PubMed Health⌕ Search

Biomedical subjects

J B Paolaggi

Publications and source records attributed to J B Paolaggi.

At least 19 recordsLinked to original sources
PubMed1992

Classification of nonspecific low back pain. I. Psychological involvement in low back pain. A clinical, descriptive approach.

An unselected sample of outpatient subjects (n = 330) with localized nonspecific low back pain (LBP) was studied. Investigation consisted of clinical assessment, physical examination, and psychiatric interview based on the DSM-III classification. A psychiatric disorder, according to the DSM-III criteria (axis I) was found in 41% of the subjects. Multiple correspondence analysis and cluster analysis were used to objectively identify clinical subtypes without preconceived theoretical models. Correspondence analyses suggested the existence of a 'psychological pain' syndrome consisting of several of the following symptoms: diffuse back pain, impossibility to assess intensity of pain on a pain scale, aggravation of pain by changing climate, by domestic activities or by psychological factors and dysesthesias in the back. Cluster analysis provided support for a four-group classification of low back pain, which may be interpreted through the relationships between psychological disturbances and the LBP clinical features. The results call for further investigation of the complex relationship between psychological disturbances and back pain. However, clinicians must be aware of the interest of a minimal psychiatric assessment in low back pain patients: psychiatric disorders frequently appear in these patients and an appropriate treatment of the psychiatric syndrome may reduce back pain.

Adolescent↗
PubMed1992

Classification of nonspecific low back pain. II. Clinical diversity of organic forms.

A classification study was conducted in an unselected sample of outpatient subjects with localized nonspecific low back pain. The heterogeneity of a subgroup of patients without a psychiatric disorder according to the DSM-III classification (axis I), and whose low back pain may be labeled as 'purely organic' (see part 1 of the study in the companion paper), led to further evaluation of this group by correspondence and cluster analysis. A seven-cluster population structure emerged from the cluster analysis. Comprehensive description of these clusters suggests at least four well-differentiated clinical entities or 'syndromes.' Although no satisfactory correlation with pre-existing 'pathoanatomic' classification or hypotheses was found, this variable clinical presentation suggests different etiological or physiopathologic patterns for low back pain (and possibly more specific management of this condition). More comprehensive descriptions and evaluations of clinical symptoms and syndromes appear necessary in order to elaborate a clinical classification of LBP.

Acute Disease↗
PubMed1991

Clinical and psychological diversity of non-specific low-back pain. A new approach towards the classification of clinical subgroups.

This study explored the clinical and psychological features of non-specific low-back pain (LBP) using multivariate statistical methods including correspondence analysis, cluster analysis and discriminant analysis. An unselected population of subjects (n = 330) complaining of localized LBP to hospital rheumatologists during 1988 was studied. 41% of the subjects (n = 136) were classified as having a psychiatric disorder according to the DSM-III criteria (Axis I). A number of different organic syndromes were identified and the importance of psychological influences on the clinical presentation of LBP was demonstrated. Cluster analyses provided further evidence for a four-group typology of LBP, which may be interpreted through the relationships or interactions between psychological disturbances and the clinical features of LBP. This study highlights the need, in etiological research, to take into account the clinical diversity of non-specific LBP and to investigate further the complex relationships between psychological disturbances and back pain.

Adult↗
PubMed1991

Reliability of interpretation of plain lumbar spine radiographs in benign, mechanical low-back pain.

A study was conducted to investigate the variability of interpretation of plain lumbar spine radiographs by rheumatologists in benign low-back pain (LBP). Intra- and interobserver agreement in classifying the presence of primary radiologic abnormalities according to pre-established criteria was assessed by the Kappa statistic in 115 anteroposterior and lateral radiograms. A significant variability of interpretation was observed for many findings often considered important in benign LBP. Particularly, low levels of agreement were observed for apophyseal joint abnormalities. Schmorl's nodes, spondylolysis, and structural deviations. Elaboration and validation of better standardized criteria for the main radiologic abnormalities is needed to improve the reliability of interpretation of lumbar spine radiographs.

Back Pain↗
PubMed1991

[Epidemiological research in rheumatology: current status and prospects].

Rheumatic diseases are very common and their consequences on both the individuals (leading cause of activity limitation between the age of the 18 and 64 years) and on society (socio-economic costs) are considerable. However, the epidemiology of these diseases remains poorly known. In this paper, a review of the epidemiological data for the most frequent rheumatic diseases (including recent advances) is followed by an analysis of the specific obstacles to epidemiological research in the rheumatology field and by a proposal of possible developments.

Adolescent↗
PubMed1991

[Evaluation of the Amor criteria for spondylarthropathies and European Spondylarthropathy Study Group (ESSG). A cross-sectional analysis of 2,228 patients].

Two sets of criteria have been proposed to discriminate spondylarthropathies (SA) from other rheumatic diseases. To evaluate their performance, we conducted a cross-sectional study in the patients observed during one week in 28 French Departments of Rheumatology by 91 staff-teaching physicians. The physicians had to apply these criteria to all their patients and had to classify them as definite SA, definite other rheumatic disease or possible SA. The analysis performed on the 2,088 patients with a definite diagnosis (124 SA and 1,964 controls) showed the following results: (table; see text) Of the 140 patients with possible SA, 37 fulfilled both sets of criteria, 22 the ESSG criteria alone and 12 the Amor criteria alone. These data suggest that a) the overall performance of these two sets of criteria is similar; b) this performance is better in the group of patients with a definite diagnosis; c) the patients without a definite diagnosis require a longer follow-up to assess the clinical relevance of these two sets of criteria.

Cross-Sectional Studies↗
PubMed1990

[Psychologic and social factors in low-back pain].

Psychological factors seem to play a major role in low-back pain, but unfortunately the definition of the so-called "functional" low-back pain is mainly negative, and the characteristics of its symptoms should be more precise. Disorders of personality and/or psychiatric disorders may be present, but they may be independent of the cause and presentation of the pain. One must therefore provide more details on the clinical picture for which the possible psychological disorders (depression, anxiety, pathomimicry, etc.) are held responsible. The alleged social factors seem to be due to an uncertain and not yet elucidated mechanism. Thus, a better methodological approach is needed in future, resting on validated diagnostic criteria of spinal and psychiatric diseases, in order to determine the role played by each organic, psychiatric and social element implicated in this complex pathology.

Affective Symptoms↗
PubMed1990

[Polymyalgia rheumatica and temporal arteritis. Observations on prognosis and treatment].

1. There is still controversy about polymyalgia rheumatica (PMR) and temporal arteritis (TA), either expressions of a single disease or two different conditions with overlapping. Nearly 50% of TA present with a PMR syndrome and 5% of PMR have a positive temporal artery biopsy. 2. Biopsy is useful for diagnostic purposes but does not seem to have any prognostic value in the management of PMR and TA. 3. The best symptomatic treatment is represented by prednisone. Prednisone has to be continued over a large period of time creating adverse effects in elderly people unless minimal doses are used. 4. TA visual or neurological complications are often observed in the first weeks of the disease thus leading many authors to recommend high doses (0.5 mg to 1 mg/kg/day) to patients with TA and even with PMR. To us starting high doses are to be used in severe clinical conditions of TA, particularly those presenting visual symptoms (nevertheless lower doses may be successful as well). Concerning other patients with TA and with PMR a starting dose of 10 to 30 mg depending on the clinical picture then a follow up dosage of 10 and even less, is suggested.

Biopsy↗
PubMed1989

[Critical review of the epidemiology of backache].

High frequency occurrence of back pain and the magnitude of its impact on society explain the large number of epidemiologic studies. Most investigators have considered back pain as a whole, without reference to different etiological types of back pain, probably for lack of an available classification of these types. Prevalence of back pain in general populations varies between 14 and 45% and annual incidence around 6%. Risk factors for low back pain are often social or cultural factors: smoking, driving, psychological stress. These factors seem to be far from the starting point of the disease process. Vagueness of case descriptions may explain in part the disappointing results of analytic surveys. Indistinctness of risk factors, especially workplace factors, is the principal reason for the poor results of intervention epidemiology: very few primary prevention programs and no educational programs ("low back school") have been shown to be really effective.

Back Pain↗