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PubMed2000

Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults.

BACKGROUND: Multidisciplinary biopsychosocial rehabilitation programs are widely applied for chronic low back pain patients. The biopsychosocial approach for low back pain could also be considered to prevent chronicity by carrying out the rehabilitation if the acute pain is prolonged. Nevertheless multidisciplinary treatment programmes are often laborious and long processes and require good collaboration between the patient, the rehabilitation team and the work place. By workplace visits and close relationship with occupational health care one might expect results in terms of patients working ability. OBJECTIVES: The objective of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for subacute low back pain among working age adults. SEARCH STRATEGY: The reviewed studies for this structured Cochrane review were identified from electronic bibliographic databases, the Science Citation Index, reference checking and consulting experts in the rehabilitation field. The original search was planned and performed for more broad area of musculoskeletal disorders. Trials on subacute low back pain were separated afterwards. SELECTION CRITERIA: From all references found in our original search we selected randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs). Trials had to assess the effectiveness of multidisciplinary rehabilitation for working age patients suffering from subacute low back pain (more than 4 weeks but less than 3 months). The rehabilitation program was required to be multidisciplinary, i.e.; it had to consist of a physician's consultation plus either a psychological, social or vocational intervention, or a combination of these. DATA COLLECTION AND ANALYSIS: Four blinded reviewers selected the randomized controlled trials and controlled trials that met the specified inclusion criteria. Two experts in the field of rehabilitation evaluated the clinical relevance and applicability of the findings of the selected studies to actual clinical use. Two other blinded reviewers extracted the data and assessed the main results and the methodological quality of the studies using standardized forms. Finally, a qualitative analysis was performed to evaluate the level of scientific evidence for the effectiveness of multidisciplinary rehabilitation. MAIN RESULTS: After screening 1808 abstracts, and the references of 65 reviews, we found only 2 relevant studies that satisfied our criteria on subacute low back pain. They were both considered to be methodologically low quality randomized controlled trials. The clinical relevance of included studies was sufficient. The level of scientific evidence for the effectiveness of multidisciplinary rehabilitation was moderate on subacute low back pain showing that multidisciplinary rehabilitation which includes workplace visit or more comprehensive occupational health care intervention helps patients to return to work faster, makes sick leaves less and alleviates subjective disability. REVIEWER'S CONCLUSIONS: We conclude that there is moderate evidence of positive effectiveness of multidisciplinary rehabilitation for subacute low back pain and workplace visit increases the effectiveness. But because this evidence is based on the trials that had some methodological shortcomings and several expensive multidisciplinary rehabilitation programmes are commonly used for common subacute low back problems, there is an obvious need for high quality trials in this field.

Acute Disease↗

PubMed1993

Diagnosis and treatment of discogenic low back pain.

Low back pain (LBP) is very prevalent in the general population. Treatment of nonradicular back pain, in the absence of deformity, continues to be controversial. Recently, anatomic dissections, magnetic resonance imaging studies, and the use of provocative discograms (pain-related response during the injection similar to the typical pattern of pain reported prior to the procedure) have contributed to our understanding of the etiology of discogenic back pain. Various techniques of spine fusion, with and without instrumentation, have altered the natural history of LBP unresponsive to conservative treatment. This review discusses the etiology and diagnosis of discogenic back pain and the treatment options available to the spine surgeon.

Diagnosis, Differential↗

PubMed2004

Self-care guidelines for the management of nonspecific low back pain.

Low back pain is a very common disorder among adults. However, most low back pain is nonspecific; it has no known cause and cannot be given a precise pathoanatomical diagnosis. Nonspecific low back pain can be very painful, but it is not serious; it is basically an age-related disorder that is affected by differences in occupation, genetics, and personal behavior. There are many different treatments for nonspecific low back pain, but most of them are ineffective. Most patients improve considerably during the first 4 weeks-with or without medical treatment. There is increasing support in the medical literature for patients to assume more responsibility for self-care, and less dependence upon the health care provider. Evidence-based self-care guidelines are presented for use by both the health care provider and the patient. The guidelines offer advice regarding medication, exercise, physical activity, coping skills, and prevention of the next episode.

Adult↗

PubMed1991

Effects of spinal flexion and extension exercises on low-back pain and spinal mobility in chronic mechanical low-back pain patients.

It has been estimated that one fourth to one half of all patients treated in physical therapy clinics suffer from low-back pain. The purpose of this study was to compare the effects of spinal flexion (Group I) and extension (Group II) exercises on low-back pain severity and thoracolumbar spinal mobility in chronic mechanical low-back pain patients. Both groups had significantly less low-back pain after treatment (P less than .10). There was no significant difference, however, between the spinal flexion and extension exercises in reduction of low-back pain severity. The results indicated a significant difference between the groups in increasing the sagittal mobility (P less than .10). The results did not indicate any significant difference between and within groups in increasing the coronal and transverse mobility of the thoracolumbar spine. Either the spinal flexion or extension exercises could be used to reduce chronic mechanical low-back pain severity, but the flexion exercises had an advantage in increasing the sagittal mobility within a short period of time.

Adult↗

PubMed2001

2001 Volvo Award Winner in Clinical Studies: Effects of a media campaign on back pain beliefs and its potential influence on management of low back pain in general practice.

STUDY DESIGN: Quasi-experimental, nonrandomized, nonequivalent, parallel group-controlled study involving before and after telephone surveys of the general population and postal surveys of general practitioners was conducted, with an adjacent state used as a control group. OBJECTIVES: To evaluate the effectiveness of a population-based intervention designed to alter beliefs about back pain, influence medical management, and reduce disability and workers' compensation-related costs. SUMMARY OF BACKGROUND DATA: A multimedia campaign begun during 1997 in Victoria, Australia, positively advised patients with back pain to stay active and exercise, not to rest for prolonged periods, and to remain at work. METHODS: The campaign's impact on population beliefs about back pain and fear-avoidance beliefs was measured in telephone surveys, and the effect of the campaign on the potential management of low back pain by general practitioners was assessed by eliciting their likely approach to two hypothetical scenarios in mailed surveys. Demographically identical population groups in Victoria and the control state, New South Wales, were surveyed at three times: before, during, and after intervention in Victoria. RESULTS: The studies were completed by 4730 individuals in the general population and 2556 general practitioners. There were large statistically significant improvements in back pain beliefs over time in Victoria (mean scores on the Back Beliefs Questionnaire, 26.5, 28.4, and 29.7), but not in New South Wales (26.3, 26.2, and 26.3, respectively). Among those who reported back pain during the previous year, fear-avoidance beliefs about physical activity improved significantly in Victoria (mean scores on the Fear-Avoidance Beliefs Questionnaire for physical activity, 14, 12.5, and 11.6), but not in New South Wales (13.3, 13.6, and 12.7, respectively). General practitioners in Victoria reported significant improvements over time in beliefs about back pain management, as compared with their interstate colleagues. There were statistically significant interactions between state and time for 7 of 10 responses on management of acute low back pain, and for 6 of 10 responses on management of subacute low back pain. CONCLUSION: A population-based strategy of providing positive messages about back pain improves the beliefs of the general population and general practitioners about back pain and appears to influence medical management.

Australia↗

PubMed2005

Effects of recreational physical activity and back exercises on low back pain and psychological distress: findings from the UCLA Low Back Pain Study.

OBJECTIVES: We sought to estimate the effects of recreational physical activity and back exercises on low back pain, related disability, and psychological distress among patients randomized to chiropractic or medical care in a managed care setting. METHODS: Low back pain patients (n=681) were randomized and followed for 18 months. Participation in recreational physical activities, use of back exercises, and low back pain, related disability, and psychological distress were measured at baseline, at 6 weeks, and at 6, 12, and 18 months. Multivariate logistic regression modeling was used to estimate adjusted associations of physical activity and back exercises with concurrent and subsequent pain, disability, and psychological distress. RESULTS: Participation in recreational physical activities was inversely associated--both cross-sectionally and longitudinally--with low back pain, related disability, and psychological distress. By contrast, back exercise was positively associated--both cross-sectionally and longitudinally--with low back pain and related disability. CONCLUSIONS: These results suggest that individuals with low back pain should refrain from specific back exercises and instead focus on nonspecific physical activities to reduce pain and improve psychological health.

Adult↗

PubMedDate not supplied

Differential diagnosis of low back pain.

Low back pain is a symptom common to many vertebral and extravertebral affections. The origin of low back pain mostly derives from a pathology localized in the spine, as in the case of degenerative lesions, neoplastic lesions, infections, fractures, metabolic diseases such as osteoporosis, or more rarely, rheumatological diseases. The causes of extravertebral low back pain may be renal, pancreatic, gastrointestinal, or of the female genital apparatus. The authors present a series of clinical aspects which must always be taken into consideration in order to avoid errors in the diagnosis and evaluation of a patient with low back pain.

Diagnosis, Differential↗

PubMed1998

Occupational role performance in persons with back pain.

PURPOSE: Back pain is a major cause of work disability but there is little data on the impact of back pain among persons who are working. The purpose of this study was to develop a measure of occupational role performance for individuals with back pain and to examine its relationship with sociodemographic and work-related factors. METHOD: Item analysis and reduction resulted in a short, eight-item Occupational Role Questionnaire (ORQ) consisting of two scales, a productivity scale and a satisfaction with work scale. The scales had good internal consistency and correlated as expected with the Roland and Morris Disability Scale. RESULTS: In a multivariate logistic model, significant negative effects on work satisfaction were observed for age 30-39 years relative to age 50+, having a job that required lifting, and the level of disability. CONCLUSION: The ORQ may have applications in studying the consequences of back pain and other chronic conditions in the workplace.

Adult↗

PubMed2005

Low back pain in military recruits in relation to social background and previous low back pain. A cross-sectional and prospective observational survey.

BACKGROUND: Traditionally, studies on the etiology of low back pain have been carried out in adult populations. However, since low back pain often appears early in life, more research on young populations is needed. This study focuses on the importance of social background factors and previous low back pain in the development of low back pain in military recruits. METHODS: During a three-month period, Danish military recruits with different social backgrounds live and work under the same conditions. Thus, there is an opportunity to investigate the influence of social background on the development of low back pain, when persons are removed from their usual environment and submitted to a number of new stressors. In addition, the importance of the recruits' previous low back pain history in relation to low back pain during military service was studied. This was done by means of questionnaires to 1,711 recruits before and after this three-month period. RESULTS: Sedentary occupation was negatively associated with long-lasting low back pain (>30 days during the past year) at baseline with an odds ratios of 0.55 (95% CI: 0.33-0.90). This effect vanished during service. Having parents with higher education increased the risk of low back pain during service (OR: 1.9;1.2-3.0, for the highest educated group), but not of the consequences (leg pain and exemption from duty), whereas high IQ decreased the risk of these consequences (odds ratios as low as 0.2;0.1-0.8 for exemption from duty in the group with highest IQ). Long-lasting low back pain prior to service increased the risk of long-lasting low back pain (OR: 4.8;2.1-10.8), leg pain (OR: 3.3;1.3-8.3) and exemption from duty during service (OR: 5.9;2.4-14.8). CONCLUSION: Sedentary occupation is negatively associated with low back pain at baseline. This protective effect disappears, when the person becomes physically active. For predicting trouble related to the low back during service, the duration of low back pain prior to service and IQ-level are the most important factors.

Adult↗

PubMed2004

[Is Qi Gong suitable for the prevention of low back pain?].

Low back pain is one of the main problems of health care, and has many causes. To prevent low back pain daily activities are highly important--static work as well as dynamic movement--carried out in an ergonomic and economical way. Studies have shown that the compliance of patients with regard to exercise training and ergonomic recommendations is not very high. The main posture of Qi Gong training is similar to the recommended posture by low back schools. Qi gong exercises respect basic physiological and ergonomic principles of movement in every way. Qi Gong fulfils the most important criteria for the prevention and therapy of idiopathic low back pain. Qi Gong training requires no special equipment. It is simple and can be undertaken everywhere. A growing number of people have become interested in Qi Gong, and train regularly and effectively. Low back pain rarely occurs in such people, and therefore Qi Gong should be considered as one of the most effective means of prevention.

Breathing Exercises↗

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↗

PubMed1997

Test-retest reliability of patient reports of low back pain.

Low back pain is, in large part, a subjective illness. Clinicians must use patient descriptions of the severity and location of low back pain and how it responds to various activities and positions to make diagnostic and treatment decisions. Therefore, it is important to understand how reliably patients describe these aspects of low back pain. The purpose of this study was to determine the test-retest reliability of a visual analogue scale measure of pain intensity, a pain drawing measure of pain location, and the pain response to activity and position questionnaire. Fifty-three subjects (28 men and 25 women) with a mean age of 54.2 years were recruited from an outpatient orthopaedic clinic. They completed the visual analogue scale, pain drawing, and pain response to activity and position questionnaire before and again immediately after seeing their physician. Thirty-three subjects also completed the visual analogue scale and pain drawing measure that evening and the next morning. Test-retest reliability of the visual analogue scale and pain drawing measure was examined using an intraclass correlation coefficient. Reliability of each item on the pain response to activity and position questionnaire was examined by calculating an unweighted Cohen's kappa. Overall, the three pain measures demonstrated fair to good test-retest reliability: 1) visual analogue scale = .66-.93, 2) pain drawing = .58-.94, and 3) pain response to activity and position questionnaire = .46-.89. The results of this study suggest that, although there is some variability in how consistently patients report various aspects of low back pain, the reliability of these pain measures is sufficient to permit their use in making clinical decisions and measuring treatment outcomes.

Female↗

PubMed2003

Low back pain.

Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. Acute back pain is the most common presentation and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong psychological overlay: work dissatisfaction, boredom, and a generous compensation system contribute to it. Among the diagnoses offered for chronic pain is fibromyalgia, an urban condition (the diagnosis is not made in rural settings) that does not differ materially from other instances of widespread chronic pain. Although disc protrusions detected on X-ray are often blamed, they rarely are responsible for the pain, and surgery is seldom successful at alleviating it. No single treatment is superior to others; patients prefer manipulative therapy, but studies have not demonstrated that it has any superiority over others. A WHO Advisory Panel has defined common outcome measures to be used to judge the efficacy of treatments for studies.

Acute Disease↗

PubMed1994

Continuous passive motion in seating: a new strategy against low back pain.

Low back pain commonly reduces tolerance for the prolonged sitting required by many occupations and routine daily activities. In order to provide lumbar lordotic continuous passive motion (CPM), a pneumatic device was developed. This device includes a lumbar support bladder, which is cyclically inflated and deflated by a pump and valve system. This system is controlled by a timer and by pressure feedback from the bladder. The user selects cycle duration and support pressure. Using a simulated automobile setting, the first part of this study demonstrated that CPM produces lumbar lordotic motion and improved comfort for subjects without histories of low back pain. In the second part of the study, 28 people with chronic low back pain reported greater comfort using CPM during their routine motor vehicle operation. Further research is needed to determine whether this promising new strategy against low back pain can reduce occupational disability due to sitting intolerance.

Adult↗

PubMed1997

Risk indicators of low back pain among workers in Japan. Association of familial and physical factors with low back pain.

STUDY DESIGN: A questionnaire was given to 3,042 Japanese workers at a factory in 1992. It surveyed age, gender, weight, height, job classification, and work environment, as well as the perceived causes, onset age, and characteristics of low back pain. Family history of low back pain among first-degree relatives and perception of physical condition also were assessed. OBJECTIVES: To investigate the risk indicators of low back pain in Japanese workers with various kinds of job classifications in a manufacturing company. SUMMARY OF BACKGROUND DATA: Risk indicators of low back pain in Japanese patients have not been fully investigated in previous studies. METHODS: Prevalence rates and characteristics of low back pain were examined among 3,042 factory workers (2,517 men and 525 woman) with jobs with varying physical demands. In the analysis of risk indicators of low back pain, the odds ratios and 95% confidence intervals were computed. In addition, a multiple logistic analysis was performed to evaluate risk indicators of low back pain. RESULTS: Point and lifetime prevalence of low back pain were correlated with the physical demands of the job. The perceived cause found to be most associated with low back pain were lifting in workers with jobs requiring moderate to heavy work and sports activity in sedentary workers. Family history of low back pain in parents, siblings, and children was a risk indicator of low back pain. The average age of the first attack of low back pain in workers with a family history of it in their parents was significantly younger than that in workers with no family history in a multiple logistic analysis in male workers, the physical work demands, age, and family history of low back pain in their parents were risk indicators; however, obesity was not a risk indicator. Physical and mental conditions of workers also were associated with low back pain. CONCLUSIONS: The physical job demands show a clear association with the point and lifetime prevalence of low back pain, and improvements in work conditions may decrease low back symptoms among workers. It is likely that a family history of low back pain and physical and mental conditions of workers also should be considered in the management of low back pain.

Adult↗

PubMed2000

Neck or shoulder pain and low back pain in Finnish adolescents.

The aim of this study was to investigate the prevalence and determinants of self-reported neck or shoulder pain (NSP) and low back pain (LBP) among 12-18-year-olds. A questionnaire was mailed to a nationally representative sample of 11,276 12-, 14-, 16- and 18-year-olds in 1991. The response rate was 77%. NSP was perceived at least once a week by 15% of 12-18-year-olds and LBP by 8%. Both symptoms were more prevalent among girls than among boys, and the prevalence increased with age. Among the determinants investigated, the number of perceived psychosomatic symptoms had the strongest association with NSP and LBP. Our study confirmed the co-morbidity of NSP and LBP, and indicated that NSP is more frequent than believed among 16-18-year-old girls. The strong association of psychosomatic symptoms with NSP and LBP suggests that the latter two pain states could be more psychosomatic than nociceptive in character.

Adolescent↗

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↗

PubMed2005

Physical and emotional functioning of adult patients with chronic abdominal pain: comparison with patients with chronic back pain.

UNLABELLED: Adults with chronic abdominal pain remain a poorly defined population, despite the debilitation and depression associated with this therapeutically challenging condition. This study compared patients with chronic abdominal pain with an empirically well-known group of patients with chronic pain (back pain) to investigate similarities and differences in their physical and mental functioning. This retrospective, cross-sectional study included 136 patients with abdominal pain and 364 patients with back pain seen in a comprehensive pain rehabilitation center. Patients' functioning was assessed with the Short Form-36 Health Survey, Multidimensional Pain Inventory, Center for Epidemiological Studies-Depression scale, and Coping Strategies Questionnaire-Catastrophizing subscale. Both the abdominal and back pain patients reported long-standing and severe pain, numerous surgery procedures, poor functioning, and high prevalence of depression. When age, education, and marital status were controlled for, analyses showed that although patients with abdominal pain reported significantly better physical functioning than patients with back pain (P < .001), their overall health perception was significantly poorer (P < .001). Although less prevalent, it is clear that patients with chronic abdominal pain exhibit poor functioning and prevalence of depression that are comparable to patients with chronic back pain. This study also suggests distinct characteristics that are vital to consider for effective treatment of this chronic pain population. PERSPECTIVE: As a result of being an overlooked and poorly defined population, adults with chronic abdominal pain might not receive adequate pain management treatment. Learning more about the physical and emotional functioning of patients with long-standing abdominal pain can increase recognition of the needs of and improve treatment for this population.

Abdominal Pain↗