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PubMed1997

[Are low back pain and radiological changes during puberty risk factors for low back pain in adult age? A 25-year prospective cohort study of 640 school children].

Recent reports have stated that low back pain (LBP) among children is a common problem comparable with that in adults. This 25-year prospective cohort study confirms that 11% of the cohort have had a history of LBP in adolescence with an 84% lifetime prevalence of LBP in these subjects as adults compared with 70% in the rest of the cohort. LBP was associated with increased morbidity and decreased working capacity. Thirteen percent of the cohort had radiological abnormalities, mainly Scheuermann changes, in the thoracic and lumbar spine as adolescents, with no positive correlation to LBP in this period. Unlike other reports our results did not show any association between X-ray changes in the lower spine in adolescents and a higher prevalence of LBP in adults. Stepwise logistic regression analyses showed that LBP in the growth period and familial occurrence of back disease are important risk factors for LBP later in life, with an observed probability of 88% if both factors are present. Preventive measures in the school period seem to be of great importance.

Adolescent↗
PubMed1996

Management of back pain in athletes.

Back pain affects millions of people. It affects 80% of the population and up to 52% at any given time. Back pain is not limited to sedentary individuals; it has significant effects on athletes as well. Depending upon the sport, incidence rates of back pain occur in athletes from 1.1% to as high as 30%. Athletes differ from the non-athletic population in that their incentives to return to activity are considerably different than non-athletes. The reasons may vary from the will to win through to significant financial considerations. Although reasons for recovery are different, the physiology and mechanics of repair of injured soft tissue in the athlete is the same as for the non-athlete. Proper management of the athlete requires ruling out emergent causes of back pain such as tumour, infection, acute fracture, progressive neurological deficit, visceral sources (e.g. pancreatitis, abdominal aortic aneurysm), and rheumatoid variants. Once a good history and physical is performed, a simple classification system can be utilised to manage the athlete presenting with back pain. This system can be expressed as: (a) regional back pain; (b) radicular leg pain; (c) radicular leg pain with progressive neurological deficit; and (d) cauda equina syndrome. Each of these categories needs to be managed in a specific manner and can provide the healthcare professional with simple, straightforward guidelines for handling the athlete with lower back pain. The key is to return the athlete to the field of play in a safe and timely manner.

Athletic Injuries↗
PubMed1977

Symposium on arthritis in older persons. Section III. Osteoarthritis and back pain. Examination of the back in the geriatric patient.

Older people often complain of back pain, but it usually is not a major complaint except in the presence of serious disease such as malignancy, compression fractures from osteoporosis, or disc-space infections. When back pain is a serious symptom in the elderly patient, the physician should look beyond the obvious evidences of degenerative joint disease for these other more serious conditions. Satisfactory examination of the back does not require an undue amount of time. It is important that it be done systematically. Simple, rapid, and adequate procedures are described.

Aged↗
PubMed2004

[Chronic widespread pain and tender points in low back pain: a population-based study].

BACKGROUND: Clinical observation suggests a frequent coincidence of back pain (BP) and fibromyalgia (FMA). Based on data from a population survey on back pain we studied the hypothesis of FMA being a frequent underlying condition of BP. We additionally studied the association of the severity of back pain and both chronic widespread musculoskeletal pain and active tender points. PROBANDS AND METHODS: Data from a regional two-stage survey on urban German residents (aged 25-74 years) of Luebeck/Northern Germany (N=3969) were reanalyzed. The survey combined a postal questionnaire screening with a subsequent medical-psychological examination. Only subjects with back pain on the day of filling in the questionnaire were invited (n = 875). The response and participation rates were 82% and 73%, respectively. The severity of back pain was graded according to Kohlmann and Raspe (1994; based on pain severity and disability). In assessing widespread pain and tender points and classifying FMA-cases, we followed the criteria of the American College of Rheumatology (Wolfe et al. 1990). Standardized psychometric scales were used to measure general health status, bodily complaints, depressiveness, and catastrophizing cognitions. RESULTS: In Luebeck, the overall point prevalence of back pain reached 39%. Among those invited and examined we found 27%, 25%, and 19% with back pain grade 1, 2 or 3, respectively. 29% reported no back pain on the day of examination. 12.6% of probands with actual back pain reported chronic widespread pain. The number of active tender points showed a significant and relevant association with back pain grade and was additionally correlated with all indicators of somatic and psychological distress. CONCLUSION: Our data do not support the hypothesis of FMA as a frequent underlying condition of BP. We found, however, a close correlation between BP grade (and amount of distress) and tender points count. More severe forms of BP imply an increasing allodynia/hyperalgesia, itself being associated with a higher amount of somatic and psychological distress (Chronic severe) back pain seems to be more than simply pain in the back.

Adult↗
PubMed1993

Evaluation of impairment related to low back pain.

Low back pain is the leading cause of disability and expense from work-related conditions in the United States. Forty percent of the expense of the worker's compensation program is spent on claims involving the low back. There are several systems of impairment evaluation in use in the United States, but the most commonly used has been developed by the American Medical Association. Evaluation of impairment related to the low back is expressed as a percent impairment of the whole person and is calculated by combining values related to: (1) diagnostic based categories, (2) range of motion of the spine, and (3) neurologic deficits in the lower extremities. Using this system, and given a cooperative patient, a reproducible quantification of impairment can be obtained to help administrators of the worker's compensation system more fairly compensate injured workers for partial permanent disability.

Accidents, Occupational↗
PubMed2003

Low back pain in Flemish adolescents and the role of perceived social support and effect on the perception of back pain.

AIM: To document the prevalence of low back pain (LBP) in Flemish adolescents and to recognize the association between perceived social support and affect and medical consultation and reduction of activities. METHODS: The study comprised 620 adolescents. A questionnaire was used to elicit the characteristics of LBP. Perceived social support and affect were investigated using the Personal Resource Questionnaire (PRQ) and the Positive Affect Negative Affect Scale (PANAS), respectively. Comparisons were made between adolescents with LBP and adolescents without LBP. Within the LBP group, answers from adolescents appealing for medical advice were compared with those who did not seek advice. Another comparison was done between adolescents who reduced their activities and those who did not. Descriptive statistics, the median test for two samples, a chi2 test or Fisher's exact probability test and logistic regression analysis were used for data analysis. RESULTS: Month prevalence of LBP was 24.7%. Thirteen adolescents visited a physician or received treatment, pain severity being the sole factor associated with the decision. Fifteen adolescents reduced their sports activities and 11 reduced or stopped other leisure activities. Pain severity and negative affect were the main associated factors. CONCLUSION: The results of the present study encourage further research on the role of pain perception and the influence of psychosocial factors on back pain in adolescents.

Adolescent↗
PubMed2002

Low back pain.

Low back pain is a very common condition, with about 80% of people suffering from it at some point in their lives. It is usually self-limited, resolving in 4 to 8 weeks in more than 50% of patients, yet the recurrence rate is high, about 85%. Because of the complexity of the bony, muscular ligamentous, and neural elements of the back, a specific anatomic diagnosis often cannot be made. Evaluation should include a careful history and physical examination, paying particular attention to alarm symptoms or "red flags" mentioned in the text. Imaging procedures are usually not necessary because of the lack of specificity and the high rate of early, spontaneous remission. Exceptions to this include history of recent trauma, presence of red flags or chronic unremitting course. Many treatment modalities, including physical therapy, ultrasound, thermal therapy, and local injection have been tried, but most studies are inconclusive as to their effectiveness. Prolonged bed rest is not indicated. Nonsteroidal anti-inflammation agents, judicious use of muscle relaxers, and patient education about the cause and prognosis are justified.

Diagnosis, Differential↗
PubMed2004

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care.

OBJECTIVE: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. [See figure]. DESIGN: Pragmatic randomised trial with factorial design. SETTING: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. PARTICIPANTS: 1334 patients consulting their general practices about low back pain. MAIN OUTCOME MEASURES: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. RESULTS: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred. CONCLUSIONS: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.

Adult↗
PubMed2001

How effective is the acute low back pain screening questionnaire for predicting 1-year follow-up in patients with low back pain?

OBJECTIVES: The aim of this study was to investigate potential associations between the Acute Low Back Pain Screening Questionnaire (ALBPSQ), a biopsychosocial screening instrument for identifying patients at risk of chronicity, and relevant variables at 1-year follow-up in a cohort of patients with low back pain. STUDY DESIGN: A 1-year prospective study was conducted in which patients who had previously received treatment in the Northern Ireland National Health Service (n = 118) were requested to complete a follow-up questionnaire package of pain and functional disability measures and a patient-centered questionnaire of seven variables considered relevant from the patient's perspective. PATIENTS: Ninety patients (76% response rate) returned the completed questionnaire package. RESULTS: The ALBPSQ total score and cutoff score of 112 were significantly positively associated with the pain and functional disability questionnaire scores at follow-up but did not significantly discriminate for difference scores on these measures. Although six of the seven patient-centered variables were significantly associated with the screening questionnaire total score, the cutoff score was strongly predictive of only one variable (work loss) and failed to demonstrate high levels of sensitivity for other variables (i.e., medication use, additional treatment, poor exercise participation). CONCLUSIONS: The findings of this study demonstrate that scores on the ALBPSQ were positively correlated with patients' levels of pain and functional disability at 1-year follow-up and correctly classified all patients reporting some degree of work loss but had minimal predictive strength for the other patient-centered variables evaluated.

Acute Disease↗
PubMed2006

Occupational low back pain.

Low back injury is one of the most common conditions in the workplace. The causes are multifactorial and must be sought during the physician's examination. Failure to perform a comprehensive history and physical examination ultimately can lead to treatment failure and injury recurrence. A comprehensive history and physical may help clinicians to differentiate organic and nonorganic causes of low back pain. Different diagnoses need specific rather than generalized treatment programs. Teaching clinicians the nuances of the history and physical examination in a setting with an injured worker is the goal of this article.

Humans↗
PubMed1988

Pain drawings in chronic back pain.

Pain drawings were obtained from two groups of patients and one of nonpatients, in a total of 264 subjects, all suffering from back pain. The pain drawings were rated in four grades according to the degree of nonorganic and extended pain. The reliability was excellent with an intra- and interrater agreement of 80 and 70%, respectively. Three quarters of the nonpatient group had dull aching pain in the lower back only, whereas widespread or nonanatomical pain was prevalent in patients responding poorly to treatment. A correlation was also found to ethnic background and social situation but not to alcohol abuse or psychiatric illness. Pain drawings afford an important clue to nonorganic factors in the assessment of back pain.

Alcoholism↗
PubMed1989

Back pain.

Acute back pain in younger patients almost always resolves within two months. Recurrent episodes in older patients are associated with degenerative changes. The correct diagnosis and optimum management are important for the individual patient, as well as having economic implications for both the patient and the nation.

Acute Disease↗
PubMed1996

Managing sports-related low back pain.

Low back pain is a common complaint among both the general and the athletic populations. A thorough evaluation and specific diagnosis is required before prescribing treatment. A complete rehabilitation program should include exercises to enhance strength, flexibility, endurance, and coordination. This article focuses on exercises to improve flexibility.

Athletic Injuries↗
PubMed2005

Meta-analysis: acupuncture for low back pain.

BACKGROUND: Low back pain limits activity and is the second most frequent reason for physician visits. Previous research shows widespread use of acupuncture for low back pain. PURPOSE: To assess acupuncture's effectiveness for treating low back pain. DATA SOURCES: Randomized, controlled trials were identified through searches of MEDLINE, Cochrane Central, EMBASE, AMED, CINAHL, CISCOM, and GERA databases through August 2004. Additional data sources included previous reviews and personal contacts with colleagues. STUDY SELECTION: Randomized, controlled trials comparing needle acupuncture with sham acupuncture, other sham treatments, no additional treatment, or another active treatment for patients with low back pain. DATA EXTRACTION: Data were dually extracted for the outcomes of pain, functional status, overall improvement, return to work, and analgesic consumption. In addition, study quality was assessed. DATA SYNTHESIS: The 33 randomized, controlled trials that met inclusion criteria were subgrouped according to acute or chronic pain, style of acupuncture, and type of control group used. The principal [correction] measure of effect size was the standardized mean difference, since the trials assessed the same outcome but measured it in various ways. For the primary outcome of short-term relief of chronic pain, the meta-analyses showed that acupuncture is significantly more effective than sham treatment (standardized mean difference, 0.54 [95% CI, 0.35 to 0.73]; 7 trials) and no additional treatment (standardized mean difference, 0.69 [CI, 0.40 to 0.98]; 8 trials). For patients with acute low back pain, data are sparse and inconclusive. Data are also insufficient for drawing conclusions about acupuncture's short-term effectiveness compared with most other therapies. LIMITATIONS: The quantity and quality of the included trials varied. CONCLUSIONS: Acupuncture effectively relieves chronic low back pain. No evidence suggests that acupuncture is more effective than other active therapies.

Acupuncture Therapy↗
PubMed1991

Low back pain.

Low back pain (LBP) affects a large proportion of the population and is an increasingly costly problem in the western world. This review highlights some of the recent theories relating to LBP and the conflicting evidence which has been brought to light. Theories relating to the causes of LBP have included single and multiple factors such as abnormal physical findings, mechanical, psychosocial and economic factors. The two lowest lumbar segments are most often afflicted in LBP sufferers, but the diagnosis of LBP is otherwise uncertain in most cases due to insufficient knowledge relating to the validity of clinical tests, inconsistent terminology and unclear symptomatic patterns. Despite a lack of understanding of the exact anatomical cause of LBP, an abundance of therapeutic models exist, most of which are purely empirical, and few methods have been shown to be clinically useful. Similarly, insufficient knowledge of the causes of LBP makes primary, secondary and tertiary prevention difficult.

Back Pain↗
PubMed2005

Iatrogenic (para-) spinal abscesses and meningitis following injection therapy for low back pain.

Low back pain is often treated with paraspinal injections of analgesics and steroids. Infectious complications of these techniques are rare but they can potentially hold high risks for the patients. History and clinical data of all patients admitted to a neurological unit suffering from community acquired purulent meningitis were prospectively analyzed during an 8 year interval (1992 and 2000) with special regard to the previous medical history. One hundred and twenty eight patients were included in the study. Eight out of 128 patients (6.25%) had a history of single or repeated paravertebral (4/8), facet-joint (2/8), peridural (1/8) or spinal (1/8) injections 2-21 days before admission to the hospital. In six out of eight patients either Staphylococcus aureus (4/8) or coagulase-negative staphylococci (2/8) were found in the cerebro spinal fluid (CSF), in two patients no causative organism was detected. One patient died, three survived with sequel. Repeated paraspinal, peridural or spinal injections with analgesic drugs in combination with corticosteroids hold a risk for parameningeal inoculation of bacteria resulting in paraspinal, spinal, and epidural abscesses or meningitis. The absolute frequency of these complications may be rare but they are responsible for a considerable proportion of community acquired purulent CNS infections.

Adolescent↗
PubMed2002

Second Prize: The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: findings from the UCLA low back pain study.

BACKGROUND: Although chiropractors often use physical modalities with spinal manipulation, evidence that modalities yield additional benefits over spinal manipulation alone is lacking. OBJECTIVE: The purpose of the study was to estimate the net effect of physical modalities on low back pain (LBP) outcomes among chiropractic patients in a managed-care setting. METHODS: Fifty percent of the 681 patients participating in a clinical trial of LBP treatment strategies were randomized to chiropractic care with physical modalities (n = 172) or without physical modalities (n = 169). Subjects were followed for 6 months with assessments at 2, 4, and 6 weeks and at 6 months. The primary outcome variables were average and most severe LBP intensity in the past week, assessed with numerical rating scales (0-10), and low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire. RESULTS: Almost 60% of the subjects had baseline LBP episodes of more than 3 months' duration. The 6-month follow-up was 96%. The adjusted mean differences between groups in improvements in average and most severe pain and disability were clinically insignificant at all follow-up assessments. Clinically relevant improvements in average pain and disability were more likely in the modalities group at 2 and 6 weeks, but this apparent advantage disappeared at 6 months. Perceived treatment effectiveness was greater in the modalities group. CONCLUSIONS: Physical modalities used by chiropractors in this managed-care organization did not appear to be effective in the treatment of patients with LBP, although a small short-term benefit for some patients cannot be ruled out.

Adult↗