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At least 19 recordsLinked to original sources

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↗

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↗

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↗

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↗

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↗

PubMed1985

Low back pain.

Low back pain is one of the most common and costly afflictions of our Society. The majority of adults will have at least one episode of acute low back pain that will likely resolve regardless of treatment. Lumbar spine radiographs are overused and there is little scientific support for many of the therapeutic interventions advocated. Even for those patients with symptomatic herniated disc, only a small fraction will ultimately require surgical intervention.

Arthritis↗

PubMed1988

Office management of low back pain.

Low back pain, with or without sciatica, is a very common medical problem. Since a great majority of patients can be successfully treated with nonoperative methods, office management of these patients is a very important issue for all clinicians. Patients with low back pain can be divided into three major groups: 1) the first group with acute (initial onset or very occasional recurrent) symptoms, 2) the second group with chronic (frequent intermittent recurrent or persistent) symptoms and 3) the third group with resistant symptoms. For the first group with acute symptoms, establishment of a specific diagnosis is rarely necessary. An active nonoperative treatment program (brief rest, protection, physical therapy modalities, medication, exercises, and reconditioning) provides a high rate (nearly 90 to 95 per cent) of success (return to normal activities and work) within 8 to 12 weeks. For the second group, with chronic symptoms, establishment of a specific diagnosis and a comprehensive and specific history are essential. Diagnostic procedures for specific pathologic conditions are outlined. A clear and specific treatment goal should be established and communicated to all the parties involved. Nonoperative treatment for this group includes back school, postural exercises, bracing, exercises for strength and endurance, work-site modification, vocational counseling, and pain management. For the third group with resistant symptoms, the role of the orthopedic or neurosurgeon is as a consultant to a pain management team for evaluation and treatment of missed diagnosis or complications of previous treatments.

Acute Disease↗

PubMed1989

Radiologic investigation of low back pain.

Low back pain is one of the commonest disorders, yet is the most confusing. The cost in work-time lost and in the search for and treatment of its many causes amounts to billions of dollars annually. The traditional techniques for anatomic visualization have been plain-film radiography and myelography, but they have limitations. The development of computed tomography and magnetic resonance imaging have substantially improved anatomic imaging. However, invasive procedures, such as discography, percutaneous nerve-root blocking and percutaneous facet injection, may be helpful in patients with disabling pain in whom noninvasive methods give negative findings, show abnormalities that do not correlate with the symptoms or identify multiple sites of disease. The invasive procedures are believed by some to be associated with too many complications. We have attempted to clarify the strengths and weaknesses of the currently available methods of investigating low back pain and the indications for their use.

Adult↗

PubMed1991

Low back pain.

Low back pain (LBP) affects a large proportion of the population and is an increasingly costly problem in the western world. This review highlights some of the recent theories relating to LBP and the conflicting evidence which has been brought to light. Theories relating to the causes of LBP have included single and multiple factors such as abnormal physical findings, mechanical, psychosocial and economic factors. The two lowest lumbar segments are most often afflicted in LBP sufferers, but the diagnosis of LBP is otherwise uncertain in most cases due to insufficient knowledge relating to the validity of clinical tests, inconsistent terminology and unclear symptomatic patterns. Despite a lack of understanding of the exact anatomical cause of LBP, an abundance of therapeutic models exist, most of which are purely empirical, and few methods have been shown to be clinically useful. Similarly, insufficient knowledge of the causes of LBP makes primary, secondary and tertiary prevention difficult.

Back Pain↗

PubMed1988

Acute low back pain: diagnosis and management of mechanical back pain.

Low back pain is the most common musculoskeletal complaint seen in an ambulatory care setting and affects 80 per cent of all persons at some time in their lives. It is the number one cause of activity restriction in people under 45. With the exception of progressive neuromotor compromise, the initial treatment of nearly all causes of LBP is conservative: the use of analgesics and/or anti-inflammatory agents, bed rest, and patient education.

Acute Disease↗

PubMed1991

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

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

Adolescent↗

PubMed1987

[Labor of freight-container tractor drivers and low-back pain. Characteristics of the low-back pain through clinical findings].

In order to clarify the characteristics of the low-back pain which is prevalent among freight-container tractor drivers, a medical examination, composed of orthopedic tests and questions about health conditions, was carried out on 231 tractor drivers. Prevailing complaints were: dullness or stiffness of the shoulder (71%); dullness of the neck (69%); dullness of the low back (62%); low-back pain (42%); dullness of the lower limbs (39%) and dullness of the back (36%). The rates of complaints of dullness or pain of the neck, shoulder, upper limbs, back or lower limbs, and disturbance of daily activity were associated with the grade of low-back pain evaluated from the subjective symptoms. Orthopedic examination revealed fatigue signs of muscles i.e. tenderness of the body trunk and limbs, tenderness or percussion pain on the spinous processes, and poor results in some tests on muscle strength. These findings were seen more frequently in the group with subjective symptoms, but even among the group without symptoms, they were evident to some degree. These findings were considered to originate from the fact that the freight-container tractors had many ergonomic problems and the daily driving hours of many drivers were estimated to exceed the allowable vibration exposure time of the ISO.

Activities of Daily Living↗

PubMed1992

Classification of nonspecific low back pain. I. Psychological involvement in low back pain. A clinical, descriptive approach.

An unselected sample of outpatient subjects (n = 330) with localized nonspecific low back pain (LBP) was studied. Investigation consisted of clinical assessment, physical examination, and psychiatric interview based on the DSM-III classification. A psychiatric disorder, according to the DSM-III criteria (axis I) was found in 41% of the subjects. Multiple correspondence analysis and cluster analysis were used to objectively identify clinical subtypes without preconceived theoretical models. Correspondence analyses suggested the existence of a 'psychological pain' syndrome consisting of several of the following symptoms: diffuse back pain, impossibility to assess intensity of pain on a pain scale, aggravation of pain by changing climate, by domestic activities or by psychological factors and dysesthesias in the back. Cluster analysis provided support for a four-group classification of low back pain, which may be interpreted through the relationships between psychological disturbances and the LBP clinical features. The results call for further investigation of the complex relationship between psychological disturbances and back pain. However, clinicians must be aware of the interest of a minimal psychiatric assessment in low back pain patients: psychiatric disorders frequently appear in these patients and an appropriate treatment of the psychiatric syndrome may reduce back pain.

Adolescent↗

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↗

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↗

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↗

PubMed1992

Interexaminer reliability and discriminant validity of inclinometric measurement of lumbar rotation in chronic low-back pain patients and subjects without low-back pain.

The interexaminer reliability of an inclinometer procedure to measure lumbar rotation was evaluated by two chiropractic clinicians who examined 25 chronic (greater than 6 months) low-back pain patients and 25 subjects without low-back pain. These groups were compared for differences in mean left, right, and total rotation. Patients who had lumbar spinal surgery were excluded. Twenty-eight men and 22 women, ranging in age from 28-38 years, were evaluated. Reliability between examiners was evaluated by Pearson's correlation coefficient and the intraclass correlation coefficient. All coefficients were significant (P less than 0.01). Errors in prediction and examiner disagreement were evaluated by the standard error of estimate and the interexaminer measurement error. The standard errors of estimate (range: 1.4-4.4) and the interexaminer measurement errors (range: 3.8-10.4) were large compared to the scale of measurement. An analysis of variance of differences between the chronic low-back pain patients and asymptomatics revealed significantly more left rotation in the asymptomatic subjects (F = 8.4; df = 1; P less than 0.006). Also, there was significantly more total rotation in the asymptomatic subjects (F = 4.143; df = 1; P less than 0.048). However, because of the large error attributed to this procedure, it is not possible to say whether the difference between the two groups is a result of the large error or some "real" difference. Therefore, the procedure described in this study should not be used as a clinical outcome measure.

Adult↗

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↗