Functioning in neck and low back pain from a 12-year perspective: A prospective population-based study

Patients' experiences with musculoskeletal spinal pain: A qualitative systematic review protocol

BACKGROUND

Musculoskeletal (MSK) spinal pain encapsulates various conditions including lumbar (low back), cervical (neck), and thoracic pain that significantly impact individual and global health. While clinical aspects of spinal pain have been well-studied, understanding patients' personal narratives and lived experiences remains essential for enhancing patient-centered care, improving treatment adherence, and informing healthcare policies. It provides deep insights into the impacts of spinal pain, guiding more effective and empathetic treatment approaches. This systematic review aims to synthesize qualitative evidence on patients' experiences with MSK spinal pain, providing insight into the challenges faced, coping strategies, daily life impacts, and healthcare interactions. The objective of this review is to synthesize the qualitative evidence regarding the lived experiences of patients with MSK spinal pain.

METHODS

This systematic review will use a meta-aggregation approach to synthesize data from qualitative studies, that will be identified through a comprehensive search of electronic databases and supplemented by grey literature searches. Two independent reviewers will screen, identify, and extract data from eligible studies. In cases of disagreement, conflicts will be resolved by consulting a third reviewer. These same reviewers will then use the Joanna Briggs Institute (JBI) qualitative quality assessment tool to evaluate the methodological quality of the identified studies, with the derived scores informing the synthesis process, that will involve extracting each study's findings along with their supporting illustrations, then grouped into categories based on similarity in meaning. These categories will then be aggregated to form synthesized findings.

IMPLICATIONS

Synthesized findings on patients' lived experiences with MSK spinal pain including key themes, patterns, and insights will be presented. By emphasizing patient narratives, the results of the review can contribute to the optimization of outcomes, and to enhance patient-provider relations and improve quality of care in MSK spinal health.

Perceptions in orthopedic surgery on the use of cannabis in treating pain: a survey of patients with spine pain (POSIT Spine)

BACKGROUND

Back pain is the leading cause of disability worldwide. Despite guidelines discouraging opioids as first-line treatment, opioids remain the most prescribed drugs for back pain. There is renewed interest in exploring the potential medical applications of cannabis, and with the recent changes in national legislation there is a unique opportunity to investigate the analgesic properties of cannabis.

METHODS

This was a multi-center survey-based study examining patient perceptions regarding cannabis for spine pain. We included patients presenting with back or neck pain to one of three Orthopedic clinics in Ontario. Our primary outcome was perceived effect of cannabis on back pain, while secondary outcomes were perceptions regarding potential applications and barriers to cannabis use.

RESULTS

259 patients participated in this study, 35.3% (90/255) stating they used cannabis medically. Average pain severity was 6.5/10 ± 0.3 (95% CI 6.2-6.8). Nearly three-quarters were prescribed opioids (73.6%, 148/201), with oxycodone/oxycontin (45.9% 68/148) being the most common, and almost half of (49.3%, 73/148) had used an opioid in the last week. Patients estimated cannabis could treat 54.3% ± 4.0 (95% CI 50.3-58.3%) of their spine pain and replace 46.2% ± 6. 6 (95% CI 39.6-52.8%) of their current analgesics. Age (β = - 0.3, CI - 0.6-0.0), higher pain severity (β = 0.4, CI 0.1-0.6) and previous cannabis use (β = 14.7, CI 5.1-24.4) were associated with a higher perceived effect of cannabis. Patients thought cannabis would be beneficial to treat pain (129/146, 88.4%), and reduce (116/146, 79.5%) or eliminate opioids (102/146, 69.9%). Not considering using cannabis for medical purposes (65/150, 43.3%) was the number one reported barrier.

CONCLUSIONS

Patients estimated medical cannabis could treat more than half of their spine pain, with one in three patients already using medical cannabis. 79% of patients also believe cannabis could reduce opioid usage. This data will help support more research into cannabis for musculoskeletal pain.

Confirmatory study of the usefulness of quantum molecular resonance and microdissectomy for the treatment of lumbar radiculopathy in a prospective cohort at 6 months follow-up

OBJECTIVES

Low back pain is a common musculoskeletal complaint and while prognosis is usually favorable, some patients experience persistent pain despite conservative treatment and invasive treatment to target the root cause of the pain may be necessary. The aim of this study is to evaluate patient outcomes after treatment of lumbar radiculopathy (LR) with quantum molecular resonance radiofrequency coblation disc decompression and percutaneous microdiscectomy with grasper forceps (QMRG).

METHODS

This prospective cohort study was carried out in two Spanish hospitals on 58 patients with LR secondary to a contained hydrated lumbar disc hernia or lumbar disc protrusion of more than 6 months of evolution, which persisted despite conservative treatment with analgesia, rehabilitation, and physiotherapy, and/or epidural block, in the previous 2 years. Patients were treated with QMRG and the outcomes were measured mainly using the Douleur Neuropathique en 4 Questions, Numeric Rating Scale, Oswestry Disability Index, SF12: Short Form 12 Health Survey, Patient Global Impression of Improvement, Clinical Global Impression of Improvement, and Medical Outcomes Study Sleep Scale.

RESULTS

Patients who received QMRG showed significant improvement in their baseline scores at 6 months post-treatment. The minimal clinically important difference (MCID) threshold was met by 26-98% of patients, depending on the outcome measure, for non-sleep-related outcomes, and between 17 and 62% for sleep-related outcome measures. Of the 14 outcome measures studied, at least 50% of the patients met the MCID threshold in 8 of them.

CONCLUSION

Treatment of LR with QMRG appears to be effective at 6 months post-intervention.

Study protocol for a feasibility study of an online educational programme for people working and living with persistent low back pain

BACKGROUND

Low back pain (LBP) is the main cause of activity limitation and work absence across the world, leading to a high social and economic burden for individuals, families, the labour market and society. The overall aim of this multicentre study is to test the usability, acceptability and feasibility of an evidence-based, digital education programme for people living and working with persistent LBP who are in sedentary or physically demanding jobs and need advice on ergonomics, self-management of pain and healthy behavioural strategies.

METHODS

This is the protocol of a multinational, multicentre, prospective uncontrolled feasibility study targeting people with persistent LBP in Lithuania, Northern Ireland, Italy, Sweden and Portugal. Eligible participants will be offered the opportunity to use the MyRelief educational platform as part of their care and will undergo evaluations at baseline (enrollment) and 1-month follow-up. Feasibility will be assessed using measures of recruitment and retention, intervention engagement, outcome measure completion rates and within-group effect sizes in response to the digital education programme.

DISCUSSION

This study will identify the challenges and implications of delivering a digital training programme in advance of potentially delivering the programme via an online educational platform available on mobile devices. The findings will inform the design of a future randomised controlled trial if it proves feasible.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04673773 . Registered 17 December 2020.

Association Between Smoking and Pain, Functional Disability, Anxiety and Depression in Patients With Chronic Low Back Pain

Objectives: Chronic low back pain (CLBP) accounts for a majority of the disability associated with LBP, which can produce long-term negative effects. This cross-sectional study aimed to investigate the association between smoking and pain, dysfunction and psychological status in patients with CLBP. Methods: The 54 patients with CLBP were recruited and divided into smoking and non-smoking groups. Their pain, dysfunction, anxiety, depression, fear and quality of life were evaluated. The amount of cigarettes smoked daily was recorded. Results: Significant differences in VAS, ODI, RMDQ and FABQ and the impact of LBP on life and work were found between smoking and non-smoking patients. In addition, a correlation was found between the daily cigarette smoking amount and VAS_max, FABQ_total, SDS and FABQ-W. Moreover, a correlation was observed between the amount of cigarettes smoked daily and the degree of impact of low back pain on work. Conclusion: The study found that smoking affected the aggravation of symptoms in patients with CLBP, which indicated that patients with CLBP and people at risk of LBP should be aware of the harm caused by smoking.

Preliminary evaluation of the efficacy of quantum molecular resonance coablative radiofrequency and microdiscectomy

Aims: The aim of this study was to determine whether there exists a difference in efficacy in the treatment of lumbar radiculopathy with quantum molecular resonance coablative radiofrequency, and quantum molecular resonance coablative radiofrequency and percutaneous microdiscectomy with grasper forceps (QMRG). Patients & methods: A total of 28 patients from La Fe University and Polytechnic Hospital in Valencia were enrolled in a retrospective cohort. Results: Treatment with QMRG significantly improved non-sleep-related and sleep-related outcome measures. At 6 months post-intervention, treatment with QMRG resulted in significantly better scores in numeric rating scale, Oswestry Disability Index, Short Form 12 Health Survey Physical and Total, Patient Global Impression of Improvement, sleep disturbance and the two sleep problems indexes. Conclusion: Treatment of lumbar radiculopathy with QMRG appears to be more effective at 6 months post-intervention.

Artificial intelligence X-ray measurement technology of anatomical parameters related to lumbosacral stability

PURPOSE

To develop a deep learning-based model for measuring automatic lumbosacral anatomical parameters from lateral lumbar radiographs and compare its performance to that of attending-level radiologists.

METHODS

A total of 1791 lateral lumbar radiographs were collected through the PACS system and used to develop the deep learning-based model. Landmarks for the four used parameters, including the lumbosacral lordosis angle (LSLA), lumbosacral angle (LSA), sacral horizontal angle (SHA), and sacral inclination angle (SIA), were identified and automatically labeled by the model. At the same time, the measurement results were obtained through landmarks on the test set compared to manual measurements as the reference standard. Statistical analyses of the Percentage of Correct Key Points (PCK), intra-class correlation coefficient (ICC), Pearson correlation coefficient, mean absolute error (MAE), root mean square error (RMSE), and Bland-Altman plots were performed to evaluate the performance of the model.

RESULTS

The mean differences between the reference standard and the model for LSLA, LSA, SHA, and SIA, were 0.39°, 0.09°, 0.13°, and 0.12°, respectively. A strong correlation and consistency between the four parameters were found between the model and reference standard (ICC = 0.92-0.98, r = 0.92-0.97, MAE = 1.35-1.84, RMSE = 1.82-2.51), while with statistically significant difference for LSLA (p = 0.02).

CONCLUSIONS

The presented model revealed clinically equivalent measurements in terms of accuracy, while superior measurements were obtained in terms of cost-effectiveness, reliability, and reproducibility. The model may help clinicians improve their understanding and evaluation of lumbar diseases and LBP from a quantitative perspective in practical work. (ChiCTR2100048250).

Analysis of the Effect of Wearing Extensible and Non-Extensible Lumbar Belts on Biomechanical Factors of the Sit-to-Stand Movement and Pain-Related Psychological Factors Affecting Office Workers with Low Back Pain

This study aimed to investigate the effects of wearing extensible and non-extensible lumbar belt (LB) on biomechanical factors of the sit-to-stand (STD) movement and pain-related psychological factors affecting office workers with low back pain. Among 30 office workers, 15 with low back pain (LBP) were assigned to the experimental group and 15 healthy adults were assigned to the control group. The participants performed STD movement in random order of three different conditions: without LB (Condition 1), with extensible LB (Condition 2), and with non-extensible LB (Condition 3). Biomechanical variables of STD movement in each condition were measured using a three-dimensional motion analysis system and force plate. Pain-related psychological factors were measured only in the experimental group. Among the biomechanical factors of STD movement, an interaction effect was found in the maximum anterior pelvic tilt angle and total-phase range of motion of the trunk (p < 0.05). Pain intensity, pain-related anxiety, and pain catastrophizing were decreased in the conditions with lumbar belts (Conditions 2 and 3) compared to the condition without LB (Condition 1) (p < 0.05). Extensible and non-extensible lumbar belts engender biomechanically beneficial effects during STD movement in both office workers with LBP and healthy office workers. Further, pain intensity, pain-related anxiety, and pain catastrophizing were decreased in office workers with LBP. Therefore, both types of extensible lumbar belts may be helpful in the daily life of patients with LBP and office workers.

Factors associated with low back pain among construction workers in Nepal: A cross-sectional study

BACKGROUND

Low back pain (LBP) is the commonest cause of disability throughout the world. This study aimed to determine the prevalence and factors associated with LBP among the construction workers in Nepal.

METHODS

A community-based cross-sectional study was conducted among the construction workers working in Banepa and Panauti municipalities of Kavre district, from September 2019 to February 2020. Data was collected purposively by face-to-face interview from 402 eligible participants from the both municipalities using semi-structured questionnaire. Mobile-based data collection was done using KoboCollect. Data were exported to and analysed using R-programming software (R-3.6.2). Univariate and multivariate logistic regressions were performed. All tests were two tailed and performed at 95% confidence interval (CI).

RESULT

One-year prevalence of LBP among construction workers were 52.0% (95%CI: 47.0-57.0). The higher odds of LBP was reported among females [adjusted odds ratio (aOR) = 2.42; 95%CI: 1.12-5.23], those living below poverty-line (aOR = 2.35; 95%CI: 1.32-4.19), participants with more than five years of work experience (aOR = 1.66; 95%CI: 1.01-2.73) and those with intermediate sleep quality (aOR = 2.06; CI: 1.03-4.11). About 80.0% of construction workers with LBP never seek healthcare services due to: a) time constraints (90.9%), b) financial constraints (18.1%) and c) fear of losing wages on seeking healthcare services (40.9%). The majority of the participants (94.8% among those without LBP and 72.3% among those with LBP) did nothing to prevent or manage LBP.

CONCLUSION

The prevalence of LBP in the past one year was high among construction workers where majority of workers never did anything to prevent or manage LBP. Therefore, the public health professionals should set up the health promotion, education, and interventions aimed at increasing awareness on preventive techniques and predisposing factors of LBP.

The effect of health education on prevention of low back pain for health caregivers and cleaning workers

AIM

The aim of this study was to determine the effect of health education on prevention of low back pain for health caregivers and cleaning workers.

BACKGROUND

Low back pain is a common health problem in the workplace. Health education is important in the prevention and recurrence of low back pain.

METHODS

A quasi-experimental design with a pre-test and post-test control group was used. The population of the study consisted of health caregivers and cleaning workers working in a university hospital in Turkey. A total of 120 participants, 60 in the intervention group and 60 in the control group, were included in the study. Data were collected between October 2016 and April 2017. A questionnaire, the Oswestry Low Back Pain Scale and the Knowledge Evaluation Form were used to collect data. Health education was given to the intervention group.

RESULTS

Following the health education, the mean scores of the Oswestry Low Back Pain Scale in the intervention group were significantly lower than the control group and had a larger effect size.

CONCLUSION

This study provides evidence for the effectiveness of health education in the prevention of low back pain in health caregivers and cleaning workers.

AAAPT Diagnostic Criteria for Acute Low Back Pain with and Without Lower Extremity Pain

OBJECTIVE

Low back pain is one of the most common reasons for which people visit their doctor. Between 12% and 15% of the US population seek care for spine pain each year, with associated costs exceeding $200 billion. Up to 80% of adults will experience acute low back pain at some point in their lives. This staggering prevalence supports the need for increased research to support tailored clinical care of low back pain. This work proposes a multidimensional conceptual taxonomy.

METHODS

A multidisciplinary task force of the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) with clinical and research expertise performed a focused review and analysis, applying the AAAPT five-dimensional framework to acute low back pain.

RESULTS

Application of the AAAPT framework yielded the following: 1) Core Criteria: location, timing, and severity of acute low back pain were defined; 2) Common Features: character and expected trajectories were established in relevant subgroups, and common pain assessment tools were identified; 3) Modulating Factors: biological, psychological, and social factors that modulate interindividual variability were delineated; 4) Impact/Functional Consequences: domains of impact were outlined and defined; 5) Neurobiological Mechanisms: putative mechanisms were specified including nerve injury, inflammation, peripheral and central sensitization, and affective and social processing of acute low back pain.

CONCLUSIONS

The goal of applying the AAAPT taxonomy to acute low back pain is to improve its assessment through a defined evidence and consensus-driven structure. The criteria proposed will enable more rigorous meta-analyses and promote more generalizable studies of interindividual variation in acute low back pain and its potential underlying mechanisms.

Posturography Comparison and Discriminant Analysis Between Individuals With and Without Chronic Low Back Pain

OBJECTIVE

The aims of this study were to evaluate the center of pressure (CoP) in individuals with chronic low back pain (LBP) compared with matched controls and perform discriminant analysis to detect which CoP variables differentiate the groups.

METHODS

Thirty-two participants with LBP and 33 matched controls were evaluated on a force plate in a bipedal static position for 30 seconds in 2 conditions: eyes open (EO) and eyes closed (EC). Two discriminant analyzes were performed to detect which CoP variables could discriminate between groups.

RESULTS

Those with LBP had higher values (ie, poorer balance) for most variables compared with the control group. With EO, total displacement of sway (TDS) was as follows: LBP group (median [25%-75%]) 31.77 (26.39-41.79) cm, control group 27.21 (22.29-31.78) cm, P = .008 and area: LBP group 3.31 (2.33-4.68) cm², control group 1.77 (1.3-2.71) cm². With EC, TDS was as follows: LBP group 49.6 (39.65-68.15) cm, control group 38.77 (30.36; 45.65) cm, P = .003 and area: LBP group 4.68 (2.6-7.28) cm², control group 2.4 (2.1-3.34) cm². The discriminating variables in the EO condition were the TDS for the LBP group and the anteroposterior mean velocity for the control group, while in the EC condition they were mediolateral dispersion and area for the LBP group.

CONCLUSION

Individuals with chronic LBP had worse postural control performance than matched controls, and it is possible to characterize those with and without LBP with CoP variables.

Steroids and L-Lysine Aescinate for Acute Radiculopathy Due to a Herniated Lumbar Disk

Background and objectives. The efficacy of commonly prescribed analgesic and adjuvant drugs for the management of patients with radiculopathy has not been well established. Oral steroids are commonly used to treat sciatica or radiculopathy due to a herniated disk but the effect remains controversial. L-lysine aescinate showed superiority over placebo or baseline therapy with NSAIDs alone in treating sciatica, but have not been evaluated in an appropriately powered clinical trial. Materials and Methods. Randomized, double-blind clinical trial conducted in two health centers in collaboration with Uzhhorod Natioanl University in Ukraine. Adults (N = 90) with acute radicular pain and a herniated disk confirmed by MRI were eligible. Participants were randomly assigned to three groups (N = 30 in each) to receive a baseline therapy with lornoxicam (16 mg per day) and adjunctive 5-day course of IV dexamethasone (first group: 8 mg per day/40 mg total) or 0,1% solution of L-lysine aescinate (5 mL and 10 mL for group 2 and 3 respectively). Primary outcomes were Visual Analogue Scale changes and the straight leg raise angle at 15th and 30th day. Results. The level of pain improvement at 15th days after initiation of therapy with dexamethasone or solution of L-lysine aescinate at doses of 5 or 10 mL was not significantly different. The lowest levels of pain were achieved in patients who received the L-lysine aescinate 10 mL, but the range of decrease in pain was slightly greater in the group administered dexamethasone. Conclusions. Among patients with acute radiculopathy due to a herniated lumbar disk a short course of IV dexamethasone or L-lysine aescinate resulted in pain improvement at 15th and 30th day. Dexamethasone may be preferable if a longer-term analgesic effect is needed. Taking into account side effects of dexamethasone, a solution of L-lysine aescinate can be used to relieve pain symptoms.

Prevalence of Spondylolysis in Symptomatic Adolescent Athletes: An Assessment of Sport Risk in Nonelite Athletes

OBJECTIVE

To assess the risk of spondylolysis by sport in nonelite adolescent athletes with low back pain (LBP).

DESIGN

Retrospective case series.

SETTING

Hospital-based sports medicine clinic.

PATIENTS

The medical charts of 1025 adolescent athletes with LBP (age 15 ± 1.8 years) were examined; 308 (30%) were diagnosed with a spondylolysis.

ASSESSMENT OF RISK

Risk of spondylolysis was assessed in 11 sports for males and 14 sports for females.

MAIN OUTCOME MEASURE

Relative risk of diagnosis of spondylolysis injury.

RESULTS

The risk of spondylolysis differed by sex with baseball (54%), soccer (48%), and hockey (44%) having the highest prevalence in males and gymnastics (34%), marching band (31%), and softball (30%) for female athletes. Baseball was the only sport to demonstrate a significant increased risk of spondylolysis.

CONCLUSIONS

The sports with the greatest risk of spondylolysis in adolescent athletes in this study were not consistent with published literature. Clinicians should be cautious generalizing high-risk sports to their practice, as geographic region and level of the athlete may significantly influence the incidence of spondylolysis in the population they are treating.

Unilateral Osteotomy of Lumbar Facet Joint Induces a Mouse Model of Lumbar Facet Joint Osteoarthritis

STUDY DESIGN

The lumbar facet joint (LFJ) osteoarthritis (OA) model that highly mimics the clinical conditions was established and evaluated.

OBJECTIVE

Here, we innovatively constructed and evaluated the aberrant mechanical loading-related LFJ OA model.

SUMMARY OF BACKGROUND DATA

LFJ is the only true synovial joint in a functional spinal unit in mammals. The LFJ osteoarthritis is considered to contribute 15% to 45% of low back pain. The establish of animal models highly mimicking the clinical conditions is a useful tool for the investigation of LFJ OA. However, the previously established animal models damaged the LFJ structure directly, which did not demonstrate the effect of aberrant mechanical loading on the development of LFJ osteoarthritis.

METHODS

In the present study, an animal model for LFJ degeneration was established by the unilateral osteotomy of LFJ (OLFJ) in L4/5 unit to induce the spine instability. Then, the change of contralateral LFJ was evaluated by morphological and molecular biological techniques.

RESULTS

We showed that the OLFJ induced instability accelerated the cartilage degeneration of the contralateral LFJ. Importantly, the SRμCT elucidated that the three-dimensional structure of the subchondral bone changed in contralateral LFJ, indicated as the abnormity of bone volume/total volume ratio (BV/TV), trabecular pattern factor (Tb. Pf), and the trabecular thickness (Tb. Th). Immunostaining further demonstrated the uncoupled osteoclastic bone resorption, and bone formation in the subchondral bone of contralateral LFJ, indicated as increased activity of osteoclast, osteoblast, and Type H vessels.

CONCLUSION

We develop a novel LFJ OA model demonstrating the effect of abnormal mechanical instability on the degeneration of LFJ. This LFJ degeneration model that highly mimics the clinical conditions is a valuable tool to investigate the LFJ osteoarthritis.

LEVEL OF EVIDENCE

N/A.

Integrating Mobile-health, health coaching, and physical activity to reduce the burden of chronic low back pain trial (IMPACT): a pilot randomised controlled trial

Background

Low back pain is one of the most prevalent musculoskeletal conditions and the highest contributor to disability in the world. It is characterized by frequent relapses leading to additional care-seeking. Engagement in leisure physical activity is associated with lower recurrences and better prognosis and potentially reduced care-seeking. Our aim was to investigate the feasibility and preliminary efficacy of a patient-centred physical activity intervention, supported by health coaching and mobile health, to reduce care-seeking, pain and disability in patients with chronic low back pain after treatment discharge.

Methods

We conducted a pilot randomised controlled trial with blinded outcome assessment. Sixty-eight participants were recruited from four public outpatient physiotherapy departments and the general community in Sydney. The intervention group received a physical activity information booklet, plus one face-to-face and 12 telephone-based health coaching sessions. The intervention was supported by an internet-based application and an activity tracker (Fitbit). Control group (standard care) received the physical activity information booklet and advice to stay active. Feasibility measures included recruitment rate, intervention compliance, data completeness, and participant satisfaction. Primary outcomes were care-seeking, pain levels and activity limitation. Outcomes were assessed at baseline, 6-month follow-up and weekly for 6 months.

Results

Ninety potential participants were invited over 15 months, with 68 agreeing to take part (75%). Overall, 903 weekly questionnaires were answered by participants from a total of 1107 sent (89%). Participants were largely satisfied with the intervention (mean = 8.7 out of 10 on satisfaction scale). Intervention group participants had a 38% reduced rate of care-seeking (Incidence Rate Ratio (IRR): 0.62, 95% CI: 0.32 to 1.18, p = 0.14, using multilevel mixed-effects Poisson regression analysis) compared to standard care, although none of the estimates was statistically significant. No between groups differences were found for pain levels or activity limitation.

Conclusion

The health coaching physical activity approach trialed here is feasible and well accepted by participants and may reduce care-seeking in patients with low back pain after treatment discharge, although further evaluation with an adequately powered trial is needed.

Trial registration

Australian and New Zealand Trial Registry ACTRN12615000189527. Registered prospectively on 26–02–2015.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2454-y) contains supplementary material, which is available to authorized users.

The Frequency of Different Risk Factors for Lower Back Pain in a Tertiary Care Hospital

Background and purpose Lower back pain is an extremely common health problem and causes more global disability than any other condition. Moreover, it causes an enormous economic burden in both developed and developing countries. The aim of this study is to determine the frequency of different risk factors for lower back pain in a tertiary care centre in Islamabad. Methods A cross-sectional study was conducted at Shifa International Hospital's neurosurgery and neurology outpatient department from September 2016 to February 2017. A total of 375 patients with lower back pain were interviewed regarding risk factors. Results Among the 375 patients, the majority were men (51.7%, n = 194). The mean patient age was 42.05 ± 15.35 years (mean ± standard deviation); most of the patients belonged to the 21- to 40-year-old age group (48%, n = 180). The majority (78.4%) had chronic back pain. Lower back pain was found to be predominant in housewives (30.1%, n = 113), followed by those with office jobs (18.1%, n = 68), private jobs (i.e., truck drivers, shopkeepers) (14.7%, n = 55), and healthcare workers (12.3%, n = 46). In terms of work schedule, 51.2% of patients reported working around 41-50 hours per week. The major risk factors identified were lack of exercise (76.3%, n = 286), use of soft foam mattress (52.0%, n = 195), prolonged sitting (50.4%, n = 189), lifting heavy weight (48.5%, n = 182), bending or twisting (41.6%, n = 156), sleep disorder (41.6%, n = 156), anxiety (39.5%, n = 148), hypertension (32.3%, n = 121), and depression (28.8%, n = 108). Conclusions Our study concludes that lower back pain is a multifactorial phenomenon. Age, gender, profession, working hours, comorbid conditions, trauma, lifestyle, and stresses in life all play a role in its causation. Increasing physical activity and modifying lifestyle are suggested to prevent this major health issue.

The importance and impact of patients' health literacy on low back pain management: a systematic review of literature

BACKGROUND CONTEXT

Health literacy (HL) and the overall ability of patients to seek, understand, and apply health information play an important role in the management of chronic pain conditions. Awareness of how patients' HL skills influence their pain experience and how their ability to understand the treatment regimen and to manage chronic pain may allow physicians to adjust clinical treatment accordingly. Despite the prevalence and the substantial economic impact of chronic low back pain (LBP), little is known about the relationship between HL and the treatment and management of this common disease entity.

PURPOSE

The purpose of this systematic review of published research was to examine the importance and the implications of HL in the treatment and management of LBP.

STUDY DESIGN AND METHODS

A literature search was performed in Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychInfo using medical subject heading (MeSH) terms related to LBP, HL, and patient education, which yielded only three studies that directly addressed HL among patients suffering from LBP.

RESULTS

We identified only a limited number of studies that focused specifically on HL in the LBP population that were included in this review. The majority of studies excluded from this review focused on patient levels of educational attainment and patient education programs without addressing patients' HL levels and their impact on adherence to educational programs, self-care management, and rehabilitation, among other factors. The three studies that are critically reviewed in this review either use a direct measure of HL or make an effort to address HL in their programs. All three studies emphasize the importance of considering the HL of patients in the treatment and management of LBP.

CONCLUSIONS

Building on these studies and the narrative review of other relevant literature, we identified significant gaps in current research addressing HL in the treatment and management of LBP. We developed recommendations for future research based on an assessment of strengths and limitations of available evidence-based studies.

Increased pain sensitivity in migraine and tension-type headache coexistent with low back pain: A cross-sectional population study

BACKGROUND

Low back pain is common in the general population and in individuals with primary headaches. We assessed the relative frequency of self-reported back pain in persons with and without primary headaches and examined pain sensitivity.

METHOD

A population of 796 individuals completed a headache interview based on ICHD criteria and provided data of interest in a self-administered questionnaire. Headache cases were classified into chronic (≥15) (CH) or episodic (<15 headache days/month) (EH). A total of 495 had a pericranial total tenderness score (TTS), and 494 had cephalic and extracephalic pressure pain thresholds (PPTs) assessed.

RESULTS

Adjusted for age, gender, education and poor self-rated health, 1-year relative frequency of back pain was higher in individuals with CH (82.5%) and EH (80.1%) compared to no headache group (65.7%). In persons with back pain, TTS was higher in CH, (26.3 ± 12.1) than in EH, (18.5 ± 10.0; p < 0.001) and higher in both groups than in those with no headache, 10.8 ± 8.5 (p < 0.001 and p < 0.001, respectively). In persons with back pain, temporalis PPT were lower in CH, 169.3 ± 57.8, than in EH, 225.2 ± 98.1, and in no headache group, 244.3 ± 105.4 (p = 0.02 and p = 0.01, respectively). In persons with back pain, finger PPT were lower in CH, 237.1 ± 106.7, than in EH, 291.3 ± 141.3, or in no headache group, 304.3 ± 137.4 (p = 0.02 and p < 0.001, respectively).

CONCLUSION

Back pain is highly frequent in individuals with CH, followed by EH and no headache. In persons with CH, back pain is associated with lower cephalic and extracephalic PPTs suggesting central sensitization may be a substrate or consequence of comorbidity.

SIGNIFICANCE

We found that back pain has high relative frequency in individuals with CH followed EH and no headache. Back pain is associated with low cephalic and extracephalic PPTs in individuals with CH. Central sensitization may be a substrate or consequence of this comorbidity of back pain and CH.

An Observational Study on Recurrences of Low Back Pain During the First 12 Months After Chiropractic Treatment

OBJECTIVES

The purpose of this study was to investigate recurrence rate and prognostic factors in a large population of patients with low back pain (LBP) up to 1 year after chiropractic care using standardized definitions.

METHODS

In Switzerland, 722 patients with LBP (375 male; mean age = 44.5 ± 13.8 years) completed the Numeric Rating Scale for pain (NRS) and the Oswestry Disability Index (ODI) before treatment and 1, 3, 6, and 12 months later (ODI up to 3 months). Based on NRS values, patients were categorized as "fast recovery," "slow recovery," "recurrent," "chronic," and "others." In multivariable logistic regression models, age, sex, work status, duration of complaint (subacute: ≥14 days to <3 months; chronic: ≥3 months), previous episodes, baseline NRS, and baseline ODI were investigated as predictors.

RESULTS

Based on NRS values, 13.4% of the patients were categorized as recurrent. The recurrent pattern significantly differed from fast recovery in duration of complaint (subacute: odds ratio [OR] = 3.3; chronic: OR = 10.1). The recurrent and chronic pattern significantly differed in duration of complaint (chronic: OR = 0.14) and baseline NRS (OR = 0.75).

CONCLUSION

Recurrence rate was low in this LBP patient population. The duration of complaint before treatment was the main predictor for recurrence. The fact that even subacute duration significantly increased the odds for an unfavorable course of LBP is of clinical relevance.

Does educational attainment increase the risk of low back pain when genetics are considered? A population-based study of Spanish twins

BACKGROUND CONTEXT

There is limited research investigating educational attainment as a risk factor for low back pain (LBP), with the influence of gender commonly being neglected. Furthermore, genetics and early shared environment explain a substantial proportion of LBP cases and need to be controlled for when investigating risk factors for LBP.

PURPOSE

To investigate whether educational attainment affects the prevalence and risk of LBP differently in men and women while controlling for the influence of genetics and early shared environment.

STUDY DESIGN

This is a cross-sectional and prospective twin case-control study.

PATIENT SAMPLE

Adult monozygotic (MZ) and dizygotic (DZ) twins from the Murcia Twin Registry, with available data on educational attainment, formed the base sample for this study. The prevalence analysis considered twins with available data on LBP in 2013 (n=1,580). The longitudinal analysis considered twins free of LBP at baseline (2009-2011), with available data on LBP at follow-up (2013) (n=1,077).

OUTCOME MEASURES

Data on the lifetime prevalence of activity limiting LBP (outcome) and educational attainment (risk factor) were self-reported.

METHODS

The prevalence analysis investigated the cross-sectional association between educational attainment and LBP, whereas the longitudinal analysis investigated whether educational attainment increased the risk of developing LBP. Both analyses were performed in the following sequence. First, a total sample analysis was performed on all twins (considering them as individuals), adjusting for confounding variables selected by the data. Second, to control for the influence of genetics and early shared environment, a within-pair case-control analysis (stratified by zygosity) was performed on complete twin pairs discordant for LBP (ie, one twin had LBP, whereas the co-twin did not). All analyses were stratified for gender where possible, with an interaction term determining whether gender was a significant moderator of the association between educational attainment and LBP.

RESULTS

Women with either general secondary or university education were less likely to experience (prevalence analysis) or to develop LBP (longitudinal analysis). Educational attainment did not affect the risk of LBP in men. When controlling for the effects of genetics and early shared environment, the relationship between educational status and LBP in women was no longer statistically significant.

CONCLUSIONS

Educational attainment affects LBP differently in men and women, with higher levels of education only decreasing the risk of developing LBP in women. After adjusting for genetics and early shared environment, the relationship between educational attainment and LBP in women disappears. This suggests that genetics and early shared environment are confounding the relationship between educational attainment and LBP in women.

The impact of depression among chronic low back pain patients in Japan

Background

Chronic low back pain (CLBP) is associated with significant disability and reductions in health related quality of life (HRQoL), which can negatively impact overall function and productivity. Depression is also associated with painful physical symptoms, and is often present in patients with chronic pain. However, the incremental burden associated with depression or symptoms of depression among CLBP patients is not well understood. The objective of this study was to investigate the impact of depression on HRQoL in CLBP and to assess the relationship between depression and work impairment and healthcare use among CLBP patients in Japan.

Methods

Data were extracted from the 2014 Japan National Health and Wellness Survey (N = 30,000). CLBP was defined by report of diagnosed low back pain ≥3 months duration. Depression was assessed using the Patient Health Questionnaire (PHQ-9). Measurements assessed included pain, HRQoL, labor force participation, work productivity and healthcare utilization. Patients with depression (PHQ-9 ≥ 10) were compared to patients without depression (PHQ-9 < 10) using t-tests for continuous and count variables and chi-square for categorical variables, which were followed by generalized linear models adjusted for covariates. The association between presenteeism and other patient outcomes and characteristics was analysed using nonparametric correlations (Spearman’s rho).

Results

Depressed CLBP patients had significantly more severe pain and higher levels of pain compared with patients without depression (P < 0.001). Depression was associated with worse HRQoL in CLBP patients. Presenteeism, overall work impairment and activity impairment were 1.8, 1.9 and 1.7 times as high, respectively, among those with depression relative to those without depression. CLBP patients with depression had almost twice as many healthcare provider visits in 6 months than those without depression. The pattern of results remained consistent after adjustment for sociodemographic and general health characteristics. Analysis also indicated presenteeism was closely related to overall work impairment (rho = 0.99).

Conclusions

Depression among CLBP patients in Japan was associated with higher pain scores and lower HRQoL scores, as well as lower labor productivity and increased healthcare use. Screening for depression in CLBP patients should be an essential part of CLBP patient care.

Risk Factors Linked to Psychological Distress, Productivity Losses, and Sick Leave in Low-Back-Pain Employees: A Three-Year Longitudinal Cohort Study

Background. Low back pain (LBP) is one of the most common health problems worldwide. Purpose. To investigate the link between baseline demographic and occupational, medical, and lifestyle data with following psychological and occupational outcomes in a large sample of employees with LBP over a 3-year period. Study Design. Three-year prospective cohort study. Methods. Italian-speaking employees (N = 4492) with a diagnosis of LBP were included. Screening at Time 1 was done in order to collect information about severity and classification of LBP, demographic, lifestyle, and occupational status data. Psychological distress (PGWBI) and occupational burden were assessed after 3 years. Results. After 3 years, employees with LBP not due to organic causes had an increased risk of psychological distress. Gender appears to be an important variable for following occupational burden. Indeed, being a white-collar man with a LBP without organic causes seems to be a protective factor for following work outcomes, while being a white-collar woman with a LBP not due to organic causes appears to be a risk factor for subsequent sick leave. Moreover, LBP severity affects psychological and occupational outcomes. Conclusion. Our findings have several implications that could be considered in preventive and supportive programs for LBP employees.

The geometric curvature of the spine during the sirshasana, the yoga's headstand

This study analysed the behaviour of the geometric curvature of the spine during sirshasana. The position of dorsal retroreflective markers was computed via stereophotogrammetric analysis in six males and five females (29.4 ± 8.8 years, 63.0 ± 11.4 kg, 1.66 ± 0.08 m [average ± standard deviation]). The spinal points were projected onto the sagittal and frontal planes of the trunk, a polynomial was fitted to the data and the two-dimensional geometric curvature was quantified. The inferior lumbar lordosis decreased compared to the orthostatic position and gait, which may favour the posterior protrusion of the lumbar spinal nucleus pulposus in people with posterior herniation. The lateral deviation at the middle of the thoracic spine increases during sirshasana, which may reflect increased difficulties for postural control and spinal loads. It could be useful for promoting positive spinal structural and functional chronic adaptations for healthy participants, if the yoga programme is carefully planned and the spinal alignment is carefully monitored during a headstand. However, it may aggravate some spinal diseases, especially scoliosis.

Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials

Background

There is good evidence that therapist-delivered interventions have modest beneficial effects for people with low back pain (LBP). Identification of subgroups of people with LBP who may benefit from these different treatment approaches is an important research priority.

Aim and objectives

To improve the clinical effectiveness and cost-effectiveness of LBP treatment by providing patients, their clinical advisors and health-service purchasers with better information about which participants are most likely to benefit from which treatment choices. Our objectives were to synthesise what is already known about the validity, reliability and predictive value of possible treatment moderators (patient factors that predict response to treatment) for therapist-delivered interventions; develop a repository of individual participant data from randomised controlled trials (RCTs) testing therapist-delivered interventions for LBP; determine which participant characteristics, if any, predict clinical response to different treatments for LBP; and determine which participant characteristics, if any, predict the most cost-effective treatments for LBP. Achieving these objectives required substantial methodological work, including the development and evaluation of some novel statistical approaches. This programme of work was not designed to analyse the main effect of interventions and no such interpretations should be made.

Methods

First, we reviewed the literature on treatment moderators and subgroups. We initially invited investigators of trials of therapist-delivered interventions for LBP with > 179 participants to share their data with us; some further smaller trials that were offered to us were also included. Using these trials we developed a repository of individual participant data of therapist-delivered interventions for LBP. Using this data set we sought to identify which participant characteristics, if any, predict response to different treatments (moderators) for clinical effectiveness and cost-effectiveness outcomes. We undertook an analysis of covariance to identify potential moderators to apply in our main analyses. Subsequently, we developed and applied three methods of subgroup identification: recursive partitioning (interaction trees and subgroup identification based on a differential effect search); adaptive risk group refinement; and an individual participant data indirect network meta-analysis (NWMA) to identify subgroups defined by multiple parameters.

Results

We included data from 19 RCTs with 9328 participants (mean age 49 years, 57% females). Our prespecified analyses using recursive partitioning and adaptive risk group refinement performed well and allowed us to identify some subgroups. The differences in the effect size in the different subgroups were typically small and unlikely to be clinically meaningful. Increasing baseline severity on the outcome of interest was the strongest driver of subgroup identification that we identified. Additionally, we explored the application of Bayesian indirect NWMA. This method produced varying probabilities that a particular treatment choice would be most likely to be effective for a specific patient profile.

Conclusions

These data lack clinical effectiveness or cost-effectiveness justification for the use of baseline characteristics in the development of subgroups for back pain. The methodological developments from this work have the potential to be applied in other clinical areas. The pooled repository database will serve as a valuable resource to the LBP research community.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme. This project benefited from facilities funded through Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform, with support from Advantage West Midlands (AWM) and the Wolfson Foundation.

Acute and Chronic Low Back Pain

Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function.

Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials

BACKGROUND

The efficacy of epidural and facet joint injections has been assessed utilizing multiple solutions including saline, local anesthetic, steroids, and others. The responses to these various solutions have been variable and have not been systematically assessed with long-term follow-ups.

METHODS

Randomized trials utilizing a true active control design were included. The primary outcome measure was pain relief and the secondary outcome measure was functional improvement. The quality of each individual article was assessed by Cochrane review criteria, as well as the criteria developed by the American Society of Interventional Pain Physicians (ASIPP) for assessing interventional techniques. An evidence analysis was conducted based on the qualitative level of evidence (Level I to IV).

RESULTS

A total of 31 trials met the inclusion criteria. There was Level I evidence that local anesthetic with steroids was effective in managing chronic spinal pain based on multiple high-quality randomized controlled trials. The evidence also showed that local anesthetic with steroids and local anesthetic alone were equally effective except in disc herniation, where the superiority of local anesthetic with steroids was demonstrated over local anesthetic alone.

CONCLUSION

This systematic review showed equal efficacy for local anesthetic with steroids and local anesthetic alone in multiple spinal conditions except for disc herniation where the superiority of local anesthetic with steroids was seen over local anesthetic alone.

A 35-year trend analysis for back pain in Austria: the role of obesity

Background

The prevalence of back pain is constantly increasing and a public health problem of high priority. In Austria there is a lack of empirical evidence for the development of back pain and its related factors. The present study aims to investigate trends in the prevalence of back pain across different subpopulations (sex, age, obesity).

Methods

A secondary data analysis based on five nationally representative cross-sectional health surveys (1973–2007) was carried out. Face-to-face interviews were conducted in private homes in Austria. Subjects aged 20 years and older were included in the study sample (n = 178,818). Obesity was defined as BMI≥30 kg/m² and adjusted for self-report bias. Back pain was measured as the self-reported presence of the disorder.

Results

The age-standardized prevalence of back pain was 32.9% in 2007; it was higher among women than men (p<0.001), higher in older than younger subjects (p<0.001) and higher in obese than non-obese individuals (p<0.001). During the investigation period the absolute change in the prevalence of back pain was +19.4%. Among all subpopulations the prevalence steadily increased. Obese men showed the highest increase of and the greatest risk for back pain.

Conclusion

These results help to understand the development of back pain in Austria and can be used to plan controlled promotion programs. Further monitoring is recommended in order to control risk groups and plan target group-specific prevention strategies. In Austria particular emphasis should be on obese individuals. We recommend conducting prospective studies to confirm our results and investigate causal relationships.

Acute and chronic low back pain

Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function.

Limitação no trabalho por dor lombar em fumicultores do sul do Brasil

Introdução:o trabalho agrícola exige esforço físico e posturas inadequadas que são de risco para dor lombar e limitação no trabalho. A dor lombar, em especial a crônica, é responsável por grande número de afastamentos do trabalho.Objetivo:avaliou-se a prevalência de limitação no trabalho por dor lombar crônica (DLC), dor lombar no último mês (DLM) e dor lombar aguda (DLAguda), bem como as tarefas que os fumicultores deixaram de fazer devido a essas patologias.Métodos:estudo transversal realizado no ano de 2011 com uma amostra aleatória de 2469 fumicultores de São Lourenço do Sul/RS. A investigação de fatores associados à limitação por DLM foi realizada através da regressão de Poisson.Resultados:as prevalências de limitação no trabalho por DLC, DLM e DLAguda foram respectivamente, de 37,6%, 14,4,% e 7,8%. Carregar folhas, empilhar lenha e colher baixeiro foram as tarefas que os fumicultores mais deixaram de fazer. Na análise ajustada, foram associadas à limitação por DLM: idade, gastos com imposto sobre a propriedade de veículos automotores (IPVA), dificuldades para pagar dívidas e problemas psiquiátricos menores. Indivíduos com DLAguda deixam de fazer as mesmas tarefas daqueles com DLC, mas estes têm muito mais limitação no trabalho.

Ten-year follow-up of strengthening versus flexibility exercises with or without abdominal bracing in recurrent low back pain

STUDY DESIGN

Randomized prevention trial.

OBJECTIVE

To compare the long-term effect of strengthening versus flexibility exercises and to evaluate the additional effect of abdominal bracing in recurrent low back pain (LBP).

SUMMARY OF BACKGROUND DATA

No conclusions could be made regarding appropriate exercise types or parameters in recurrent LBP. Abdominal bracing increases trunk stiffness; however, its long-term effect has not been evaluated in recurrent LBP yet.

METHODS

Six hundred patients with recurrent LBP participated. They were randomized into 4 groups-150 patients (age: 42.5 ± 12.7) performed strengthening exercises; 150 patients (age: 41.3 ± 11.5) performed flexibility exercises; 150 patients (age: 41.0 ± 13.2) performed strengthening exercises and used abdominal bracing in daily activities/exercises; and 150 patients (age: 40.6 ± 12.3) performed flexibility exercises and used abdominal bracing in daily activities/exercises. At the beginning of the study and at the end of 10 consecutive years were recorded 6 outcomes-frequency, intensity, and duration of pain, as well as frequency, intensity, and duration of exercises.

RESULTS

Regarding the first 4 outcomes-all groups showed improvement from the beginning to the second year, but worsening from the second to the 10th year; there was no difference between strengthening and flexibility groups; bracing groups showed better results versus nonbracing groups. Intensity, frequency, and duration of the pain correlated with each other and with frequency of the exercises, but not with exercise duration or intensity.

CONCLUSION

The exercise frequency is more important than the type, duration, or intensity of the exercise. Abdominal bracing adds to the exercise effect. It could be considered as a "preliminary muscle back belt on demand" increasing the trunk stiffness and the frequency of the trunk muscle contractions/cocontractions without interruption of daily activities, which may remind/convince the patients to exercise more frequently. Frequent exercising and bracing seems effective long-term prevention advices in recurrent LBP.

LEVEL OF EVIDENCE

2.

The global burden of low back pain: estimates from the Global Burden of Disease 2010 study

OBJECTIVE

To estimate the global burden of low back pain (LBP).

METHODS

LBP was defined as pain in the area on the posterior aspect of the body from the lower margin of the twelfth ribs to the lower glutaeal folds with or without pain referred into one or both lower limbs that lasts for at least one day. Systematic reviews were performed of the prevalence, incidence, remission, duration, and mortality risk of LBP. Four levels of severity were identified for LBP with and without leg pain, each with their own disability weights. The disability weights were applied to prevalence values to derive the overall disability of LBP expressed as years lived with disability (YLDs). As there is no mortality from LBP, YLDs are the same as disability-adjusted life years (DALYs).

RESULTS

Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, LBP ranked highest in terms of disability (YLDs), and sixth in terms of overall burden (DALYs). The global point prevalence of LBP was 9.4% (95% CI 9.0 to 9.8). DALYs increased from 58.2 million (M) (95% CI 39.9M to 78.1M) in 1990 to 83.0M (95% CI 56.6M to 111.9M) in 2010. Prevalence and burden increased with age.

CONCLUSIONS

LBP causes more global disability than any other condition. With the ageing population, there is an urgent need for further research to better understand LBP across different settings.

α-Lipoic acid and superoxide dismutase in the management of chronic neck pain: a prospective randomized study

BACKGROUND AND OBJECTIVE

Since oxidative stress plays a pathogenetic role in chronic neck pain (CNP), we investigated whether a combination of α-lipoic acid (ALA) and superoxide dismutase (SOD) might improve pain control and the efficacy of physiotherapy ("multimodal therapy") in patients with CNP.

SETTING

This study was conducted in the Rehabilitation Unit of the Department of Surgical and Oncological Sciences at the University Policlinic in Palermo, Italy.

DESIGN AND PATIENTS

This was a prospective, randomized, open study in outpatients.

INTERVENTION

Patients randomly received either physiotherapy alone (group 2; n = 45) or a combination of ALA 600 mg and SOD 140 IU daily in addition to physiotherapy (group 1; n = 51), for 60 days. Pain was assessed by a visual analogue scale (VAS) and a modified Neck Pain Questionnaire (mNPQ). Treatment compliance and safety were also evaluated.

RESULTS

Both groups experienced a significant reduction in the VAS and mNPQ scores after 1 month; however, while no further improvement was observed in group 2 at 60 days, group 1 showed a further VAS reduction (p < 0.001). In addition, in the mNPQ at 60 days, more patients in group 1 than in group 2 reported that their neck pain was improved (p < 0.01), and they showed greater compliance with prescribed physiotherapy (p = 0.048). No drug reaction was observed.

CONCLUSION

Use of ALA/SOD in combination with physiotherapy may be a useful approach to CNP, being antioxidants that act on nerve inflammation and disease progression.

CLINICAL REHABILITATION IMPACT

These preliminary observations suggest that some interesting goals (better pain control and physical wellbeing) can be achieved by multimodal therapy in CNP patients.

An epidemiologic analysis of low back pain in primary care: a hot humid country and global comparison

BACKGROUND

Low back pain is one of the most common conditions for which patients seek medical care.

AIM

The aim of the study was to study the epidemiology of low back pain in primary care setting with emphasis on frequency, sociodemographic factors, and impact of low back pain on lifestyle habits.

SUBJECTS AND METHODS

This is a cross-sectional study. A representative sample of 2742 patients was approached and 2180 subjects agreed to participate in this study (79.5%). The survey was conducted among primary health care visitors during the period from March to October 2012. The questionnaire collected the sociodemographic characteristics, lifestyle habits, and type of treatment taken for relief from recruited subjects.

RESULTS

Of the subjects studied, 52.9% were males and 47.1% were females. The prevalence of low back pain in the study sample was 59.2%. Low back pain was more prevalent among women (67.7%) than among men (51.6%). The proportion of low back pain was highest in the age-group 45 to 55 years in both the genders (37.6% and 36.4%, respectively). Nearly half of the men (45.7%) and women (45.2%) with low back pain were overweight with a significant difference (P < .001). More than half of the women with low back pain were housewives (50.4%), whereas most of the men had clerical jobs (36.8%). There was a significant difference observed between men and women in terms of nationality (P < .001), body mass index (P < .001), and occupation (P < .001). Prolonged standing (41.2% vs 29.5%; P < .001) and use of sponge mattress (50.9% vs 45.8%; P .041) was significantly higher among male patients with low back pain compared with females. Coughing/sneezing/straining (9.7% vs 5.9%; P = .01) were more frequent triggering factors in male patients with low back pain as compared with females.

CONCLUSION

The study findings revealed that the prevalence of low back pain was higher among women than among men. Low back pain was observed more frequently among older people and among those who were overweight.

Modification of rat model of sciatica induced by lumber disc herniation and the anti-inflammatory effect of osthole given by epidural catheterization

One of the most treatable causes of lower back pain and associated sciatica is lumbar disc herniation (LDH), which is characterized by rupture of the hard outer wall (annulus fibrosis) in a lumbar intervertebral disc. In the current study, we aimed to: (1) develop and characterize a rat model of sciatica induced by LDH, while introducing a novel method of epidural catheterization; (2) use this model to evaluate the effect of osthole on pain due to LDH, and (3) gain insight into the mechanisms through which osthole affects sciatica induced by LDH. The results indicate that our newly developed rat model maintained mechanical allodynia for 28 days without reduction. Moreover, cyclooxygenase-2 (COX-2) and nitric oxide synthase (NOS) were overexpressed in the associated inflammatory response, which is consistent with clinical manifestations of the disease. We then used this model to study the effect and mechanisms through which osthole affected pain due to LDH. Our study suggests that osthole is capable of reversing hyperalgesia due to LDH, potentially through modulation of activity of COX-2 and NOS, two important proteins for the exacerbation of pain due to LDH. Finally, a molecular modeling simulation showed that osthole has unique binding capabilities to both NOS and COX-2. As the model-induced mechanical hyperalgesia response was consistent, and the position of the catheter tip and the extension/spreading of the drug in the epidural space were reliable, this study developed an improved model to study remedies for sciatic pain. Moreover, our studies demonstrate that osthole may be a feasible treatment for the reduction of pain due to hyperalgesia.

Low back pain

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF). The purpose of these low back pain clinical practice guidelines, in particular, is to describe the peer-reviewed literature and make recommendations related to (1) treatment matched to low back pain subgroup responder categories, (2) treatments that have evidence to prevent recurrence of low back pain, and (3) treatments that have evidence to influence the progression from acute to chronic low back pain and disability.

Linking self-determined functional problems of patients with neck pain to the International Classification of Functioning, Disability, and Health (ICF)

OBJECTIVE

To describe commonly reported self-determined functional problems in patients with neck pain and to evaluate their fit to the components of the International Classification of Functioning, Disability, and Health (ICF).

METHODS

Overall, 249 patients were included in this cross-sectional study that comprised patients with neck pain referred to the outpatient clinic at Oslo University Hospital (2007-2009). Patients were asked to report their three most significant functional problems on the Patient-Specific Functional Scale, a self-determined measure of function. The ICF was used as a tool for analysis. Meaningful concepts within the functional problems were identified, coded, and linked to second-level categories within the components of "body functions," and "activities and participation." Two researchers performed coding and linking independently. The ICF categories were presented by percentage of the total number of functional problems linked to the ICF.

RESULTS

Of 628 reported functional problems, 13 meaningful ICF domains were identified: four domains belonging to the body functions component (b) and nine domains belonging to activities and participation components (d). Within the 88 second-level ICF classification categories of body functions, the most frequently reported items were sleep function (b134; 27%) and mobility of joint functions (b710; 26%). Within the 538 second-level categories of activities and participation, remunerative employment was reported as the most frequent item (d850; 15%), closely followed by doing housework (d640; 14%), and recreation and leisure activities (d920; 13%). Only two meaningful concepts, described as "be active" and "to function after activities," were not assigned to a specific ICF category.

CONCLUSION

The majority of the specific functional problems presented by patients in this study showed a good fit with the ICF model. The substantial number of links to the activities and participation categories, such as mobility, domestic life, employment, and social and civic life, suggests that a comprehensive approach, as well as the involvement of a multidisciplinary team, should be present in the rehabilitation of neck pain-related disability.

Immigration, acculturation and chronic back and neck problems among Latino-Americans

Higher acculturation is associated with increased obesity and depression among Latino-Americans, but not much is known about how acculturation is related to their prevalence of back and neck problems. This study examines whether acculturation is associated with the 12-month prevalence of self-reported chronic back or neck problems among US-born and immigrant Latinos. We performed multivariable logistic regression analysis of data from 2,553 noninstitutionalized Latino adults from the 2002-2003 National Latino and Asian American Survey (NLAAS). After adjusting for demographic, physical and mental health indicators, English proficiency, nativity and higher generational status were all significantly positively associated with the report of chronic back or neck problems. Among immigrants, the proportion of lifetime in the US was not significantly associated. Our findings suggest that the report of chronic back or neck problems is higher among more acculturated Latino-Americans independent of health status, obesity, and the presence of depression.

Measuring the global burden of low back pain

Low back pain is a major cause of morbidity in high-, middle- and low-income countries, yet to date it has been relatively under-prioritised and under-funded. One important reason may be the low ranking it has received relative to many other conditions included in the previous Global Burden of Disease studies, due in part to a lack of uniformity in how low back pain is defined and a paucity of suitable data. We present an overview of methods we have undertaken to ensure a more accurate estimate for low back pain in the Global Burden of Disease 2005 study. This will help clinicians to contextualise the new estimates and rankings when they become available at the end of 2010. It will also be helpful in planning further population-based epidemiological studies of low back pain to ensure their estimates can be included in the future Global Burden of Disease studies.