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Results for “Low Back Pain”

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PubMed2006

Work-related factors contributing to chronic disability in low back pain.

Low back pain is a costly and incapacitating musculoskeletal disorder. Prospective studies documenting the capacity of work-related factors to predict chronicity are few in number, the methodology used is very diversified, and the results obtained diverge. The aim of the present study is to investigate the capacity of work-related objective (non-psychosocial) and psychosocial factors to predict chronic disability related to low back pain. A longitudinal prospective study with two measurement times was carried out. The sample (N = 258) consisted of workers with subacute low back pain who were on sick leave and receiving compensation from the CSST (Quebec Workers' Compensation Board). Of all the work-related variables measured, perceived stress and fears and beliefs about work were associated with return to work status at the six-month follow-up. The results obtained show the importance of considering fears and beliefs about work when identifying people in the subacute phase of low back pain who are at risk of developing chronic disability.

Adolescent↗

PubMed2001

A prospective randomized controlled study of VAX-D and TENS for the treatment of chronic low back pain.

Low back pain is one of the most significant medical and socioeconomic problems in modern society. International guidelines call for evidence-based management for the pain and disability associated with musculoskeletal disorders. The purpose of this randomized controlled trial is to address the question of efficacy and appropriateness of vertebral axial decompression (VAX-D) therapy, a new technology that has been shown in clinical research to create negative intradiscal pressures, and has been shown to be effective in treating patients presenting with chronic low back pain (> 3 months duration) with associated leg pain. Successful outcome was defined as a 50% reduction in pain utilizing a 10 cm Visual Analog Pain Scale and an improvement in the level of functioning as measured by patient-nominated disability ratings. Patients were randomly assigned to VAX-D or to TENS which was used as a control treatment or placebo. The TENS treatment demonstrated a success rate of 0%, while VAX-D demonstrated a success rate of 68.4% (p < 0.001). A statistically significant reduction in pain and improvement in functional outcome was obtained in patients with chronic low back pain treated with VAX-D.

Adult↗

PubMed1999

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

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.

Adult↗

PubMed1999

Nonoperative treatment of low back pain.

Low back pain is a common problem with substantial social and economic issues. Physicians continue to have difficulty managing this condition despite an increased awareness of its magnitude. In addition, there is a misperception about the outcome of patients affected with low back pain; most continue to suffer from pain. We present a nonoperative approach and review various diagnostic and treatment strategies with respect to both scientific and clinical merit. Although many treatment strategies have not been well proved in the scientific literature, thoughtful review of the available information provides a basis for the use of these treatment methods in the patient with refractory pain. This approach can be used in conjunction with existing information to assist clinicians in the management of patients with acute low back pain.

Bed Rest↗

PubMed1993

Medical therapy of low back pain.

Low back pain is a common clinical symptom usually associated with mechanical disorders, primarily muscle strain, affecting the lumbosacral spine. The majority of patients with low back pain improve within a 2-month period with conservative medical management. Conservative management includes limited physical activity, injections, nonsteroidal anti-inflammatory drugs, and muscle relaxants. These therapies work best in combination and are very effective in decreasing low back pain.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1992

A physical therapy model for the treatment of low back pain.

Low back pain is commonly seen in physical therapy practice, and many methods of treatment are used to reduce it. In this article, we discuss the magnitude of the low back pain problem, outline the various treatment methods, and develop a strategy to classify and standardize the treatment of the patient who has low back pain. We will develop this thought process by discussing five management considerations: (1) the dilemma of diagnosis, (2) the information gained from the assessment, (3) a patient classification system, (4) the objectives of the low back treatment process, and (5) a proposed physical therapy intervention model that matches the objectives of treatment to the classification of the patient.

Acute Disease↗

PubMed2000

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

Low back pain is a common medical problem but has decreased in frequency in the occupational setting over the past decade. The weather affects low back pain but to a minor degree. Physical factors, as well as job satisfaction, play a role in the development and perpetuation of low back pain. In contradistinction to previous measurements, intradiscal pressure has been determined in vivo to be greater in the standing than the sitting position. Adenovirus-mediated gene transfer to nucleus pulposus cells may be the initial stage of a new form of therapy for degenerative disc disease. Bed rest is not more helpful than activity as tolerated for the treatment of sciatica. The outcome of spinal stenosis surgery is more closely associated with the patient's perception of improvement than with the degree of canal narrowing.

Humans↗

PubMed2001

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

Low back pain affects a minority of individuals over 65 years of age. Four years after the onset of sciatica, the number of individuals working is independent of their workers' compensation status. A complex interaction of metalloproteinases, cytokines, chondrocytes, and macrophages are necessary for the resorption of herniated intervertebral discs. Positional magnetic resonance imaging in the seated extended posture identifies foraminal narrowing that is not visualized with conventional magnetic resonance studies. Compression associated with cauda equina syndrome must be reversed within 48 hours to preserve neurologic function. The gene for transforming growth factor can be transferred to intervertebral discs, resulting in increased proteogylcan production in a rabbit animal model. An aerobic exercise program is as effective as more expensive exercise programs in the treatment of chronic low back pain. Complementary therapies, willow bark and magnets, have marginal benefit for low back pain. Surgical intervention results in improved function for spinal stenosis patients.

Animals↗

PubMed2004

The unique role of osteopathic physicians in treating patients with low back pain.

Low back pain is a common and costly condition in industrialized nations. Consequently, a variety of treatment modalities and providers are available. A widely recognized clinical practice guideline states that spinal manipulation, as potentially provided by various types of practitioners, can be helpful for patients with acute low back problems without radiculopathy when used within the first month of symptoms. The underlying principles of osteopathic manipulative treatment (OMT) suggest the potential utility of OMT in both acute and chronic low back pain. The author summarizes the methodologic characteristics and results of the three major clinical trials of OMT for low back pain conducted in the United States and discusses their implications for osteopathic medicine.

Humans↗

PubMed2002

Sports medicine approach to low back pain.

Low back pain is a common, recurrent affliction in the general population. Research has indicated that, contrary to traditional beliefs, bed rest is not an effective therapy. Existing evidence supports the use of early activity and exercise in treatment of acute and chronic low back pain. Since the sports medicine model of rehabilitation is based on early, progressive activity, its principles can be usefully applied to the management of low back pain in the general population.

Athletic Injuries↗

PubMed2005

What diagnostic tests are useful for low back pain?

Low back pain (LBP) is a common problem that poses some interesting and difficult diagnostic problems. It is typically benign and self-limited, but it is occasionally the presenting symptom of serious systemic disease. The general diagnostic approach to low back pain is to check for 'red flags' in the history and physical that suggest the presence of malignancy, infection or spondyloarthridites, and for neurological compromise that could indicate that surgery is required (cauda equina syndrome) or may be beneficial (such as herniated discs or spinal stenosis that have not improved with conservative care). In the absence of these features, imaging is of limited value. Recent research has begun to evaluate subgroups with 'non-specific' low back pain that seem to benefit from specific interventions such as median branch or sacroiliac joint injections, manipulation, or specific exercises, but these require further investigation and validation.

Diagnosis, Differential↗

PubMed1996

The role of the iliolumbar ligament in low back pain.

Low back pain is caused by a variety of etiologies. Some clinicians have postulated that much low back pain is due to trauma to the iliolumbar ligament. The iliolumbar ligament is one of the three pelvic-lumbar ligaments and develops during the 12th week of gestation. The iliolumbar ligament appears to be a major stabilizing component between the vertebral spine and the pelvis. The innervation of the iliolumbar ligament appears similar to the posterior lumbar ligaments. Our hypothesis is: micro-trauma to the iliolumbar ligament is the primary cause of many cases of chronic low back pain because (1) it is the weakest component of the multifidus triangle; (2) there is increased susceptibility to injury due to its angulated attachment; (3) it is a primary inhibitor of excess sacral flexion; (4) it is a highly innervated nociceptive tissue; and (5) it plays an increased role with progressive disc degeneration.

Back Pain↗

PubMed2001

Low Back Pain.

Low back problems are extremely common. In the United States, it is estimated that 15% to 20% of the population, and approximately half of working-age adults, admit to back pain each year. Low back pain (LBP) is a symptom and not a specific disease, and there are a large number of potential causes. The vast majority of patients with LBP have a musculoskeletal cause. Ninety percent of patients with acute low back problems recover within a month with very conservative treatment. Because of the multiple possible causes in the musculoskeletal category, and because of the self-limited nature of most patients' pain, only about 15% of patients can be given a specific diagnosis to explain their LBP. Although 90% of patients with LBP have self-limited disease, recurrent attacks of pain are common, and approximately 10% of patients develop chronic LBP. In general, LBP is over-evaluated and over-treated, which results in wasted money and medical resources, and often yields inferior clinical outcomes. The physician's job, when evaluating a patient with acute LBP, is to look for "red flags"--symptoms and signs that should prompt additional evaluation and treatment. Without "red flag" conditions, LBP should be treated with "comfort control" measures only. These measures include activity modification and the use of simple analgesics. Manipulation therapy may be helpful in the short term (within the first month of onset), although other physical therapies are more helpful beyond 1 month from onset. Surgical intervention on the spine for patients without tumors, infection, and fracture should be reserved for patients with progressive or unrelenting compression of one or more lumbosacral nerve roots by a herniated intervertebral disk. Neurologists should be involved in the evaluation and treatment of patients with LBP, because many of the worrisome underlying conditions affect the nerve roots, and most of the surgical interventions are based on documentation of the presence of nerve root impingement. Neurologists can determine if these indications are present, and do not have a vested interest in recommending costly procedures.

Journal Article↗

PubMed1986

Low back pain.

Low back pain is a frequent source of disability during the productive years of life. Repeated trauma is a major causative factor. Maintaining ideal body weight and good muscle tone, especially of the abdominal musculature, can minimize low back pain. Lumbar disc protrusion and extrusion may be treated by medical therapy, by neurosurgical intervention or possibly by chemonucleolysis. Other important causes of back pain are arthritis, facet disease and spinal stenosis. Evaluation of low back pain should include tests to uncover a psychogenic source.

Arthritis↗

PubMed2005

Trunk muscle co-ordination during gait: relationship between muscle function and acute low back pain.

Low back pain costs billions of Euros annually in all industrialized countries. Often radiological diagnosis fails to give evidence of the pathogenesis of low back pain. Although psychophysiological characteristics have an influence, it seems that insufficient muscular spinal stabilization may play the major role in the development of low back pain. Assessment of trunk muscle stabilization activity during everyday activities is rare. Therefore, in this study healthy persons were investigated during walking on a treadmill at a speed of 4 km/h. Women (n = 16) with no history of back pain were investigated before and after a static loading situation of the spine, i.e. while wearing a waistcoat. After this loading situation four women developed pain (pain subjects). Surface EMG (SEMG) was taken from five trunk muscles of both sides. Grand averaged amplitude curves over stride, amplitude normalized curves and variation between all included strides were calculated for all muscles and subjects, respectively. The normal range of all calculated parameters was defined within the span between the 5th and the 95th percentiles of all pain free subjects. Data were evaluated according to deviations from the normal range. Already before the load situation, pain subjects showed considerable deviations from the normal range, mainly of their abdominal muscles. There was no relationship between magnitude of deviation and pain intensity, but perceived exertion was highest in those subjects who showed the most symptoms in terms of number of muscles being identified as considerably deviating from the normal range. No specific "dysfunction pattern" could be identified, which argues for highly individual mechanisms instead of a single target muscle. The results suggest cumulative effects of different disturbance levels resulting in acute back pain. Since deviations could be identified already before the pain occurred, disturbed muscle function seems to be a risk factor for developing back pain. Further investigations aimed at clear identification of and, as a second step, correction of muscle function are necessary.

Journal Article↗

PubMedDate not supplied

Outpatient management of low back pain.

Low back pain affects 80% of adults some time in their lives. It is expensive, costing more than $16 billion per year, and causes 40-50% of all lost work days. A variety of disorders can cause low back pain, but the majority of time the problem is self-limiting and resolves within a few weeks. There are specific risk factors associated with low back pain, temporary measures that can be helpful to decrease discomfort, and specific ways to prevent future episodes. The most important management modality is education, and most patients are treated in the outpatient setting. Nursing care is frequently provided by telephone. Using the nursing process, the nurse can assess and advise patients in a systematic, timely manner while maintaining a nursing focus.

Ambulatory Care↗

PubMed1991

Low back pain.

Low back pain is a very common and significant problem in our society, and there are both mechanical and psychosocial aspects to its etiology. This paper presents a systematic approach to the treatment of common types of low back pain. Treatment, beginning with conservative care, is outlined in this paper in the form of an algorithm. Current research directed at both the diagnostic and treatment aspects of low back pain is addressed.

Back Pain↗

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↗