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PubMed2000

Fibro-fatty nodules and low back pain. The back mouse masquerade.

BACKGROUND: Few useful interventions exist for patients with persistent low back pain. We suggest that a fibro-fatty nodule ("back mouse") may be an identifiable and treatable cause of this and other types of pain. METHODS: We describe 2 patients with painful nodules in the lower back and lateral iliac crest areas. In both cases, the signs and symptoms were unusual and presented at locations distant from the nodule. One patient complained of severe acute lower abdominal pain, and the other had been treated for chronic recurrent trochanteric bursitis for several years. RESULTS: In both patients, symptoms appeared to be relieved by multiple injection of the nodule. DISCUSSION: There is agreement that back mice exist. Referred pain from the nodules might explain the distant symptoms and signs in these cases. Multiple puncture may be an effective treatment because it lessens the tension of a fibro-fatty nodule. CONCLUSIONS: Randomized trials on this subject are needed. In the meantime, physicians should keep back mice in mind when presented with atypical and unaccountable symptoms in the lower abdomen, inguinal region, or legs.

Bursitis↗
PubMed1997

Prevalence of pain combinations and overall pain: a study of headache, stomach pain and back pain among school-children.

The prevalence of pain combinations among school children is addressed in view of earlier findings of high pain prevalence in this population. The study considers the prevalence of combinations of three common pains headache, stomach pain and back pain-in a random national sample of 2173 Icelandic 11-12 and 15-16 year-old school children. According to the results from this study there is a 78.2% prevalence of monthly pain. One or more instances of weekly pain is experienced by 40.4% of the children, and 15.6% experience two or three pains weekly. Relevance of gender is greater when dealing with combinations of monthly than weekly pain. Combinations of weekly pains are more gender related than single weekly pains. Girls have significantly more frequent overall pain than boys. The distribution of pain combinations varies by age but not overall pain. The study yields important information about the extent of the overall problem of pain among school children and indicates the need to further study the correlates of different pain combinations in this age group.

Abdominal Pain↗
PubMed1991

Predicting disability time using formal low back pain measurement: the Low Back Pain Simulation Scale.

Objective evaluation of simulation in low back pain is currently not possible. A new simulation scale based on subject response to 103 pain words has shown promise in discriminating patients with low back pain from those simulating low back pain. Administration of this scale to 1679 individuals who were injured at work produced a 10.4% sample with scores in the simulation range. This subsample projected more intense pain and were disabled longer. These findings were replicated in a second study in which treating physicians rated the degree of physical pathology and symptom exaggeration blind to patient classification by the Low Back Pain Simulation Scale. Medical assessment indicated less organic pathology and greater symptom exaggeration among patients classified as simulators providing a measure of support for the validity of the simulation scale.

Adolescent↗
PubMed2003

[Chronic back pain: more than pain in the back. Findings of a regional survey among insurees of a workers pension insurance fund].

BACKGROUND: Surveys with a main focus on back pain tend to isolate the complaint from possibly concomitant pains, other symptoms and disorders. Severe chronic back pain is assumed here to imply more than pain in the back. PARTICIPANTS AND METHODS: We report results from a two stage survey conducted in 1998 - 2000. The initial postal questionnaire addressed all 10,000 actively employed blue collar workers from a regional pension fund (Landesversicherungsanstalt Schleswig-Holstein) aged 40 - 54 and residing in or around Luebeck/Germany (68 % males). Subjects reporting severe and disabling back pain were invited to a socio-medical examination. The response and participation rates were 58 % and 65 % respectively. Non-response and non-participation seem to result in minor though opposite, effects. RESULTS: The prevalence of current back pain (back pain of any severity within the past 7 days) is high (68 %; including 16 % with severe, disabling back pain) despite the preponderance of males and a probable healthy worker effect. 82 % of subjects participating in the second round reported recurrent or persisting back pain on the day of examination, in the majority with a chronic fluctuating and overall deteriorating course pattern. 18 % reported no current back pain and hence gave prospective (and additionally retrospective) evidence of an episodic-intermittent course of the disorder. The former group showed significantly more pains, bodily complaints, dysfunctional cognitions, emotional distress and concomitant disorders. 35 % of them indicated back pain as their dominant health problem; 49 % identified back pain and another disorder as dominant, and 16 % reported other prominent health problems. More than 70 % of "other" disorders originated from the musculoskeletal system often involving the extremities. SUMMARY AND CONCLUSION: Back pain is very common among blue collar workers. Severe disabling back pain is usually associated with numerous other pains, bodily complaints, disorders, and indicators of psychological distress ("amplified back pain"). However, even amplified back pain is not always the sole or dominant health problem. Assessing the degree of "amplification" seems helpful in splitting a previously homogeneous group of severely affected back pain sufferers-with possible prognostic and therapeutic consequences.

Adult↗
PubMed1991

Previous back pain and risk of developing back pain in a future pregnancy.

Four hundred twenty-nine pregnant women who had back pain before pregnancy and 375 pregnant women with no previous back pain were followed at regular intervals from the 12th week of pregnancy until delivery; back-pain complaints were recorded. Overall , back pain occurred twice as often in the group with a back-pain history (period prevalence) (P less than 0.001). The point prevalence of back pain in weeks 12, 24, 30, and 36 was three times higher in the group who had had back pain before pregnancy indicating that pain was not only more prevalent but also lasted longer in that group. Women who had been pregnant previously tended to have an increased risk of back pain, and there was a statistically significant correlation between multiparity and longer periods of back pain (P less than 0.001). Young age increased the risk of back pain (P less than 0.001). Pain intensity was higher in the younger women during the first part of their pregnancies but not later on (P less than 0.05).

Adult↗
PubMed1997

Back Pain among U.S. Workers: Comparison of Worker Attributes According to Self-reported Causes of Back Pain.

Back pain is a significant health problem, especially in industry. To gain a better understanding of back pain in light of its diverse causality, data for 29,322 working adults interviewed in the Occupational Health Supplement to the 1988 National Health Interview Survey were analyzed by self-reported cause of back pain. The 12-month prevalences of back pain for "injury or repeated activities at work," "injury or repeated activities not at work," and "other reasons," were 9.1%, 4.4%, and 4.0%, respectively. The worker attributes and work impacts associated with these self-reported causes were compared for this nationally representative sample. Results from multivariate logistic regressions indicated different profiles of worker attributes among the three cause-specific subgroups of back-pain sufferers. Work impact was substantial in all cases, but was highest for workers with work-related back pain.

Journal Article↗
PubMedDate not supplied

Effect of preexisting back pain on the incidence and severity of back pain in intercollegiate rowers.

BACKGROUND: Back pain is a common problem among rowers. PURPOSE: To determine whether preexisting back pain is a significant risk factor for back pain in intercollegiate rowers and how it relates to the ability of athletes to participate in college rowing. STUDY DESIGN: Survey. METHODS: Surveys from 1829 former intercollegiate rowing athletes were analyzed. The surveys included questions concerning back pain before the subjects' college career, back pain during intercollegiate rowing, missed practices, the duration of time lost from college rowing because of back pain, and career-ending back pain. Back pain was defined as pain lasting longer than 1 week. RESULTS: More subjects with preexisting back pain developed back pain during their college rowing career than subjects without preexisting back pain (57.1% versus 36.6%). Of those with preexisting pain, 55% missed practice because of back pain and 8% ended their college rowing careers; for those without preexisting pain, the percentages were 62% and 17%, respectively. For subjects with pain before their college rowing career, 78.8% missed less than 1 week and 5.9% missed more than 1 month. For subjects with no preexisting pain, 61.9% missed less than 1 week and 18.1% missed more than 1 month. CONCLUSIONS: While rowers with preexisting back pain are more likely to have back pain in college, they are less likely to miss extended periods of practice time or end their college rowing careers because of back pain.

Back Pain↗
PubMed2004

Does anticipation of back pain predispose to back trouble?

Limb movement imparts a perturbation to the body. The impact of that perturbation is limited via anticipatory postural adjustments. The strategy by which the CNS controls anticipatory postural adjustments of the trunk muscles during limb movement is altered during acute back pain and in people with recurrent back pain, even when they are pain free. The altered postural strategy probably serves to protect the spine in the short term, but it is associated with a cost and is thought to predispose spinal structures to injury in the long term. It is not known why this protective strategy might occur even when people are pain free, but one possibility is that it is caused by the anticipation of back pain. In eight healthy subjects, recordings of intramuscular EMG were made from the trunk muscles during single and repetitive arm movements. Anticipation of experimental back pain and anticipation of experimental elbow pain were elicited by the threat of painful cutaneous stimulation. There was no effect of anticipated experimental elbow pain on postural adjustments. During anticipated experimental back pain, for single arm movements there was delayed activation of the deep trunk muscles and augmentation of at least one superficial trunk muscle. For repetitive arm movements, there was decreased activity and a shift from biphasic to monophasic activation of the deep trunk muscles and increased activity of superficial trunk muscles during anticipation of back pain. In both instances, the changes were consistent with adoption of an altered strategy for postural control and were similar to those observed in patients with recurrent back pain. We conclude that anticipation of experimental back pain evokes a protective postural strategy that stiffens the spine. This protective strategy is associated with compressive cost and is thought to predispose to spinal injury if maintained long term.

Adult↗
PubMed2006

Occupations associated with a high risk of self-reported back pain: representative outcomes of a back pain prevalence study in the Federal Republic of Germany.

Given the increasing medical and economic implications of back pain, occupation-specific prevalence data may provide important pointers for preventive programmes targeted at promoting preventive behaviour and improving conditions. The National German Health Survey is the first study to provide the basis for a representative nationwide analysis of back pain prevalence by occupational category. The net sample comprises a total of 3,488 earners aged 18-69. One in three earners in the Federal Republic of Germany (34%) experienced back pain during the 7 days prior to being interviewed. The 1-year prevalence rate is 60%. Occupational categories associated with a lower-than-average back pain prevalence are highly qualified professionals, senior management, and production occupations associated with a comparatively low degree of manual labour. In contrast, an above-average prevalence was identified for occupations associated with physically strenuous work involving one-sided postures, moving, carrying and holding heavy weights, and work typically performed in poor conditions or bad weather. Our data demonstrates significant inter-occupational differences in terms of self-reported back pain. The results underline the importance of measures to promote preventive behaviour and improve the working conditions of those in low-skill manual labour occupations.

Adolescent↗
PubMed2005

The symptom of night pain in a back pain triage clinic.

STUDY DESIGN: Prospective longitudinal study of patients attending a back pain triage clinic with night pain. OBJECTIVE: To assess the importance of the symptom of night pain in patients attending a back pain triage clinic. SUMMARY OF BACKGROUND DATA: The 1994 US Agency for Health Care Policy and Research guidelines suggest nighttime pain should be used as a "red flag." Night pain is known to occur in many conditions, and although common in patients with known serious pathology, the prevalence of night pain in a back pain triage clinic is not known. METHODS: A total of 482 consecutive patients attending a back pain triage clinic were assessed, including history of frequency and duration of night pain. Clinical examination was performed, and demographic data obtained. Magnetic resonance imaging was performed if indicated according to local guidelines. Oswestry, visual analog scales (for pain), and hospital anxiety depression scale, patient-based outcome scores were obtained. RESULTS: There were 213 patients who had night pain, with 90 having pain every night. No serious pathology was identified. Patients with night pain had 4.95 hours continuous sleep (range 2-7) and were woken 2.5 times/night (range 0-6). Patients with pain every night had higher Oswestry, visual analog scale, and hospital anxiety depression scale scores than those who did not. CONCLUSIONS: Although it is a significant and disruptive symptom for patients, these results challenge the specificity of the presence of night pain per se as a useful diagnostic indicator for serious spinal pathology in a back pain triage clinic.

Adolescent↗
PubMed1998

The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults.

STUDY DESIGN: Population-based, cross-sectional, mailed survey. OBJECTIVES: To determine the lifetime, 6-month period, and point prevalence of low back pain and its related disability among Saskatchewan adults and to investigate the presence and strength of selective response bias. SUMMARY OF BACKGROUND DATA: There have been many reports of the prevalence of low back pain in different populations, and the estimates vary widely depending on case definition. However, most studies fail to differentiate between trivial and disabling back pain, which raises the issue of the usefulness of these estimates. No studies have yet documented the prevalence of graded low back pain severity and its related disability in a North American, general, population-based survey. METHODS: The Saskatchewan Health and Back Pain Survey was mailed to a probability sample of 2184 Saskatchewan adults between 20 and 69 years of age. Fifty-five percent of the eligible population responded to the survey. Respondents were compared with nonrespondents, and the presence of selective response bias by back pain status was investigated by wave analysis. The point and lifetime prevalence of low back pain was determined by simple questions, and the 6-month period prevalence of low back pain was determined by the Chronic Pain Questionnaire. All estimates were age standardized to the Saskatchewan population. RESULTS: The authors estimate that at the time of the survey 28.4% (95% confidence interval, 25.6-31.1) of the Saskatchewan adult population were experiencing low back pain, and 84.1% (95% confidence interval, 81.9-86.3) had experienced it during their lifetime. Overall, 48.9% (95% confidence interval, 45.9-52.0) of the population had experienced low intensity/low-disability low back pain in the previous 6 months, 12.3% (95% confidence interval, 10.3-14.4) had experienced high-intensity/low-disability low back pain, and an additional 10.7% (95% confidence interval, 8.8-12.5) had experienced high-disability low back pain in the previous 6 months. There was little variation in the estimates over age groups, but women experienced more high-disability back pain than men. There was no evidence of selective response bias by low back pain status in the survey. CONCLUSION: Low-intensity/low-disability low back pain is a common problem in the general population. Approximately 11% of the adult population studied had been disabled by low back pain in the previous 6 months.

Adult↗
PubMed2002

Validity of the French-language version of the Quebec back pain disability scale in low back pain patients in France.

OBJECTIVES: The primary objectives were to evaluate the acceptability in France of the Quebec Back Pain Disability Scale (QBPDS) in its original French-language version and to study its correlational validity against indicators of impairment, pain, disability, psychological status, and perceived health status. MATERIAL AND METHODS: Thirty-two patients with chronic low back pain were recruited at the rheumatology outpatient clinic of a French hospital. A physical examination was performed for determination of an impairment score, and scales were completed for pain (visual analog scale and Saint-Antoine Questionnaire), disability (QBPDS and Dallas Scale [DS]), perceived health status (Nottingham Health Profile, NHP), and psychological status (Hospital Anxiety and Depression Scale, HADS). RESULTS: Acceptability, internal consistency, and content validity of the QBPDS were satisfactory. Investigation of correlational validity showed good agreement with the DPQ (r = 0.755) and NHP (r = 0.739) and fair agreement with the impairment score (r = 0.449), the VAS pain score (r = 0.448), and the HADS score (r = 0.473). The QBPDS showed good discriminating power. Validity of the QBPDS was confirmed. DISCUSSION: Our results confirm the good measurement properties of the original French-language version of the QBPDS in French hospital-clinic patients with chronic low back pain. Comparison of the QBPDS and DPQ in this study shows that the QBPDS is better for evaluating disability, whereas the DPQ evaluates the overall, functional, psychological, and social impact of low back pain.

Adult↗
PubMed2006

Fear-avoidance beliefs about back pain in patients with subacute low back pain.

The fear-avoidance beliefs of patients with subacute low back pain (LBP) considered at risk for chronic disabling LBP are not well known. The objectives of this cross-sectional descriptive survey, conducted in secondary care practice, were to assess fear-avoidance beliefs about back pain in patients with subacute LBP and to seek an association between physician or patient characteristics and level of fear-avoidance beliefs. A total of 286 rheumatologists completed a self-administered questionnaire assessing physicians' demographic, professional data, personal history of back pain, and back pain fear-avoidance beliefs (on the Fear-Avoidance Belief Questionnaire [FABQ]) and 443 patients with sLBP completed one on pain, perceived handicap and disability (Quebec Back Pain Disability Scale), anxiety and depression (Hospital Anxiety Depression questionnaire), and back pain beliefs (FABQ). Mean FABQ scores for rheumatologists for physical activities (FABQ Phys) and occupational activities (FABQ Work) were 9.2+/-4.4 (range 0-21) and 16.7+/-6.9 (range 2-37), respectively, and patient scores were 16.7+/-5.2 and 19.3+/-12.4, respectively. A total of 68% of patients and 10% of physicians had a high rating on the FABQ Phys (>14). Patients' fear-avoidance beliefs about physical activity were associated with low level of education (odds ratio [OR] 4.19; 95% confidence interval [CI] 1.83-9.57), patients' perceived disability (OR 1.05; CI 1.03-1.07), and physicians' high FABQ Phys score (OR 5.92; CI 1.31-26.32). Here we show that fear-avoidance beliefs about back pain were high in patients with subacute LBP and their rheumatologists.

Acute Disease↗
PubMed1997

Psychosocial factors in the workplace--do they predict new episodes of low back pain? Evidence from the South Manchester Back Pain Study.

STUDY DESIGN: A prospective, population-based cohort study of working adults. OBJECTIVES: To determine whether work-related psychosocial factors and social status predict the occurrence of new episodes of low back pain and influence consultation behavior. SUMMARY AND BACKGROUND DATA: Dissatisfaction with work and social status has been associated with low back pain in several studies; few of these studies have been prospective or population based. METHODS: An initial postal survey was returned by 4,501 (59%) adults (18-75 years old) registered with two primary care practices. From this, a cohort of 1,412 people currently in employment and free of low back pain was identified, and baseline information on work-related psychosocial factors and psychologic distress was obtained. Social class was derived from current occupation using a standardized classification. New episodes of low back pain occurring in the next 12 months were identified by continuous monitoring of primary care consulters and by mailing a second questionnaire a year later to identify occurrences of low back pain for which no consultation was sought. RESULTS: The baseline cross-sectional survey showed modest but significant associations between low back pain and perceived inadequacy of income (risk ratio 1.3), dissatisfaction with work (risk ratio 1.4) and social class IV/V (risk ratio 1.2). In the follow-up year, the risk of reporting low back pain for which no consultation was sought doubled in those dissatisfied with their work. Both perceived inadequacy of income (odds ratio 3.6) and social class IV/V (odds ratio 4.8) were strongly associated with consulting with a new episode of low back pain during the follow-up year, an association more marked in women. The associations with work dissatisfaction and perceived adequacy of income were not explained by general psychologic distress or social status. CONCLUSION: People dissatisfied with work are more likely to report low back pain for which they do not consult a physician, whereas lower social status and perceived inadequacy of income are independent risks for working people to seek consultation because of low back pain.

Adult↗
PubMed1975

Back pain and isometric back muscle strength of workers in a Danish factory.

105 factory workers (38 females and 67 males) have been questioned about their frequency of back pain. 60% of the females and 61% of the males have previously experienced episodes of back pain. 21% of the females and 37% of the males have been absent from work due to back pain. The incidence of back pain is not related to age, height, sort of work, or isometric muscle strength of the back (IS). For the males the incidence rises with increasing weight, i.e. combination of height and obesity, but is not related to any two single factors. For the females there is no correlation between the incidence of pain and weight. IS is correlated to height and age in the males but not in the females. Standards for IS are presented and suggested as a guide to evaluation of the working capabilities of individual subjects with back pain.

Adult↗