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PubMed1988

A comparison between the Minnesota Multiphasic Personality Inventory and the 'Mensana Clinic Back Pain Test' for validating the complaint of chronic back pain.

Reports on the efficacy of the Minnesota Multiphasic Personality Inventory (MMPI) for selecting patients with valid complaints of pain have been equivocal. The Mensana Clinic Back Pain Test (MPT) was able to predict, with some degree of success, patients who had a definite organic pathologic condition. However, the MMPI measures personality traits, whereas the MPT measures the impact of pain on a patient's life. To determine which of the two tests would be a better predictor of actual physical abnormalities, and hence valid pain complaints, a comparison was undertaken between the two tests. The charts of 83 patients admitted to the Neurosurgery Service of Johns Hopkins Hospital with complaints of back pain were assessed. MMPI test results, as well as test results for the MPT, were compared to the presence or absence of pathologic conditions on electromyography, nerve conduction velocity studies, thermography, myelogram, or computerized axial tomography scan. The MPT had a correlation factor of -.59700, that was significant as P = .000005. Of the 52 patients scoring 17 points or less on the MPT, 85% had objective physical abnormalities, considered moderate or severe by blind review. Of the 31 patients scoring 18 points or greater on the MPT, only 26% had objective physical findings that were considered moderate or severe. Only the F scale (faking badly) of the MMPI correlated with objective physical abnormalities (r = .21340, P less than .033). However, 60% of the patients with T scores of less than 70 on the F scale had objective findings, whereas 75% of patients with T scores greater than 70 had objective physical findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Back Pain↗

PubMed2001

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

Low back pain affects a minority of individuals over 65 years of age. Four years after the onset of sciatica, the number of individuals working is independent of their workers' compensation status. A complex interaction of metalloproteinases, cytokines, chondrocytes, and macrophages are necessary for the resorption of herniated intervertebral discs. Positional magnetic resonance imaging in the seated extended posture identifies foraminal narrowing that is not visualized with conventional magnetic resonance studies. Compression associated with cauda equina syndrome must be reversed within 48 hours to preserve neurologic function. The gene for transforming growth factor can be transferred to intervertebral discs, resulting in increased proteogylcan production in a rabbit animal model. An aerobic exercise program is as effective as more expensive exercise programs in the treatment of chronic low back pain. Complementary therapies, willow bark and magnets, have marginal benefit for low back pain. Surgical intervention results in improved function for spinal stenosis patients.

Animals↗

PubMed1999

Nonoperative treatment of low back pain.

Low back pain is a common problem with substantial social and economic issues. Physicians continue to have difficulty managing this condition despite an increased awareness of its magnitude. In addition, there is a misperception about the outcome of patients affected with low back pain; most continue to suffer from pain. We present a nonoperative approach and review various diagnostic and treatment strategies with respect to both scientific and clinical merit. Although many treatment strategies have not been well proved in the scientific literature, thoughtful review of the available information provides a basis for the use of these treatment methods in the patient with refractory pain. This approach can be used in conjunction with existing information to assist clinicians in the management of patients with acute low back pain.

Bed Rest↗

PubMed2002

Sports medicine approach to low back pain.

Low back pain is a common, recurrent affliction in the general population. Research has indicated that, contrary to traditional beliefs, bed rest is not an effective therapy. Existing evidence supports the use of early activity and exercise in treatment of acute and chronic low back pain. Since the sports medicine model of rehabilitation is based on early, progressive activity, its principles can be usefully applied to the management of low back pain in the general population.

Athletic Injuries↗

PubMedDate not supplied

Outpatient management of low back pain.

Low back pain affects 80% of adults some time in their lives. It is expensive, costing more than $16 billion per year, and causes 40-50% of all lost work days. A variety of disorders can cause low back pain, but the majority of time the problem is self-limiting and resolves within a few weeks. There are specific risk factors associated with low back pain, temporary measures that can be helpful to decrease discomfort, and specific ways to prevent future episodes. The most important management modality is education, and most patients are treated in the outpatient setting. Nursing care is frequently provided by telephone. Using the nursing process, the nurse can assess and advise patients in a systematic, timely manner while maintaining a nursing focus.

Ambulatory Care↗

PubMed2000

Repositioning error in low back pain. Comparing trunk repositioning error in subjects with chronic low back pain and control subjects.

STUDY DESIGN: Repositioning error of the trunk was tested in 20 subjects with chronic low back pain and in 20 control subjects. The 3Space Tracker (Polhemus, Colchester, VT), a device that measures three-dimensional position in space, was used to determine the subject's trunk position. OBJECTIVES: To determine whether repositioning error is different in subjects with chronic low back pain than in control subjects. SUMMARY OF BACKGROUND DATA: Proprioception allows the body to maintain proper orientation during static and dynamic activities. In peripheral joint injuries, researchers have demonstrated a loss of some aspects of proprioception and improvement in outcome with retraining. Although the components of proprioception in subjects with low back pain have not been well studied, it is thought that these persons lose some elements of proprioception that can be measured in a quantifiable way. If so, then rehabilitation to improve these deficits is important. In this pilot study, one aspect of proprioception, repositioning error, was examined. METHODS: The subjects attempted to replicate target positions of the trunk in flexion, extension, lateral bending, and lateral rotation. Repositioning error was calculated as the absolute difference between the actual and the subject-replicated target positions. RESULTS: No significant difference was found in repositioning error between the control subjects and the persons with chronic low back pain. CONCLUSIONS: Because proprioception is complex and entails the use of many afferent receptors, it is difficult to measure any one afferent deficiency discretely. The authors believe that this study, in which one aspect of proprioception was measured in an indirect manner, provides important background information on low back position sense. Further studies analyzing aspects of proprioception in subjects with low back pain are recommended.

Adult↗

PubMed2005

What diagnostic tests are useful for low back pain?

Low back pain (LBP) is a common problem that poses some interesting and difficult diagnostic problems. It is typically benign and self-limited, but it is occasionally the presenting symptom of serious systemic disease. The general diagnostic approach to low back pain is to check for 'red flags' in the history and physical that suggest the presence of malignancy, infection or spondyloarthridites, and for neurological compromise that could indicate that surgery is required (cauda equina syndrome) or may be beneficial (such as herniated discs or spinal stenosis that have not improved with conservative care). In the absence of these features, imaging is of limited value. Recent research has begun to evaluate subgroups with 'non-specific' low back pain that seem to benefit from specific interventions such as median branch or sacroiliac joint injections, manipulation, or specific exercises, but these require further investigation and validation.

Diagnosis, Differential↗

PubMed1987

Low back pain.

Low back pain is a frequent medical complaint that is often the result of a conflict between a compressed or degenerated disc and the inflamed nerve root. The discoradicular conflict is best treated with dual modality therapy: mechanical treatment to relieve disc compression and anti-inflammatory treatment for the congested root. Almost all cases of acute low back pain can be treated with conservative therapy, including the use of non-steroidal anti-inflammatory drugs (NSAIDs), and surgery should be used only as a last resort. Results of a study comparing oral administration of piroxicam with indomethacin and diclofenac for reduction of spontaneous low back pain indicated that the three drugs are nearly identical in efficacy. In other investigations, intramuscular piroxicam (one injection of 40 mg/d for two days, then 20 mg/d) performed favorably in terms of pain relief and tolerance as compared with higher doses of intramuscular ketoprofen and diclofenac administered in two daily doses.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2002

A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study.

STUDY DESIGN: A randomized clinical trial. OBJECTIVES: To compare the effectiveness of medical and chiropractic care for low back pain patients in managed care; to assess the effectiveness of physical therapy among medical patients; and to assess the effectiveness of physical modalities among chiropractic patients. SUMMARY OF BACKGROUND DATA: Despite the burden that low back pain places on patients, providers, and society, the relative effectiveness of common treatment strategies offered in managed care is unknown. METHODS: Low back pain patients presenting to a large managed care facility from October 30, 1995, through November 9, 1998, were randomly assigned in a balanced design to medical care with and without physical therapy and to chiropractic care with and without physical modalities. The primary outcome variables are average and most severe low back pain intensity in the past week, assessed with 0 to 10 numerical rating scales, and low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire. RESULTS: Of 1,469 eligible patients, 681 were enrolled; 95.7% were followed through 6 months. The mean changes in low back pain intensity and disability of participants in the medical and chiropractic care-only groups were similar at each follow-up assessment (adjusted mean differences at 6 months for most severe pain, 0.27, 95% confidence interval, -0.32-0.86; average pain, 0.22, -0.25-0.69; and disability, 0.75, -0.29-1.79). Physical therapy yielded somewhat better 6-month disability outcomes than did medical care alone (1.26, 0.20-2.32). CONCLUSIONS: After 6 months of follow-up, chiropractic care and medical care for low back pain were comparable in their effectiveness. Physical therapy may be marginally more effective than medical care alone for reducing disability in some patients, but the possible benefit is small.

Analgesics↗

PubMedDate not supplied

Impact of litigation on quality of life outcomes in patients with chronic low back pain.

Low back pain progresses to chronic low back pain (CLBP) in 5-10 per cent of patients. A Multi-disciplinary Pain Management Programme was tested in 20 patients (m = 4, f = 16). This regime involved psychological and behaviour modification strategies, combined with intensive exercise. Treatment outcome in terms of impairment was assessed by lumbar flexibility, trunk muscle endurance and pain. The disability assessed was exercise fitness and handicap was assessed using the Sickness Impact Profile (SIP) to define the impact of the condition on the patient's life. Overall the patients showed significant improvement (p < 0.05) in all of the measured variables. Patients with on-going litigation however (n = 11) showed no significant improvement in the SIP quality of life score, although they shared the significant improvements attained by the whole group in the domains of impairment (lumbar flexibility, trunk muscle endurance and pain) and disability (exercise fitness).

Adult↗

PubMed2003

[Theories and models of chronicity: on the way to a broader definition of chronic back pain].

Chronic back pain is one of the most common and costly disorders. An overview shows that chronicity has various definitions, of which purely temporal ones predominate. Back pain is said to be "chronic" if it lasts for a variable number of weeks or months. Our attempt to refine such definitions is based on three previous works: Loeser's multidimensional pain model, the oncological TNM model and the International Classification of Functioning, Disability and Health of WHO (ICF). We suggest an unidirectional process of pain in the back to a complex pain syndrome including other types of pain, various bodily complaints and cognitive as well as emotional impairments, and propose an empirically testable research model.

Back Pain↗

PubMed2006

The course of high-sensitive C-reactive protein in correlation with pain and clinical function in patients with acute lumbosciatic pain and chronic low back pain - a 6 months prospective longitudinal study.

In this prospective longitudinal study with a follow-up of 6 months, the course of serum concentration of C-reactive protein was measured by an ultrasensitive immunoassay in 31 patients with acute lumbosciatic pain and 41 patients with chronic low back pain. High-sensitive CRP (hsCRP), pain and clinical function were assessed at ten fixed time-points during follow-up. The course of hsCRP values was assessed in relation to the course of pain and clinical function adjusting for possible confounding factors. At the beginning of the study, there were no statistically significant differences in mean hsCRP levels in patients with acute lumbosciatic pain (1.49mg/l) compared to the levels obtained in patients with chronic low back pain (1.30mg/l) and those in a control group from the general population (1.26mg/l). In patients with acute lumbosciatic pain, hsCRP declined significantly in the initial period of 3 weeks with a corresponding decrease in pain and improvement in function and clinical evaluation as assessed with the straight leg raising test (SLR), whereas after this period, the course of the hsCRP did not correspond with the clinical parameters. In patients with chronic low back pain, hsCRP remained approximately constant throughout the whole period with no correlation with pain or function. As a conclusion, according to this study levels of hsCRP do not have a major clinical relevance when evaluating the long-term course of patients with acute lumbosciatic pain and chronic low back pain and therefore should not be taken into primary consideration when decisions on therapy are made.

Acute Disease↗

PubMed1985

A comparison between the MMPI and the 'Mensana Clinic Back Pain Test' for validating the complaint of chronic back pain in women.

Reports on the efficacy of the Minnesota Multiphasic Personality Inventory (MMPI) for selecting patients with valid complaints of pain, have been equivocal. The Mensana Clinic Screening Test for Chronic Back Pain Patients (MPT) was able to predict, with some degree of success, patients who had definite organic pathology. However, ther MMPI measures personality traits, while the MPT measures the impact of pain on a patient's life. In order to determine which of the two tests would be a better predictor of actual physical abnormalities, and hence valid pain complaints, a comparison was undertaken between the two tests. The charts of 53 female admissions to the Neurosurgery Service of Johns Hopkins Hospital, with the complaint of back pain, were assessed. MMPI test results, as well as test results for the MPT, were compared to the presence or absence of pathology on electromyography, nerve conduction velocity studies, thermography, myelogram, CT scan, or X-ray. The MPT had a correlation factor of -0.5384, that was significant at the 0.00002 level. Of the 30 patients scoring 17 points or less on the MPT, 77% had objective physical abnormalities, considered moderate or severe by blind review. Of the 23 patients scoring 18 points or greater on the MPT, only 18% had objective physical findings that were considered moderate or severe. Only the depression scale (scale no. 2) of the MMPI correlated with objective physical abnormalities (R = -0.30). However, only 58% of the patients with T scores on scale no. 2 of less than 70 had objective findings, while 56% of patients with T scores greater than 70 had objective physical findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Back Pain↗

PubMed1995

Pelvic pain and low back pain in pregnant women--an epidemiological study.

BACKGROUND: Pelvic Pain in Pregnancy (PPP) has been diagnosed increasingly often in Norway. The relation to Low Back Pain (LBP) is unclear. METHODS: The answers to 5,400 questionnaires were collected from Norwegian women shortly after delivery, and the occurrence of PPP and LBP in relation to various characteristics was studied. RESULTS: 21% of primipara had had both PPP and LBP, whereas 51% had had neither. The figures in multipara were 31% and 33%. After stratification by parity the frequency of both types of pain decreased with increasing age. The largest occupational risk factor of PPP and/or LBP was having to twist or bend several times an hour. This may be preventable. Partial regression coefficients for parity, smoking, and weight of newborn were significantly larger with PPP than with LBP. CONCLUSION: The association of PPP and LBP to occupational exposure was similar. The statistical explanatory pattern, and thus possibly the etiology, is different in the two conditions.

Adult↗

PubMed1999

Accuracy of recall of usual pain intensity in back pain patients.

Pain intensity ratings of 'usual' pain, or pain 'on average', are gaining in popularity since they are arguably a more realistic measure of a patient's pain status than the single snapshot of 'current' pain. An alternative to the 'actual average' of ratings obtained from multiple measures is the single rating of patients' recall of their 'usual' pain over a period of time, usually 1 week. The use of such a scale relies on the assumption that patients can accurately recall their 'usual' pain. Although accuracy of memory for pain has been investigated, most studies have failed to use appropriate statistical analyses for accuracy (validity). In this study, 200 back pain patients completed four daily recordings of pain intensity over 7 days. These were averaged to compute 'actual average' pain intensity. The next day, patients estimated their pain over the week at its 'least', 'worst' and 'on average' ('usual') as well as recording their 'current' pain intensity. Using the Intra-class Correlation Coefficient (ICC) to compute accuracy, the single rating asking patients to estimate their pain 'on average' over the week was found to be an accurate measure of 'actual average' pain intensity (ICC=0.82) and more accurate than 'current' pain (ICC=0.66). Although some composite measures of single ratings gave more accurate estimates of 'actual average' pain, this was not considered sufficient advantage to advocate their use. The results of this study propose the single rating of pain 'on average' as a valid and practical measure of a patient's pain intensity over a period of 1 week.

Adolescent↗

PubMed1989

Labour pain: correlations with menstrual pain and acute low-back pain before and during pregnancy.

Low-back pain is a major component of labour pain in a substantial number of women. The purpose of this study was to determine whether episodes of acute low-back pain prior to pregnancy is a predictor of low-back pain during labour. 114 women received the Short-Form McGill Pain Questionnaire (SF-MPQ) during labour and were asked to describe the pain separately for front and back contraction pain or continuous pain. The day after the birth of the child the women were interviewed to determine whether they had (a) a history of episodes of acute low-back pain before pregnancy, (b) low-back pain during pregnancy, and (c) low-back pain during menstruation. The results show that episodic low-back pain before pregnancy is not correlated with any aspect of labour pain. However, it is significantly correlated with episodes of low-back pain during pregnancy. In contrast, low-back pain during menstruation is significantly correlated with labour pain scores recorded for back and front contraction pain as well as for continuous back pain. The significant correlation of labour pain with back pain during menstruation suggests that both share a common underlying mechanism. Similarly, the correlation of low-back pain during pregnancy with episodes of acute low-back pain before pregnancy suggests that the strain on back muscles during pregnancy may activate the mechanisms that underlie the usual forms of low-back pain.

Abdomen↗

PubMed2006

Amantadine sulfate reduces experimental sensitization and pain in chronic back pain patients.

We investigated if established psychophysical measures of enhanced experimental sensitization in chronic musculoskeletal pain can be reduced by adjuvant treatment with a N-methyl-d-aspartate receptor antagonist, amantadine sulfate, and whether a reduction in sensitization might be accompanied by a concurrent improvement in clinical pain. Sensitization was evaluated by an experimental tonic heat model of short-term sensitization with concurrent subjective and behavioral psychophysical scaling. Twenty-six patients with chronic back pain were included in the randomized, double-blind, placebo-controlled study and received daily dosages of either placebo or 100 mg of amantadine sulfate during a 1-wk treatment. Participants completed quantitative sensory testing of pain thresholds and experimental sensitization before and after treatment and clinical pain ratings before, during, and after treatment. Experimental sensitization and clinical pain were reduced in patients receiving verum. Initially, experimental sensitization was enhanced in patients, with early sensitization at nonpainful intensities of contact heat and enhanced sensitization at painful intensities, as shown previously. After 1 wk of treatment, experimental sensitization was reduced with amantadine sulfate but not with placebo. We conclude that adjuvant chronic pain treatment with N-methyl-d-aspartate receptor antagonists might be beneficial for chronic pain if enhanced sensitization is involved and that the quantitative sensory test of temporal summation may be used to verify this.

Adult↗

PubMed1998

Low back pain in college athletes. A prospective study correlating lower extremity overuse or acquired ligamentous laxity with low back pain.

STUDY DESIGN: A prospective evaluation of the incidence of low back pain in college athletes was undertaken. OBJECTIVES: To evaluate prospectively leg length discrepancy, hip flexor tightness, and lower extremity acquired laxity or overuse as predictive factors for low back pain in college athletes. SUMMARY OF BACKGROUND DATA: A pilot study found an association between low back pain and the factors to be studied. Several allusions to the kinetic chain theory appear in the literature, but little prospective research has been done in examining the effects of lower extremity involvement on the back. METHODS: Two-hundred fifty-seven college athletes representing nine varsity sports were screened during a preseason sports physical examination. Measures of flexibility, ligamentous stability, leg length discrepancy, and overuse syndromes were recorded. Athletes were observed throughout the ensuing year for low back pain requiring treatment by the athletic trainer. Those athletes with low back pain as the result of direct trauma to the region were excluded from the data. RESULTS: Twenty-four athletes (9.3%) received treatment for low back pain. Thirteen of 87 women (15%) compared with 11 of 170 men (6%) required treatment for low back pain (P = 0.048). Of 57 athletes with lower extremity acquired laxity or overuse, low back pain developed in 14 (P < 0.001). CONCLUSIONS: Athletes with lower extremity acquired ligamentous laxity or overuse may be at risk for the development of noncontact low back pain during athletic competition. Female athletes with lower extremity involvement appeared to have a higher incidence of low back pain treatment compared with their male counterparts. Inflexibility of the lower extremities or leg length discrepancy were not associated with future low back pain treatment.

Adult↗