggett, Laura E; Soril, Lesley JJ; Lorenzetti, Diane L; Noseworthy, Tom; Steadman, Rodney; Tiwana, Simrandeep; Clement, Fiona

    2014-01-01

    BACKGROUND: Radiofrequency ablation (RFA), a procedure using heat to interrupt pain signals in spinal nerves, is an emerging treatment option for chronic low back pain. Its clinical efficacy has not yet been established. OBJECTIVE: To determine the efficacy of RFA for chronic low back pain associated with lumbar facet joints, sacroiliac joints, discogenic low back pain and the coccyx. METHODS: A systematic review was conducted. Medline, EMBASE, PubMed, SPORTDiscus, CINAHL and the Cochrane Library were searched up to August 2013. Abstracts and full-text articles were reviewed in duplicate. Included articles were sham-controlled randomized controlled trials (RCTs), assessed the efficacy of RFA, reported at least one month of follow-up and included participants who had experienced back pain for at least three months. Data were extracted in duplicate and quality was assessed using the Cochrane Risk of Bias tool. Due to heterogeneity, as well as a lack of reported mean differences and SDs, meta-analysis was not possible using these data. RESULTS: The present systematic review retrieved 1063 abstracts. Eleven sham-controlled RCTs were included: three studies involving discogenic back pain; six studies involving lumbar facet joint pain; and two studies involving sacroiliac joint pain. No studies were identified assessing the coccyx. The evidence supports RFA as an efficacious treatment for lumbar facet joint and sacroiliac joint pain, with five of six and both of the RCTs demonstrating statistically significant pain reductions, respectively. The evidence supporting RFA for the treatment of discogenic pain is mixed. CONCLUSIONS: While the majority of the studies focusing on lumbar facet joints and sacroiliac joints suggest that RFA significantly reduces pain in short-term follow-up, the evidence base for discogenic low back pain is mixed. There is no RCT evidence for RFA for the coccyx. Future studies should examine the clinical significance of the achieved pain reduction

  10. Efficacy and safety of tanezumab versus naproxen in the treatment of chronic low back pain.

    PubMed

    Kivitz, Alan J; Gimbel, Joseph S; Bramson, Candace; Nemeth, Mary Anne; Keller, David S; Brown, Mark T; West, Christine R; Verburg, Kenneth M

    2013-07-01

    Tanezumab is a humanized monoclonal antibody that specifically inhibits nerve growth factor as a treatment for chronic pain. This phase IIB study investigated the efficacy and safety of tanezumab for chronic low back pain vs placebo and naproxen. Patients (N=1347) received intravenous tanezumab (5, 10, or 20mg every 8weeks), naproxen (500mg twice daily), or placebo. The primary efficacy end point was mean change in daily average low back pain intensity (LBPI) from baseline to week 16. Secondary end points included mean change from baseline to week 16 in the Roland Morris Disability Questionnaire and Patient's Global Assessment (PGA) of low back pain. Tanezumab 10 and 20mg had similar efficacy profiles and significantly improved LBPI, Roland Morris Disability Questionnaire, and PGA scores vs both placebo and naproxen (P⩽.05). Tanezumab 5mg provided improvement of PGA scores vs placebo (P⩽.05), and naproxen resulted in significant improvement of LBPI vs placebo (P⩽.05). Adverse event incidence was comparable across tanezumab doses but higher than with placebo or naproxen. Arthralgia, pain in extremity, headache, and paresthesia were the most commonly reported adverse events by tanezumab-treated patients. The most frequently reported adverse events resulting in discontinuation of tanezumab treatment were arthralgia and paresthesia; the highest frequency was observed with tanezumab 20mg (both 1.4%). Serious adverse event incidence was similar across treatments. In conclusion, tanezumab provided significantly greater improvement in pain, function, and global scores vs placebo and naproxen in patients with chronic low back pain.

  11. Core stability exercises in individuals with and without chronic nonspecific low back pain.

    PubMed

    Marshall, Paul Wm; Desai, Imtiaz; Robbins, Daniel W

    2011-12-01

    Marshall, PWM, Desai, I, and Robbins, DW. Core stability exercises in individuals with and without chronic nonspecific low back pain. J Strength Cond Res 25(12): 3404-3411, 2011-The aim of this study was to measure trunk muscle activity during several commonly used exercises in individuals with and without low back pain (LBP). Abdominal bracing was investigated as an exercise modification that may increase the acute training stimulus. After an initial familiarization session, 10 patients with LBP and 10 matched controls performed 5 different exercises (quadruped, side bridge, modified push-up, squat, shoulder flexion) with and without abdominal bracing. Trunk muscle activity and lumbar range of motion (LROM) were measured during all exercises. Muscle activity was measured bilaterally during each exercise from rectus abdominis (RA), external obliques (EO), and lumbar erector spinae (ES) with pairs of surface electrodes. Recorded signals were normalized to a percentage of maximal voluntary contractions performed for each muscle. The ES activity was lower for the LBP group during the quadruped (p < 0.05) and higher for RA and EO during the side bridge (p < 0.001), compared to for the healthy controls. Higher muscle activity was observed across exercises in an inconsistent pattern when abdominal bracing was used during exercise. The LROM was no different between groups for any exercise. The lack of worsening of symptoms in the LBP group and similar LROM observed between groups suggest that all exercises investigated in this study are of use in rehabilitating LBP patients. The widespread use of abdominal bracing in clinical practice, whether it be for patients with LBP or healthy individuals, may not be justified unless symptoms of spinal instability are identified.

  12. Participatory ergonomic intervention for prevention of low back pain: assembly line redesign case.

    PubMed

    Bernardes, João Marcos; Wanderck, Claudia; Moro, Antônio Renato Pereira

    2012-01-01

    This paper gives an overview of a participatory ergonomic intervention aimed at reducing low back pain cases in the dispatch department of a catalogue and e-commerce retail company. Based on the findings of the ergonomic analysis and design committee, the company's own employees redesigned the assembly line's layout. As a result of these changes two job tasks that involved manual material handling of boxes, identified by the revised NIOSH equation as posing an increased risk for lifting-related low back pain, were totally eliminated, and the employees responsible for moving boxes from the end of the assembly line to pallets on the ground were given more control over their jobs, and these jobs were also enriched with a new, less heavy task. These results demonstrate that participatory ergonomic interventions are a viable and effective strategy to reduce the exposure to work-related physical and psychosocial risk factors for low back pain. PMID:22317739

  13. A rare cause of postpartum low back pain: pregnancy- and lactation-associated osteoporosis.

    PubMed

    Terzi, Rabia; Terzi, Hasan; Özer, Tülay; Kale, Ahmet

    2014-01-01

    Pregnancy- and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis. It results in severe low back pain in the last trimester of pregnancy and in the postpartum period, decreases in height, and fragility fractures, particularly in the vertebra. The current case report presents a 32-year-old patient who presented with back and low back pain that began in the last trimester of the pregnancy and worsened at two months postpartum and who was diagnosed with pregnancy- and lactation-associated osteoporosis after exclusion of other causes; the findings are discussed in view of the current literature. PLO is a rare clinical condition causing significant disability. PLO must be kept in mind in the differential diagnosis in patients presenting with low back pain during or after pregnancy. The patients must be evaluated for the risk factors of PLO, and an appropriate therapy must be initiated.

  14. Stress fractures of the sacrum. An atypical cause of low back pain in the female athlete.

    PubMed

    Johnson, A W; Weiss, C B; Stento, K; Wheeler, D L

    2001-01-01

    Low back pain is a common finding in an athletically active premenopausal female population. We describe an unusual cause of persistent low back/sacroiliac pain: a fatigue-type sacral stress fracture. Plain radiographs, bone scans, computed tomography, and magnetic resonance imaging studies were obtained in the female athletes to determine the nature of the pathologic abnormality. The most significant risk factor for fatigue-type sacral stress fractures was an increase in impact activity due to a more vigorous exercise program. Potential risk factors such as abnormal menstrual history, dietary deficiencies, and low bone mineral density were examined. The clinical course was protracted, with an average 6.6 months of prolonged low back pain before resolution of symptoms. Sacral fatigue-type stress fractures did not preclude the athletes from returning to their previous level of participation once healing had occurred.

  15. Association of worker characteristics and early reimbursement for physical therapy, chiropractic and opioid prescriptions with workers’ compensation claim duration, for cases of acute low back pain: an observational cohort study

    PubMed Central

    Busse, Jason W; Ebrahim, Shanil; Heels-Ansdell, Diane; Wang, Li; Couban, Rachel; Walter, Stephen D

    2015-01-01

    Objective To assess the association between early reimbursement for physiotherapy, chiropractic and opioid prescriptions for acute low back pain (LBP) with disability claim duration. Design Observational cohort study. Setting and participants From a random sample of 6665 claims for acute, uncomplicated LBP approved by the Ontario Workplace Safety and Insurance Board (WSIB) in 2005, we analysed 1442 who remained on full benefits at 4 weeks after claim approval. Primary outcome measure Our primary outcome was WSIB claim duration. Results We had complete data for all but 3 variables, which had <15% missing data, and we included missing data as a category for these factors. Our time-to-event analysis was adjusted for demographic, workplace and treatment factors, but not injury severity, although we attempted to include a sample with very similar, less-severe injuries. Regarding significant factors and treatment variables in our adjusted analysis, older age (eg, HR for age ≥55 vs <25=0.52; 99% CI 0.36 to 0.74) and WSIB reimbursement for opioid prescription in the first 4 weeks of a claim (HR=0.68; 99% CI 0.53 to 0.88) were associated with longer claim duration. Higher predisability income was associated with longer claim duration, but only among persistent claims (eg, HR for active claims at 1 year with a predisability income >$920 vs ≤$480/week=0.34; 99% CI 0.17 to 0.68). Missing data for union membership (HR=1.27; 99% CI 1.01 to 1.59), and working for an employer with a return-to-work programme were associated with fewer days on claim (HR=1.78; 99% CI 1.45 to 2.18). Neither reimbursement for physiotherapy (HR=1.01; 99% CI 0.86 to 1.19) nor chiropractic care (HR for active claims at 60 days=1.15; 99% CI 0.94 to 1.41) within the first 4 weeks was associated with claim duration. Our meta-analysis of 3 studies (n=51 069 workers) confirmed a strong association between early opioid use and prolonged claim duration (HR=0.57, 95% CI 0.48 to 0.69; low certainty

  16. Biospectral analysis of the bladder channel point in chronic low back pain patients

    NASA Astrophysics Data System (ADS)

    Vidal, Alberto Espinosa; Nava, Juan José Godina; Segura, Miguel Ángel Rodriguez; Bastida, Albino Villegas

    2012-10-01

    Chronic pain is the main cause of disability in the productive age people and is a public health problem that affects both the patient and society. On the other hand, there isn't any instrument to measure it; this is only estimated using subjective variables. The healthy cells generate a known membrane potential which is part of a network of biologically closed electric circuits still unstudied. It is proposed a biospectral analysis of a bladder channel point as a diagnosis method for chronic low back pain patients. Materials and methods: We employed a study group with chronic low back pain patients and a control group without low back pain patients. The visual analog scale (VAS) to determine the level of pain was applied. Bioelectric variables were measured for 10 seconds and the respective biostatistical analyses were made. Results: Biospectral analysis on frequency domain shows a depression in the 60-300 Hz frequency range proportional to the chronicity of low back pain compared against healthy patients.

  17. Low Back Pain in Diabetes Mellitus and Importance of Preventive Approach

    PubMed Central

    Eivazi, Maghsoud; Abadi, Laleh

    2012-01-01

    Background: Musculoskeletal pain is known to be a common problem in diabetic patients. In spite of this fact, there is little information about epidemiology aspect of Low Back Pain (LBP) and necessity of taking preventive approach in diabetic patients. The aim of this study was to determine the prevalence of LBP in diabetic patients and its comparison with non-diabetic subjects. Methods: Low back pain frequency was examined among 317 diabetic patients referred to endocrine clinic, Sina Hospital, Tabriz city, Iran during 3 months interval. The control group included 100 participants who were parents of students of Tabriz University. All participants were asked to fill out a questionnaire including Roland Morris Disability Questionnaire (RMDQ) and Face Pain Scale (FPS). Result: Of the 317 diabetic patients, 63.4% (201) reported LBP while in non-diabetic group was 47% (47).The average functional disability in diabetic group was 9 while in control group was 7. Inter-correlation between low back pain intensity scale and functional disability were significant (r=0.52, P<0.01). Discussion: Low back pain is a common problem in diabetic patients in terms of intensity, frequency and functional level of disability. PMID:24688921

  18. Brodie's abscess of the posterior ilium: a rare cause for low back pain in children

    PubMed Central

    Balaji, Gopisankar; Thimmaiah, Sreenivas; Menon, Jagdish

    2014-01-01

    Brodie's abscess of the pelvis is very rare in healthy children. It can be missed because of its varied presentation. We present an 11-year-old boy who presented with low back pain. Investigations revealed a well-defined lesion in the posterior ilium. He underwent open biopsy and debridement. At the end of the final follow-up, he was asymptomatic and there was no recurrence. We present this case for the rare site of Brodie's abscess and for its unusual presentation as low back pain. PMID:24813201

  19. Brodie's abscess of the posterior ilium: a rare cause for low back pain in children.

    PubMed

    Balaji, Gopisankar; Thimmaiah, Sreenivas; Menon, Jagdish

    2014-05-09

    Brodie's abscess of the pelvis is very rare in healthy children. It can be missed because of its varied presentation. We present an 11-year-old boy who presented with low back pain. Investigations revealed a well-defined lesion in the posterior ilium. He underwent open biopsy and debridement. At the end of the final follow-up, he was asymptomatic and there was no recurrence. We present this case for the rare site of Brodie's abscess and for its unusual presentation as low back pain.

  20. Case Study: The Use of Massage Therapy to Relieve Chronic Low-Back Pain

    PubMed Central

    Allen, Laura

    2016-01-01

    Objectives To study the effects of massage on chronic low-back pain in a patient with four different diagnoses: osteoarthritis, scoliosis, spinal stenosis, and degenerative disc disease. The patient’s goal was to cut down on the amount of pain medication he takes. Methods A 63-year-old man with chronic back pain received four massages across a twenty-day period. Progress was recorded using the Oswestry Low Back Pain Scale, as he self-reported on levels of pain and interference with his activities of daily living. Results Improvement was noted in 9 out of 10 measurements of self-reported pain and activities of daily living, with the only exception being his ability to lift heavy objects, which remained unchanged. The most dramatic differences were improvements in his ability to walk, and in the changing degrees of pain. The client also self-reported being able to decrease his pain medication and the ability to ride his bicycle for the first time in years. Conclusions Massage therapy is a promising treatment for chronic low-back pain for patients who may have multiple pathologies, any one of which could be responsible for the condition. Further study is encouraged to determine the efficacy of massage therapy as a readily accessible, lower-cost alternative to more invasive therapies and as an adjunct to regular medical care, when appropriate. PMID:27648110

  1. Case Study: The Use of Massage Therapy to Relieve Chronic Low-Back Pain

    PubMed Central

    Allen, Laura

    2016-01-01

    Objectives To study the effects of massage on chronic low-back pain in a patient with four different diagnoses: osteoarthritis, scoliosis, spinal stenosis, and degenerative disc disease. The patient’s goal was to cut down on the amount of pain medication he takes. Methods A 63-year-old man with chronic back pain received four massages across a twenty-day period. Progress was recorded using the Oswestry Low Back Pain Scale, as he self-reported on levels of pain and interference with his activities of daily living. Results Improvement was noted in 9 out of 10 measurements of self-reported pain and activities of daily living, with the only exception being his ability to lift heavy objects, which remained unchanged. The most dramatic differences were improvements in his ability to walk, and in the changing degrees of pain. The client also self-reported being able to decrease his pain medication and the ability to ride his bicycle for the first time in years. Conclusions Massage therapy is a promising treatment for chronic low-back pain for patients who may have multiple pathologies, any one of which could be responsible for the condition. Further study is encouraged to determine the efficacy of massage therapy as a readily accessible, lower-cost alternative to more invasive therapies and as an adjunct to regular medical care, when appropriate.

  2. Skew-symmetric Random Effect Models with Application to a Preventive Cohort Study: Improving Outcomes in Low Back Pain Patients

    PubMed Central

    Mansourian, Marjan; Mahdiyeh, Zahra; Park, Jongbae J; Haghjooyejavanmard, Shaghayegh

    2013-01-01

    Background: To investigate the respective contribution of various biologic and psychosocial factors, especially Health Related Quality of Life (HRQOL) as a main outcome, in the natural history of acute low back pain (LBP) and to evaluate the impact of this condition on HRQOL. Methods: In a prospective cohort study For 24 weeks, 150 patients were assessed at an outpatient clinic in Korea consulting for low back and confirmed disc herniation duration at inclusion and treated with treatment package comprised of herbal medicines, acupuncture, bee venom acupuncture, and a Korean version of spinal manipulation (Chuna). Study participants were evaluated at baseline and every 4 weeks for 24 weeks. Low back intensity levels were measured on a visual analog scale (0-10), back function was evaluated with the Oswestry Disability Index (0-100), disability assessed by HRQOL assessed by the short form 36 health survey (0-100 in 8 different sub-categories). Results: Out of 150 patients, 128 completed the 24 weeks of traditional therapy. Patients reported improvements SF-36 outcome measures. At the completion of the study, low back pain scores improved by a mean of 3.3 (95% CI = 2.8 to 3.8). According to the results of our modeling, low back intensity level, back function and BMI measures had significant effects on quality of life during study. Interpreting the coefficients of modeling, the impact of the decreasing acute LBP episode on HRQOL by VAS and ODI outcomes, was high and important. Conclusions: This study highlights the large contribution of integrative package therapy as an effective preventive method for improving LBP patient's HRQOL. PMID:23626884

  3. Paraspinous Lidocaine Injection for Chronic Nonspecific Low Back Pain: A Randomized Controlled Clinical Trial

    PubMed Central

    Imamura, Marta; Imamura, Satiko Tomikawa; Targino, Rosa Alves; Morales-Quezada, León; Onoda Tomikawa, Luis C.; Onoda Tomikawa, Luis G.; Alfieri, Fabio M.; Filippo, Thais R.; da Rocha, Ivan D.; Neto, Raul Bolliger; Fregni, Felipe; Battistella, Linamara Rizzo

    2016-01-01

    In this large, sham-controlled, randomized trial, we examined the efficacy of the combination of standard treatment and paraspinous lidocaine injection compared with standard therapy alone in subjects with chronic low back pain. There is little research-based evidence for the routine clinical use of paraspinous lidocaine injection for low back pain. A total of 378 subjects with nonspecific chronic low back pain were randomized to 3 groups: paraspinous lidocaine injection, analgesics, and exercises (group 1, LID-INJ); sham paraspinous lidocaine injection, analgesics, and exercises (group 2, SH-INJ); and analgesics and exercises (group 3, STD-TTR). A blinded rater assessed the study outcomes at 3 time points: baseline, after treatment, and after 3 months of follow-up. There were increased frequency of pain responses and better low back functional scores in the LID-INJ group compared with the SH-INJ and STD-TTR groups. These effects remained at the 3-month follow-up but differed between all 3 groups. There were significant changes in pain threshold immediately after treatment, supporting the effects of this intervention in reducing central sensitization. Paraspinous lidocaine injection therapy is not associated with a higher risk of adverse effects compared with conventional treatment and sham injection. Its effects on hyperalgesia might correlate with changes in central sensitization. PMID:26828801

  4. Discovery of the drivers of inflammation induced chronic low back pain: from bacteria to diabetes.

    PubMed

    Gorth, Deborah J; Shapiro, Irving M; Risbud, Makarand V

    2015-10-01

    The intervertebral disc is a unique avascular organ that supports axial skeleton flexion and rotation. The high proteoglycan content of the nucleus pulposus tissue, present at the center of the disc, is pivotal for its mechanical function, distribution of compressive loads. Chronic low back pain, a prevalent and costly condition, is strongly associated with disc degeneration. Degenerated discs exhibit high levels of inflammatory cytokines, matrix catabolizing enzymes, and an overall reduction in proteoglycan content. Although the cytokine profile of diseased discs has been widely studied, little is known of what initiates and drives inflammation and subsequent low back pain. Recent studies have shown that anaerobic bacteria are present in a high percentage of painful, herniated discs and long-term treatment with antibiotics resolves symptoms associated with chronic low back pain. It is thought that these anaerobic bacteria in the disc may stimulate inflammation through toll-like receptors to further exacerbate disc degeneration. Despite the promise and novelty of this theory, there are other possible inflammatory mediators that need careful consideration. The metabolic environment associated with diabetes and atypical matrix degradation products also have the ability to activate many of the same inflammatory pathways as seen during microbial infection. It is therefore imperative that the research community must investigate the contribution of all possible drivers of inflammation to address the wide spread problem of discogenic chronic low back pain. PMID:26562470

  5. The causality field (extrinsic and intrinsic factors) in industrial subacute low back pain patients.

    PubMed

    Ohlund, C; Lindström, I; Eek, C; Areskoug, B; Nachemson, A

    1996-04-01

    In a prospective, randomized study, primarily designed to test the efficacy of activation on consecutive blue-collar workers sick-listed for 6 weeks due to subacute low back pain, 25% of the workers were excluded for medical reasons. In the intervention study (n = 103), only a minority of cases (6%) had 'true' subacute complaints, i.e. no prior history of low back pain. Subjective reports on general well-being, health status and work-related ergonomic factors were significantly lower or worse in patients than in reference samples. The randomized intervention study could establish a significant effect of graded activation on work return, but the effect seemed to be restricted to patients moderately disabled, i.e. one-third of the subacute low back pain patients included. A predictive four-factor model on work return increased the possibility of identifing nonresponders (chronic low back pain) more than threefold with a specificity (91%) and sensitivity (74%) comparable to that of clinical disc herniation. The history of a prolonged disablement process, cognitive factors, pain behavior and mentally straining ergonomic factors seemed to be of importance. Psychological reactions, or 'barriers to recovery', were slightly different in treatment and control groups but the type of intervention did not significantly alter the predictive model, suggesting that subsets of the study sample may benefit from other optional functional approaches. Descriptive characteristics of the study sample emphasized that subacute low back pain patients cannot be conceptualized as a homogeneous group. Four sub-groups could be identified: (a) specific medical disorders; (b) spontaneous recovery group; (c) moderately disabled back pain patients; and (d) nonresponders. The results support proposals that treatment should be tailored according to individual needs and that better case management should have priority for those belonging to the nonresponder group.

  6. Change of barometric pressure influences low back pain in patients with vacuum phenomenon within lumbar intervertebral disc.

    PubMed

    Kasai, Yuichi; Takegami, Kenji; Uchida, Atsumasa

    2002-08-01

    The present study investigates whether changes in barometric pressure influence low back pain in patients with vacuum phenomenon within lumbar intervertebral discs. Twenty-four patients with low back pain were examined: 12 with vacuum phenomenon within the intervertebral discs (VP [+] group) and 12 without the vacuum phenomenon (VP [-] group). All patients consented to an evaluation of low back pain in a hyperbaric oxygen chamber. In the VP (+) group, low back pain became more severe in one patient when atmospheric pressure was elevated, and in eight patients when atmospheric pressure was decreased. In the VP (-) group, two patients experienced more severe low back pain when atmospheric pressure was decreased. Our study demonstrated that low back pain might be aggravated by atmosphere depression in patients with lumbar disease associated with the vacuum phenomenon.

  7. Review for the generalist: evaluation of low back pain in children and adolescents

    PubMed Central

    2010-01-01

    Back pain is common in children and adolescents. Most cases of back pain are non-specific and self-limiting. In children and adolescents, pain is usually related to the posterior elements of the spine and disc-related problems are rare. Serious pathology, including malignancy and infection needs to be excluded. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the immature skeleton. Diagnostic imaging is useful in the evaluation of a child or adolescent with low back pain and can help guide management. This article will review common causes of back pain in the pediatric population. PMID:21092217

  8. Neural Correlates of Fear of Movement in Patients with Chronic Low Back Pain vs. Pain-Free Individuals

    PubMed Central

    Meier, Michael L.; Stämpfli, Philipp; Vrana, Andrea; Humphreys, Barry K.; Seifritz, Erich; Hotz-Boendermaker, Sabina

    2016-01-01

    Fear of movement (FOM) can be acquired by a direct aversive experience such as pain or by social learning through observation and instruction. Excessive FOM results in heightened disability and is an obstacle for recovery from acute, subacute, and chronic low back pain (cLBP). FOM has further been identified as a significant explanatory factor in the Fear Avoidance (FA) model of cLBP that describes how individuals experiencing acute back pain may become trapped into a vicious circle of chronic disability and suffering. Despite a wealth of evidence emphasizing the importance of FOM in cLBP, to date, no related neural correlates in patients were found and this therefore has initiated a debate about the precise contribution of fear in the FA model. In the current fMRI study, we applied a novel approach encompassing: (1) video clips of potentially harmful activities for the back as FOM inducing stimuli; and (2) the assessment of FOM in both, cLBP patients (N = 20) and age- and gender-matched pain-free subjects (N = 20). Derived from the FA model, we hypothesized that FOM differentially affects brain regions involved in fear processing in patients with cLBP compared to pain-free individuals due to the recurrent pain and subsequent avoidance behavior. The results of the whole brain voxel-wise regression analysis revealed that: (1) FOM positively correlated with brain activity in fear-related brain regions such as the amygdala and the insula; and (2) differential effects of FOM between patients with cLBP and pain-free subjects were found in the extended amygdala and in its connectivity to the anterior insula. Current findings support the FOM component of the FA model in cLBP. PMID:27507941

  9. Neural Correlates of Fear of Movement in Patients with Chronic Low Back Pain vs. Pain-Free Individuals.

    PubMed

    Meier, Michael L; Stämpfli, Philipp; Vrana, Andrea; Humphreys, Barry K; Seifritz, Erich; Hotz-Boendermaker, Sabina

    2016-01-01

    Fear of movement (FOM) can be acquired by a direct aversive experience such as pain or by social learning through observation and instruction. Excessive FOM results in heightened disability and is an obstacle for recovery from acute, subacute, and chronic low back pain (cLBP). FOM has further been identified as a significant explanatory factor in the Fear Avoidance (FA) model of cLBP that describes how individuals experiencing acute back pain may become trapped into a vicious circle of chronic disability and suffering. Despite a wealth of evidence emphasizing the importance of FOM in cLBP, to date, no related neural correlates in patients were found and this therefore has initiated a debate about the precise contribution of fear in the FA model. In the current fMRI study, we applied a novel approach encompassing: (1) video clips of potentially harmful activities for the back as FOM inducing stimuli; and (2) the assessment of FOM in both, cLBP patients (N = 20) and age- and gender-matched pain-free subjects (N = 20). Derived from the FA model, we hypothesized that FOM differentially affects brain regions involved in fear processing in patients with cLBP compared to pain-free individuals due to the recurrent pain and subsequent avoidance behavior. The results of the whole brain voxel-wise regression analysis revealed that: (1) FOM positively correlated with brain activity in fear-related brain regions such as the amygdala and the insula; and (2) differential effects of FOM between patients with cLBP and pain-free subjects were found in the extended amygdala and in its connectivity to the anterior insula. Current findings support the FOM component of the FA model in cLBP. PMID:27507941

  10. Clinical efficacy and safety of eperisone for low back pain: A systematic literature review.

    PubMed

    Bavage, Sachin; Durg, Sharanbasappa; Ali Kareem, Shoukath; Dhadde, Shivsharan B

    2016-10-01

    Eperisone, an analgesic and centrally acting muscle relaxant has been in use for the treatment of low back pain (LBP). The present systematic review evaluates the efficacy and safety of eperisone in patients with LBP. Cochrane Back and Neck (CBN) Group and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were adopted to perform this systematic review. For risk of bias assessment CBN Group and Moga tools were used. Seven (5 randomized controlled trials [RCTs] and 2 uncontrolled studies) studies involving 801 participants were included. Eperisone intervention may be effective in acute LBP patients with less adverse effects (relative risk, 0.25; 95% confidence interval, 0.15-0.41; p<0.0001). Eperisone also improved paraspinal blood flow and was found to have efficacy similar to tizanidine in chronic LBP patients. The included studies in this review are of smaller sample size and short duration to support eperisone use in LBP. However, we recommend well-designed RCTs of high quality with larger sample size and longer follow-up to confirm the clinical benefits of eperisone in the treatment of acute or chronic LBP. PMID:27371896

  11. Clinical efficacy and safety of eperisone for low back pain: A systematic literature review.

    PubMed

    Bavage, Sachin; Durg, Sharanbasappa; Ali Kareem, Shoukath; Dhadde, Shivsharan B

    2016-10-01

    Eperisone, an analgesic and centrally acting muscle relaxant has been in use for the treatment of low back pain (LBP). The present systematic review evaluates the efficacy and safety of eperisone in patients with LBP. Cochrane Back and Neck (CBN) Group and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were adopted to perform this systematic review. For risk of bias assessment CBN Group and Moga tools were used. Seven (5 randomized controlled trials [RCTs] and 2 uncontrolled studies) studies involving 801 participants were included. Eperisone intervention may be effective in acute LBP patients with less adverse effects (relative risk, 0.25; 95% confidence interval, 0.15-0.41; p<0.0001). Eperisone also improved paraspinal blood flow and was found to have efficacy similar to tizanidine in chronic LBP patients. The included studies in this review are of smaller sample size and short duration to support eperisone use in LBP. However, we recommend well-designed RCTs of high quality with larger sample size and longer follow-up to confirm the clinical benefits of eperisone in the treatment of acute or chronic LBP.

  12. Study protocol title: a prospective cohort study of low back pain

    PubMed Central

    2013-01-01

    Background Few prospective cohort studies of workplace low back pain (LBP) with quantified job physical exposure have been performed. There are few prospective epidemiological studies for LBP occupational risk factors and reported data generally have few adjustments for many personal and psychosocial factors. Methods/design A multi-center prospective cohort study has been incepted to quantify risk factors for LBP and potentially develop improved methods for designing and analyzing jobs. Due to the subjectivity of LBP, six measures of LBP are captured: 1) any LBP, 2) LBP ≥ 5/10 pain rating, 3) LBP with medication use, 4) LBP with healthcare provider visits, 5) LBP necessitating modified work duties and 6) LBP with lost work time. Workers have thus far been enrolled from 30 different employment settings in 4 diverse US states and performed widely varying work. At baseline, workers undergo laptop-administered questionnaires, structured interviews, and two standardized physical examinations to ascertain demographics, medical history, psychosocial factors, hobbies and physical activities, and current musculoskeletal disorders. All workers’ jobs are individually measured for physical factors and are videotaped. Workers are followed monthly for the development of low back pain. Changes in jobs necessitate re-measure and re-videotaping of job physical factors. The lifetime cumulative incidence of low back pain will also include those with a past history of low back pain. Incident cases will exclude prevalent cases at baseline. Statistical methods planned include survival analyses and logistic regression. Discussion Data analysis of a prospective cohort study of low back pain is underway and has successfully enrolled over 800 workers to date. PMID:23497211

  13. Blocking the mineralocorticoid receptor improves effectiveness of steroid treatment for low back pain in rats

    PubMed Central

    Ye, Ling; Xie, Wenrui; Strong, Judith A.; Zhang, Jun-Ming

    2014-01-01

    Background Localized inflammation of lumbar dorsal root ganglia (DRG) may contribute to low back pain. Local injections of corticosteroids used for low back pain are sometimes ineffective. Many corticosteroids activate not only the target glucocorticoid receptor (GR) but also the mineralocorticoid receptor (MR), which may have pro-inflammatory effects countering the effects of GR activation. Methods A low back pain model was implemented in rats (n = 6 -10 per group) by locally inflaming the L5 DRG. Sensory neuron excitability and mechanical hypersensitivity of the hind paws were measured. Tested steroids were applied locally to the inflamed DRG or orally. Results The selective MR blocker eplerenone reduced pain behaviors when given orally starting at the time of surgery, or starting 7 days later. The highly GR-selective agonist fluticasone, applied locally to the inflamed DRG, was much more effective in reducing mechanical hypersensitivity. The MR/GR agonist 6-α methylprednisolone, commonly injected for low back pain, reduced mechanical hypersensitivity when applied locally to the DRG, but was less effective than fluticasone. Its effectiveness was improved by combining it with local eplerenone. All tested steroids reduced hyperexcitability of myelinated sensory neurons (n = 71 – 220 cells per group) after inflammation, particularly abnormal spontaneous activity. Conclusions This preclinical study indicates the MR may play an important role in low back pain involving inflammation. Some MR effects may occur at the level of the sensory neuron. It may be useful to consider the action of clinically used steroids at the MR as well as at the GR. PMID:24781496

  14. The Efficacy of a Perceptive Rehabilitation on Postural Control in Patients with Chronic Nonspecific Low Back Pain

    ERIC Educational Resources Information Center

    Paolucci, Teresa; Fusco, Augusto; Iosa, Marco; Grasso, Maria R.; Spadini, Ennio; Paolucci, Stefano; Saraceni, Vincenzo M.; Morone, Giovanni

    2012-01-01

    Patients with chronic low back pain have a worse posture, probably related to poor control of the back muscles and altered perception of the trunk midline. The aim of this study was to evaluate the efficacy of a perceptive rehabilitation in terms of stability and pain relief in patients with chronic nonspecific low back pain. Thirty patients were…

  15. Disrupted functional connectivity of the periaqueductal gray in chronic low back pain

    PubMed Central

    Yu, Rongjun; Gollub, Randy L.; Spaeth, Rosa; Napadow, Vitaly; Wasan, Ajay; Kong, Jian

    2014-01-01

    Chronic low back pain is a common neurological disorder. The periaqueductal gray (PAG) plays a key role in the descending modulation of pain. In this study, we investigated brain resting state PAG functional connectivity (FC) differences between patients with chronic low back pain (cLBP) in low pain or high pain condition and matched healthy controls (HCs). PAG seed based functional connectivity (FC) analysis of the functional MR imaging data was performed to investigate the difference among the connectivity maps in the cLBP in the low or high pain condition and HC groups as well as within the cLBP at differing endogenous back pain intensities. Results showed that FC between the PAG and the ventral medial prefrontal cortex (vmPFC)/rostral anterior cingulate cortex (rACC) increased in cLBP patients compared to matched controls. In addition, we also found significant negative correlations between pain ratings and PAG–vmPFC/rACC FC in cLBP patients after pain-inducing maneuver. The duration of cLBP was negatively correlated with PAG–insula and PAG–amygdala FC before pain-inducing maneuver in the patient group. These findings are in line with the impairments of the descending pain modulation reported in patients with cLBP. Our results provide evidence showing that cLBP patients have abnormal FC in PAG centered pain modulation network during rest. PMID:25379421

  16. Efficacy of the Multifidus Retraining Program in Computer Professionals with Chronic Low Back Pain

    PubMed Central

    Thankappan, Sreeja Mannickal

    2016-01-01

    Study Design Randomized controlled trial. Purpose To contrast the efficacy of two exercise programs—multifidus retraining program (MRP) and traditional back exercises (TBE)—on pain and functional disability in individuals with chronic low back pain. Overview of Literature Low back pain is a common musculoskeletal disorder. Mechanical low back pain does not involve nerve roots. Stability of the spine is provided by the ligaments and muscles of the lower back and abdomen. Although weakness of the superficial trunk and abdominal muscles are the primary risk factors, recent studies have demonstrated the involvement of weakness and lack of control of the deep trunk muscles, especially the multifidus and transverse abdominis muscles. Therefore, exercises to restore optimal lumbar multifidus function are important in rehabilitation strategies. Methods Thirty individuals were randomly assigned to receive TBE, where exercises focused on the superficial muscles of abdomen and low back (control, group A) and MRP, where exercises focused on the deep multifidus muscles fibers (experimental, group B). Groups were examined to find the effect of these exercises on visual analog scale rated pain (visual analogical scale) and functional disability assessed by the Oswestry disability questionnaire. The exercise program lasted for 6 weeks on alternate days, with 20 repetitions of each exercise, with each move held for 5–8 seconds. Subjects were evaluated at the start of the study and after completion of the 6-week exercise program. Results As compared to baseline, both treatments were effective in relieving pain and improving disability (p<0.001). The MRP group had significant gains for pain and functional disability when compared to the TBE group (both p<0.001). Conclusions Both techniques lessen pain and reduce disability. MRP is superior to TBE in reducing pain and improving function. PMID:27340523

  17. Treating co-occurring chronic low back pain & generalized anxiety disorder.

    PubMed

    Janzen, Kristina; Peters-Watral, Brenda

    2016-01-16

    The complex, bidirectional correlation between chronic low back pain (CLBP) and generalized anxiety disorder (GAD), common ailments in primary care, can increase the risk of inadequate treatment. This article will review the relationship between CLBP and GAD and provide optimal management strategies for NPs caring for individuals with this dyad. PMID:26642348

  18. Inflammation in low back pain may be detected from the peripheral blood: suggestions for biomarker

    PubMed Central

    Li, Yong; Liu, Jun; Liu, Zong-zhi; Duan, Da-peng

    2016-01-01

    Biomarker for prediction of development of low back pain, and disease progression in chronic conditions are virtually non-existent. In the present study, we examined evidence of inflammation in the peripheral blood and demonstrated significant changes in neuroinflammation markers in subjects with chronic low back pain in comparison with control subjects. The present study was performed using peripheral blood from subjects with chronic low back pain and age-matched control subjects. Western blotting, real-time RT-PCR, cell culture and in vitro assays were incorporated to perform the current study. We obtained evidence that the balance between proinflammatory and anti-inflammatory cytokines is misaligned, with decrease in interleukin-10 (IL-10) expression and increase in interleukin-6 (IL-6) expression. Furthermore, we demonstrated increase in CD16 monocyte expression. Cells were cultured under differential conditions to generate M1/M2 macrophages. In the macrophages, opioid secretory capacity was shown to be diminished. Finally, Dragon (repulsive guidance molecule b, RGMb) expression was shown diminished in M1 macrophages, which serves as a key transcriptional inhibitor of IL-6 expression. These biochemical and cellular alterations in chronic low back pain can serve as potential biomarkers for assessing disease initiation, intensity and progression. PMID:27380953

  19. Nonspecific Chronic Low Back Pain Patients Are Deconditioned and Have An Increased Body Fat Percentage

    ERIC Educational Resources Information Center

    Hodselmans, Audy P.

    2010-01-01

    The aim of this cross-sectional study was to compare data on the level of aerobic capacity and body composition of nonspecific chronic low back pain (CLBP) patients with normative data matched for sex, age and level of sporting activity. The study population consisted of 101 outpatients with nonspecific CLBP who had entered a rehabilitation…

  20. Inflammation in low back pain may be detected from the peripheral blood: suggestions for biomarker.

    PubMed

    Li, Yong; Liu, Jun; Liu, Zong-Zhi; Duan, Da-Peng

    2016-08-01

    Biomarker for prediction of development of low back pain, and disease progression in chronic conditions are virtually non-existent. In the present study, we examined evidence of inflammation in the peripheral blood and demonstrated significant changes in neuroinflammation markers in subjects with chronic low back pain in comparison with control subjects. The present study was performed using peripheral blood from subjects with chronic low back pain and age-matched control subjects. Western blotting, real-time RT-PCR, cell culture and in vitro assays were incorporated to perform the current study. We obtained evidence that the balance between proinflammatory and anti-inflammatory cytokines is misaligned, with decrease in interleukin-10 (IL-10) expression and increase in interleukin-6 (IL-6) expression. Furthermore, we demonstrated increase in CD16 monocyte expression. Cells were cultured under differential conditions to generate M1/M2 macrophages. In the macrophages, opioid secretory capacity was shown to be diminished. Finally, Dragon (repulsive guidance molecule b, RGMb) expression was shown diminished in M1 macrophages, which serves as a key transcriptional inhibitor of IL-6 expression. These biochemical and cellular alterations in chronic low back pain can serve as potential biomarkers for assessing disease initiation, intensity and progression. PMID:27380953

  1. Inflammation in low back pain may be detected from the peripheral blood: suggestions for biomarker.

    PubMed

    Li, Yong; Liu, Jun; Liu, Zong-Zhi; Duan, Da-Peng

    2016-08-01

    Biomarker for prediction of development of low back pain, and disease progression in chronic conditions are virtually non-existent. In the present study, we examined evidence of inflammation in the peripheral blood and demonstrated significant changes in neuroinflammation markers in subjects with chronic low back pain in comparison with control subjects. The present study was performed using peripheral blood from subjects with chronic low back pain and age-matched control subjects. Western blotting, real-time RT-PCR, cell culture and in vitro assays were incorporated to perform the current study. We obtained evidence that the balance between proinflammatory and anti-inflammatory cytokines is misaligned, with decrease in interleukin-10 (IL-10) expression and increase in interleukin-6 (IL-6) expression. Furthermore, we demonstrated increase in CD16 monocyte expression. Cells were cultured under differential conditions to generate M1/M2 macrophages. In the macrophages, opioid secretory capacity was shown to be diminished. Finally, Dragon (repulsive guidance molecule b, RGMb) expression was shown diminished in M1 macrophages, which serves as a key transcriptional inhibitor of IL-6 expression. These biochemical and cellular alterations in chronic low back pain can serve as potential biomarkers for assessing disease initiation, intensity and progression.

  2. Self-Report of Depressive Symptoms in Low Back Pain Patients.

    ERIC Educational Resources Information Center

    Crisson, James; And Others

    1986-01-01

    Presents two studies designed to examine the self-report of depressive symptoms in low back pain patients (N=134). Both studies found that patients were more likely to report somatic than cognitive symptoms of depression. Patients with multiple physical findings were not more likely to report somatic symptoms than patients with few physical…

  3. Group Outpatient Physical and Behavioral Therapy for Chronic Low Back Pain.

    ERIC Educational Resources Information Center

    Cohen, Michael J.; And Others

    1983-01-01

    Compared the effectiveness of behavioral (BT) or physical therapy (PT) for treating chronic low back pain (CLBP), for 13 BT patients and 12 PT patients. Treatments were conducted in a group outpatient setting. Posttreatment results showed general improvement for patients in both groups, but few treatment-specific differences in outcome measures.…

  4. Comparison of Operant Behavioral and Cognitive-Behavioral Group Treatment for Chronic Low Back Pain.

    ERIC Educational Resources Information Center

    Turner, Judith A.; Clancy, Steve

    1988-01-01

    Assigned chronic low back pain patients to operant behavioral (OB) treatment, cognitive-behavioral (CB) treatment, or waiting-list (WL) condition. Both treatments resulted in decreased physical and psychosocial disability. OB patients' greater improvement leveled off at followup; CB patients continued to improve over the 12 months following…

  5. Hysteria Scale Elevations in Low Back Pain Patients: A Risk Factor for Misdiagnosis?

    ERIC Educational Resources Information Center

    Prokop, Charles K.

    1986-01-01

    Examined the nature of elevations on the Hysteria scale of the Minnesota Multiphasic Personality Inventory in low back pain patients. Subscales reflecting somatic complaints were more powerful predictors of diagnostic status than were subscales with nonsomatic content. Overlapping and nonoverlapping items on the Hysteria and Hypochondriasis scales…

  6. Role of Self-Efficacy in Rehabilitation Outcome among Chronic Low Back Pain Patients.

    ERIC Educational Resources Information Center

    Altmaier, Elizabeth M.; And Others

    1993-01-01

    Examined role of self-efficacy beliefs in rehabilitation of 45 low back pain patients participating in 3-week rehabilitation program. Increments in self-efficacy beliefs during program were not associated with improved patient functioning at discharge. However, in support of theorized role of self-efficacy in behavior change, increments in…

  7. Imperfect placebos are common in low back pain trials: a systematic review of the literature

    PubMed Central

    Kamper, S. J.; Herbert, R. D.; Maher, C. G.; McAuley, J. H.

    2008-01-01

    The placebo is an important tool to blind patients to treatment allocation and therefore minimise some sources of bias in clinical trials. However, placebos that are improperly designed or implemented may introduce bias into trials. The purpose of this systematic review was to evaluate the adequacy of placebo interventions used in low back pain trials. Electronic databases were searched systematically for randomised placebo-controlled trials of conservative interventions for low back pain. Trial selection and data extraction were performed by two reviewers independently. A total of 126 trials using over 25 different placebo interventions were included. The strategy most commonly used to enhance blinding was the provision of structurally equivalent placebos. Adequacy of blinding was assessed in only 13% of trials. In 20% of trials the placebo intervention was a potentially genuine treatment. Most trials that assessed patients’ expectations showed that the placebo generated lower expectations than the experimental intervention. Taken together, these results demonstrate that imperfect placebos are common in low back pain trials; a result suggesting that many trials provide potentially biased estimates of treatment efficacy. This finding has implications for the interpretation of published trials and the design of future trials. Implementation of strategies to facilitate blinding and balance expectations in randomised groups need a higher priority in low back pain research. Electronic supplementary material The online version of this article (doi:10.1007/s00586-008-0664-3) contains supplementary material, which is available to authorized users. PMID:18421484

  8. Treatment of Common Low Back Pain: A New Approach to an Old Problem.

    PubMed

    Bosscher, Hemmo A; Heavner, James E

    2015-07-01

    Low back pain is very common, but the pathophysiology is poorly understood. We present a new hypothesis regarding the pathophysiology of common low back pain supported by our flexible endoscopic observations of the epidural cavity (epiduroscopy), anatomic dissection of embalmed and fresh cadavers, and careful review of preexisting information available on the anatomy of the epidural space and neuroforamen. A new approach to the treatment of common low back pain based on the hypothesis was developed and is presented in the case reports of five patients. Treatment focuses on a perichondrium derivative; the peridural membrane, which creates a suprapedicular compartment in the neuroforamen where we hypothesize inflammatory material accumulates. This produces common low back pain by causing inflammation and sensitization of the peridural membrane and periosteum that forms the boundaries of this compartment. Percutaneous Ablation and Curettage and Inferior Foraminotomy (PACIF(sm)) aims to destroy the peridural membrane, denervate sensitive structures, and remove inflammatory tissues from the suprapedicular canal. The proposed mechanism of action and safety of PACIF(sm) is discussed in the context of epidural and neuroforaminal anatomy. As shown by the five case reports, PACIF(sm) appears to be highly effective and safe, warranting further evaluation.

  9. An epidemiological study of low back pain among oil drilling workers in India.

    PubMed

    Tiwari, Rajnarayan R; Saha, Asim

    2014-02-01

    Many episodes of low back pain are disabling, thus making it one of the costly occupational health problem. The proper alignment and lifting operations during drilling process frequently exposed the oil-drilling workers to unusual strain on the spine and thus make them susceptible for developing low back pain. The present cross-sectional study was carried out in 71 oil-drilling workers. The prevalence of self-reported low back pain was found to be 29.6%. Higher prevalence was found in those working in awkward working posture (c 2 = 6.41; df = 1; p < 0.01). No other factors, namely, age, obesity, duration of exposure, smoking habit, family history of musculoskeletal disorders, exposure to vibration, lifting of weights and past history of injury was found to be statistically significant. Furthermore, using univariate and multivariate analysis, none of the factor was found to have excess risk of occurrence of low back pain, which can partly be attributed to small sample size. PMID:22740620

  10. Isometric force production parameters during normal and experimental low back pain conditions

    PubMed Central

    Descarreaux, Martin; Blouin, Jean-Sébastien; Teasdale, Normand

    2005-01-01

    Background The control of force and its between-trial variability are often taken as critical determinants of motor performance. Subjects performed isometric trunk flexion and extension forces without and with experiment pain to examine if pain yields changes in the control of trunk forces. The objective of this study is to determine if experimental low back pain modifies trunk isometric force production. Methods Ten control subjects participated in this study. They were required to exert 50 and 75% of their isometric maximal trunk flexion and extension torque. In a learning phase preceding the non painful and painful trials, visual and verbal feedbacks were provided. Then, subjects were asked to perform 10 trials without any feedback. Time to peak torque, time to peak torque variability, peak torque variability as well as constant and absolute error in peak torque were calculated. Time to peak and peak dF/dt were computed to determine if the first peak of dF/dt could predict the peak torque achieved. Results Absolute and constant errors were higher in the presence of a painful electrical stimulation. Furthermore, peak torque variability for the higher level of force was increased with in the presence of experimental pain. The linear regressions between peak dF/dt, time to peak dF/dt and peak torque were similar for both conditions. Experimental low back pain yielded increased absolute and constant errors as well as a greater peak torque variability for the higher levels of force. The control strategy, however, remained the same between the non painful and painful condition. Cutaneous pain affects some isometric force production parameters but modifications of motor control strategies are not implemented spontaneously. Conclusions It is hypothesized that adaptation of motor strategies to low back pain is implemented gradually over time. This would enable LBP patients to perform their daily tasks with presumably less pain and more accuracy. PMID:15703067

  11. An interdisciplinary guideline development process: the Clinic on Low-back pain in Interdisciplinary Practice (CLIP) low-back pain guidelines

    PubMed Central

    Rossignol, Michel; Poitras, Stéphane; Dionne, Clermont; Tousignant, Michel; Truchon, Manon; Arsenault, Bertrand; Allard, Pierre; Coté, Manon; Neveu, Alain

    2007-01-01

    Background Evaluation of low-back pain guidelines using Appraisal of Guidelines Research and Evaluation (AGREE) criteria has shown weaknesses, particularly in stakeholder involvement and applicability of recommendations. The objectives of this project were to: 1) develop a primary care interdisciplinary clinical practice guideline aimed at preventing prolonged disability from low-back pain, using a community of practice approach, and 2) assess the participants' impressions with the process, and evaluate the relationship between participant characteristics and their participation. Methods Ten stakeholder representatives recruited 136 clinicians to participate in this community of practice. Clinicians were drawn from the following professions: physiotherapists (46%), occupational therapists (37%), and family physicians (17%). Using previously published guidelines, systematic reviews, and meta-analyses, a first draft of the guidelines was presented to the community of practice. Four communication tools were provided for discussion and exchanges with experts: a web-based discussion forum, an anonymous comment form, meetings, and a symposium. Participants were prompted for comments on interpretation, clarity, and applicability of the recommendations. Clinical management recommendations were revised following these exchanges. At the end of the project, a questionnaire was sent to the participants to assess satisfaction towards the guidelines and the development process. Results Twelve clinical management recommendations on management of low-back pain and persistent disability were initially developed. These were discussed through 188 comments posted on the discussion forum and 103 commentary forms submitted. All recommendations were modified following input of the participants. A clinical algorithm summarizing the guidelines was also developed. A response rate of 75% was obtained for the satisfaction questionnaire. The majority of respondents appreciated the development

  12. An evidence-based diagnostic classification system for low back pain

    PubMed Central

    Vining, Robert; Potocki, Eric; Seidman, Michael; Morgenthal, A. Paige

    2013-01-01

    Introduction: While clinicians generally accept that musculoskeletal low back pain (LBP) can arise from specific tissues, it remains difficult to confirm specific sources. Methods: Based on evidence supported by diagnostic utility studies, doctors of chiropractic functioning as members of a research clinic created a diagnostic classification system, corresponding exam and checklist based on strength of evidence, and in-office efficiency. Results: The diagnostic classification system contains one screening category, two pain categories: Nociceptive, Neuropathic, one functional evaluation category, and one category for unknown or poorly defined diagnoses. Nociceptive and neuropathic pain categories are each divided into 4 subcategories. Conclusion: This article describes and discusses the strength of evidence surrounding diagnostic categories for an in-office, clinical exam and checklist tool for LBP diagnosis. The use of a standardized tool for diagnosing low back pain in clinical and research settings is encouraged. PMID:23997245

  13. Effects of the CORE Exercise Program on Pain and Active Range of Motion in Patients with Chronic Low Back Pain.

    PubMed

    Cho, Hwi-Young; Kim, Eun-Hye; Kim, Junesun

    2014-08-01

    [Purpose] This study aimed to identify the effects of the CORE exercise program on pain and active range of motion (AROM) in patients with chronic low back pain. [Subjects and Methods] Thirty subjects with chronic low back pain were randomly allocated to two groups: the CORE group (n = 15) and the control group (n = 15). The CORE group performed the CORE exercise program for 30 minutes a day, 3 times a week, for 4 weeks, while the control group did not perform any exercise. The visual analog scale (VAS) and an algometer were used to measure pain, and pain-free AROM in the trunk was measured before and after the intervention. [Results] The CORE group showed significantly decreased VAS scores at rest and during movement and had a significantly increased pressure pain threshold in the quadratus lumborum and AROM in the trunk compared with those in the control group. [Conclusion] This study demonstrated that the CORE exercise program is effective in decreasing pain and increasing AROM in patients with chronic low back pain. Thus, the CORE exercise program can be used to manage pain and AROM in patients with chronic low back pain.

  14. Mechanisms of low back pain: a guide for diagnosis and therapy

    PubMed Central

    Allegri, Massimo; Montella, Silvana; Salici, Fabiana; Valente, Adriana; Marchesini, Maurizio; Compagnone, Christian; Baciarello, Marco; Manferdini, Maria Elena; Fanelli, Guido

    2016-01-01

    Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 3 months. CLBP represents the second leading cause of disability worldwide being a major welfare and economic problem. The prevalence of CLBP in adults has increased more than 100% in the last decade and continues to increase dramatically in the aging population, affecting both men and women in all ethnic groups, with a significant impact on functional capacity and occupational activities. It can also be influenced by psychological factors, such as stress, depression and/or anxiety. Given this complexity, the diagnostic evaluation of patients with CLBP can be very challenging and requires complex clinical decision-making. Answering the question “what is the pain generator” among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a mis-diagnosis can generate therapeutical mistakes. Traditionally, the notion that the etiology of 80% to 90% of LBP cases is unknown has been mistaken perpetuated across decades. In most cases, low back pain can be attributed to specific pain generator, with its own characteristics and with different therapeutical opportunity. Here we discuss about radicular pain, facet Joint pain, sacro-iliac pain, pain related to lumbar stenosis, discogenic pain. Our article aims to offer to the clinicians a simple guidance to identify pain generators in a safer and faster way, relying a correct diagnosis and further therapeutical approach. PMID:27408698

  15. The Association Between Obesity and Low Back Pain and Disability Is Affected by Mood Disorders

    PubMed Central

    Chou, Louisa; Brady, Sharmayne R.E.; Urquhart, Donna M.; Teichtahl, Andrew J.; Cicuttini, Flavia M.; Pasco, Julie A.; Brennan-Olsen, Sharon L.; Wluka, Anita E.

    2016-01-01

    Abstract Low back pain (LBP) and obesity are major public health problems; however, the relationship between body composition and low back pain in men is unknown. This study aims to examine the association between body composition and LBP and disability in a population-based sample of men, as well as the factors that may affect this relationship. Nine hundred seventy-eight male participants from the Geelong Osteoporosis Study were invited to participate in a follow-up study in 2006. Participants completed questionnaires on sociodemographics and health status. Low back pain was determined using the validated Chronic Back Pain Grade Questionnaire and the presence of an emotional disorder was assessed using the Hospital Anxiety Depression Scale. Body composition was measured using dual energy x-ray absorptiometry. Of the 820 respondents (84% response rate), 124 (15%) had high-intensity low back pain and/or disability (back pain). Low back pain was associated with higher body mass index (28.7 ± 0.4 vs 27.3 ± 0.2 kg/m2, P = 0.02) and waist–hip ratio (0.97 ± 0.006 vs 0.96 ± 0.006, P = 0.04), with increased tendency toward having a higher fat mass index (8.0 vs 7.6 kg/m2, P = 0.08), but not fat-free mass index (P = 0.68). The associations between back pain and measures of obesity were stronger in those with an emotional disorder, particularly for waist–hip ratio (P = 0.05 for interaction) and fat mass index (P = 0.06 for interaction). In a population-based sample of men, high-intensity LBP and/or disability were associated with increased levels of obesity, particularly in those with an emotional disorder. This provides evidence to support a biopsychosocial interaction between emotional disorders and obesity with low back pain. PMID:27082599

  16. The effect of experimental low back pain on lumbar muscle activity in people with a history of clinical low back pain: a muscle functional MRI study.

    PubMed

    Danneels, Lieven; Cagnie, Barbara; D'hooge, Roseline; De Deene, Yves; Crombez, Geert; Vanderstraeten, Guy; Parlevliet, Thierry; Van Oosterwijck, Jessica

    2016-02-01

    In people with a history of low back pain (LBP), structural and functional alterations have been observed at several peripheral and central levels of the sensorimotor pathway. These existing alterations might interact with the way the sensorimotor system responds to pain. We examined this assumption by evaluating the lumbar motor responses to experimental nociceptive input of 15 participants during remission of unilateral recurrent LBP. Quantitative T2 images (muscle functional MRI) were taken bilaterally of multifidus, erector spinae, and psoas at several segmental levels (L3 upper and L4 upper and lower endplate) and during several conditions: 1) at rest, 2) upon trunk-extension exercise without pain, and 3) upon trunk-extension exercise with experimental induced pain at the clinical pain-side (1.5-ml intramuscular hypertonic saline injections in erector spinae). Following experimental pain induction, muscle activity levels similarly reduced for all three muscles, on both painful and nonpainful sides, and at multiple segmental levels (P = 0.038). Pain intensity and localization from experimental LBP were similar as during recalled clinical LBP episodes. In conclusion, unilateral and unisegmental experimental LBP exerts a generalized and widespread decrease in lumbar muscle activity during remission of recurrent LBP. This muscle response is consistent with previous observed patterns in healthy people subjected to the same experimental pain paradigm. It is striking that similar inhibitory patterns in response to pain could be observed, despite the presence of preexisting alterations in the lumbar musculature during remission of recurrent LBP. These results suggest that motor output can modify along the course of recurrent LBP.

  17. Do bacteria play an important role in the pathogenesis of low back pain?

    PubMed

    Fisher, Thomas J; Osti, Orso L

    2015-11-01

    Considerable interest has been generated recently regarding an alternative hypothesis for the pathogenesis of low back pain and radiculopathy in the presence of intervertebral disc prolapse. Traditionally, back pain and radicular (sciatic) symptoms have been attributed to mechanical compression of neural tissue by herniated disc material and to inflammation caused by exposure of the nerve roots to disc tissue. Recent research however has suggested that low-grade infection within the intervertebral disc by anaerobic bacteria may be responsible. The development of Modic changes in the corresponding adjacent vertebral endplates has also been suggested as an indicator of infection. This article is a thorough review of the current literature regarding the hypothesis that low-grade anaerobic bacterial infection may be the cause of disabling low back pain and radiculopathy.

  18. The efficiency assessment of rehabilitation with DBC method in low back pain patients.

    PubMed

    Giemza, Czesław; Bodnar, Agnieszka; Kabała, Tomasz; Gruszecka, Dominika; Lipnicki, Wojciech; Magiera, Przemysław; Kowalski, Jacek

    2006-12-29

    Rehabilitation in patients with low back pain is one of the crucial therapeutic and social problems. This work attempts to present therapeutic procedures according to DBC (Documentation Based Care) treatment concept. The aim of the research was to assess the efficiency of DBC method on the basis of spine mobility in frontal, saggital and transverse plane and also on the basis of patient's subjective feelings. The research was carried out among 50 patients (52,5 years on average) including 23 females and 27 males. All the patients participating in the research were chosen deliberately and suffered from chronic low back pain caused by degenerative changes. On the basis of research range of motion (ROM) improvement in all planes, decrease of pain and functional impairment were stated.

  19. Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain: a cluster analysis.

    PubMed

    Rabey, Martin; Slater, Helen; OʼSullivan, Peter; Beales, Darren; Smith, Anne

    2015-10-01

    The objectives of this study were to explore the existence of subgroups in a cohort with chronic low back pain (n = 294) based on the results of multimodal sensory testing and profile subgroups on demographic, psychological, lifestyle, and general health factors. Bedside (2-point discrimination, brush, vibration and pinprick perception, temporal summation on repeated monofilament stimulation) and laboratory (mechanical detection threshold, pressure, heat and cold pain thresholds, conditioned pain modulation) sensory testing were examined at wrist and lumbar sites. Data were entered into principal component analysis, and 5 component scores were entered into latent class analysis. Three clusters, with different sensory characteristics, were derived. Cluster 1 (31.9%) was characterised by average to high temperature and pressure pain sensitivity. Cluster 2 (52.0%) was characterised by average to high pressure pain sensitivity. Cluster 3 (16.0%) was characterised by low temperature and pressure pain sensitivity. Temporal summation occurred significantly more frequently in cluster 1. Subgroups were profiled on pain intensity, disability, depression, anxiety, stress, life events, fear avoidance, catastrophizing, perception of the low back region, comorbidities, body mass index, multiple pain sites, sleep, and activity levels. Clusters 1 and 2 had a significantly greater proportion of female participants and higher depression and sleep disturbance scores than cluster 3. The proportion of participants undertaking <300 minutes per week of moderate activity was significantly greater in cluster 1 than in clusters 2 and 3. Low back pain, therefore, does not appear to be homogeneous. Pain mechanisms relating to presentations of each subgroup were postulated. Future research may investigate prognoses and interventions tailored towards these subgroups. PMID:26020225

  20. Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain: a cluster analysis.

    PubMed

    Rabey, Martin; Slater, Helen; OʼSullivan, Peter; Beales, Darren; Smith, Anne

    2015-10-01

    The objectives of this study were to explore the existence of subgroups in a cohort with chronic low back pain (n = 294) based on the results of multimodal sensory testing and profile subgroups on demographic, psychological, lifestyle, and general health factors. Bedside (2-point discrimination, brush, vibration and pinprick perception, temporal summation on repeated monofilament stimulation) and laboratory (mechanical detection threshold, pressure, heat and cold pain thresholds, conditioned pain modulation) sensory testing were examined at wrist and lumbar sites. Data were entered into principal component analysis, and 5 component scores were entered into latent class analysis. Three clusters, with different sensory characteristics, were derived. Cluster 1 (31.9%) was characterised by average to high temperature and pressure pain sensitivity. Cluster 2 (52.0%) was characterised by average to high pressure pain sensitivity. Cluster 3 (16.0%) was characterised by low temperature and pressure pain sensitivity. Temporal summation occurred significantly more frequently in cluster 1. Subgroups were profiled on pain intensity, disability, depression, anxiety, stress, life events, fear avoidance, catastrophizing, perception of the low back region, comorbidities, body mass index, multiple pain sites, sleep, and activity levels. Clusters 1 and 2 had a significantly greater proportion of female participants and higher depression and sleep disturbance scores than cluster 3. The proportion of participants undertaking <300 minutes per week of moderate activity was significantly greater in cluster 1 than in clusters 2 and 3. Low back pain, therefore, does not appear to be homogeneous. Pain mechanisms relating to presentations of each subgroup were postulated. Future research may investigate prognoses and interventions tailored towards these subgroups.

  1. Effect sizes of non-surgical treatments of non-specific low-back pain

    PubMed Central

    Hayden, J.; Bombardier, C.; van Tulder, M.

    2007-01-01

    Numerous randomized trials have been published investigating the effectiveness of treatments for non-specific low-back pain (LBP) either by trials comparing interventions with a no-treatment group or comparing different interventions. In trials comparing two interventions, often no differences are found and it raises questions about the basic benefit of each treatment. To estimate the effect sizes of treatments for non-specific LBP compared to no-treatment comparison groups, we searched for randomized controlled trials from systematic reviews of treatment of non-specific LBP in the latest issue of the Cochrane Library, issue 2, 2005 and available databases until December 2005. Extracted data were effect sizes estimated as Standardized Mean Differences (SMD) and Relative Risk (RR) or data enabling calculation of effect sizes. For acute LBP, the effect size of non-steroidal anti-inflammatory drugs (NSAIDs) and manipulation were only modest (ES: 0.51 and 0.40, respectively) and there was no effect of exercise (ES: 0.07). For chronic LBP, acupuncture, behavioral therapy, exercise therapy, and NSAIDs had the largest effect sizes (SMD: 0.61, 0.57, and 0.52, and RR: 0.61, respectively), all with only a modest effect. Transcutaneous electric nerve stimulation and manipulation had small effect sizes (SMD: 0.22 and 0.35, respectively). As a conclusion, the effect of treatments for LBP is only small to moderate. Therefore, there is a dire need for developing more effective interventions. PMID:17619914

  2. Nordic Walking and chronic low back pain: design of a randomized clinical trial

    PubMed Central

    Morsø, Lars; Hartvigsen, Jan; Puggaard, Lis; Manniche, Claus

    2006-01-01

    Background Low Back Pain is a major public health problem all over the western world. Active approaches including exercise in the treatment of low back pain results in better outcomes for patients, but it is not known exactly which types of back exercises are most beneficial or whether general physical activity provide similar benefits. Nordic Walking is a popular and fast growing type of exercise in Northern Europe. Initial studies have demonstrated that persons performing Nordic Walking are able to exercise longer and harder compared to normal walking thereby increasing their cardiovascular metabolism. Until now no studies have been performed to investigate whether Nordic Walking has beneficial effects in relation to low back pain. The primary aim of this study is to investigate whether supervised Nordic Walking can reduce pain and improve function in a population of chronic low back pain patients when compared to unsupervised Nordic Walking and advice to stay active. In addition we investigate whether there is an increase in the cardiovascular metabolism in persons performing supervised Nordic Walking compared to persons who are advised to stay active. Finally, we investigate whether there is a difference in compliance between persons receiving supervised Nordic Walking and persons doing unsupervised Nordic Walking. Methods One hundred and fifty patients with low back pain for at least eight weeks and referred to a specialized secondary sector outpatient back pain clinic are included in the study. After completion of the standard back centre treatment patients are randomized into one of three groups: A) Nordic Walking twice a week for eight weeks under supervision of a specially trained instructor; B) Unsupervised Nordic Walking for eight weeks after one training session with an instructor; C) A one hour motivational talk including advice to stay active. Outcome measures are pain, function, overall health, cardiovascular ability and activity level. Results No

  3. Prevalence and risk factors for low back pain among professional cooks working in school lunch services

    PubMed Central

    Nagasu, Miwako; Sakai, Kazuhiro; Ito, Akiyoshi; Tomita, Shigeru; Temmyo, Yoshiomi; Ueno, Mitsuo; Miyagi, Shigeji

    2007-01-01

    Background The prevalence of self-reported low back pain among professional cooks was estimated to examine the effects of daily life conditions, job-related factors, and psychological factors on this disorder. Methods Data was collected using a mailed self-administered questionnaire. Results Of 7100 cooks, 5835 (82%) replied to the questionnaire, including 1010 men and 4825 women. The mean age was 41.4 for men and 47.5 for women. The prevalence of low back pain during a 1-month period was 72.2% among men and 74.7% among women, with no significant differences between groups. By logistic regression analyses, factors significantly associated with the prevalence of low back pain in 1 month were female gender (prevalence ratio [PR] 1.32; 95% CI, 1.03–1.68), current smoking (PR 1.57; 95% CI, 1.24–1.98), and past smoking (PR 1.35; 95% CI, 1.01–1.79). As for job-related factors, the number of cooked lunches per person (PR 1.28; 95% CI, 1.05–1.56), breaks in the morning session (PR 1.33; 95% CI, 1.13–1.56), kitchen environment (PR 1.09; 95%, CI, 1.03–1.15), and height of cooking equipment (PR 1.13; 95% CI, 1.08–1.19) were associated with the prevalence of low back pain. As for psychological factors, job satisfaction (PR 1.22; 95% CI, 1.03–1.45), stress at work (PR 1.68; 95% CI, 1.42–1.99), financial constraints (PR 1.23; 95% CI, 1.03–1.47), health-related stress (PR 1.31; 95% CI, 1.08–1.59) and worries about the future (PR 1.24; 95% CI, 1.01–1.52) were similarly associated. Conclusion Daily life conditions, job-related factors, and psychological factors are associated with the occurrence of low back pain. It is important to take comprehensive preventive measures to address a range of work and life conditions that can be improved to decrease the incidence of low back pain for professional cooks. PMID:17650300

  4. Severe low back pain as the initial symptom of venous thrombosis of the inferior vena cava

    PubMed Central

    Tabatabai, Mohsen Abdul Wahab; Butros, Victor Mikhaeel; Mahdi, Shihab Ahmed; Ahmad, Mohammad Javad

    2014-01-01

    A 45-year-old previously well male truck driver presented to the emergency department with severe low back pain; lumbosacral X-ray was normal and he was given analgaesics and discharged. The following day, he presented to the emergency department again, his pain had not responded to the analgaesics; this time he also presented with massive bilateral swelling of lower limbs and left testicle that started 3 h earlier. The pain was severe, dull and interfered with the patient's ability to walk. An urgent workup revealed extensive thrombosis of the inferior vena cava. PMID:25155491

  5. A 69-Year-Old Presenting With Musculoskeletal Low Back Pain: A Case of Lumbosacral Chordoma

    PubMed Central

    Williams, Shawn P.; Beckerman, Bernard; Piña Fonti, Maria Elena

    2014-01-01

    Objective The purpose of this case report is to describe the presentation of a patient with lumbosacral chordoma characterized by somatic chronic low back pain and intermittent sacral nerve impingement. Case report A 69-year-old male presenting to an emergency department (ED) with low back pain was provided analgesics and muscle relaxants then referred for a series of chiropractic treatments. Chiropractic treatment included manipulation, physical therapy, and rehabilitation. After 3 times per week for a total of 4 weeks, re-examination showed little relief of his symptoms. His pain symptoms worsened and he presented to the ED for the second time. Magnetic resonance imaging was performed and revealed a high intensity mass. Intervention and outcome The soft tissue mass identified on magnetic resonance imaging was surgically removed. Shortly after the surgery, the patient developed post-operative bleeding and was returned to surgery. During the second procedure, he developed a post-operative hemorrhage related to the development of disseminated intravascular coagulation and subsequently died during the second procedure. A malignant lumbosacral chordoma was diagnosed on pathologic examination. Conclusion This case report describes the presentation of a patient with lumbosacral chordoma presenting with musculoskeletal low back pain. Chordomas are rare with few prominent manifestations. An early diagnosis can potentially make a difference in morbidity and mortality. Due to its insidious nature, it is a difficult diagnosis and one that is often delayed. PMID:25685125

  6. The effects of core muscle release technique on lumbar spine deformation and low back pain

    PubMed Central

    Lee, Myounggi; Song, Changho; Jo, Younggwan; Ha, Donghun; Han, Dongwook

    2015-01-01

    [Purpose] The purpose of this study was to examine the effects of the core muscle release technique on correction of lumbar deformation and alleviation of low back pain. [Subjects] Ninety patients diagnosed with lumbar deformation and low back pain participated in this study. [Methods] The participants were divided into three groups according to method of treatment. The first group was treated with the core muscle release technique (CRT), the second group was treated with general exercise, and the third group was treated with electrotherapy. The core muscle release technique group received 50-minute of the core muscle release technique 5 times a week for 2 weeks, and the participants in this group were instructed not to receive any other treatments. After the 2 weeks of treatment, the patients were reexamined. The general exercise group performed Williams flexion exercises and McKenzie extension exercises 5 times a week for 2 weeks. The electrotherapy group was treated by application of electrotherapy with an interferential current therapy machine (TM-301. TOPMED. Seongnam, Republic of Korea) to the abdominal muscles and back muscles of the lumbar region. [Results] The data suggest that the core muscle release technique, general exercise, and electrotherapy all helped to decrease the alignment angle and VAS score. Of these treatment methods, however, the core muscle release technique was the most effective for treatment of lumbar spine deformation and low back pain. [Conclusion] The core muscle release technique was most effective for correction of lumbar spine deformation and pain alleviation. PMID:26157254

  7. Value of repeat CT scans in low back pain and radiculopathy.

    PubMed

    Schroeder, Josh E; Barzilay, Yair; Kaplan, Leon; Itshayek, Eyal; Hiller, Nurith

    2016-02-01

    We assessed the clinical value of repeat spine CT scan in 108 patients aged 18-60 years who underwent repeat lumbar spine CT scan for low back pain or radiculopathy from January 2008 to December 2010. Patients with a neoplasm or symptoms suggesting underlying disease were excluded from the study. Clinical data was retrospectively reviewed. Index examinations and repeat CT scan performed at a mean of 24.3 ± 11.3 months later were compared by a senior musculoskeletal radiologist. Disc abnormalities (herniation, sequestration, bulge), spinal stenosis, disc space narrowing, and bony changes (osteophytes, fractures, other changes) were documented. Indications for CT scan were low back pain (60 patients, 55%), radiculopathy (46 patients, 43%), or nonspecific back pain (two patients, 2%). A total of 292 spine pathologies were identified in 98 patients (90.7%); in 10 patients (9.3%) no spine pathology was seen on index or repeat CT scan. At repeat CT scan, 269/292 pathologies were unchanged (92.1%); 10/292 improved (3.4%), 8/292 worsened (2.8%, disc herniation or spinal stenosis), and five new pathologies were identified. No substantial therapeutic change was required in patients with worsened or new pathology. Added diagnostic value from repeat CT scan performed within 2-3 years was rare in patients suffering chronic or recurrent low back pain or radiculopathy, suggesting that repeat CT scan should be considered only in patients with progressive neurologic deficits, new neurologic complaints, or signs implying serious underlying conditions.

  8. Low back pain during pregnancy caused by a sacral stress fracture: a case report

    PubMed Central

    2012-01-01

    Introduction Sacral stress fractures are a rare but well known cause of low back pain. This type of fracture has also been observed as a postpartum complication. To date, no cases of intrapartum sacral stress fractures have been described in the literature. Case presentation We report the case of a 26-year-old Caucasian European primigravid patient (30 weeks and two days of gestation) who presented to our outpatient clinic with severe low back pain that had started after a downhill walk 14 days previously. She had no history of trauma. A magnetic resonance imaging scan revealed a non-displaced stress fracture of the right lateral mass of her sacrum. Following her decision to opt for non-operative treatment, our patient received an epidural catheter for pain control. The remaining course of her pregnancy was uneventful and our patient gave birth to a healthy child by normal vaginal delivery. Conclusions We conclude that a sacral stress fracture must be considered as a possible cause of low back pain during pregnancy. PMID:22475388

  9. Long-term safety and effectiveness of tanezumab as treatment for chronic low back pain.

    PubMed

    Gimbel, Joseph S; Kivitz, Alan J; Bramson, Candace; Nemeth, Mary Anne; Keller, David S; Brown, Mark T; West, Christine R; Verburg, Kenneth M

    2014-09-01

    A noncontrolled, randomized, multicenter study (NCT00924664) evaluated long-term safety and effectiveness of tanezumab in patients with chronic low back pain following a randomized placebo- and active-controlled parent study that evaluated analgesic efficacy. Patients were randomized to tanezumab 10mg (n=321) or 20mg (n=527) administered at 8-week intervals via 3 intravenous injections followed by 4 subcutaneous injections. Effectiveness analyses included change from parent study baseline in Brief Pain Inventory Short Form, Roland Morris Disability Questionnaire, and Patient's Global Assessment of low back pain. Safety assessments included adverse event documentation, physical/neurological examinations, and laboratory tests. Mean treatment duration during the extension study was 194 and 202 days with tanezumab 10 and 20mg, respectively. Both tanezumab doses provided similar and sustained improvements in all effectiveness outcomes. The most frequently reported adverse events were arthralgia, paresthesia, and hypoesthesia. Adverse events initially described as osteonecrosis were reported in 6 patients (tanezumab 10mg, n=2; tanezumab 20mg, n=4); 9 additional patients (tanezumab 10mg, n=7; tanezumab 20mg, n=2) underwent total joint replacement (TJR). A blinded, independent adjudication committee reviewed all 6 patients with reported osteonecrosis and 4 of the 9 patients undergoing TJR. Adjudication outcomes were osteonecrosis (n=0), worsening osteoarthritis (n=5; 1 rapidly progressive), and another diagnosis or indeterminate (n=5). Tanezumab 10mg had better tolerability than tanezumab 20mg, and may represent an effective long-term treatment for chronic low back pain.

  10. Low back pain during pregnancy in Iranian women: Prevalence and risk factors.

    PubMed

    Ansari, Noureddin Nakhostin; Hasson, Scott; Naghdi, Soofia; Keyhani, Sousan; Jalaie, Shohreh

    2010-01-01

    Low back pain (LBP) is a common and often disabling condition that deserves attention. Although LBP during pregnancy is a common clinical problem, only one study was found documenting prevalence of LBP during pregnancy in Iran. No investigation evaluated the diagnostic value of possible risk factors. The aims of the present, cross-sectional study were 1) to ascertain the prevalence of LBP of Iranian women during pregnancy and compare to other ethnic/cultural groups and 2) identify risk factors associated with LBP during pregnancy in Iranian women. One hundred three women were interviewed in the obstetric ward of a university hospital within 48 hours after giving birth. Possible risk factor associations were studied by using nonparametric tests, and sensitivity, specificity, positive and negative predictive, and likelihood ratio values were calculated for the interview questions about previous low back pain, LBP during menstruation, and trauma during pregnancy. The prevalence of LBP during pregnancy was found to be 57.3%, which is similar to most other countries. Pain onset was most frequently reported in the third trimester of pregnancy (40.7%) and was often reported to be in the low back area (71.2%). Almost half of the patients reported their pain as being moderate (44.1%). The logistic regression model demonstrated that the LBP during menstruation predicts a high risk for LBP during the current pregnancy. The study showed that LBP during menstruation and previous LBP may be useful tests for ruling out and ruling in LBP during pregnancy, respectively.

  11. Do Physical Symptoms Predict the Outcome of Surgical Fusion in Patients with Discogenic Low Back Pain?

    PubMed Central

    Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Aoki, Yasuchika; Nakamura, Junichi; Miyagi, Masayuki; Suzuki, Miyako; Kubota, Gou; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Shiga, Yasuhiro; Abe, Koki; Fujimoto, Kazuki; Kanamoto, Hiroto; Inoue, Gen; Takahashi, Kazuhisa

    2016-01-01

    Study Design Retrospective case series. Purpose To determine whether symptoms predict surgical outcomes for patients with discogenic low back pain (DLBP). Overview of Literature Specific diagnosis of DLBP remains difficult. Worsening of pain on flexion is a reported symptom of DLBP. This study sought to determine whether symptoms predict surgical outcomes for patients with DLBP. Methods We investigated 127 patients with low back pain (LBP) and no dominant radicular pain. Magnetic resonance imaging was used to select patients with disc degeneration at only one level. If pain was provoked during discography, we performed fusion surgery (87 patients). Visual analogue scale score and responses to a questionnaire regarding symptoms including worsening of pain on flexion or extension were assessed. Symptom sites before surgery were categorized into LBP alone, or LBP plus referred inguinal or leg pain. We followed 77 patients (average 3.0 years) and compared symptoms before surgery with surgical outcome. Results Sixty-three patients with a good outcome showed postsurgical pain relief (≥60% pain relief) and 14 patients with a poor outcome did not (<60% pain relief). In patients with good outcomes, worsening of LBP was evident in 65% of cases on flexion and in 35% on extension. However, these findings were not significantly different from those in patients with poor outcomes. The percentage of patients with LBP alone was significantly lower and the percentage of patients with LBP plus referred inguinal or leg pain was significantly higher in the group with good surgical outcome compared with patients in the group with poor surgical outcome (p<0.05). Conclusions Worsening of pain on extension may be a symptom of DLBP. Surgical outcomes were superior in patients with both LBP and either referred inguinal or leg pain compared with those having LBP alone. PMID:27340531

  12. Evaluation and Treatment of Low Back Pain: A Clinically Focused Review for Primary Care Specialists.

    PubMed

    Hooten, W Michael; Cohen, Steven P

    2015-12-01

    Low back pain (LBP) is a leading cause of disability worldwide. In the absence of a classification system for pain syndromes, classification of LBP on the basis of the distribution of pain as axial (pain generally localized to the low back) or radicular neuropathic (pain radiating to the lower extremities) is relevant to clinical practice because the distribution of pain is often a corollary of frequently occurring disease processes involving the lumbar spine. Common sources of axial LBP include the intervertebral disc, facet joint, sacroiliac joint, and paraspinal musculature, whereas common sources of radicular pain include a herniated intervertebral disc and spinal stenosis. The accuracy of historical and physical examination findings has been established for sacroiliac joint pain, radiculopathy, and lumbar spinal stenosis. However, the accuracy of similar data, so-called red flags, for identifying the underlying medical sources of LBP has been overstated. Diagnostic imaging studies can be useful, and adherence to established guidelines can protect against overuse. Multiple pharmacological trials exist for the management of LBP; however, the long-term outcomes of commonly used drugs are mixed. For carefully selected patients with axial LBP, radiofrequency denervation techniques can provide sustained pain relief. In patients with radicular pain, transforaminal epidural steroid injections may provide short-term pain relief, but neurostimulation may confer more enduring benefits of refractory symptoms. Pain-related indications for commonly performed operations include spinal decompression for radicular symptoms as well as spinal fusion or disc prosthesis for discogenic LBP. Physical modalities and psychological treatments can improve pain and functioning, but patient preferences may influence treatment adherence. PMID:26653300

  13. Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research.

    PubMed

    1994-12-01

    This Quick Reference Guide for Clinicians contains highlights from the Clinical Practice Guideline version of Acute Low Back Problems in Adults, which was developed by a private-sector panel of health care providers and consumers. The Quick Reference Guide is an example of how a clinician might implement the panel's findings and recommendations on the management of acute low back problems in working-age adults. Topics covered include the initial assessment of patients presenting with acute low back problems, identification of red flags that may indicate the presence of a serious underlying medical condition, initial management, special studies and diagnostic considerations, and further management considerations. Instructions for clinical testing for sciatic tension, recommendations for sitting and unassisted lifting, tests for identification of clinical pathology, and algorithms for patient management are included.

  14. Multipotent Mesenchymal Stem Cell Treatment for Discogenic Low Back Pain and Disc Degeneration

    PubMed Central

    Zeckser, Jeffrey; Wolff, Michael; Tucker, Jason; Goodwin, Josh

    2016-01-01

    Low back pain with resultant loss of function, decreased productivity, and high economic costs is burdensome for both the individual and the society. Evidence suggests that intervertebral disc pathology is a major contributor to spine-related pain and degeneration. When commonly used conservative therapies fail, traditional percutaneous or surgical options may be beneficial for pain relief but are suboptimal because of their inability to alter disc microenvironment catabolism, restore disc tissue, and/or preserve native spine biomechanics. Percutaneously injected Multipotent Mesenchymal Stem Cell (MSC) therapy has recently gained clinical interest for its potential to revolutionarily treat disc-generated (discogenic) pain and associated disc degeneration. Unlike previous therapies to date, MSCs may uniquely offer the ability to improve discogenic pain and provide more sustained improvement by reducing disc microenvironment catabolism and regenerating disc tissue. Consistent treatment success has the potential to create a paradigm shift with regards to the treatment of discogenic pain and disc degeneration. PMID:26880958

  15. Diagnosis and Treatment of Low Back Pain in the Pediatric Population

    PubMed Central

    Taxter, Alysha J.; Chauvin, Nancy A.; Weiss, Pamela F.

    2014-01-01

    Back pain in the pediatric population is a common complaint presenting to sports medicine clinic. There is a wide differential that should be considered, including mechanical, infectious, neoplastic, inflammatory, and amplified musculoskeletal pain. The history, pain quality, and examination are key components to help distinguish the etiologies of the pain and direct further evaluation. Laboratory investigations, including blood counts and inflammatory markers, can provide insight into the diagnosis. The HLA-B27 antigen can be helpful if a spondyloarthropathy is suspected. Imaging as clinically indicated typically begins with radiographs, and the use of MRI, CT, or bone scan can provide additional information. Proper diagnosis of back pain is important because prognosis and treatments are significantly different. This paper will review the pertinent evaluation, differential diagnoses, and treatment of low back pain in the pediatric population. PMID:24565826

  16. [Conservative treatment of chronic low back pain: what is new in 2008?].

    PubMed

    Balagué, F; Ochoa Amaya, G; Genevay, S

    2009-03-11

    An overview of the recent literature on chronic low back pain is presented from a general practitioner's perspective. Several drugs are available however the magnitude of their effect is low and they should be tailored to patient's preference. The cost-benefit ratio of strong opioid is controversial. Different types of exercises have favourable effect on function and quality of life. Graded activity, taking into account kinesio-phobia, may be more important than any specific type of exercise. Spinal infiltration should only be used in much selected patients. In case of unfavourable evolution, multidisciplinary approaches should be the next step. Caring for low back pain patients is a difficult exercise. There is no universal recipe. The emphasis should be put on tailoring treatment approaches to patient perspective.

  17. Possible Mechanisms of Low Back Pain due to Whole-Body Vibration

    NASA Astrophysics Data System (ADS)

    Pope, M. H.; Wilder, D. G.; Magnusson, M.

    1998-08-01

    The investigators describe their multifaceted approach to the study of the relationship between whole-body vibration and low back pain.In vitroexperiments, using percutaneous pin-mounted accelerometers have shown that the natural frequency is at 4·5 Hz. The frequency response was affected by posture, seating, and seat-back inclination. The response appears to be largely determined by the rocking of the pelvis. Electromyographic studies have shown that muscle fatigue occurs under whole body vibration. After whole body vibration exposure the muscle response to a sudden load has greater latency. Vehicle driving may be a reason for low back pain or herniated nucleus pulposus. Prolonged seating exposure, coupled with the whole body vibration should be reduced for those recovering from these problems. Vibration attenuating seats, and correct ergonomic layout of the cabs may reduce the risks of recurrence.

  18. Slipping accidents causing low-back pain in a gearbox factory.

    PubMed

    Manning, D P; Shannon, H S

    1981-01-01

    An accident model was used to analyze data in terms of the first event in all reported accidents occurring in a gearbox factory during 1974. The data were used to study the causes of lumbosacral injuries. A labor force of 2000 men sustained 99 lumbosacral injuries, 54 of which led to absence of one or more days. Twenty of the 54 were initiated by slipping, and 17 presented as a sudden onset of low-back pain without any preceding accidental event. A review of all patients who were absent following a slipping accident disclosed that the lumbosacral region was by far the commonest part of the body injured. Tripping was an infrequent cause of these injuries. Slipping rarely features in the literature as a cause of low-back pain. It is suggested that this is due to confusion between various contributory factors and events forming an accident.

  19. Locating and treating low back pain of myofascial origin by ischemic compression

    PubMed Central

    Hains, Guy

    2002-01-01

    The purpose of this article is to describe a method to identify and treat trigger points of myofascial origin by ischemic compression among patients with low back pain. In addition to a review of the literature, the author draws upon his own clinical experience to accomplish this goal. In general, thumb pressure is used for the identification, localization and treatment of trigger points and tender spots within the muscles of the lumbar, pelvic, femoral and gluteal areas. The management of low back pain of myofascial origin by ischemic compression can be used in any setting, without the need of specialized equipment. In addition to clinical effectiveness within a wide range of safety, this approach is easy on the practitioner and well tolerated by the patient. ImagesFigure 1Figure 9

  20. Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement tests

    PubMed Central

    Scholtes, Sara A.; Gombatto, Sara P.; Van Dillen, Linda R.

    2009-01-01

    Background Clinical data suggest that active limb movements may be associated with early lumbopelvic motion and increased symptoms in people with low back pain. Methods Forty-one people without low back pain who did not play rotation-related sports and 50 people with low back pain who played rotation-related sports were examined. Angular measures of limb movement and lumbopelvic motion were calculated across time during active knee flexion and active hip lateral rotation in prone using a three-dimensional motion capture system. Timing of lumbopelvic motion during the limb movement tests was calculated as the difference in time between the initiation of limb movement and lumbopelvic motion normalized to limb movement time. Findings During knee flexion and hip lateral rotation, people with low back pain demonstrated a greater maximal lumbopelvic rotation angle and earlier lumbopelvic rotation, compared to people without low back pain (P<0.05). Interpretation The data suggest that people with low back pain who play rotation-related sports may move their lumbopelvic region to a greater extent and earlier during lower limb movements than people without low back pain. Because people perform many of their daily activities in early to midranges of joint motion the lumbopelvic region may move more frequently across the day in people with low back pain. The increased frequency may contribute to increased lumbar region tissue stress and potentially low back pain symptoms. Lower limb movements, therefore, may be important factors related to the development or persistence of low back pain. PMID:18990474

  1. High Intensity Laser Therapy (HILT) versus TENS and NSAIDs in low back pain: clinical study

    NASA Astrophysics Data System (ADS)

    Zati, Allesandro; Fortuna, Damiano; Valent, A.; Filippi, M. V.; Bilotta, Teresa W.

    2004-09-01

    Low back pain, caused by lumbar disc herniation, is prevalently treated with a conservative approach. In this study we valued the efficacy of High Intensity Laser Therapy (HILT), compared with accepted therapies such as TENS and NSAIDs. Laser therapy obtained similar results in the short term, but better clinical effect over time than TENS and NSAIDs. In conclusion high intensity laser therapy appears to be a interesting new treatment, worthy of further research.

  2. Estimating investment worthiness of an ergonomic intervention for preventing low back pain from a firm's perspective

    PubMed Central

    Hughes, Richard E.; Nelson, Nancy A.

    2009-01-01

    A mathematical model was developed for estimating the net present value (NPV) of the cash flow resulting from an investment in an intervention to prevent occupational low back pain (LBP). It combines biomechanics, epidemiology, and finance to give an integrated tool for a firm to use to estimate the investment worthiness of an intervention based on a biomechanical analysis of working postures and hand loads. The model can be used by an ergonomist to estimate the investment worthiness of a proposed intervention. The analysis would begin with a biomechanical evaluation of the current job design and post-intervention job. Economic factors such as hourly labor cost, overhead, workers' compensation costs of LBP claims, and discount rate are combined with the biomechanical analysis to estimate the investment worthiness of the proposed intervention. While this model is limited to low back pain, the simulation framework could be applied to other musculoskeletal disorders. The model uses Monte Carlo simulation to compute the statistical distribution of NPV, and it uses a discrete event simulation paradigm based on four states: (1) working and no history of lost time due to LBP, (2) working and history of lost time due to LBP, (3) lost time due to LBP, and (4) leave job. Probabilities of transitions are based on an extensive review of the epidemiologic review of the low back pain literature. An example is presented. PMID:19028380

  3. Evaluation of low back pain risks in a beef skinning operation.

    PubMed

    Das, B; Sengupta, A K

    2000-01-01

    The low back pain risks in a beef skinning operation at a high stand kill floor workstation was evaluated. The increases in compressive forces at lower back (L5/S1) between normal slump (back angle 25 degrees, measured in the sagittal plane) and severe (45 degrees ) and between normal slump and very severe (70 degrees ) bent back postures were 387 N or 28% and 616 N or 45%, respectively. The high spine load coupled with high level of repetition can have a high probability of fatigue failure in the spine structural members. Non-neutral back posture for a large portion of the total work time can be a low back pain risk factor. The videotape analysis showed that the times involved during the task performance for the bent back (more than 25 degrees ) and severe bent back (more than 45 degrees ) were 48.4 and 33.5% of the total cycle time, respectively. The upper limit from OWAS (Ovako Working Posture Analysis System) for bent back posture is 30% of the total cycle time. The bent and twisted back posture (both more than 25 degrees ) time was 10.4% compared to OWAS limit of 5%. This indicated that actions are needed in the near future to alleviate the risk of low back pain. Ergonomics redesign of the workstation was recommended for the operation.

  4. Comparison of chronic low-back pain patients hip range of motion with lumbar instability

    PubMed Central

    Lee, Sang wk; Kim, Suhn Yeop

    2015-01-01

    [Purpose] The purpose of this study was to compare differences in hip range of motion between a lumbar stability group and a lumbar instability group of patients with chronic low-back pain. [Subjects] Sixty-nine patients with chronic low-back pain were divided into two groups: a lumbar stability group (n=39) and a lumbar instability group (n=30). [Methods] The patients were assessed using a goniometer to evaluate the hip range of motion at pre-test. Data were analyzed using SPSS 18.0 software for Windows. The experimental data were analyzed using one-way ANOVA, repeated one-way ANOVA, and the t-test, and a significance level of 0.05. [Results] The limitation of hip range of motion of the lumbar instability group was significantly greater than that of the lumbar stability group. [Conclusion] The chronic low-back pain patients showed greater limitation of hip range of motion than healthy persons, and among them, those who had lumbar instability showed greater limitation than those with lumbar stability. PMID:25729165

  5. Possible mechanisms for the reduction of low back pain associated with standing on a sloped surface.

    PubMed

    Gallagher, Kaitlin M; Wong, Alexander; Callaghan, Jack P

    2013-03-01

    Prolonged standing in an occupational setting has long been associated with the development of low back pain. In response to this, researchers have investigated various interventions that can alleviate low back pain and discomfort, such as anti-fatigue mats, shoe insoles, and more recently, sloped platforms. The purpose of this study was to investigate the effects of a sloped surface on kinematics and trunk muscle thickness during quiet and prolonged occupational standing. Eleven participants performed 1-min quiet standing tasks on three surfaces - level ground, incline, and decline - followed by 16-min of prolonged standing in each condition. Trunk, lumbar, and global pelvis angles were measured during each standing condition, and muscle thickness measurements of erector spinae and the lateral abdominal wall were taken during the quiet standing task. During quiet standing, there were systematic changes in trunk, lumbar, and pelvis angles with the different surfaces; however, these changes were not accompanied by systematic changes in muscle thickness. The responses found during the quiet standing were consistent during prolonged standing. As a result, the reduced perceived low back pain found when using sloped platforms is likely not the result of changes in morphology of the trunk musculature, but might be related to the altered kinematics caused by standing on these platforms. PMID:22885160

  6. Screening for malignancy in low back pain patients: a systematic review

    PubMed Central

    Maher, Christopher G.; Refshauge, Kathryn M.

    2007-01-01

    To describe the accuracy of clinical features and tests used to screen for malignancy in patients with low back pain. A systematic review was performed on all available records on MEDLINE, EMBASE, and CINAHL electronic databases. Studies were considered eligible if they investigated a cohort of low back pain patients, used an appropriate reference standard, and reported sufficient data on the diagnostic accuracy of tests. Two authors independently assessed methodological quality and extracted data to calculate positive (LR+) and negative (LR−) likelihood ratios. Six studies evaluating 22 different clinical features and tests were identified. The prevalence of malignancy ranged from 0.1 to 3.5%. A previous history of cancer (LR+ = 23.7), elevated ESR (LR+ = 18.0), reduced hematocrit (LR+ = 18.2), and overall clinician judgement (LR+ = 12.1) increased the probability of malignancy when present. A combination of age ≥50 years, a previous history of cancer, unexplained weight loss, and failure to improve after 1 month had a reported sensitivity of 100%. Overall, there was poor reporting of methodological quality items, and very few studies were performed in community primary care settings. Malignancy is rare as a cause of low back pain. The most useful features and tests are a previous history of cancer, elevated ESR, reduced hematocrit, and clinician judgement. PMID:17566791

  7. Advice for the management of low back pain: a systematic review of randomised controlled trials.

    PubMed

    Liddle, S Dianne; Gracey, Jacqueline H; Baxter, G David

    2007-11-01

    To synthesise the evidence relating to the effectiveness of advice, the relevance of its content and frequency, and to compare the advice being offered to acute, subacute and chronic low back pain (LBP) patients. A systematic review of Randomised Controlled Trials (RCTs) using advice, either alone or with another intervention. The QUOROM guidelines and the Cochrane Collaboration Back Review Group Guidelines for Systematic Reviews were followed throughout: methodological assessment identified RCTs of 'high' or 'medium' methodological quality, based on their inclusion of at least 50% of the specified internal validity criteria. Outcome measures were analysed based on five recommended core outcome domains; pain, work disability, back-specific function, generic health status and satisfaction with care. Relevant RCTs (n=56) were scored for methodological quality; 39 RCTs involving 7347 patients qualified for inclusion, based upon their methodological quality. Advice as an adjunct to exercise was most effective for improving pain, back-specific function and work disability in chronic LBP but, for acute LBP, was no more effective for improving these outcomes than simple advice to stay active. Advice as part of a back school was most effective for improving back-specific function in subacute LBP; these trials generally demonstrated long-term positive results. Advice as an adjunct to exercise was the most common form of treatment for acute and chronic LBP; advice as part of a back school was most commonly used for subacute LBP. Fifteen percent of acute LBP trials had a positive outcome, compared to 86% and 74% of subacute and chronic LBP trials respectively. A wide variety of outcome measures were used, making valid comparisons between treatment outcomes difficult. The advice provided to patients with LBP within RCTs varied considerably depending on symptom duration. The findings of this review have important implications for clinical practice, and for the design of further

  8. Kinematics of Shooting in High School and Collegiate Lacrosse Players With and Without Low Back Pain

    PubMed Central

    Wasser, Joseph G.; Chen, Cong; Vincent, Heather K.

    2016-01-01

    Background: Low back pain (LBP) and motion alterations can occur in athletes who engage in high-speed throwing motions. The relationship between LBP and shooting motion in lacrosse players is not yet known. Purpose: To quantify the effects of LBP on key kinematic parameters of the lacrosse shot and determine the contribution of the severity of LBP on specific kinematic parameters of the shooting motion. Study Design: Controlled laboratory study. Methods: High school and collegiate players (N = 24) were stratified into 2 groups based on back pain symptoms (LBP or no pain). Three-dimensional motion capture of overhead throws was used to collect data on knee, pelvis, trunk, and shoulder kinematics as well as crosse stick (the stick capped with a strung net) and ball speed. Results: Mean low back numeric pain rating scale (NRSpain) score was 2.9. Knee flexion at ball release was greater in the LBP than no pain group, indicating a more bent knee (P = .04). The LBP group demonstrated less angular velocity transfer from pelvis to trunk than the no pain group (P = .05). Total range of motion of the pelvis and shoulders during the shot and follow-through were less in the LBP group than the no pain group (83.6° ± 24.5° vs 75.9° ± 24.5°, P = .05). Age- and sex-adjusted regression analyses revealed that the low back NRSpain rating contributed 6.3% to 25.0% of the variance to the models of shoulder transverse rotation range of motion, trunk and shoulder rotation angular velocities, and knee flexion angle (P < .05). Conclusion: LBP severity significantly contributes to trunk and shoulder motion restriction during lacrosse shooting. Inclusion of lumbopelvic and core training and prehabilitation programs for high school and collegiate players may reduce pain in affected players as well as help them to attain appropriate motion parameters and avoid secondary musculoskeletal injuries. Clinical Relevance: This research identified a prehabilitation need in the understudied

  9. Efficacy of coblation annuloplasty in discogenic low back pain: a prospective observational study.

    PubMed

    He, Liangliang; Hu, Xiangyu; Tang, Yuanzhang; Li, Xiuhua; Zheng, Shuyue; Ni, Jiaxiang

    2015-05-01

    In degenerative disc, the innervated outer annulus is confirmed to the major origin resulted in discogenic pain. To alleviate the discogenic pain, annuloplasty with electrothermal technology was proved to be effective, which mainly involves the thermal heating of the annulus to denature collagen fibers and denervate posterior annular nerve fibers. However, little is known that efficacy of annuloplasty with coblation technology in treating discogenic pain through directly interrupting nerves in outer annulus.The purpose of this study was to evaluate the clinical outcomes of coblation annuloplasty for the treatment of discogenic low back pain.In a clinical prospective observational study, 17 consecutive patients with discogenic low back pain underwent coblation annuloplasty under local anesthesia. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, and modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 6 months of follow-up.The preoperative pain VAS score was 6.5 ± 0.8(95% confidence interval [CI] 6.1-6.9) and the pain VAS score decreased to 2.9 ± 1.6 (95% CI 2.1-3.8), 2.9 ± 1.7 (95% CI 2.1-3.8), 3.2 ± 1.6 (95% CI 2.4-4.1), 3.2 ± 1.7 (95% CI 2.4-4.2) at 1 week and 1, 3 and 6 month postoperatively, respectively. 12 (70.6%), 11 (64.7%), 10 (58.8%) and 10 (58.8%) of patients reported significant pain relief at 1 week and 1, 3 and 6 months postoperatively. At 1, 3, and 6 months postoperatively, the numbers of patients with "excellent" or "good" ratings were 13 (76.5%), 11 (64.7%), and 10 (58.8%) according to the modified MacNab criteria. No serious complications were observed.The finds show that coblation annuloplasty is an effective, safe, and less uncomfortable procedure in managing discogenic low back pain.

  10. A comprehensive review of clinical trials on the efficacy and safety of drugs for the treatment of low back pain.

    PubMed

    Schnitzer, Thomas J; Ferraro, Aimee; Hunsche, Elke; Kong, Sheldon X

    2004-07-01

    A systematic review involving 50 randomized controlled trials (4,863 patients) published since 1980 was undertaken with the objective of assessing efficacy and safety of low back pain (LBP) medications. The methodological quality of each trial was evaluated based on a standardized system. Quality scores ranged from 26 to 82 points on a 100-point scale (from 0 to 100), indicating an overall moderate quality of the trials reviewed. Limited evidence was found regarding the effectiveness of drug treatments for LBP and current studies focused on short-term usage of the therapies. Available evidence supported the effectiveness of non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) in acute and chronic LBP, of muscle relaxants in acute LBP, and of antidepressants in chronic LBP; safety results were heterogeneous. More rigorously designed trials should be implemented to establish comparative efficacy and safety of drugs used to treat chronic and acute LBP. PMID:15223086

  11. Effectiveness of Sling Exercise for Chronic Low Back Pain: A Systematic Review

    PubMed Central

    Lee, Jin-Su; Yang, Seung-Hoon; Koog, Yun-Hyung; Jun, Hyun-Ju; Kim,, Se-Hun; Kim,, Ki-Jong

    2014-01-01

    [Purpose] This study investigated effects of sling exercise for patients with chronic low back pain. [Methods] We reviewed all relevant papers indexed in PubMed, SCOPUS, and the Cochrane Registered Trials. Eligible trials were randomized controlled trials that compared sling exercise with any type of treatment. We extracted data on muscle thickness, muscle activation, pain, and disability, and assessed the methodological quality of the data. Seven studies met our inclusion criteria. [Results] When sling exercise had an impact on activation of the trunk muscles, increasing the trunk muscle thickness, and the reduction in pain and disability had been assessed shortly after the final exercise session, it was more effective than general exercise at activating trunk muscles, but not more effective at increasing trunk muscle thickness and improving pain and disability than general exercise. [Conclusion] As sling therapy studies are based on a small number of trials, we cannot draw conclusions about the therapeutic effects of sling exercise. When segmental stabilizing exercise and individually designed programs are added to sling exercise, it increases the effectiveness of sling exercise at improving low back pain. This should be the focus of future studies. PMID:25202202

  12. The Cooper River Bridge Run Study of low back pain in runners and walkers.

    PubMed

    Woolf, Shane K; Barfield, William R; Nietert, Paul J; Mainous, Arch G; Glaser, John A

    2002-01-01

    Investigations dedicated to examining relationships between low back pain (LBP) and factors specific to running and walking are limited. Current literature suggests runners and walkers may have a lower relative risk for significant LBP. The purpose of this study was to investigate the incidence, prevalence, and possible risk factors for LBP among a group of runners and walkers. A survey was administered to participants who registered for either a 10-kilometer run or 4-mile recreational walk. A total of 539 responses were received. Previous history of LBP was reported by 74% of respondents overall. Prevalence of LBP at the time of survey completion was 13.6%. Low back pain was experienced more frequently by obese runners and by those who reported certain patterns of shoe wear. Regular participation in aerobics correlated with a reduced lifetime risk for LBP. We believe these findings warrant further investigation. This knowledge may benefit not only athletes in training, but other fitness enthusiasts, including casual runners and walkers and those who jog or walk to rehabilitate low back injuries.

  13. Comparison of Transforaminal and Parasagittal Epidural Steroid Injections in Patients With Radicular Low Back Pain

    PubMed Central

    Hashemi, Seyed Masoud; Aryani, Mohamad Reza; Momenzadeh, Sirus; Razavi, Seyed Sajad; Mohseni, Gholamreza; Mohajerani, Seyed Amir; Esmilijah, Ali Akbar

    2015-01-01

    Background: Epidural steroid injection (ESI), including transforaminal (TF) epidural injections and interlaminar (IL) epidural steroid injections are commonly performed procedures for the management of lumbosacral radicular pain. Parasagittal interlaminar (PIL) approach could enable higher ventral epidural spread, with fewer complications than TF. Objectives: This study aims to compare the effectiveness of PIL and TF ESI in relieving the pain and disability of patients with lumbosacral pain. Patients and Methods: This prospective study enrolled 64 patients, aged between 18 to 75 years, with a diagnosis of low back pain and unilateral lumbosacral radicular pain. The patients were randomized to receive fluoroscopically guided epidural injection, through either the PIL or TF approach. Patients were evaluated for effective pain relief [numerical rating scale (NRS) < 3] by 0 - 10 numeric rating scale (NRS) and functional improvement by the Oswestry Disability Index (ODI). Results: Effective pain relief [numeric rating scale (NRS) < 3] was observed in 77.3% (95% CI: 67‒90.5%) of patients in PIL group and 74.2% (95% CI: 62.4 - 89.4%) of patients in the TF group (P = 0.34), at 4 weeks. Mean NRS score was not significantly different between the PIL group compared to the TF group, at 4 weeks (P = 0.19). Number of patients with improved disability (measured by ODI < 20%) was not significantly different in PIL group (78% of cases) compared to the TF group (76% of cases), at 4 weeks (P = 0.21). There were no adverse effects observed in any of our patients. Conclusions: The PIL epidural injection is as effective as TF epidural injection in improving pain and functional status, in patients with chronic lumbosacral low back pain, due to disc degeneration. PMID:26587400

  14. Classification of Chronic Back Muscle Degeneration after Spinal Surgery and Its Relationship with Low Back Pain

    PubMed Central

    Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Aoki, Yasuchika; Nakamura, Junichi; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Kubota, Gou; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Shiga, Yasuhiro; Abe, Koki; Fujimoto, Kazuki; Kanamoto, Hirohito; Inoue, Gen; Takahashi, Kazuhisa

    2016-01-01

    Study Design Retrospective case series. Purpose To classify back muscle degeneration using magnetic resonance imaging (MRI) and investigate its relationship with back pain after surgery. Overview of Literature Back muscle injury and degeneration often occurs after posterior lumbar surgery, and the degeneration may be a cause of back pain. However, the relationship between back muscle degeneration and back pain remains controversial. Methods A total of 84 patients (average age, 65.1 years; 38 men, 46 women) with lumbar spinal stenosis underwent posterior decompression surgery alone. MRI (1.5 tesla) was evaluated before and more than a year after surgery in all patients. Muscle on MRI was classified into three categories: low intensity in T1-weighted imaging, high intensity in T2-weighted imaging (type 1), high intensity in both T1- and T2-weighted images (type 2), and low intensity in both T1- and T2-weighted imaging (type 3). The prevalence of the types and their relationship with back pain (determined on a visual analog scale) were evaluated. Results MRI revealed muscle degeneration in all patients after surgery (type 1, 6%; type 2, 82%; and type 3, 12%). Type 2 was significantly more frequent compared with types 1 and 3 (p<0.01). Low back pain was significantly improved after surgery (p<0.01). Low back pain was not associated with any MRI type of muscle degeneration after surgery (p>0.05). Conclusions Various pathologies of back muscle degeneration after posterior lumbar surgery were revealed. Type 2 (fatty) change was most frequent, and other patients had type 3 (scar) or type 1 (inflammation or water-like) changes. According to the Modic classification of bone marrow changes, Modic type 1 change is associated with inflammation and back pain. However, no particular type of back muscle degeneration was correlated with back pain after surgery. PMID:27340532

  15. Effects of experimentally induced low back pain on the sit-to-stand movement and electroencephalographic contingent negative variation.

    PubMed

    Jacobs, Jesse V; Yaguchi, Chie; Kaida, Chizuru; Irei, Mariko; Naka, Masami; Henry, Sharon M; Fujiwara, Katsuo

    2011-11-01

    It is becoming increasingly evident that people with chronic, recurrent low back pain (LBP) exhibit changes in cerebrocortical activity that associate with altered postural coordination, suggesting a need for a better understanding of how the experience of LBP alters postural coordination and cerebrocortical activity. To characterize changes in postural coordination and pre-movement cerebrocortical activity related to the experience of acutely induced LBP, 14 healthy participants with no history of LBP performed sit-to-stand movements in 3 sequential conditions: (1) without experimentally induced LBP; NoPain1, (2) with movement-associated LBP induced by electrocutaneous stimulation; Pain, and (3) again without induced LBP; NoPain2. The Pain condition elicited altered muscle activation and redistributed forces under the seat and feet prior to movement, decreased peak vertical force exerted under the feet during weight transfer, longer movement times, as well as decreased and earlier peak hip extension. Stepwise regression models demonstrated that electroencephalographic amplitudes of contingent negative variation during the Pain condition significantly correlated with the participants' change in sit-to-stand measures between the NoPain1 and Pain conditions, as well as with the subsequent difference in sit-to-stand measures between the NoPain1 and NoPain2 conditions. The results, therefore, identify the contingent negative variation as a correlate for the extent of an individual's LBP-related movement modifications and to the subsequent change in movement patterns from before to after the experience of acutely induced LBP, thereby providing a direction for future studies aimed to understand the neural mechanisms underlying the development of altered movement patterns with LBP.

  16. Misdiagnosis of Sacral Stress Fracture: An Underestimated Cause of Low Back Pain in Pregnancy?

    PubMed Central

    Perdomo, Ambar Deschamps; Tomé-Bermejo, Félix; Piñera, Angel R.; Alvarez, Luis

    2015-01-01

    Patient: Female, 28 Final Diagnosis: Sacral stress fracture Symptoms: Lumbosacral pain during pregnancy Medication: — Clinical Procedure: Activity modification • conservative treatment Specialty: Orthopedics and Traumatology Objective: Challenging differential diagnosis Background: Sacral stress fracture during pregnancy is an uncommon condition with unclear pathophysiology, presenting with non-specific symptoms and clinical findings. To date, few cases have been published in the literature describing the occurrence of sacral stress fracture during pregnancy. Case Report: We report a 28-year-old primigravid patient who developed lumbosacral pain at the end of the second trimester. Symptoms were overlooked throughout pregnancy and the postpartum period, resulting in the development of secondary chronic gait and balance problems. Conclusions: Stress fracture of the sacrum should be included in the differential diagnosis of low back and sacral pain during pregnancy. Its prevalence is probably underestimated because of the lack of specificity of the symptoms. Plain radiographs are not appropriate due to radiation exclusion; magnetic resonance is the only method that can be applied safely. There is limited information on natural history but many patients are expected to have a benign course. However, misdiagnosis may lead to prolonged morbidity and the development of secondary gait abnormalities. Stress fracture of the sacrum should be included in the differential diagnosis of low back and sacral pain during pregnancy. A high index of suspicion is necessary to establish an early diagnosis and appropriate treatment. PMID:25656418

  17. Cranial Treatment and Spinal Manipulation for a Patient With Low Back Pain: A Case Study

    PubMed Central

    Powell, Wayne; Knaap, Simone F.C.

    2015-01-01

    Objective The purpose of this case study is to present chiropractic management of a patient with chronic low back pain by focusing on the craniomandibular system. Clinical Features A 37-year-old man consulted a chiropractor for pain in the lumbosacral area with radiation down the anterolateral side of the upper left leg. The symptoms started after a fall the previous year. Examination showed a post-traumatic chronic L4-L5 facet dysfunction and left sacro-iliac joint dysfunction. Chiropractic spinal manipulation to the lumbar spine and pelvis gave only temporary relief from the pain. Intervention and Outcome A year later a bone scintigraphy was conducted, in which a lesion was found over the right sphenoid area. Cranial treatment of this area was added to the chiropractic treatment plan. After this treatment, the patient reported that he was pain free and could return to normal activities of daily living. Conclusion The clinical progress of this case suggests that for some patients, adding craniosacral therapy may be helpful in patients with low back symptoms. PMID:26644786

  18. Reassurance during low back pain consultations with GPs: a qualitative study

    PubMed Central

    Holt, Nicola; Pincus, Tamar; Vogel, Steven

    2015-01-01

    Background Reassurance is commonly recommended in guidelines for the management of low back pain in primary care, although it is poorly defined, and what it means to patients remains unknown. Aim To explore how patients with low back pain perceive practitioners’ reassuring behaviours during consultations. Design and setting Qualitative study undertaken with patients from nine GP surgeries in Northamptonshire, England. Method Twenty-three patients who had recently consulted for non-specific low back pain were recruited from general practice. Semi-structured interviews explored what they had found reassuring during their consultations and the effect of such reassurance since their consultations. Interview transcripts were analysed using the thematic framework method. Results Patients each brought to their consultations experiences, beliefs, expectations, and concerns that they wanted the doctor to hear and understand. They were reassured implicitly when it seemed the doctor was taking them seriously and wanted to help; this was also achieved through relationship building and feeling that the GP was readily available to them. However, it was only explicit, informational reassurance that directly addressed patients’ concerns by providing them with explanations ruling out serious disease, and helped them to understand and cope with their pain. Conclusion The themes of implicit and explicit reassurance uncovered here correspond with ideas of affective and cognitive reassurance, respectively. Although the findings support the use of information and education to alleviate concerns, the role of implicit reassurance through relationship building and empathy remains less clear. The impact of these behaviours on outcomes should form a priority for future research. PMID:26412846

  19. An evidence-based approach to the evaluation and treatment of low back pain in the emergency department.

    PubMed

    Borczuk, Pierre

    2013-07-01

    Low back pain is the most common musculoskeletal complaint that results in a visit to the emergency department, and it is 1 of the top 5 most common complaints in emergency medicine. Estimates of annual healthcare expenditures for low back pain in the United States exceed $90 billion annually, not even taking lost productivity and business costs into account. This review explores an evidence-based rationale for the evaluation of the patient with low back pain, and it provides guidance on risk stratification pertaining to laboratory assessment and radiologic imaging in the emergency department. Published guidelines from the American College of Physicians and American Pain Society are reviewed, with emphasis on best evidence for pharmacologic treatments, self-care interventions, and more invasive procedures and surgery in management of low back pain. Utilizing effective and proven strategies will avoid medical errors, provide better care for patients, and help manage healthcare resources and costs. PMID:24044786

  20. The effects of stabilization exercise with an oral assistive device on pain and functionality of low back pain patients.

    PubMed

    Lee, Jung-Ho; Park, Young-Han; Jang, Sang-Hun

    2015-10-01

    [Purpose] This study examined low back pain patients' decrease in pain and improvement in functionality after performance of a lumbar stabilization exercise using an oral assistive device, which can replace a lumbar assistive device. [Subjects and Methods] The experimental group (n=12) conducted a stabilization exercise using an oral assistive device after conventional physical therapy. The control group (n=12) received conventional physical therapy. In order to objectively measure pain in this study, a visual analogue scale (VAS) was used. In order to evaluate the subjects' functional aspects while living with low back pain, the Oswestry Disability Index (ODI) was used. [Results] There were statistically significant improvements in the comparison of the VAS and ODI of the experimental group and the control group. The experimental group's VAS and ODI significantly improved after the intervention compared to the control group. [Conclusion] The stabilization exercise using the assistive device after conventional physical therapy in the rehabilitation of low back pain patients reduced subjects' pain and increased their functional activities.

  1. The effects of extracorporeal shock wave therapy on pain, disability, and depression of chronic low back pain patients.

    PubMed

    Han, Hyeonjee; Lee, Daehee; Lee, Sangyong; Jeon, Chunbae; Kim, Taehoon

    2015-02-01

    [Purpose] The purpose of this study was to examine the effects of extracorporeal shock wave therapy on pain, disability, and depression of chronic low back pain patients. [Subjects] In this study, 30 chronic low back pain patients were divided into an extracorporeal shock wave therapy group (ESWTG, n=15) and a conservative physical therapy group (CPTG, n=15). [Methods] The ESWTG received extracorporeal shock wave therapy and the CPTG received general conservative physical therapy two times per week for six weeks. Pain was measured using a visual analog scale (VAS), the degree of disability of the patients was assessed using the Oswestry Disability Index (ODI), and their degree of depression was measured using the Beck depression index (BDI). [Results] In intra-group comparisons, ESWTG and CPTG showed significant decreases in VAS, ODI, and BDI scores. Intergroup comparisons revealed that these decreases in VAS, ODI, and BDI scores were significantly larger in ESWTG than in CPTG. [Conclusion] Extracorporeal shock wave therapy is an effective intervention for the treatment of pain, disability, and depression in chronic low back pain patients.

  2. Methods to measure peripheral and central sensitization using quantitative sensory testing: A focus on individuals with low back pain.

    PubMed

    Starkweather, Angela R; Heineman, Amy; Storey, Shannon; Rubia, Gil; Lyon, Debra E; Greenspan, Joel; Dorsey, Susan G

    2016-02-01

    Quantitative sensory testing can be used to assess peripheral and central sensitization; important factors that contribute to the individual's experience of pain and disability. Many studies use quantitative sensory testing in patients with low back pain to detect alterations in pain sensitivity, however, because investigators employ different protocols, interpretation of findings across studies can become problematic. The purpose of this article is to propose a standardized method of testing peripheral and central pain sensitization in patients with low back pain. Video clips are provided to demonstrate correct procedures for measuring the response to experimental pain using mechanical, thermal and pressure modalities. As nurse researchers and clinicians increase utilization of quantitative sensory testing to examine pain phenotypes, it is anticipated that more personalized methods for monitoring the trajectory of low back pain and response to treatment will improve outcomes for this patient population.

  3. The relationship between pain severity and patient-reported outcomes among patients with chronic low back pain in Japan

    PubMed Central

    Montgomery, William; Vietri, Jeffrey; Shi, Jing; Ogawa, Kei; Kariyasu, Sawako; Alev, Levent; Nakamura, Masaya

    2016-01-01

    Objective The aim of this study was to quantify the impact of pain severity on patient-reported outcomes among individuals diagnosed with chronic low back pain in Japan. Methods Data were provided by the 2012 Japan National Health and Wellness Survey (N=29,997), a web-based survey of individuals in Japan aged ≥18 years. This analysis included respondents diagnosed with low back pain of ≥3-month duration. Measures included the revised Medical Outcomes Study 36-Item Short-Form Survey Instrument, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, the Work Productivity and Activity Impairment: General Health questionnaire, and self-reported all-cause health care visits (6 months). Generalized linear models were used to assess the relationship between outcomes and severity of pain in the past week as reported on a numeric rating scale ranging from 0 (no pain) to 10 (pain as bad as you can imagine), controlling for length of diagnosis, sociodemographics, and general health characteristics. Results A total of 290 respondents were included in the analysis; mean age was 56 years, 41% were females, and 56% were employed. Pain severity was 3/10 for the first quartile, 5/10 for the median, and 7/10 for the third quartile of this sample. Increasing severity was associated with lower scores for mental and physical component summaries and Short-Form 6D health utility, higher depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) scores, greater absenteeism and presenteeism, greater activity impairment, and more health care provider visits (all P<0.0001). Conclusion The impact of chronic low back pain on health-related quality of life, depression and anxiety symptoms, impairment to work and daily activities, and health care use increases with the severity of pain. Interventions reducing the severity of pain may improve numerous health outcomes even if the pain cannot be eliminated. PMID:27330326

  4. Knee Pain and Low Back Pain Additively Disturb Sleep in the General Population: A Cross-Sectional Analysis of the Nagahama Study

    PubMed Central

    Murase, Kimihiko; Tabara, Yasuharu; Ito, Hiromu; Kobayashi, Masahiko; Takahashi, Yoshimitsu; Setoh, Kazuya; Kawaguchi, Takahisa; Muro, Shigeo; Kadotani, Hiroshi; Kosugi, Shinji; Sekine, Akihiro; Yamada, Ryo; Nakayama, Takeo; Mishima, Michiaki; Matsuda, Shuichi; Matsuda, Fumihiko; Chin, Kazuo

    2015-01-01

    Introduction Association of knee and low back pain with sleep disturbance is poorly understood. We aimed to clarify the independent and combined effects of these orthopedic symptoms on sleep in a large-scale general population. Methods Cross-sectional data about sleep and knee/low back pain were collected for 9,611 community residents (53±14 years old) by a structured questionnaire. Sleep duration less than 6 h/d was defined as short sleep. Sleep quality and the presence of knee and low back pain were evaluated by dichotomous questions. Subjects who complained about knee or low back pains were graded by tertiles of a numerical response scale (NRS) score and a Roland-Morris disability questionnaire (RDQ) score respectively. Multivariate regression analyses were performed to determine the correlates of short sleep duration and poor sleep quality. Results Frequency of participants who complained of the orthopedic symptoms was as follows; knee pain, 29.0%; low back pain, 42.0% and both knee and low back pain 17.6%. Both knee and low back pain were significantly and independently associated with short sleep duration (knee pain: odds ratio (OR) = 1.19, p<0.01; low back pain: OR = 1.13, p = 0.01) and poor sleep quality (knee pain: OR = 1.22, p<0.01; low back pain; OR = 1.57, p<0.01). The group in the highest tertile of the NRS or RDQ score had the highest risk for short sleep duration and poor sleep quality except for the relationship between the highest tertile of the RDQ score and short sleep duration.(the highest tertile of the NRS: OR for short sleep duration = 1.31, p<0.01; OR for poor sleep quality = 1.47, p<0.01; the highest tertile of the RDQ: OR for short sleep duration = 1.11, p = 0.12; OR for poor sleep quality = 1.81, p<0.01) Further, coincident knee and low back pain raised the odds ratios for short sleep duration (either of knee or low back pain: OR = 1.10, p = 0.06; both knee and low back pain: OR = 1.40, p<0.01) and poor sleep quality (either of knee or

  5. Lower Extremity Fatigue, Sex, and Landing Performance in a Population With Recurrent Low Back Pain

    PubMed Central

    Haddas, Ram; James, C. Roger; Hooper, Troy L.

    2015-01-01

    Context: Low back pain and lower extremity injuries affect athletes of all ages. Previous authors have linked a history of low back pain with lower extremity injuries. Fatigue is a risk factor for lower extremity injuries, some of which are known to affect female athletes more often than their male counterparts. Objective: To determine the effects of lower extremity fatigue and sex on knee mechanics, neuromuscular control, and ground reaction force during landing in people with recurrent low back pain (LBP). Design: Cross-sectional study. Setting: A clinical biomechanics laboratory. Patients or Other Participants: Thirty-three young adults with recurrent LBP but without current symptoms. Intervention(s): Fatigue was induced using a submaximal free-weight squat protocol with 15% body weight until task failure was achieved. Main Outcome Measure(s): Three-dimensional knee motion, knee and ankle moments, ground reaction force, and trunk and lower extremity muscle-activity measurements were collected during 0.30-m drop vertical-jump landings. Results: Fatigue altered landing mechanics, with differences in landing performance between sexes. Women tended to have greater knee-flexion angle at initial contact, greater maximum knee internal-rotation angle, greater maximum knee-flexion moment, smaller knee-adduction moment, smaller ankle-inversion moment, smaller ground reaction force impact, and earlier multifidus activation. In men and women, fatigue produced a smaller knee-abduction angle at initial contact, greater maximum knee-flexion moment, and delays in semitendinosus, multifidus, gluteus maximus, and rectus femoris activation. Conclusions: Our results provide evidence that during a fatigued 0.30-m landing sequence, women who suffered from recurrent LBP landed differently than did men with recurrent LBP, which may increase women's exposure to biomechanical factors that can contribute to lower extremity injury. PMID:25322344

  6. Postural control during prolonged standing in persons with chronic low back pain.

    PubMed

    Lafond, Danik; Champagne, Annick; Descarreaux, Martin; Dubois, Jean-Daniel; Prado, Janina M; Duarte, Marcos

    2009-04-01

    Prolonged standing has been associated with the onset of low back pain symptoms in working populations. So far, it is unknown how individuals with chronic low back pain (CLBP) behave during prolonged unconstrained standing (PS). The aim of the present study was to analyze the control of posture by subjects with CLBP during PS in comparison to matched healthy adults. The center of pressure (COP) position of 12 CLBP subjects and 12 matched healthy controls was recorded in prolonged standing (30min) and quiet stance tasks (60s) on a force plate. The number and amplitude of COP patterns, the root mean square (RMS), speed, and frequency of COP sway were analyzed. Statistical analyses showed that CLBP subjects produced less postural changes in the antero-posterior direction with decreased postural sway during the prolonged standing task in comparison to the healthy group. Only CLBP subjects were influenced by the prolonged standing task, as demonstrated by their increased COP RMS, COP speed and COP frequency in the quiet standing trial after the prolonged standing task in comparison to the pre-PS trial. The present study provides additional evidence that individuals with CLBP might have altered sensory-motor function. Their inability to generate responses similar to those of healthy subjects during prolonged standing may contribute to CLBP persistence or an increase risk of recurrent back pain episodes. Moreover, quantification of postural changes during prolonged standing could be useful to identify CLBP subjects prone to postural control deficits. PMID:19084411

  7. Relation between indicators for quality of occupational rehabilitation of employees with low back pain

    PubMed Central

    van der Weide, W. E.; Verbeek, J. H.; van Dijk, F. J.

    1999-01-01

    OBJECTIVES: To assess if the implementation of guidelines for occupational rehabilitation of patients with low back pain by means of process variables--a set of objective criteria for technical performance and continuity of care--led to a better outcome in clinical and return to work variables. METHODS: The study group consisted of 59 patients with at least 10 days of sick leave because of low back pain. Univariate analyses as well as multiple logistic regression and Cox's regression analyses were performed to assess the relation between quality of care and outcome. RESULTS: Process indicators for technical competence, continuity of care, and total performance were all significantly related to satisfaction of employees. Continuity of care and total performance were significantly related to working status at 3 months, and time to return to work. None of the process indicators was related to pain or disability after 3 months follow up. Satisfaction was not related to any of the other outcome variables. This indicates that if guidelines for occupational rehabilitation are met, outcome is better. CONCLUSION: Quality of the process of care was related to outcome. Interventions of occupational physicians need improvement in the areas of continuity of care and communication with treating physicians. The effectiveness of an improved intervention should be studied in a subsequent randomised clinical trial.   PMID:10472321

  8. Evidence base and future research directions in the management of low back pain

    PubMed Central

    Abbott, Allan

    2016-01-01

    Low back pain (LBP) is a prevalent and costly condition. Awareness of valid and reliable patient history taking, physical examination and clinical testing is important for diagnostic accuracy. Stratified care which targets treatment to patient subgroups based on key characteristics is reliant upon accurate diagnostics. Models of stratified care that can potentially improve treatment effects include prognostic risk profiling for persistent LBP, likely response to specific treatment based on clinical prediction models or suspected underlying causal mechanisms. The focus of this editorial is to highlight current research status and future directions for LBP diagnostics and stratified care. PMID:27004162

  9. Revisiting the Corticomotor Plasticity in Low Back Pain: Challenges and Perspectives

    PubMed Central

    Massé-Alarie, Hugo; Schneider, Cyril

    2016-01-01

    Chronic low back pain (CLBP) is a recurrent debilitating condition that costs billions to society. Refractoriness to conventional treatment, lack of improvement, and associated movement disorders could be related to the extensive brain plasticity present in this condition, especially in the sensorimotor cortices. This narrative review on corticomotor plasticity in CLBP will try to delineate how interventions such as training and neuromodulation can improve the condition. The review recommends subgrouping classification in CLBP owing to brain plasticity markers with a view of better understanding and treating this complex condition. PMID:27618123

  10. Revisiting the Corticomotor Plasticity in Low Back Pain: Challenges and Perspectives.