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PubMed2004

Intrathecal drug delivery for treatment of chronic low back pain: report from the National Outcomes Registry for Low Back Pain.

OBJECTIVE: To obtain data on patient demographics, clinical practices, and long-term outcomes for patients with chronic low back pain treated with implantable drug-delivery systems. DESIGN: The National Outcomes Registry for Low Back Pain collected data at baseline, trialing, implant (or decision not to implant), and at 6- and 12-month follow-ups. Data were collected at all time points, regardless of implant status. OUTCOME MEASURES: Numeric pain ratings and Oswestry Low Back Pain Disability scores from implanted patients were compared among baseline and 6- and 12-month follow-ups. Patients were also asked to rate their quality of life and satisfaction with the therapy. RESULTS: Thirty-six physicians enrolled 166 patients to be trialed for drug-delivery systems. The trialing success rate was 93% (154 patients). In all, 136 patients (82%) were implanted. In the implant group, numeric pain ratings dropped by more than 47% for back pain and more than 31% for leg pain at the 12-month follow-up. More than 65% of implanted patients reduced their Oswestry scores by at least one level at their 12-month follow-ups compared with baseline. At 12-month follow-ups, 80% of implanted patients were satisfied with their therapy and 87% said they would undergo the procedure again. CONCLUSIONS: Current clinical practices related to trialing of drug-delivery systems resulted in the majority of patients successfully trialed. At 12-month follow-ups, implanted patients experienced reductions in numeric back and leg pain ratings, improved Oswestry scores, and high satisfaction with the therapy.

Adult↗

PubMed1999

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

Low back pain continues to affect a significant proportion of the younger, working population between 35 and 45 years of age. An important study has correlated macroscopic and microscopic intervertebral disc alterations starting in the second decade of life with oxidative stress manifested by the presence of N-(carboxylmethyl)lysine. Job satisfaction remains a strong predictive factor for the identification of individuals with acute back pain who will develop chronic pain. Patients with pyogenic vertebral osteomyelitis may have an increase in their erythrocyte sedimentation rate during the first 2 weeks of antibiotic therapy without requiring surgical intervention. Magnetic resonance imaging enhancement of migrated disc fragments identifies individuals who are likely to resolve sciatica without surgical intervention. As many as 25% of individuals with low back pain are symptomatic at 12 months, in contradistinction to the dictum of resolution of pain in 2 months. Nonsteroidal anti-inflammatory drugs and muscle relaxants are a very effective combination for the effective treatment of acute low back pain. A majority of chiropractic manipulations are performed for inappropriate indications.

Adult↗

PubMed1993

Perspective on low back pain.

Low back pain is a common and expensive ailment among the working population. Despite the increasing amount of basic and clinical knowledge on low back pain, the precise causes of almost all cases cannot yet be defined. The tissues that could be the sources of pain in the low back have been better identified. The validity of the commonly used diagnosis of facet syndrome is now being questioned, and a favorable response to injection of the facet joints should not be considered an indication for posterior lumbar fusion. Studies continue to indicate that total body vibration and cigarette smoking have a relationship to disk degeneration. Improved imaging techniques such as computed tomography and magnetic resonance imaging allow better visualization of the pathology in the vertebral column, but the correlation between these imaging findings and clinical symptoms has yet to be proven. Psychosocial factors are now recognized as important in patients with low back pain. Surgical procedures, even when appropriately indicated, have produced no better result than has the natural course of the condition.

Humans↗

PubMed1996

Low back pain and its relationship to back strength and physical activity in children.

OBJECTIVE: The objective of the study was to determine the occurrence of low back pain and its relationship to back strength and physical activity in children. METHODS AND MATERIALS: The study included 53 boys and 43 girls aged 10 to 19 years from a group of 116 children who had undergone isometric strength testing 4 years previously. No intervention was performed. Each child was asked five questions concerning low back pain. A questionnaire to quantify participation in athletic activities and manual labor was used as the basis for calculation of each child's activity level. Isometric back flexor and extensor strength were measured with the same method used 4 years previously. Statistical analyses were performed with appropriate correction for confounding factors. RESULTS: The frequency of low back pain and the relationship between low back pain and age, between low back pain and back strength, and between low back pain and physical activity were determined. There was a history of low back pain in 51%, and the frequency of low back pain in the past year was 35%. Eight percent of the children had been limited by low back pain, and 7% had seen a doctor for the pain. The first incident of low back pain occurred at a mean age of 12.3 years. The frequencies of a history of low back pain and of low back pain in the past year increased significantly with age (p = 0.02 and 0.01 respectively). Increased physical activity was significantly associated with a history of low back pain (p = 0.03), and increased back flexor strength was significantly associated with a history of low back pain and of low back pain in the past year (p = 0.03 and 0.008, respectively). The rate of low back flexor or strength over 4 years had a significantly positive association with the occurrence of low back pain in the past year (p = 0.008). CONCLUSIONS AND RELEVANCE: Low back pain is common in children, and, in contrast to adults, low back pain in these children was more common with increased physical activity and stronger back flexors. We believe the main causes of low back pain in children are musculotendinous strains and ligamentous sprains.

Adolescent↗

PubMed1989

Low back pain and the post-laminectomy pain syndrome.

Back pain is one of the most common disorders seen in general practice. Patients with chronic low back pain form a large proportion of the work of any pain relief unit. The aetiology of low back pain and the post-laminectomy pain syndrome are briefly presented and treatment of the 'failed back surgery patient' and the patient with arachnoiditis are discussed.

Arachnoiditis↗

PubMed1995

Estimating the prevalence of low back pain in the general population. Evidence from the South Manchester Back Pain Survey.

STUDY DESIGN: This report gives the results of a population-based cross-sectional mailed questionnaire, with prospective follow-up of survey responders and nonresponders. OBJECTIVE: To determine the 1-month period prevalence of low back pain in an adult population in the United Kingdom and to estimate the effect of nonresponse bias. SUMMARY OF BACKGROUND DATA: Previous United Kingdom population studies have reported a 1-year period prevalence of low back pain of 37%. However, the definitions of low back pain have varied, and the influence of nonresponse rarely has been reported. METHODS: The study population was made up of all 7669 adults (18 to 75 years old) registered with two family practices in a sociodemographically mixed suburban area. The questionnaire, including a pain drawing to identify the site of any pain, was mailed to the entire study population. Two repeat mailings were sent to nonresponders. Family practice consultations about low back pain by individuals from the study population were monitored over the following 12 months using computerized records of all surgery contacts. RESULTS: Of the study population, 4501 (59%) responded. The 1-month period prevalence of low back pain was 39% (35% in males, 42% in females). The age distribution was unimodal, with peak prevalence in those aged 45 to 59 years old. Responders to the first mailing had a small but nonsignificant increase in prevalence compared with those who responded to the second or third mailing. Nonresponders had a subsequent consultation rate for low back pain that was 22% lower than that for the survey responders. CONCLUSIONS: After considering potential differences in nonresponders, the estimated 1-month prevalence of low back pain was between 35% and 37%. Prevalence figures in survey responders may overestimate the true population prevalence by a modest amount.

Adolescent↗

PubMed1999

[A simple therapeutic regime for subacute back pain].

Low back pain seems to be an intrinsic factor in most people's lives. Its cause is still largely unknown. Several structures have been suggested as important pain generators, but proof is still largely lacking. The prognosis is generally regarded as good, but in some patients acute low back pain progresses into a chronic disorder. Some suggest that our way of handling the problem might be partly responsible for the increase in chronic low back pain during the last forty years. Rather than structural derangement, a functional disturbance in the complex reflex system that coordiantes the network of paraspinal muscles could be the background for the impairment. A guarded behaviour and fear can increase the muscular dysfunction and make the situation worse. A simple regime for an effective fear-avoidance and activation program is outlined. The approach includes a clinical examination combined with information for patients about the nature of the problem, provided in a manner designed to reduce fear and give them reason to resume light normal activity.

Back Pain↗

PubMed2006

Soft tissue determinants of low back pain.

Low back pain is one of the complaints most commonly seen in the clinical setting. Correctly or incorrectly, these patients are often given the diagnosis of fibromyalgia, myofascial pain syndrome, disk herniation, or some other label. It is important to recognize the soft tissue causes of low back pain and understand how they can be most appropriately diagnosed and managed. Nonligamentous disorders of the low back region may occur in isolation or in combination with underlying discogenic, ligamentous, and facet-mediated causes of pain. Therefore, in order to fully evaluate and treat a patient with low back pain, it is necessary to consider and address these soft tissue conditions. This paper reviews soft tissue causes of low back pain and discusses how they are most appropriately diagnosed and managed.

Fascia↗

PubMedDate not supplied

[Outcome sensitivity of the North American Spine Society Instrument with special consideration for the neurogenic symptoms of chronic back pain].

BACKGROUND: Back pain is one of the most common chronic diseases in developed countries. The related enormous direct and indirect costs demand evidence-based decisions on rehabilitative care. Our study is intended to evaluate the two NASS outcome dimensions pain and neurological symptoms regarding their sensitivity to change within an inpatient rehabilitation scheme for chronic back pain. METHODS: The study observed a cohort of consecutive patients for one year (n = 70). By applying two outcomes instruments which are in common use internationally (SF-36 and NASS) it enhances comparability with other studies. Moreover the FFbH-R was applied for cross validation. RESULTS: On discharge from hospital an improvement of physical and emotional health as well as pain reduction were found. The results of the various instruments are consistent and support each other and suggest sensitivity to change of the NASS instrument regarding its pain and neurology subdimensions. CONCLUSION: The NASS outcome instrument monitors well the established therapeutic effects of chronic back pain inpatient rehabilitation schemes in the short run and in the long run over a twelve-month period following hospital discharge.

Adult↗

PubMed1996

The role of the iliolumbar ligament in low back pain.

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

Back Pain↗

PubMedDate not supplied

Can a patient educational book change behavior and reduce pain in chronic low back pain patients?

BACKGROUND CONTEXT: This study was prompted by 1) the almost universal use of patient education as an initial or at least an ancillary step in the treatment of patients presenting with low back pain, 2) the relative dearth of studies evaluating the effectiveness of patient education and 3) the complete lack of support in the few existing studies for the efficacy of education in improving patients' long-term health status. PURPOSE: A feasibility study to evaluate the efficacy of an individualized biomechanical treatment educational booklet to effect improvement in health status. STUDY DESIGN: A prospective, longitudinal cohort study. PATIENT SAMPLE: Sixty-two subjects (35 female, 27 male), average age 42.4 years, reported a mean duration of back pain before inclusion of 10.4 years. However, because of attrition, only 48 subjects had complete data across the 18-month follow-up period. OUTCOME MEASURES: Outcome measures included pain status, number of back pain episodes, subject compliance with self-care behaviors, knowledge and opinion of booklet content. METHODS: Volunteers with chronic low back pain were provided a copy of an individualized biomechanical treatment educational book and told they would undergo a written survey of its content 1 week after reading the book. Subjects' health status at 9 and 18 months was evaluated using a structured telephone interview. RESULTS: One week after the 62 subjects, with an average of 10.4 years of symptoms and extensive use of the medical system, finished reading the index book, 51.62% reported noticeable improvement in their pain, their content comprehension was good and opinions about the text were generally positive. At 9-month follow-up, there was statistically significant and clinically relevant improvement in reported pain magnitude (p< .03), number of episodes (p< .0001) and perceived benefit (p< .04). At 18-month follow-up, these gains held or demonstrated even further improvement. CONCLUSION: This study's results suggest that the Treat Your Own Back book may have considerable efficacy in helping readers decrease their own low back pain and reduce the frequency of, or even eliminate, their recurrent episodes. These findings also justify conducting a randomized controlled clinical trial to assess this book's efficacy in improving health status in subjects with low back pain with the study design including internal controls to minimize bias issues and a wider range of outcomes, including measures of pain, function, disability, patient satisfaction, utilization of health care services and psychosocial measures.

Adult↗

PubMed1993

Medical therapy of low back pain.

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

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2000

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

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

Humans↗

PubMedDate not supplied

Do epidurals cause back pain?

Postpartum back pain may occur in up to 44% of women after childbirth. The increasing use of epidural analgesia during labour over the past 35 years has led many women and some doctors to attribute postpartum back pain to this. Such suggestions, if unfounded, may undermine parturients' confidence in epidural analgesia. However, the outcome of recent, randomized studies clearly shows that epidural analgesia does not cause back pain.

Analgesia, Epidural↗

PubMed1992

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

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

Acute Disease↗

PubMed1991

Low back pain.

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

Back Pain↗

PubMed2001

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

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

Adult↗

PubMed2004

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

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

Humans↗