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PubMed2002

[Does sitting at work cause low back pain?].

INTRODUCTION: Low back pain (LBP) is a common condition that, according to standard textbooks and several review articles, is associated with sitting-while-at-work. However, to our knowledge, no meta-analysis or critical systematic literature reviews have been published. MATERIALS AND METHODS: The Medline, Embase, and OSH-ROM databases were searched for articles dealing with sitting at work in relation to low back pain for the years 1985-1997. Original studies were divided into those dealing with sitting-while-working and those dealing with sedentary occupations. Each article was systematically abstracted for core items. The quality of each article was determined on the representativeness of the study sample, response rate, the definition of LBP, and the statistical analysis. RESULTS: Thirty-five reports were identified: 14 dealing with sitting-while-working and 21 with sedentary occupations. Eight studies were found to fulfill the above-mentioned criteria. Regardless of quality, all but one of the studies failed to find a positive association between sitting-while-working and LBP. High quality studies showed a marginally negative association for sitting compared to diverse workplace exposures, for instance standing, driving, lifting, bending, and compared to diverse occupations. One low quality study associated sitting in a poor posture with LBP. DISCUSSION: Out of 35 studies, only eight fulfilled the very basic quality criteria. Nevertheless, both high-quality and low-quality studies are consistently in agreement about the lack of positive association, and we conclude that the extensive recent epidemiological literature does not support the popular opinion that sitting-while-at-work is associated with LBP.

Global Health↗

PubMed2002

Attributions, stress, and work-related low back pain.

Occupational low back pain (LBP) is a major cause of morbidity and cost. Efforts to control LBP are largely unsuccessful, and better understanding of risks is needed, especially psychological factors. The purpose of this research was to assess the association between worker attributions and LBP. Attributing LBP to internal causes may increase the worker's perceived control, whereas external attribution may cause distress. A new model was developed to explore these associations. A cross-sectional design was used in this study of 278 garment workers. Data were gathered by a self-administered questionnaire and through direct observation. Responses to questions on worker attributions of LBP cause and knowledge of back safety were subjected to factor analysis and other psychometric evaluation to develop scales. Six hypotheses were tested using multivariate logistic regression. Workers who scored high in internal attribution were more likely to be knowledgeable of back safety (OR = 3.7, 95% CI = 2.0-6.7). Workers reporting high demand were more likely to report LBP (OR = 2.3, 95% CI = 1.2-4.4). Workers attributing LBP to job tasks were more likely to report LBP (OR = 3.2, 95% CI = 1.5-6.9), and those reporting high supervisor support were less likely to report LBP (OR = 0.23, 95% CI = 0.08-0.66). Workers with annual incomes above 15,000 dollars were more likely to report LBP in the test of both the Demand-Control-Support and Attribution models (OR = 2.8, 95% CI = 1.2-6.9 and OR = 4.1, 95% CI = 1.5-11.1, respectively). While both models appeared to be useful for the study of low back pain, the R(2)(L) of the Demand-Control-Support model equaled only 11.9 percent, whereas the Attribution model equaled 26.2 percent. This study provides evidence that attribution theory is useful in the study of LBP, including in future interventions in the prevention of LBP.

Adult↗

PubMed2001

Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain.

BACKGROUND: Low back pain (LBP) affects a large proportion of the population. Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as an alternative therapy to pharmacological treatments for chronic pain. However, despite its widespread use, the effectiveness of TENS is still controversial. OBJECTIVES: The aim of this systematic review was to determine the efficacy of TENS in the treatment of chronic LBP. SEARCH STRATEGY: We searched MEDLINE, EMBASE, PEDro and the Cochrane Controlled Trials Register up to June 1, 2000. SELECTION CRITERIA: Only randomized controlled clinical trials of TENS for the treatment of patients with a clinical diagnosis of chronic LBP were included. Abstracts were excluded unless further data could be obtained from the authors. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials and extracted data using predetermined forms. Heterogeneity was tested with Cochran's Q test. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results are presented as weighted mean differences (WMD) with 95% confidence intervals (95% CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences (SMD) were calculated by dividing the difference between the treated and control by the baseline variance. SMD were used when different scales were used to measure the same concept. Dichotomous outcomes were analyzed with odds ratios. MAIN RESULTS: Five trials were included, with 170 subjects randomized to the placebo group receiving sham-TENS and 251 subjects receiving active TENS (153 for conventional mode, 98 for acupuncture-like TENS). The schedule of treatments varied greatly between studies ranging from one treatment/day for two consecutive days, to three treatments/day for four weeks. There were no statistically significant differences between the active TENS group when compared to the placebo TENS group for any outcome measures. Subgroup analysis performed on TENS application and methodological quality did not demonstrate a significant statistical difference. Remaining pre-planned subgroup analysis was not conducted due to the small number of included trials and the variety of outcome measures reported. REVIEWER'S CONCLUSIONS: The results of the meta-analysis present no evidence to support the use of TENS in the treatment of chronic low back pain. Clinicians and researchers should consistently report the characteristics of the TENS device and the application techniques used. New trials on TENS should make use of standardized outcome measures. This meta-analysis lacked data on how TENS effectiveness is affected by four important factors: type of applications, site of application, treatment duration of TENS, optimal frequencies and intensities.

Chronic Disease↗

PubMed1999

[Is exercise therapy and manipulation effective in low back pain?].

We evaluated the effectiveness of exercises and manipulation on pain, disability and sick leave in a systematic review of randomized controlled trials including patients with low back pain. Low back pain is commonly a self-limiting illness and most patients are free of symptoms within 14 days. On the basis of 11 studies, no additional benefits from exercises and manipulation were found in patients with acute complaints (0-4 weeks); thus, our results do not support guidelines that prescribe manipulation in the acute stage. One study found reduced disability and sick leave in the subacute stage (4-12 weeks) when patients were told that it was safe to move and this strategy was reinforced by a graded exercise program and visits to the workplace. Seven studies evaluated manipulation; the effectiveness was no better than other treatments or placebo. Based on seven studies in patients with chronic low back pain (> 12 weeks), there is strong evidence that exercises reduce disability and pain, but their effectiveness on sick leave is not documented. Four studies compared different exercise regimens, but found no evidence in favour of one particular method. The effectiveness of manipulation in patients with chronic pain is poorly documented.

Acute Disease↗

PubMed2004

[Diagnostics and minimally invasive therapy for chronic low back pain].

Chronic low back pain is one of the most frequent causes for seeking medical help in Germany. Many factors play a causal role in its pathogenesis. This is where the dilemma resides in narrowing down the diagnosis and deciding on subsequent therapeutic intervention. There is overall agreement on the concept of when it is expedient to initiate further diagnostic measures. With the exception of clear pathomorphological findings and the presence of cardinal symptoms or warning signs, so-called "red flags", primary back pain should not be subjected to any specific diagnostic tests and therapy during the first 3 months. We present well-established techniques for blockade, discography, and minimally invasive treatment options such as cryotherapy, procedures for thermal ablation, and intradiscal electrotherapy. Vertebroplasty, currently a frequently applied method, is also included in the discussion of minimally invasive treatment for chronic low back pain.

Back Pain↗

PubMed1989

Range of lumbar flexion in chronic low back pain.

Thirty low back pain (LBP) patients, and thirty normal controls without any back pain or disease were the subjects for this study. Lumbar flexion was measured using the skin-marking method, a MacRae and Wright's modification of Schober's method. The mean lumbar flexion for the LBP patients (5.25 +/- 2.12 cm) was significantly lower (P 0.05) than that for normal subjects (6.96 +/- 2.0 cm). The normal males had higher value of lumbar flexion than the females. There is also the tendency for lumbar flexion to decrease with advancing age. Measurement of lumbar flexion using skin-marking technique is therefore an objective method of monitoring patients with low back pain.

Adult↗

PubMedDate not supplied

[Satisfaction of patients with cervical pain and low back pain in a rehabilitation service].

BACKGROUND: The aims of the present paper are: to reduce waiting time for treatment of patients with low back pain/cervical pain; to determine the degree of satisfaction of patients being treated by groups; and to determine whether there is correlation amongst satisfaction, improvement of pain and impact on the activities of everyday life. METHODS: Prospective observational study. STUDY POPULATION: users of the surgeries of a tertiary hospital and the specialties center attached to it, who attended surgery because of cervical/low back pain, and practiced a serie of exercises. PERIOD OF STUDY: 1 october 2001 to 1 April 2002. The instrument of measurement used for evaluating pain and disability was the Von Korff questionnaire for low back pain, with an adaptation of this questionnaire for cervical pain. STATISTICAL ANALYSIS: Wilcoxon's non-parametric test. RESULTS: Total number of patients 273 (176 with cervical pain and 97 with low back pain): 198 women and 75 men. Average age: 48.5 (20-81). The self perceived evaluation of the patients treated in a group improved in 72 subjects (p<0.0001) with cervical pain and in 33 (p<0.001) with low back pain. Post-treatment pain was significantly better (p<0.001) than pre-treatment pain in both groups. Its influence on the activities of everyday life did not achieve statistical significance. Perception of the information received was positive in the cervical group (p<0.05). CONCLUSIONS: Following the application of different techniques: reduction in number of patients and waiting time - decisive factors in the satisfaction of these patients; a good acceptance of group treatment was obtained, ameliorating pain. The degree of knowledge of their pathology only improved in the cervical group.

Adult↗

PubMed1987

Predictors of low back pain disability.

Low back pain has major socioeconomic implications; much of the costs relate to disability and compensation. Theoretically, the early identification of patients at risk to become disabled from a low back episode would lead to more aggressive intervention and reduction of subsequent disability. Low back disability is related to occupational, psychosocial, diagnostic, demographic, anthropometric, health behavior, and injury factors that have been reported in the literature. The multiattribute utility model is a new experimental approach to prediction of disability. The relative weights of the various factors that might be predictive of low back disability are determined by a panel of experts. Although this model is not yet scientifically proven, it offers a promising method of answering the question, "Can low back disability be predicted?"

Adult↗

PubMed2003

Pharmacotherapy of neuropathic low back pain.

Neuropathic low back pain is examined from a structural standpoint, distinguishing processes that start from chronic inflammation and mechanical compromise and cross into the realm of neuropathy with primary neurogenic pathophysiology. The disease of chronic pain is discussed, examining peripheral and central changes in neuroanatomy, neurophysiology, and neuromolecular dynamics. The limitations of inadequate random controlled trials regarding long-term pharmacologic interventions are contrasted with excellent work in the basic science of chronic pain. Complex rational pharmacologic strategies for structural pathology, central pain processes, sites of medication action, and differing routes of administration are delineated.

Humans↗

PubMedDate not supplied

A focused review of the use of botulinum toxins for low back pain.

Chronic low back pain is the second most common illness reported by patients in the United States and accounts for substantial morbidity and health-care resource utilization. Many back and spine stressors can contribute to tissue injury, resulting in acute or chronic pain. In response to injury, biochemical processes that cause inflammation and nerve sensitization increase pain levels and contribute to a cycle of reactivity that further heightens patients' sensitivity to pain stimuli. Treatment of back pain depends on its severity, duration, and underlying cause. Traditional therapeutic options include exercise, oral anti-inflammatory or analgesic medication, antidepressants, physical therapy and, in severe cases, surgery. Unfortunately, dissatisfaction with treatment of back pain is common. Oral medications may not completely alleviate symptoms, and opioid analgesics must be used with caution because of their addictive properties. Surgery does not always produce relief and, in some cases, may even exacerbate the problem. Botulinum toxin, which has already been shown to alleviate pain associated with cervical dystonia and other conditions characterized by muscle spasticity, is now being studied for the treatment of back pain. Preliminary evaluations have shown that this treatment is safe and has the advantage of providing local relief directly to the site of injury or pain, without causing systemic side effects. Initial data from small trials also suggest that botulinum toxin is effective, alleviating back pain in selected patients. On the basis of these promising results, additional study in larger trials is warranted.

Animals↗

PubMed2004

Do medical factors predict disability in older adults with persistent low back pain?

Persistent low back pain (LBP) is one of the most common and challenging persistent pain conditions in older adults. Medical comorbidity also is common in these individuals, but its impact on disability has not been examined. The purpose of this study was, using a cross-sectional design, to examine the functional impact of pain-related and general medical comorbidity on 100 community dwelling older adults (mean age 74.3) with persistent mechanical LBP. Subjects received a structured history and physical examination, lumbosacral spine X-rays, and standardized tests of physical function. Pain-related variables included intensity, duration, extent, and lumbar motion-induced pain. General medical variables included age, comorbidity, number of medications, depressive symptoms, back range of motion, body mass index, and severity of radiographic pathology. Function/disability measures included self-reported disability, gait speed, and mean number of static lifts and amount of work performed during a dynamic lifting task. Structural equation modeling was used to evaluate the influence of pain and medical variables on function/disability. The overall regression model indicated pain and medical variables were significantly associated with function/disability measures (R2=0.45, P<0.01). Individual regression coefficients, however, indicated that only pain duration (r=-0.36, P<0.05) and pain severity (r=0.37, P<0.001) were significantly associated with function/disability. Despite the prevalence of medical co-morbidities in older PLBP subjects, they appear to be of limited utility in understanding level of disability. These findings also underscore the need to optimize pain treatment in independent older adults to optimize physical function and delay the onset of dependent living status.

Aged↗

PubMed1999

Assessment and management of acute low back pain.

Acute low back pain is commonly treated by family physicians. In most cases, only conservative therapy is needed. However, the history and physical examination may elicit warning signals that indicate the need for further work-up and treatment. These "red flags" include a history of trauma, fever, incontinence, unexplained weight loss, a cancer history, long-term steroid use, parenteral drug abuse, and intense localized pain and an inability to get into a comfortable position. Treatment usually consists of nonsteroidal anti-inflammatory agents or acetaminophen and a gradual return to usual activities. Surgery is reserved for use in patients with severe neurologic deficits and, possibly, those with severe symptoms that persist despite adequate conservative treatment.

Acute Disease↗

PubMed2000

Diagnosis and management of acute low back pain.

Acute low back pain is commonly encountered in primary care practice but the specific cause often cannot be identified. This ailment has a benign course in 90 percent of patients. Recurrences and functional limitations can be minimized with appropriate conservative management, including medications, physical therapy modalities, exercise and patient education. Radiographs and laboratory tests are generally unnecessary, except in the few patients in whom a serious cause is suspected based on a comprehensive history and physical examination. Serious causes that need to be considered include infection, malignancy, rheumatologic diseases and neurologic disorders. Patients with suspected cauda equina lesions should undergo immediate surgical investigation. Surgical evaluation is also indicated in patients with worsening neurologic deficits or intractable pain that is resistant to conservative treatment. The current recommendation is two or three days of bed rest for patients with acute radiculopathy. The treatment plan should be reassessed in patients who do not return to normal activity within four to six weeks.

Acute Disease↗

PubMed2006

Postural control in nurses with and without low back pain.

BACKGROUND: Low back pain (LBP) is common in nurses, but it is unclear if the pain is associated with measurements of postural control. Objective measurements of function might be useful in the evaluation of patients with LBP in order to evaluate and predict disability, and in the study of the pathophysiology of chronic LBP. METHODS: In a cross-sectional study, we measured the number of postural adjustments, and degree of posterior-lateral sway in 81 nurses, using a computerized postural sway four-platter measurement system. RESULTS: There were 41 (56.6%) nurses who complained of LBP at the time of testing, and another 12 (14.8%) with a past history of LBP. Nurses with LBP consistently used more postural adjustments to keep their balance (p<0.003), and in some positions postural adjustments were positively associated with the degree of past and present pain. LBP was not significantly associated with the degree of lateral sway. CONCLUSIONS: Nurses either with present or a past history of LBP use an increased number of postural adjustments to maintain balance. Studies are warranted to determine if postural testing can predict the development of LBP or aid in determining appropriate preventive measures.

Adult↗

PubMed1999

Medical knowledge and the intractable patient: the case of chronic low back pain.

Chronic low back pain (CLBP) is endemic in Western societies, and while a good deal of attention has been paid to the lay experience of such pain, much less sociological attention has been paid to the way in which medical ideas about it have been formulated. This paper takes the latter course, tracing the development of clinical notions about the relationship between pathological signs and expressed symptoms from the 1820's to the 1930's, and then placing these developments in the context of postwar notions of 'somatization'. We point to the extent to which the disparity between expressed symptoms, pathological signs and perceived disability in CLBP has led to the moral character of the sufferer forming a constant subtext to medical discourse about the condition. We also note the extent to which medical ideas themselves have been constructed in intimate linkage with socio-legal questions of compensation and worker's insurance.

Attitude of Health Personnel↗

PubMed2000

Surface EMG in chronic low back pain.

Chronic low back pain (CHLBP) occupies first place among factors restricting people's life activity under the age of 45. Frequency of CHLBP occurrence oscillates between 60 and 80%. Dysfunction of the erector trunci is a fundamental cause of CHLBP. The aim of the study was to evaluate the usefulness of surface electromyography (EMG) as an identification method in CHLBP. EMG apparatus was connected to a PC equipped with the EMG-LAB programme. This programme allows the registration, transformation, analysis and projection of results on-line. A summary of complete examination is presented in the form of statistical values of parameters such as mean amplitude, mean density, background amplitude, background density, and upper amplitude and upper density. Plain, surface electrodes were attached to the skin overlying the erector spinae at the T7 and L4 vertebrae, approximately 3-4 cm from the midline of the back. Electrodes were positioned unilaterally on the right side. A reference electrode was positioned on the skin overlying the right arm. Sixty-two patients with CHLBP were examined (30 men and 32 women, mean age 41 +/- 8 years). The control group consisted of 31 people without back problems (16 men and 15 women, mean age 39 +/- 6 years). The statistical values of mean amplitude, mean density and upper amplitude were found to be higher in the control group at the T7 level. At the L4 level, mean amplitude, mean density, background amplitude, background density and upper amplitude were significantly higher in control group. The findings of this study show that (1) dysfunction of the erector spinae plays a significant role in CHLBP, and (2) this process applies to small and large motor units, but the character of these changes is different in particular muscles. Surface EMG is an objective, non-invasive method of examining function of the erector spinae in the author's opinion.

Adult↗

PubMed2026

Spatially Contextualized Integrative Genomics Highlights Neuronal and Glial Regulatory Programs in Low Back Pain.

PURPOSE: Low back pain (LBP) is a heterogeneous pain condition with a measurable genetic contribution, but the genes, brain cell types, and spatial tissue contexts through which inherited risk is expressed remain unclear. We aimed to define cell-type-specific and spatially contextualized genetic mechanisms underlying LBP. METHODS: FinnGen R12 LBP GWAS summary statistics (42,521 cases and 353,224 controls) were integrated with brain single-nuclei eQTL data across eight major brain cell classes. We evaluated genome-wide polygenic signal using LDSC, prioritized genes using MAGMA and PoPS, and performed brain cell-type-specific eQTL-anchored Mendelian randomization, primarily based on single-instrument Wald ratio estimates, followed by Bayesian colocalization. Spatial genetic mapping was conducted using gsMap in an E16.5 murine embryonic atlas and two adult human lumbar spinal cord Visium sections. Selected candidates were assessed by RT-qPCR in neuronal-like and astroglial-like inflammatory cell models. RESULTS: LDSC supported interpretable polygenic signal for LBP. MAGMA and PoPS showed partial gene-level convergence, with TCF4 and TMEFF2 supported by both approaches. Across 1641 tested gene-cell type exposures, significant eQTL-anchored MR associations were concentrated in excitatory neurons, oligodendrocytes, inhibitory neurons, and astrocytes. Integrated eQTL-anchored MR, colocalization, and gene-prioritization evidence highlighted CLEC18A, QPRT, and GMPPB as higher-priority non-MHC candidates with moderate, but not strong, colocalization support. gsMap localized LBP-associated enrichment to neuroaxis-related embryonic regions, including brain, spinal cord, sympathetic nerve, and dorsal root ganglion, and to neuronal-like niches in adult lumbar spinal cord. RT-qPCR showed model-dependent expression changes, with QPRT and LGI4 preferentially responsive in neuronal-like SH-SY5Y cells and GMPPB and DPYSL5 responsive in astroglial-like U251 cells. CONCLUSION: These findings support neuronal and glial regulatory programs as plausible contributors to LBP genetic susceptibility and highlight CLEC18A, QPRT, and GMPPB as higher-priority non-MHC candidates with moderate colocalization support. The results provide a spatially contextualized framework for candidate prioritization in LBP, while emphasizing the need for larger cell-type-specific eQTL resources and functional validation before therapeutic or mechanistic conclusions can be drawn.

Mendelian randomization↗

PubMed2006

Assessment and correlation between clinical patterns, disability and health-related quality of life in patients with low back pain.

AIM: Low back pain (LBP) is the main symptom of most lumbar spine diseases. This symptom, due to physical, psychological and social factors, is correlated to a real disability which can affect the quality of life (QoL.) The aim of this study is to evaluate the QoL and the disability in patients with LBP and to correlate them to clinical patterns. METHODS: In this prospective multidimensional study, 108 patients underwent the following protocol: 1. collection of patient-oriented and disability data with the use of SF-36 and North American Spine Society (NASS); 2. collection of clinical, anamnestic and instrumental data (MRI, CT) with the use of DOVAC files; 3. assessment of disability with the use of Barthel index (BI) and deambulation index (DI). RESULTS: A significant correlation was found between the BI and the physical composite score (PCS), but no significant correlation was noticed between BI and the mental composite score (MCS). DI was not correlated to the SF-36. A positive Lasegue and the absence of the osteo-tendinous reflexes are significantly correlated to the disability and QoL. CONCLUSIONS: This study shows that there is no simple, linear correlation between QoL and disability.

Acute Disease↗