[About back pain--in the body and/or in the soul. A comment to a SBU-report on back pain].
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Back Pain↗
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[Specific of pharmacotherapy management in back pain among the elderly].
Back pain is one of the main reasons for physical disability among the elderly. The most frequent cause of the pain among this group is the degenerative disease. The larger part in causes of low back pain among the elderly has metabolic (osteoporosis) and neoplastic diseases. Pharmacological treatment of the back pain requires to take into consideration its etiology, course, specific biological features of the organism ageing, pain chronification features and extrasomatic influences. Environmental influences and additional diseases are not insignificant as well. The aforementioned factors determine limitations in using painkillers. The limitations concern quality area (e.g. medicine group, chosen pharmaceutical agents, way of medicine administration) and quantity area (e.g. drug dosage, time of application). The specified differences in etiology, course of low back pain and drug absorption and excretion among the elderly are not sufficiently taken into consideration. It becomes the cause of side effects of the used drugs, lack of treatment efficiency and as a result deterioration of life quality. To improve efficiency in low back pain treatment, the authors reviewed the literature and presented their own opinions on using different groups of drugs and limits of pharmacotherapy among the elderly.
Acetaminophen↗
The affective dimension of low-back pain: its influence on the outcome of back school.
OBJECTIVE: Back School is a rehabilitation treatment for back pain that requires patients to understand an educational message and motivate themselves to modify their behavior to prevent relapses. In examining failed cases, the question arose as to whether the failures could be attributed to affective dimensions of pain that could be reducing tolerance to the pain itself and jeopardizing patients' compliance. We studied the role of the affective component of back pain in Back School failures to see whether this component can be used to predict the treatment's negative results and whether it can be conditioned by the treatment itself. DESIGN: Inception cohort. SETTING: Forty-two subjects with low back pain were treated with Back School at our rehabilitation department. MAIN OUTCOME MEASURES: Evaluation was carried out before Back School treatment and after 2 months, through functional clinical examination and Short Form-McGill Pain Questionnaire (affective and sensory pain indexes). RESULTS: As outcome of the treatment, we considered the modification of spontaneous and evoked pain and the motility of the spine. Unexpectedly, the nonparametric tests did not show a significant correlation between the affective indicators before and after the treatment. As expected, the two dimensions of pain, affective and sensory, are significantly related to each other, both before and after treatment, but this correlation increases after treatment (from r = .50 to r = 88). CONCLUSIONS: The initial hypothesis was not proven. These results show that high affective scores before Back School do not influence the success of the treatment and that the Back School itself is able to modify both the sensorial and affective pain descriptors.
Adult↗
[Chronic back pain].
Low-back pain is a very common disease in Switzerland as elsewhere, with a prevalence of 65%. The pain is usually due to degeneration of the motion segment, but subsides spontaneously in some 95% of cases irrespective of the treatment. Only 5% of patients still have pain after one year; but account for over 80% of the costs due to low-back pain. Some patients can be helped by surgical fusion; however; preoperative identification of the pain source is mandatory. Since there is no consistent correlation between pain and the degree of degeneration of motion segments as seen on plain radiographs, functional radiographs, CT scan or MRI, other diagnostic methods such as facet blocks, discography and external diagnostic fixation must be used. After careful patient selection a fusion operation may be considered. Good results after fusion operations are reported in 60-80% of patients. The operative techniques are described.
Cost-Benefit Analysis↗
Back pain and pregnancy: a review.
Back pain is a common symptom in association with pregnancy. This article reviews the pathogenesis of back pain during pregnancy (gestational back pain) and of new onset postpartum back pain. The studies implicating epidural analgesia and postpartum back pain are discussed. Possible physiological mechanisms contributing to gestational back pain are outlined. Guidelines are provided for the prevention and symptomatic management of the back pain syndromes of pregnancy.
Back Pain↗
[Radiological and electrodiagnostic methods in the diagnosis of chronic pain syndromes: chronic low-back pain].
BACKGROUND: This review of radiological and other procedures used in the diagnosis of (chronic) low-back pain is not intended to provide a complete evaluation of the methods employed, because the validity, specificity and sensitivity of the various diagnostic measures are the subject of so much controversy that a comprehensive discussion would be beyond the scope of the present overview. The choice of method depends not only on the clinical symptoms but also on the localisation of the pain, the aetiology of which may also be related to the age of the patient. CAUSES OF PAIN: Radiculary pain is usually derived from anatomical structures around the roots of a nerve, but it may be of discogenic origin. Diagnosis is achieved by a combination of radiological and neurophysiological methods. It is far more difficult to localise the cause of chronic pseudoradiculary low-back pain, because the main pathological structures can be the intra-articular portions of the vertebral body, the vertebral body itself, the ligamenta intervertebralia or the muscles. Using osteoporosis as an example, the structures of the spine which may cause pain are discussed and the possible diagnostic methods are described. In addition to diagnostic procedures like CT or MRT, use can also be made of interventional radiological methods like discography or facet-joint injections. Such techniques can be supplemented by diagnostic tests under local anaesthesia which may be useful in helping to define the pain. Repeated use of these procedures is only justified if the character of the pain changes or the pain suddenly becomes more pronounced. An algorithm is presented as a guideline only, because a more standardised approach does not give sufficient consideration to the personal experience of the individual user.
English Abstract↗
Prevalence of neuropathic pain among patients suffering from chronic low back pain in Saudi Arabia.
OBJECTIVE: The aim of this study was to assess the prevalence of neuropathic pain among patients suffering from chronic low back pain using the Leeds assessment of neuropathic symptoms and signs (LANSS) pain scale. METHODS: This was a pilot study collected from 10 centers in the Middle East Region, with each center enrolling 10 patients between November 2004 and January 2004. In total, 100 patients with chronic low back pain were included in the study. The LANSS clinical assessment score was used to assess the presence of neuropathic pain. Patients with score > or =12 were considered to have neuropathic pain, while patients with score a less than 12 were considered as having nociceptive pain. RESULTS: We found that 41% of the chronic low back pain patients had neuropathic pain and 59% had nociceptive pain. CONCLUSION: The ability to identify neuropathic pain mechanisms should lead to individualized treatment resulting in improved pain control in this group of patients with chronic low back pain.
Adult↗
Sacroiliac dysfunction in dancers with low back pain.
SUMMARY. Low back pain is a common occurrence in dancers. Studies have shown its prevalence to be around 12% of all dance type of injuries. It is commonly thought by health professionals who specialize in dance medicine that sacroiliac (SI) dysfunction is one of the more common causes of low back pain in dancers. The aetiology of SI dysfunction in dancers is related to both the biomechanics of the SI joint and the physiological demands placed on the SI joint from the dynamics of dance. Injury to the SI joint can be due to a combination of a single traumatic incident, from overuse factors involving repetitive microtrauma or from emotional stress. Clinical manifestations could be pain in the back, buttock, hip and leg, and limitation of movement specific to dance. Diagnosis is based upon the deviation from normal of both the static and kinetic functions of the low back and pelvis in its relationship to the biomechanics of dance. Treatment is aimed at relieving pain, restoring the function of the SI joint and returning the dancer to full function. Copyright 1997 Harcourt Publishers Ltd.
Journal Article↗
Physical examination of horses with back pain.
The diagnosis of back pain is often a diagnosis of exclusion of other problems in the face of poor performance. It requires careful observation, thought, an open mind, and experience. The signs of back pain can be extremely variable and range from subtle to obvious. Obvious forelimb or hind limb lameness is not usually a sign of back pain. The most common differential diagnosis may be back pain secondary to degenerative joint disease of the hocks, fetlocks, or stifle. These diseases can mimic signs of back pain including lack of impulsion, shortening of the stride length, and change in the stride character similar to those seen with back pair.
Animals↗
Low back pain. A primary care challenge.
Back pain is an important problem for primary care physicians; it is common, costly, and controversial. Back pain is the second leading symptom prompting all physician visits in the United States. There are wide geographic variations in medical care for this problem, and surgical rates in the United States are twice those of most developed countries. The treatment of back pain has followed a series of fads and fashions, and work disability resulting from back pain continues to rise. For all these reasons, primary care clinicians have an important role in improving the care of patients with low back pain. Primary care clinicians face unique problems in treating these patients. First, in primary care, most patients have uncomplicated low back pain, and identifying the rare patient with an underlying malignancy or neurologic deficit is like looking for a needle in a haystack. Second, these practitioners face two populations with nonspecific back pain: one that is likely to improve no matter what (who mostly need reassurance), and a smaller group (about 20%) who are prone to development of chronic back pain and who present complex psychosocial and occupational problems. Third, these problems must be dealt with in the typical setting of a 15-minute patient visit. Finally, lifestyle changes in exercise, weight loss, and smoking cessation may be major parts of patient treatment, and improving compliance with such interventions always is a major challenge. Primary care investigators studying back pain face at least three important challenges. One is to identify more efficient diagnostic strategies that will alleviate doctors' and patients' anxieties. Second is to develop a better theory to explain the large majority of episodes of nonspecific low back pain. At present, competing theories generate competing and conflicting treatments, generating frustration among patients and loss of credibility for clinicians. Third, we need better science, with greater methodologic rigor in the evaluation of the many nonsurgical treatments used for back pain in the primary care setting.
Humans↗
An uncommon cause of back pain in pregnancy.
Back pain is a major cause of disability worldwide. A case of a 29 year old Caucasian woman with low back pain secondary to an uncommon benign condition called osteitis condensans ilii is presented and the literature is reviewed. Limited information in the literature combined with poor awareness across the specialty and among the primary care physicians leads to an extensive investigation and misdiagnosis of this benign condition. This report emphasis the salient features and the differential diagnosis in diagnosing and managing this rare condition.
Adult↗
Prevention and management of back pain in nurses.
Back pain is common in adults and may be associated with personal, psychosocial and biomechanical risk factors. Nursing is considered to be a high-risk occupation for back pain, but personal and work-based strategies can help to reduce the risk.
Back Pain↗
A cross-sectional study comparing pain and disability levels in patients with low back pain with and without transitional lumbosacral vertebrae.
OBJECTIVE: To determine whether patients with transitional lumbosacral vertebrae report more pain and disability compared with patients with normal lumbar vertebrae. METHODS: Radiographic and questionnaire data were collected from 353 patients with low back pain. Back pain severity was measured using 2 scales: one for pain over the entire episode and the other for pain during the previous week. All patients completed the Revised Oswestry Disability Questionnaire before radiography was performed. Patients were divided into 2 groups: those with and those without a transitional lumbosacral vertebra. Differences between patient groups were investigated using the unpaired t test. Multiple linear regression analysis was applied to investigate the effect of the transitional lumbosacral vertebrae on pain and disability controlling for the effects of age and sex. RESULTS: Forty-three patients (12.2%) had a transitional lumbosacral vertebra. There were no differences in pain or disability levels between the 2 groups on any of the pain scales or Revised Oswestry subscales. Older patients reported significantly more pain (P = .039) and disability (P = .002) than younger patients. CONCLUSIONS: The presence of a transitional lumbosacral vertebra in this group of patients was not related to an increased level of reported low back pain or disability.
Adolescent↗
Acupuncture and dry-needling for low back pain.
BACKGROUND: Although low-back pain is usually a self-limiting and benign disease that tends to improve spontaneously over time, a large variety of therapeutic interventions are available for its treatment. OBJECTIVES: To assess the effects of acupuncture for the treatment of non-specific low-back pain and dry-needling for myofascial pain syndrome in the low-back region. SEARCH STRATEGY: We updated the searches from 1996 to February 2003 in CENTRAL, MEDLINE, and EMBASE. We also searched the Chinese Cochrane Centre database of clinical trials and Japanese databases to February 2003. SELECTION CRITERIA: Randomized trials of acupuncture (that involves needling) for adults with non-specific (sub)acute or chronic low-back pain, or dry-needling for myofascial pain syndrome in the low-back region. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed methodological quality (using the criteria recommended by the Cochrane Back Review Group) and extracted data. The trials were combined using meta-analyses methods or levels of evidence when the data reported did not allow statistical pooling. MAIN RESULTS: Thirty-five RCTs were included; 20 were published in English, seven in Japanese, five in Chinese and one each in Norwegian, Polish and German. There were only three trials of acupuncture for acute low-back pain. They did not justify firm conclusions, because of small sample sizes and low methodological quality of the studies. For chronic low-back pain there is evidence of pain relief and functional improvement for acupuncture, compared to no treatment or sham therapy. These effects were only observed immediately after the end of the sessions and at short-term follow-up. There is evidence that acupuncture, added to other conventional therapies, relieves pain and improves function better than the conventional therapies alone. However, effects are only small. Dry-needling appears to be a useful adjunct to other therapies for chronic low-back pain. No clear recommendations could be made about the most effective acupuncture technique. AUTHORS' CONCLUSIONS: The data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain. For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and "alternative" treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain. Because most of the studies were of lower methodological quality, there certainly is a further need for higher quality trials in this area.
Acupuncture Therapy↗
Residual postsurgical back pain.
Residual Postsurgical Back Pain (RPP) is a complex problem, involving considerable etiologic and diagnostic confusion. About two-thirds of all patients enrolled in chronic pain centers in the United States suffer from RPP. More than 50 billion dollars are spent on the diagnosis and treatment of back pain in this country. In most cases, the etiology of the patient's complaints is multifactorial. Treatment is difficult and frequently involves surgical as well as non-surgical modalities. Surgical treatment is of value in a carefully selected group of patients, either those in whom the original procedure failed to correct the underlying abnormality or those who show evidence of compression of neural elements, or instability of vertebral column. Because extensive co-morbidity is often present, discrete operative intervention may not fully arrest the compete etiology of the patient's distress, and, indeed; may sometimes worsen the patient's complaints. Possible coexisting problems like degenerative disease or depression should be addressed in all patients prior to surgical intervention, so that the corrected variable is the preponderant cause of the patient's difficulty.
Back Pain↗
The association of pain with physical activities in chronic low back pain.
Most patients with chronic low back pain associate strenuous physical activities with increased pain. This association can cause avoidance of those activities believed to cause intolerable discomfort. This study explored the relationship of performance of physical activities with self-reported pain measures in 40 consecutive patients with disabling low back pain (mean duration 17 months) during a functional restoration rehabilitation program (mean treatment period 7 weeks). Evaluations were performed at initial presentation and at program completion. Measures included quantification of performance on eight physical tests assessing flexibility, lifting capacity and endurance. Before physical testing patients were asked to complete a pain analog scale, a quantified pain drawing, and a rating of the pain anticipated to result from the performance of each physical test. Results showed that pain measures did not generally correlate with measured physical performance. At completion of treatment, significant improvement in performance on all physical tests was found, but these were not associated with consistent changes in pain measures. These results demonstrate that subjects with chronic low back pain can increase their physical performance abilities within their same pain experiences. Medical recommendations for subjects' involvement in physical activities should not be based solely on the reported association of pain with those activities.
Adult↗
Herbal medicine for low back pain.
BACKGROUND: Low-back pain is a common condition and a substantial economic burden in industrialized societies. A large proportion of patients with chronic low-back pain use complementary and alternative medicine (CAM), visit CAM practitioners, or both. Several herbal medicines have been purported for use in low-back pain. OBJECTIVES: To determine the effectiveness of herbal medicine for non-specific low-back pain. SEARCH STRATEGY: We searched the following electronic databases: Cochrane Complementary Medicine Field Trials Register (Issue 3, 2005), MEDLINE (1966 to July 2005), EMBASE (1980 to July 2005); checked reference lists in review articles, guidelines and retrieved trials; and personally contacted individuals with expertise in this very specialized area. SELECTION CRITERIA: We included randomized controlled trials, examining adults (over 18 years of age) suffering from acute, sub-acute or chronic non-specific low-back pain. The interventions were herbal medicines, defined as plants that are used for medicinal purposes in any form. Primary outcome measures were pain and function. DATA COLLECTION AND ANALYSIS: Two authors (JJG & MVT) conducted the database searches. One author contacted content experts and acquired relevant citations. Full references and abstracts of the identified studies were downloaded. A hard copy was retrieved for final inclusion decisions. Methodological quality and clinical relevance were assessed separately by two individuals. Disagreements were resolved by consensus. MAIN RESULTS: Ten trials were included in this review. Two high quality trials examining the effects of Harpagophytum Procumbens (Devil's Claw) found strong evidence that daily doses standardized to 50 mg or 100 mg harpagoside were better than placebo for short-term improvements in pain and rescue medication. Another high quality trial demonstrated relative equivalence to 12.5 mg per day of rofecoxib (Vioxx). Two trials examining the effects of Salix Alba (White Willow Bark) found moderate evidence that daily doses standardized to 120 mg or 240 mg salicin were better than placebo for short-term improvements in pain and rescue medication. An additional trial demonstrated relative equivalence to 12.5 mg per day of rofecoxib. Three low quality trials on Capsicum Frutescens (Cayenne), examining various topical preparations, found moderate evidence that Capsicum Frutescens produced more favourable results than placebo and one trial found equivalence to a homeopathic ointment. AUTHORS' CONCLUSIONS: Harpagophytum Procumbens, Salix Alba and Capsicum Frutescens seem to reduce pain more than placebo. Additional trials testing these herbal medicines against standard treatments are needed. The quality of reporting in these trials was generally poor. Trialists should refer to the CONSORT statement extension for reporting trials of herbal medicine interventions.
Adult↗
A spatial configuration of the lumbo-sacral part of the vertebral column--an importance in the etiology of low back pain.
Chronic low back pain is a very important problem in our civilization. Does a spatial configuration of the vertebral column have an influence on the occurrence of chronic low back pain? Author has compared values of Whitman-Fergusson's angle and Cobb's angle for standing position in patients and controls. No significant differences between both groups have been founded. Beside of this, inclination od sacrum to a horizontal line has had an influence on a value lumbar lordosis in both groups.
Adult↗