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PubMed1993

[Problems in the treatment of back pain].

Back pain is a common disease causing tremendous costs for treatment, rehabilitation, litigation and work-loss. The reasons for back pain vary considerably and are often not clear. The effectiveness of current treatment concepts like epidural injection of steroids, blocks of facet joints, transcutaneous electrical nerve stimulation and antidepressants has not been proven. In accordance with literature, only multimodal concepts of treatment seem to be more successful as they consider somatic, psychosocial, and sports physiological aspects.

Adrenal Cortex Hormones↗

PubMed2005

[Indication and significance of pharmacological intervention for back pain].

Back pain is divided into two phases; acute pain is due to the increased signal from the nociceptive receptors in the nerve endings and chronic pain is resulting from the reconstruction of the new nervous net work during the healing stage. Use of NSAIDs and opioids is indicated for the acute pain that is not eased by taking a rest. NSAIDs is also profitable to control chronic pain, but NSAIDs has complications of renal and digestive functions. Persons with ages of more than 65 are especially liable to those dysfunctions. Pharmacological intervention on back pain may not only give the therapeutic benefits but also it can provide the clues for the elucidation of the mechanism and the new therapeutic interventions.

Acute Disease↗

PubMed2005

[Quality of life and back pain].

Back pain considering generality of its occurrence became an epidemiological problem. In a significant part the pain is persistent and not corresponds on treatment. An aim of this study was to explore a connection between chronicity of pain and quality of a life. An instrument of study was a questionnaire consisting of 6 groups of questions relating to a character of pain, its origin, and its influence on work, social and family relation. Thirty people (21 women and 9 men) in the age of 49 and 46 years with chronic back pain took part in examination. In relations of patients an origin of pain is strongly connected with character of work and beside of this pain would have a negative influence on life- satisfaction and a results of work. Results confirm a significant influence of pain on a quality of people life in different fields and besides of this they connect chronicity of process and its character with personal, psychological profile of participants.

Activities of Daily Living↗

PubMed2006

[Differential diagnosis of back pain].

Back pain is one of the most frequent clinical pictures encountered in a physician's practice. It can pose a great burden on the individual and in addition have a multifactorial origin. It can be caused by intervertebral discs, vertebral joints, nerve roots, ligaments, sacroiliac joints, or a combination of the above. Back pain, as a symptom of a systemic disease, can also be a warning signal of grave disorders such as malignancies or in the event of aortic aneurysm. The well-considered choice of appropriate diagnostic procedures and suitable treatment requires a thorough knowledge of this multifactorial clinical picture.

Back Pain↗

PubMed2001

An objective review of consumer books about back pain.

Back pain is epidemic, and dozens of books inform the public about this disorder. The increase in "self-help" medical books has not been accompanied by objective critiques of this important literature. We conducted an objective, quantified evaluation of the comprehensiveness and quality of these books. A Books in Print search resulted in 38 books on back pain, of which 27 were found and purchased. Topics covered, organization, and emphasis were coded according to scales with excellent interrater reliability. Alternative and conventional treatments were emphasized in most books, but epidemiology, natural history, and risk factors were substantially de-emphasized, covering less than 3% of the text. This objective and validated evaluation of the consumer literature provides a format for researching patient education in other health areas.

Back Pain↗

PubMedDate not supplied

Acupuncture: evidence for its use in chronic low back pain.

Back pain is a major economic burden in the UK, with increasing numbers of patients seeking complementary therapies, such as acupuncture, as a means to supplement traditional medical treatments. Studies to date have produced conflicting results relating to the efficacy of acupuncture and thus this systematic review will provide a concise summary of the clinical scenario in Western countries. A search of various electronic databases identified 11 articles consisting of three case studies, five randomized controlled trials, and two cross-over trials. Systematic examination of these articles did not provide definitive evidence to support or refute the use of acupuncture in the treatment of low back pain. In an era of increasing demands for evidence-based practice and professional accountability, the absence of irrefutable scientific evidence places nurses and medics in a vulnerable position.

Acupuncture Therapy↗

PubMed2004

Low back pain, disability and back pain myths in a community sample: prevalence and interrelationships.

This study investigated the prevalence of back pain, disability, and, of most importance, the presence of misconceptions about low back pain (LBP), its diagnosis and treatment in a bicultural community sample (Belgium). Using the Graded Chronic Pain Scale [Pain 50 (1992) 133] persons were classified according to pain intensity and disability in five subgroups. The interrelationship between LBP beliefs and these five subgroups was also investigated. In our sample (n=1624) the 6-month prevalence of low back pain was 41.8%. Only in 8.2% back pain was disabling. Misconceptions about back pain were widespread, even in the group reporting no back pain. The least misconceptions were found to exist in participants with mild LBP without disability. It is suggested that recovery from an episode of acute low back pain is an active process that involves a correction of beliefs about harm, about the need to restrict physical activities and about medical diagnosis and cure. Finally, it is argued that community actions may be useful to correct LBP myths in order to prevent the development of long-term disability due to LBP.

Activities of Daily Living↗

PubMed2003

[From back pain to life-discontent. A holistic view of psychopathological contributions to pain].

Back pain is a common and disabling condition; it afflicts young adults, and often pursues a chronic course--representing a major public health problem. The physical component of such pain is often overestimated. This paper describes five cases demonstrating how somatic factors can interact with psychological and psychiatric factors--i.e. the 'psychoaffective context'--to determine the degree of perceived pain. In a schema, we summarize the three ways in which the psychoaffective context may contribute to pain: i) physiologically, as a result of increased arousal, leading to muscle tension and perceptual hypervigilance, ii) emotionally, as a result of anxiety leading to stress and feeling of threat, and iii) cognitively, as a cognitive bias caused by increased attention to signals from the target region, and by an increased tendency to interpret these signals as aversive. Personality factors, autobiographical memory, and the place devoted to the body within the narcissistic equilibrium contribute to the degree of anxiety and cognitive bias. Moreover, anxiety and the cognitive bias are also exacerbated by the depressive syndrome that often accompany such pain. Collectively, these factors can lead to a somatization disorder and to chronic pain, even in response to an experience of minimal pain.

Adolescent↗

PubMedDate not supplied

[Non-operative treatment of chronic low back pain: specific back muscular strength training versus improvement of physical fitness].

AIM: A systematic review was performed to evaluate the clinical effects of specific back muscle and non-specific physical fitness training in chronic low back pain. METHOD: A computer-aided Medline research (19861999) of randomised clinical trials concerning both rehabilitation concepts was conducted. A rating system was used to assess the methodological score of each study. The results were analysed and a final statement for evidence according to three main parameters (back pain, physical capacity, and patients comfort) was postulated. RESULTS: Twelve randomised clinical trials were identified. Nine studies were determined as high-quality trials. For chronic low back pain specific back muscle exercises as well as non-specific fitness training were able to improve the patients' conditions sufficiently. In comparison with passive treatment or no treatment there is strong evidence for pain and physical capacity in both groups, but only a positive influence for patient' comfort in fitness groups. Nevertheless, a confrontation of both concepts in two studies did not reveal any notable differences in all three parameters. CONCLUSION: Principally, a specific strength training for back rnuscles as well as a non-specific fitness training are comparably effective to rehabilitate chronic low back pain.

Combined Modality Therapy↗

PubMed2006

Are localized low back pain and generalized back pain similar entities? Results of a longitudinal community based study.

PURPOSE: To compare subjects with localized low back pain (LBP) and with generalized back pain (BP) with regard to baseline characteristics and long-term outcomes. METHODS: A community-based longitudinal study. All inhabitants aged 22 - 70 of a single town were asked to complete self-administered questionnaires regarding back and neck pain and lifestyle characteristics. Those reporting LBP during the previous month were followed up after one year. Data were stratified by sites of pain with respect to 'localized LBP' and to 'LBP with additional sites of BP'. Among LBP measures were the Roland and Morris Disability scale and Pain symptoms indices. RESULTS: Nearly 30% of the total population (602) experienced LBP during the previous month, of whom more than half (336) reported 'localized LBP' and the rest LBP + neck and or upper back pain (Generalized BP). Both subgroups differed from those free of BP, however, those reported 'Generalized BP' comprised more females, were less educated, smoked more, were less engaged in sporting activities and reported higher level of LBP measures than those reported 'localized LBP'. After one year, both subgroups were similar with regard to lifestyle but remained different with regard to some of the LBP measures. CONCLUSIONS: Subjects with 'localized LBP' presented healthier lifestyle than subjects with 'Generalized BP'. The latter experienced higher degree of pain measures. It seems that 'Generalized BP' is not a different entity than 'localized LBP' but rather a more severe one.

Adult↗

PubMed1993

[Low back pain and back exercise].

In the last decennium, information regarding the efficacy of back exercises in the treatment of back pain has increased. It has been shown that exercise programs in acute back pain prevents chronicity, and that back exercises in chronic patients decreases back pain and disability. It is primarily the high intensity and duration of the exercise program which is the most important for a successful result rather than the design of the exercises.

Exercise↗

PubMed2006

Adjustment to chronic pain in back pain patients classified according to the motivational stages of chronic pain management.

UNLABELLED: According to Prochaska's transtheoretical model, the Freiburg Questionnaire stages of chronic pain management (FQ-STAPM) were used to classify chronic back patients into 4 distinct motivational stages. The FQ-STAMP was completed by 163 chronic back pain patients. Pain chronicity was measured by the Mainz Pain Staging System; pain intensity was measured by the numeric rating scale. Healthcare system expenses were considered as number of consulted physicians, number of stays in hospital, and number of rehabilitation programs. As psychometric tests, the lower pain disability index (PDI), the Hospital Anxiety and Depression Scale (HADS), and a quality of life score (SF36) were used. Patients were in the following motivational stages: precontemplation in 30%, preparation in 19%, action in 30%, maintenance in 21%. The intensity of pain in the precontemplation stage patients was significantly higher compared to patients in the maintenance stage. A lower pain chronicity was related to a significantly higher motivation. Moreover, there was a significant increase in healthcare system expenses by the lesser motivated patients. Patients in the maintenance stage used significantly less opioids than patients in the precontemplation stage. The higher motivated patients had a significantly lower PDI, a significantly lower HADS, and a significantly higher quality of life compared to less motivated patients. PERSPECTIVE: The study indicates that the FQ-STAPM might be a useful tool to classify chronic back pain patients and to work out a strategy together with the patient relevant to the outcome of pain management among chronic back pain patients.

Adaptation, Psychological↗

PubMed1988

Complications of chiropractic treatment for back pain.

Back pain often causes patients great despair, and they expect the primary care physician or orthopedic surgeon to provide a quick, simple solution. Rest and analgesia are the most commonly prescribed treatments, and muscle relaxants, heat, traction, and physiotherapy are also used. If these treatments do not help, the patient may search for relief through faith healing, acupuncture, chiropractic treatment, or other nonconventional forms of treatment. Although chiropractic treatment is a popular alternative, its long-term effect is questionable and the medical literature contains numerous reports of patients whose condition worsened as a result of it. Physicians should be aware of the dangers of chiropractic treatment, particularly in patients with severe spondylitic changes, osteoporosis, fractures, tumors, ankylosing spondylitis, infections, or signs of nerve root pressure.

Back Pain↗

PubMed1996

Serum relaxin, symphyseal pain, and back pain during pregnancy.

OBJECTIVE: Our purpose was to study the relationship between serum relaxin levels and back pain during pregnancy. STUDY DESIGN: A prospective clinical cohort study with repeated examinations was performed. RESULTS: There was an initial increase of relaxin levels until a peak value at the twelfth week followed by a decline until the seventeenth week. Thereafter stable serum levels around 50% of the peak value were recorded. Three months after delivery serum relaxin was not detectable. There was a significant correlation between mean serum relaxin levels during the pregnancy and symphyseal pain or low back pain occurring during late pregnancy as measured by medical history or pain-provoking test. CONCLUSION: Relaxin is known to remodel pelvic connective tissue in several mammalian species during pregnancy. The current data suggest that relaxin might be involved in the development of pelvic pain in pregnant women.

Adolescent↗

PubMed2000

Massage for low back pain.

BACKGROUND: Low back pain is one of the most common and costly musculoskeletal problems in modern societies. Proponents of massage therapy claim it can minimize pain and disability, and speed return to normal function. OBJECTIVES: To assess the effects of massage therapy for non-specific low back pain. SEARCH STRATEGY: We searched Medline, Embase, Cochrane Controlled Trials Register, Healthstar, CINAHL and Dissertation abstracts from 1966 to 1999 with no language restrictions. References in the included studies and in reviews of the literature were also screened. Contact with content experts and massage associations were also made. SELECTION CRITERIA: This review included randomized, quasi-randomized or controlled clinical trials that investigated the use of any type of massage (using the hands or a mechanical device) as a treatment for nonspecific low back pain. DATA COLLECTION AND ANALYSIS: One reviewer applied the selection criteria and extracted the data. Two reviewers (one blinded to authors, institutions and journals) independently assessed the quality of each trial. A qualitative analysis (best-evidence synthesis) was performed due to clinical heterogeneity among the included trials and insufficient data reported. MAIN RESULTS: Four randomized controlled trials met the inclusion criteria. Two trials were of high and two of low methodological quality. None evaluated massage as the main intervention. Rather, it was the control intervention in studies evaluating manipulation, electrical stimulation, and a lumbar corset. There is limited evidence showing that massage is less effective than manipulation immediately after the first session and moderate evidence showing it is less effective than TENS during the course of sessions in relieving pain and improving activity. At the completion of treatment and at 3 weeks after discharge there is no difference among massage and manipulation, electrical stimulation or corsets, but this evidence is limited. REVIEWER'S CONCLUSIONS: Based on the studies reviewed, there is insufficient evidence to recommend massage as a stand-alone treatment for non-specific low back pain. There is a need for high quality controlled trials to further evaluate the effects of massage for this condition.

Adult↗

PubMed1996

Patterns of ordering diagnostic tests for patients with acute low back pain. The North Carolina Back Pain Project.

BACKGROUND: Low back pain is a common reason for visiting a physician. Authors of guidelines and insurance payers are currently scrutinizing use of radiography and computed tomography (CT) or magnetic resonance imaging (MRI). OBJECTIVE: To study the determinants of the use of lumbar spine radiography and either CT or MRI in patients with acute low back pain. DESIGN: Prospective cohort study. SETTING: Community-based practices in North Carolina in six strata: urban primary care physicians, rural primary care physicians, urban chiropractors, rural chiropractors, orthopedic surgeons, and practitioners at a group-model health maintenance organization. PATIENTS: 1580 patients with acute low back pain. MEASUREMENTS: Telephone interviews done after the index office visit and at 2, 4, 8, 12, and 24 weeks or until complete recovery; survey of practitioners; and chart abstraction. RESULTS: During the acute back pain episode, 46% of patients had radiography and 9% had CT or MRI. Patient variables related to use of radiography included pain that began more than 2 weeks before the index visit and no previous episodes of low back pain. Practitioner variables associated with use of radiography were being a chiropractor or orthopedic surgeon and having a solo practice. Use of CT or MRI was associated with white race, neurologic deficit at baseline, sciatica, poor functional status at baseline, and small group-practice size. Practitioners' responses to clinical vignettes were associated with aggregate practitioner behavior: In the vignettes and in real life, practitioners were more likely to order CT for patients with sciatica. However, a practitioner's response to a vignette did not predict that practitioner's use of CT or MRI for similar patients in his or her own practice. CONCLUSION: Radiography is commonly used as a diagnostic test for patients with acute back pain. Clinical factors and provider specialty are major correlates of the use of imaging studies.

Acute Disease↗

PubMed1998

Combination of low back pain and previous low back pain and shoulder stiffness in construction employees.

A postal questionnaire for the prevalence of low back pain was studied with relevance to stiffness of that shoulder and a history of low back disorders in construction employees. The percentage of clerical employees with low back pain was 31.3% and of field workers was 30.3%. Odds ratios representing a relative risk factor for low back pain relating to each age group showed 2.35 in the clerical and 2.10 in the field workers at the age of 30-34 years, and 3.34 and 2.58 at the age of 35-39 years, respectively. In the persons with positive previous low back pain, the prevalence rate of low back pain was 52.6% in the clerical, and 50.2% in the field workers. Odds ratios for low back pain relating to previous low back pain significantly exceeded unity for the clerical employees (OR = 9.53) and the field workers (OR = 10.28), compared to those without a history of previous low back pain. The incidence of stiffness of the shoulder was 48.2% in the clerical and 45.2% in the field workers, and the prevalence rate of low back pain among those with stiffness of the shoulder was 68.5% in the clerical and 65.8% in the field workers. Odds ratio were 3.03 in both groups. Among each age group, the prevalence rate of stiffness of the shoulder with low back pain increased gradually to a maximum in the 45-49 age group of 19%, and then dropped. In those with a history of low back pain and/or stiffness of the shoulder, the prevalence of low back pain showed significantly greater value than other risk factors.

Adult↗

PubMed2001

Localized low back pain and low back pain as part of widespread musculoskeletal pain: two different disorders? A cross-sectional population study.

In a cross-sectional postal questionnaire study we compared individuals with localized low back pain (LBP) with individuals with LBP as part of widespread musculoskeletal pain, according to demographic and lifestyle characteristics and functional ability. All the inhabitants in Ullensaker county born 1918-20, 1928-30, 1938-40, 1948-50, 1958-60 and 1968-70 were sent a questionnaire in 1994. The study population comprised 2,893 responders. LBP as part of widespread pain indicated reduced functional ability, and the groups differed in several demographic and lifestyle characteristics.

Activities of Daily Living↗