Chapter 2. European guidelines for prevention in low back pain : November 2004.
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Europe↗
Biomedical subjects
H R Eriksen
Publications and source records attributed to H R Eriksen.
How to prevent low back pain.
This chapter summarizes the European Guidelines for Prevention in Low Back Pain, which consider the evidence in respect of the general population, workers and children. There is limited scope for preventing the incidence (first-time onset) of back pain and, overall, there is limited robust evidence for numerous aspects of prevention in back pain. Nevertheless, there is evidence suggesting that prevention of various consequences of back pain is feasible. However, for those interventions where there is acceptable evidence, the effect sizes are rather modest. The most promising approaches seem to involve physical activity/exercise and appropriate (biopsychosocial) education, at least for adults. Owing to its multidimensional nature, no single intervention is likely to be effective at preventing the overall problem of back pain, although there is likely to be benefit from getting all the players onside. However, innovative studies are required to better understand the mechanisms and delivery of prevention in low back pain.
Exercise Therapy↗
Subjective health complaints, sensitization, and sustained cognitive activation (stress).
INTRODUCTION: This review argues that "subjective health complaints" is a better and neutral term for "unexplained medical symptoms." The most common complaints are musculoskeletal pain, gastrointestinal complaints and "pseudoneurology" (tiredness, sleep problems, fatigue, and mood changes). These complaints are common in the general population, but for some these complaints reach a level that requires care and assistance. THEORETICAL ASSUMPTIONS: We suggest that these complaints are based on sensations from what in most people are normal physiological processes. In some individuals these sensations become intolerable. In some cases it may signal somatic disease, in most cases not. Cases without somatic disease, or with minimal somatic findings, occur under diagnoses like burnout, epidemic fatigue, multiple chemical sensitivity, chronic musculoskeletal pain, chronic low back pain, chronic fatigue syndrome, and fibromyalgia. These complaints are particularly common in individuals with low coping and high levels of helplessness and hopelessness. CONCLUSION: The psychobiological mechanisms for this is suggested to be sensitization in neural loops maintained by sustained attention and arousal.
Cognition↗
Psychobiological mechanisms of socioeconomic differences in health.
The association between low socioeconomic status and poor health is well established. Empirical studies suggest that psychosocial factors are important mediators for these effects, and that the effects are mediated by psychobiological mechanisms related to stress physiology. The objective of this paper is to explore these psychobiological mechanisms. Psychobiological responses to environmental challenges depend on acquired expectancies (learning) of the relations between responses and stimuli. The stress response occurs whenever an individual is faced with a challenge. It is an essential element in the total adaptive system of the body, and necessary for adaptation, performance and survival. However, a period of recovery is necessary to rebalance and to manage new demands. Individuals with low social status report more environmental challenges and less psychosocial resources. This may lead to vicious circles of learning to expect negative outcomes, loss of coping ability, strain, hopelessness and chronic stress. This type of learning may interfere with the recovery processes, leading to sustained psychobiological activation and loss of dynamic capacity to respond to new challenges. Psychobiological responses and health effects in humans and animals depend on combinations of demands and expected outcomes (coping, control). In studies of humans with chronic psychosocial stress, and low SES, cortisol baseline levels were raised, and the cortisol response to acute stress attenuated. Low job control was associated with insufficient recovery of catecholamines and cortisol, and a range of negative health effects. Biological effects of choice of lifestyle, which also depends on the acquired outcome expectancies, reinforce these direct psychobiological effects on health. The paper concludes that sustained activation and loss of capacity to respond to a novel stressor could be a cause of the higher risk of illness and disease found among people with lower SES.
Adaptation, Psychological↗
Improving subjective health at the worksite: a randomized controlled trial of stress management training, physical exercise and an integrated health programme.
Our objective was to evaluate the effect of 12 weeks of stress management training (SMT), physical exercise (PE) and an integrated health programme (IHP) in a worksite setting on subjective health complaints. To do this, we randomly split 860 employees into the following groups: control (n = 344), PE (n = 189), IHP (comprising physical exercise and health information) (n = 165) and SMT (n = 162). There were no significant effects on subjective health complaints, sick leave or job stress. However, strong and specific positive effects were experienced for the particular goal areas defined for each intervention. The PE group showed improved general health, physical fitness and muscle pain, while the SMT group showed improved stress management. The IHP group showed the strongest effects, affecting most goals set for treatment.
Adaptation, Physiological↗
Thoroughly modern worries: the relationship of worries about modernity to reported symptoms, health and medical care utilization.
OBJECTIVE: There is now greater public concern about how features of modern life pose threats to personal health. In two studies, we investigated the relationship between individuals' worries about modernity affecting health to symptom reports, perceptions of health and health care utilization. METHODS: In the first study, 526 University students completed a questionnaire measuring modern health worries (MHW), symptom reports and health perceptions. A second study utilized an existing national survey database of 7869 New Zealanders. Part of the survey examined people's concerns of modernity affecting their health in the past 12 months, as well as the use of conventional medical and alternative health care. RESULTS: We found concerns about modernity affecting health were made up of four major components: environmental pollution, toxic interventions, tainted food and radiation. MHW were significantly associated with somatic complaints and ratings of the importance of health to the individual. We also found individuals with high levels of MHW had a higher rate of food intolerance and chronic fatigue syndrome (CFS). In the second study, we found MHW to be associated with medical care utilization, particularly of alternative health practitioners. CONCLUSIONS: The results of these studies suggest concerns about modernity do cause changes in the way individuals interpret somatic information and may play a role in undermining perceptions of health. The area of MHW is worthy of study and may hold importance for understanding aspects of functional disorders.
Adolescent↗
Sensitization, subjective health complaints, and sustained arousal.
The purpose of this presentation is to discuss the possibility that sensitization is a psychobiological mechanism underlying not only multiple chemical sensitivity (MCS), but a much more general cluster of illness, referred to as "subjective health complaints". Sustained arousal, or sustained "stress" responses, may be an important factor for the development of these conditions. Patients with subjective complaints without objective changes are sometimes referred to as having "fashionable diagnoses" or "unexplained symptoms". They may be given diagnoses like MCS, epidemic fatigue, chronic fatigue syndrome, burnout, stress, a variety of intoxications, environmental illness, radiation, multiple chemical hypersensitivity, food intolerance, functional dyspepsia, irritable bowel, myalgic encephalitis, postviral syndrome, yuppie flu, fibromyalgia, or vital exhaustion. One issue is whether this is one general condition or separate entities. Another issue is whether sensitization may be the psychobiological mechanism for most or all of these conditions. Finally, is it likely that sustained arousal may facilitate the development of sensitization in some or many neural circuits? In this review, the main emphasis will be on musculoskeletal pain. This is the most frequent and most expensive condition for sickness compensation and disability. The comorbidity of other complaints, however, will also be taken into account.
Adaptation, Physiological↗
Does early intervention with a light mobilization program reduce long-term sick leave for low back pain?
STUDY DESIGN: A controlled randomized clinical trial was performed. OBJECTIVE: To investigate the effect of a light mobilization program on the duration of sick leave for patients with subacute low back pain. SUMMARY OF BACKGROUND DATA: Early intervention with information, diagnostics, and light mobilization may be a cost-effective method for returning patients quickly to normal activity. In this experiment, patients were referred to a low back pain clinic and given this simple and systematic program as an outpatient treatment. METHODS: In this study, 457 patients sick-listed 8 to 12 weeks for low back pain, as recorded by the National Insurance Offices, were randomized into two groups: an intervention group (n = 237) and a control group (n = 220). The intervention group was examined at a spine clinic and given information and advice to stay active. The control group was not examined at the clinic, but was treated with conventional primary health care. RESULTS: At 12-month follow-up assessment, 68.4% in the intervention group had returned to full-duty work, as compared with 56.4% in the control group. CONCLUSIONS: Early intervention with examination, information, and recommendations to stay active showed significant effects in reducing sick leave for patients with low back pain.
Adolescent↗
The pain of Sognsvann walks.
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Chronic Disease↗
Effects of psychological defense on processing of neutral stimuli indicated by event-related potentials (ERPs).
The Defense Mechanism Test (DMT) is claimed to identify personnel with a high risk for accidents. A new explanation for why the DMT seems to predict performance when survival depends on split second decisions is proposed. Sixteen right-handed, adult male students were tested with the DMT and with an ERP paradigm (two sine wave tones, presented binaurally). Each subject was tested with a one-stimulus paradigm, and a passive and an active oddball paradigm. Under the passive oddball condition, High defensive subjects differed from Low, having significantly smaller N2 amplitudes (low immediate perception), and significantly larger P3 amplitudes (rely on later associative mechanisms). High defensive subjects seem to have less ability to perceive the environment correctly immediately. This slowness may be fatal when life depends on split second decisions. The fundamental neurophysiological difference may also be the basis for the very complex cognitive and perceptual mechanisms involved in psychological defense mechanisms.
Adult↗
The time dimension in stress responses: relevance for survival and health.
Within the Cognitive Activation Theory of Stress (CATS), the stress response occurs whenever there is a discrepancy between what the organism is expecting, and what really exists. It affects the biochemistry of the brain, mobilizes resources, affects performance, and endocrine, vegetative, and immune systems. Initial positive feedback and feed-forward mechanisms are gradually changed by homeostatic mechanisms. Slower reactive hormones such as cortisol seem to dampen the initial response. The time course may depend on psychological mechanisms. Subjects with efficient coping show the fast- and short-lasting catecholamine response, while subjects with high defense mechanisms (related to stimulus expectancies) may show more signs of prolonged activation. Non-coping individuals show a sustained general activation which may develop into somatic disease or illness.
Adaptation, Psychological↗
A scoring system for subjective health complaints (SHC).
The aim of this study is to present a complete scoring system for subjective health complaints (SHC) as they are experienced by the lay population. The scoring system records the complaints, and does not map attributions or medical diagnoses. In all, 1,219 subjects (323 men, 896 women) from various occupations were tested with a scoring system, the SHC inventory, previously referred to as the Ursin Health Inventory (UHI). The SHC consists of 29 questions concerning severity and duration of subjective somatic and psychological complaints. The SHC inventory yields scores on single items and a total number of health complaints categorized into five factors: musculoskeletal pain (alpha=0.74), pseudoneurology (alpha=0.73), gastrointestinal problems (alpha=0.62), allergy (alpha=0.58) and flu (alpha=0.67). The SHC inventory is a systematic, easy, and reliable way to score subjective health complaints. The prevalence of these complaints is high, and should be considered before conclusions are reached about new diseases and new attributions of environmental hazards.
Adult↗
The CODE: a revised battery for coping and defense and its relations to subjective health.
A condensed test battery (the CODE) based on the Utrecht Coping List (UCL) and part of the Defense Mechanisms Inventory (DMI) has been developed to assess coping and defense in large population studies. It was tested for reliability and validity in students and back pain patients. Principal components factor analysis of the subscales of the UCL and DMI in the student sample revealed two coping clusters: "Instrumental mastery-oriented coping" and "Emotion-focused coping" and two defensive clusters: "Cognitive defense" and "Defensive hostility". "Instrumental mastery-oriented coping" was negatively related to subjective health complaints measured with Ursins Health Inventory (UHI). The back pain patients were clearly different from the students, using less coping and more defensive strategies. They had more subjective health complaints that showed negative correlations with "Instrumental mastery-oriented coping". The CODE is a comprehensive battery that may be valid for large population studies of psychological determinants of muscle pain and other subjective health problems.
Adaptation, Psychological↗
Psychological defense mechanisms and electroencephalographic arousal.
The aim of this study was to examine the relationship between psychological defense as measured by the Kragh tachistoscopic Defense Mechanisms Test (DMT), and general arousal properties of the individual as measured with electroencephalogram (EEG). The DMT assesses defense by presenting neutral and threatening pictures with very short exposure times. EEG characteristics were measured in the 8-12 Hz EEG frequency band during DMT testing. Twenty-one male subjects participated in the study. All were US Air Force personnel on active duty. Personnel with high defense mechanisms, defined in this connection as slow perception of the threat, tended to have higher cortical arousal after Stimulus exposure than the subjects with low defense mechanisms. The differences occurred mainly with new stimulus material without any threatening content. The differences in arousal response to novel stimuli may contribute to an understanding of the relationships between the Kragh DMT test and performance in life-threatening situations.
Adult↗
Physical exercise in women with intractable epilepsy.
Fifteen women with pharmacologically intractable epilepsy were given physical exercise (aerobic dancing with strength training and stretching) for 60 min, twice weekly, for 15 weeks. Seizure frequency was recorded by the patients for 3-7 months before the intervention, during the intervention period, and for 3 months after the intervention. Medication and other known seizure-influencing factors were kept as constant as possible. Self-reported seizure frequency was significantly reduced during the intervention period. The exercise also led to reduced level of subjective health complaints, such as muscle pains, sleep problems, and fatigue. The exercise reduced plasma cholesterol ratio and increased maximum O2 uptake. Because most of the patients were unable to continue the exercise on their own after the intervention period, the exercise effects were not maintained during the follow-up period. The patients were not unwilling to continue the exercise, but it was not sufficient to offer them the possibility of continuing similar types of exercise. We believe that 15 weeks is too short a time to establish a life-style change and that continued physical exercise for these patients requires a well-organized and supportive program, requiring experienced and dedicated instructors.
Adolescent↗