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Back Pain (back + pain)
Kinds of Back Pain Terms modified by Back Pain Selected AbstractsCONTROLLED-RELEASE OXYCODONE RELIEVES MODERATE TO SEVERE PAIN IN A 3-MONTH STUDY OF PERSISTENT MODERATE TO SEVERE BACK PAINPAIN MEDICINE, Issue 2 2002Article first published online: 4 JUL 200 Patricia Richards, MD, PhD; Pinggao Zhang, PhD; Michael Friedman, PhD; Rahul Dhanda, PhD. (Purdue Pharma L.P.) Introduction: Opioids are frequently prescribed for management of persistent low back pain, however, efficacy has not been well documented, and concerns are that opioids may impair physical functioning. Objective: To compare controlled-release oxycodone (CRO) with placebo in controlling pain and to observe the effect of CRO on quality of life and functionality. Methods: A double-blind, randomized, placebo-controlled, parallel-group study of 3 months duration was conducted in 110 subjects (49 males, 61 females), mean age 48 years (19,80 years). Subjects had a 3- to 12-month history of moderate to severe persistent low back pain and were previously unresponsive to therapeutic doses of NSAIDs, and/or low dose combination opioid analgesics. At baseline 4% of subjects were on opioids, 39% on NSAIDs, and 57% both NSAIDs and opioids. Subjects were treated with 10 mg CRO tablet or 10 mg oral placebo q12h, titrated to stable pain control. Existing treatment regimens of acetaminophen, NSAIDs, or oral steroids were allowed to continue. The Brief Pain Inventory (BPI), the Roland Morris Functionality Questionnaire, and the MOS 36-Item Short-Form Health Survey (SF-36) were the measures of pain intensity, functionality, and quality of life. Treatments were compared using repeated measures ANCOVA with baseline value as covariate. Results: CRO treatment was significantly superior to placebo on the BPI average pain intensity and average percent pain relief scores overall (4.6 vs 5.4, P = .03, and 47.2 vs 36.3, P = .05, respectively). Fewer CRO subjects discontinued because of inadequate pain control (P < .001). No significant differences between treatments were observed in either Roland Morris or SF-36 scores. Common adverse events for CRO were nausea, constipation, somnolence, headache, and pruritus, consistent with opioid use. Conclusions: Three-month treatment with CRO provides significant pain relief for subjects with persistent moderate to severe back pain, without significantly impairing functionality and quality of life. The support of Purdue Pharma L.P. for this research project is gratefully acknowledged. [source] CONNECTIONS BETWEEN LOWER BACK PAIN, INTERVENTIONS, AND ABSENCE FROM WORK: A TIME-BASED META-ANALYSISPERSONNEL PSYCHOLOGY, Issue 3 2000JOSEPH J. MARTOCCHIO We conducted qualitative and quantitative reviews of the medical literature to develop an understanding of the linkages between nonspecific lower back pain (LBP) and employee absenteeism, and the efficacy of lower back pain interventions (LBPI) in reducing absenteeism. First, we offered a general time-based framework to clarify the causal flows between LBP and absence. Second, we inspected LBPIs designed to ameliorate LBP, which should, in turn, lead to reduced absence-taking. Third, we conducted a meta-analysis of 45 effect sizes involving 12,214 people, to examine the relationships between both LBP and LBPIs and absenteeism. Consistent with a presumption in the medical literature, we found support for the idea that chronic LBP has a positive overall relationship with absence-taking. The relationship was stronger for absence frequency measures than time lost measures. In addition, we found that increasing aggregation time (i.e., increases in the periods over which absence is observed) enhances the size of the chronic LBP-absence connection. Further, evidence showed that LBPIs were effective overall in reducing absenteeism. Finally, when there was a temporal mismatch between the form of LBP (acute vs. chronic) and the absenteeism aggregation period in LBPI studies, effect sizes were significantly smaller. We concluded with a discussion of these results, methodological limitations, and suggestions for future research that blends medical with organizational approaches to the etiology of absence. [source] The Effect of Emergency Department Crowding on Analgesia in Patients with Back Pain in Two HospitalsACADEMIC EMERGENCY MEDICINE, Issue 3 2010Jesse M. Pines MD Abstract Objectives:, The authors assessed the association between measures of emergency department (ED) crowding and treatment with analgesia and delays to analgesia in ED patients with back pain. Methods:, This was a retrospective cohort study of nonpregnant patients who presented to two EDs (an academic ED and a community ED in the same health system) from July 1, 2003, to February 28, 2007, with a chief complaint of "back pain." Each patient had four validated crowding measures assigned at triage. Main outcomes were the use of analgesia and delays in time to receiving analgesia. Delays were defined as greater than 1 hour to receive any analgesia from the triage time and from the room placement time. The Cochrane-Armitage test for trend, the Cuzick test for trend, and relative risk (RR) regression were used to test the effects of crowding on outcomes. Results:, A total of 5,616 patients with back pain presented to the two EDs over the study period (mean ± SD age = 44 ± 17 years, 57% female, 62% black or African American). Of those, 4,425 (79%) received any analgesia while in the ED. A total of 3,589 (81%) experienced a delay greater than 1 hour from triage to analgesia, and 2,985 (67%) experienced a delay more than 1 hour from room placement to analgesia. When hospitals were analyzed separately, a higher proportion of patients experienced delays at the academic site compared with the community site for triage to analgesia (87% vs. 74%) and room to analgesia (71% vs. 63%; both p < 0.001). All ED crowding measures were associated with a higher likelihood for delays in both outcomes. At the academic site, patients were more likely to receive analgesia at the highest waiting room numbers. There were no other differences in ED crowding and likelihood of receiving medications in the ED at the two sites. These associations persisted in the adjusted analysis after controlling for potential confounders of analgesia administration. Conclusions:, As ED crowding increases, there is a higher likelihood of delays in administration of pain medication in patients with back pain. Analgesia administration was not related to three measures of ED crowding; however, patients were actually more likely to receive analgesics when the waiting room was at peak levels in the academic ED. ACADEMIC EMERGENCY MEDICINE 2010; 17:276,283 © 2010 by the Society for Academic Emergency Medicine [source] Hypothalamic,Pituitary,Adrenocortical Axis Dysregulation in Acute Temporomandibular Disorder and Low Back Pain: A Marker for Chronicity?,JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 3-4 2006John P. Garofalo Dysregulation of the hypothalamic,pituitary,adrenocortical (HPA) axis is believed to be a valid biological marker of stress. This study evaluating changes in patients with temporomandibular disorders (TMD) and low back pain (LBP) to determine whether dysregulation of this system represents a marker for chronicity. Salivary cortisol samples were collected from 78 patients (TMD = 41, LBP = 37) upon waking up and 20 minutes later daily for 2 weeks. High-risk patients for chronic pain had different overall cortisol levels versus low-risk patients. High-risk patients exhibited greater variability in terms of cortisol secretion compared with low-risk patients, F(1, 1,243) = 17.73, p < .000. These results provide evidence of a neuroendocrine mechanism underlying a constellation of psychosocial risk factors for chronic pain. [source] Peripheral Nerve Stimulation: A Treatment for Chronic Low Back Pain and Failed Back Surgery Syndrome?NEUROMODULATION, Issue 1 2009Paul Verrills MD ABSTRACT Objective., This study aims to evaluate the usefulness of peripheral nerve stimulation as a treatment option for patients with chronic low back pain. Materials and Methods., More than 12 months, we collected data on consecutive patients who had successful trials and were subsequently implanted with octrode percutaneous leads placed subcutaneously within the major area of pain. Eleven patients met diagnostic criteria for failed back surgery syndrome. A questionnaire assessed outcomes including: pain, analgesic use, and patient satisfaction. The response rate was 93% (13/14): average follow-up time was seven months. Results., There was a significant decrease in pain levels: an average reduction of 3.77 visual analog scale points. Eleven patients (85%) reported successful outcomes and an average pain reduction of 4.18 points but two reported a poor response. Pain relief was highly correlated with reduced analgesia and patient satisfaction. No complications were reported. Conclusion., This study demonstrates a treatment option that is safe, nonpharmacologic, reversible, and effective for patients with chronic low back pain that have exhausted other treatment options. [source] A Prospective, Open-label Study of Long-term Intrathecal Ziconotide for Chronic Nonmalignant Back Pain: A Case ReportNEUROMODULATION, Issue 1 2006Ann Ver Donck MD Abstract Ziconotide is an N-type calcium channel (NCC) blocking conopeptide, acting primarily at the NCC-rich dorsal horn. Reported here is an early experience with intrathecal ziconotide in a 55-year-old man with chronic pain resulting from failed back surgery. All conservative and surgical treatments, in addition to IT morphine, failed prior to enrollment in a short-term, placebo-controlled trial testing ziconotide efficacy and safety. Following successful short-term treatment, the patient was enrolled in a long-term follow-up study. The dosing regimen, onset and resolution of adverse events, and improvement on the primary efficacy measure, the Visual Analog Scale of Pain Intensity, are discussed. Overall, the patient responded positively to ziconotide. [source] painACTION-Back Pain: A Self-Management Website for People with Chronic Back PainPAIN MEDICINE, Issue 7 2010Emil Chiauzzi PhD Abstract Objective., To determine whether an interactive self-management Website for people with chronic back pain would significantly improve emotional management, coping, self-efficacy to manage pain, pain levels, and physical functioning compared with standard text-based materials. Design., The study utilized a pretest,posttest randomized controlled design comparing Website (painACTION-Back Pain) and control (text-based material) conditions at baseline and at 1-, 3, and 6-month follow-ups. Participants., Two hundred and nine people with chronic back pain were recruited through dissemination of study information online and at a pain treatment clinic. The 6-month follow-up rates for the Website and control groups were 73% and 84%, respectively. Measurements., Measures were based on the recommendations of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials and included measures of pain intensity, physical functioning, emotional functioning, coping, self-efficacy, fear-avoidance, perceived improvement with treatment, self-efficacy, and catastrophizing. Results., Compared with controls, painACTION-Back Pain participants reported significantly: 1) lower stress; 2) increased coping self-statements; and 3) greater use of social support. Comparisons between groups suggested clinically significant differences in current pain intensity, depression, anxiety, stress, and global ratings of improvement. Among participants recruited online, those using the Website reported significantly: 1) lower "worst" pain; 2) lower "average" pain; and 3) increased coping self-statements, compared with controls. Participants recruited through the pain clinic evidenced no such differences. Conclusions., An online self-management program for people with chronic back pain can lead to improvements in stress, coping, and social support, and produce clinically significant differences in pain, depression, anxiety, and global rates of improvement. [source] Preparing to Implement a Self-Management Program for Back Pain in New York City Senior Centers: What Do Prospective Consumers Think?PAIN MEDICINE, Issue 3 2010Sarah Townley RN Abstract Objective., Prior to testing the feasibility/potential efficacy of a newly developed self-management pain program for seniors with back pain, this study sought to: 1) determine prospective consumers' prior exposure to self-management pain programs, 2) determine their willingness to participate in the new program, and 3) ascertain perceived barriers/facilitators to program participation. Design., Cross-sectional survey. Setting., Six senior centers located in New York City. Participants., We enrolled a race/ethnicity stratified (African American, Hispanic, or non-Hispanic White) sample of 90 subjects who were ages 60 years or older and had chronic back pain. Results., While 60% of non-Hispanic Whites reported prior participation in a self-management pain program, fewer Hispanic (23%) and African Americans (20%) participants reported prior participation. Most participants (80%) were strongly willing to participate in the new program. Multivariate analyses revealed that only pain intensity had a trend toward significance (P = 0.07), with higher pain scores associated with greater willingness to participate. Few barriers to participation were identified, however, respondents felt that tailoring the course to best meet the needs of those with physical disabilities, providing flexibility in class timing, and informing individuals about program benefits prior to enrollment could help maximize program reach. No race/ethnicity differences were identified with respect to willingness to participate or program participation barriers. Conclusions., These data support efforts to disseminate self-management pain programs in older populations, particularly minority communities. The recommendations made by participants can help to guide implementation efforts of the newly developed pain program and may help to enhance both their reach and success. [source] Long-Term Adjustment to Work-Related Low Back Pain: Associations with Socio-demographics, Claim Processes, and Post-Settlement AdjustmentPAIN MEDICINE, Issue 8 2009John T. Chibnall PhD ABSTRACT Objective., Predict long-term adjustment (pain intensity, pain-related catastrophizing, and pain-related disability) from socio-demographic, claim process, and post-settlement adjustment variables in a cohort of 374 Workers' Compensation low back claimants. Methods., Age- and gender-matched subsamples of African Americans and Caucasians were randomly selected for long-term follow-up (6 years post-settlement) from a larger, existing cohort of Workers' Compensation low back claimants in Missouri. Computer-assisted telephone interviews were used to assess pain, catastrophizing, and disability. Path analysis and logistic regression analysis were used to predict long-term adjustment from socio-demographic variables (race, gender, age, and socioeconomic status), Workers' Compensation claim process variables (surgery, diagnosis, claim duration, treatment costs, settlement awards, and disability rating), and adjustment at baseline. Results., Poorer long-term adjustment (higher levels of pain, catastrophizing, and pain-related disability) was significantly predicted by relatively poorer adjustment at baseline, lower socioeconomic status, and African American race. African American race associations were also mediated through lower socioeconomic status. Higher levels of occupational disability, as measured by long-term rates of unemployment and social security disability, were also predicted by African American race (in addition to age and claim process factors). Conclusion., Long-term adjustment to low back pain in this cohort of Workers' Compensation claimants was stable, relative to short-term adjustment soon after settlement. Long-term adjustment was worse for people of lower socioeconomic status, particularly for economically disadvantaged African Americans, suggesting the possibility of race- and class-based disparities in the Workers' Compensation system. [source] Impact of Chronic Musculoskeletal Pathology on Older Adults: A Study of Differences between Knee OA and Low Back PainPAIN MEDICINE, Issue 4 2009Natalia E. Morone MD ABSTRACT Objectives., The study aimed to compare the psychological and physical characteristics of older adults with knee osteoarthritis (OA) vs those of adults with chronic low back pain (CLBP) and to identify psychological and physical predictors of function as measured by gait speed. Design., Secondary data analysis. Method and Patients., Eighty-eight older adults with advanced knee OA and 200 with CLBP who had participated in separate randomized controlled trials were selected for this study. Measures., Inclusion criteria for both trials included age ,65 and pain of at least moderate intensity that occurred daily or almost every day for at least the previous 3 months. Psychological constructs (catastrophizing, fear avoidance, self-efficacy, depression, affective distress) and physical measures (comorbid medical conditions, pain duration, pain severity, pain related interference, self-rated health) were obtained. Results., Subjects with CLBP had slower gait (0.88 m/s vs 0.96 m/s, P = 0.002) and more comorbid conditions than subjects with knee pain (mean 3.36 vs 1.97, P < 0.001). All the psychological measures were significantly worse in the CLBP group except the Multidimensional Pain Inventory,Affective Distress score. Self-efficacy, pain severity, and medical comorbidity burden were associated with slower gait regardless of the location of the pain. Conclusions., Older adults with chronic pain may have distinct psychological and physical profiles that differentially impact gait speed. These findings suggest that not all pain conditions are the same in their psychological and physical characteristics and may need to be taken into consideration when developing treatment plans. [source] Psychometric Properties of Commonly Used Low Back Disability Questionnaires: Are They Useful for Older Adults with Low Back Pain?PAIN MEDICINE, Issue 1 2009Gregory E. Hicks PT ABSTRACT Objectives., To evaluate the psychometric properties of two commonly used low back pain (LBP) disability questionnaires in a sample solely comprising community-dwelling older adults. Design., Single-group repeated measures design. Setting., Four continuing care retirement communities in Maryland and in Virginia. Participants., Convenience sample of 107 community-dwelling men and women (71.9%) aged 62 years or older with current LBP. Outcome Measures., All participants completed modified Oswestry Disability (mOSW) and Quebec Back Pain Disability (QUE) questionnaires, as well as the Medical Outcomes Survey Short-Form 36 questionnaire at baseline. At follow-up, 56 participants completed the mOSW and the QUE for reliability assessment. Results., Test,retest reliability of the mOSW and QUE were excellent with intraclass correlation coefficients of 0.92 (95% confidence interval [CI]: 0.86, 0.95) and 0.94 (95% CI: 0.90, 0.97), respectively. Participants with high pain severity and high levels of functional limitation had higher scores on the mOSW (P < 0.0001) and QUE (P < 0.001) scales than other participants, which represents good construct validity for both scales. The threshold for minimum detectable change is 10.66 points for the mOSW and 11.04 points for the QUE. Both questionnaires had sufficient scale width to accurately measure changes in patient status. Conclusions., It appears that both questionnaires have excellent test,retest reliability and good construct validity when used to evaluate LBP-related disability for older adults with varying degrees of LBP. Neither questionnaire appears to have superior psychometric properties; therefore, both the Oswestry and Quebec can be recommended for use among geriatric patients with LBP. [source] What Is the Relationship of Low Back Pain to Signs of Abnormal Skeletal Metabolism Detected by Bone Scans?PAIN MEDICINE, Issue 2 2008Brenda Breuer PhD ABSTRACT Background., In approximately 80,85% of patients with chronic nonspecific low back pain (NSLBP), a precise pathoanatomical diagnosis cannot be identified. Mechanisms of bone nociception may contribute to NSLBP. Objective., To determine whether findings on bone scans, which provide a pathophysiological picture of functional activity, are associated with self-reports of NSLBP intensity. Design., A cross-sectional study of the relationship of self-reported chronic NSLBP intensity to the uptake of radiolabeled technetium-99m-methylene diphosphonate in the lumbosacral area. Study Participants., Patients referred for bone scans who were at least 18 years old. Outcome Measures., Subject reports of pain intensity and intensity of uptake of radiolabeled technetium-99m-methylene diphosphonate in the lumbosacral area. Results., Among subjects who were 65 years or younger, the age-adjusted worst pain intensity accounted for 45% of the variability in the amount of tracer uptake (r = 0.67, P = 0.0006). The association was not significant for those older than 65 years. Conclusion., Further studies should be conducted on possible mechanisms relating bone nociception to chronic NSLBP in individuals who are 65 years or younger. [source] Treatment of Refractory, Chronic Low Back Pain with Botulinum Neurotoxin A: An Open-Label, Pilot StudyPAIN MEDICINE, Issue 3 2006Bahman Jabbari MD ABSTRACT Objective., To study the short- and long-term effects of botulinum neurotoxin A (BoNT-A, Botox®, Allergan Inc.) on refractory chronic low back pain. Design., The effect of botulinum neurotoxin A on chronic low back pain was prospectively studied in 75 patients with repeated treatments over a period of 14 months. Pain intensity (visual analog scale [VAS]), pain frequency (pain days), and perceived functional status (Oswestry scale) were assessed at baseline, 3 weeks, and at 2, 4, 6, 8, 10, 12, and 14 months. BoNT-A was injected into para-spinal muscles at 4,5 levels (between L1 and S1) unilaterally or bilaterally. The dose per site varied from 40 to 50 units. The total dose per session ranged from 200 to 500 units. Reinjections were performed at 4 months only when pain returned. Results., At 3 weeks, 40 patients (53%) and at 2 months, 39 patients (52%) reported significant pain relief. The change in VAS, Oswestry score, and pain days was significant compared with baseline at 2 months after each injection period (P < 0.005) and remained so over subsequent treatments. Among initial responders, 91% continued responsiveness over the length of the study. Three patients (4%), after the first treatment, had a mild flulike reaction that lasted 2,5 days. Conclusion., Botulinum neurotoxin A may be beneficial in patients with chronic low back pain. A favorable initial response predicts subsequent responsiveness. The treatment is well tolerated, and side effects are mild and transient. [source] Low Back Pain in Older Adults: Are We Utilizing Healthcare Resources Wisely?PAIN MEDICINE, Issue 2 2006Debra K. Weiner MD ABSTRACT Objectives., 1) To examine recent change in prevalence and Medicare-associated charges for non-invasive/minimally invasive evaluation and treatment of nonspecific low back pain (LBP); and 2) to examine magnetic resonance imaging (MRI) utilization appropriateness in older adults with chronic low back pain (CLBP). Design., Two cross-sectional surveys of 1) national (1991,2002) and Pennsylvania (2000,2002) Medicare data; and 2) patients aged ,,65 years with CLBP. Setting., Outpatient data. Participants., Patients aged , 65 years with LBP. Measurements., Study 1: Outpatient national and Pennsylvania Part A Medicare data were examined for number of patients and charges for all patients, and for those with nonspecific LBP. Total number of visits and charges for imaging studies, physical therapy (PT), and spinal injections was also examined for Pennsylvania. Study 2: 111 older adults with CLBP were interviewed regarding presence of red flags necessitating imaging and history of having a lumbar MRI, neurogenic claudication (NC), and back surgery. Results., Study 1: Between 1991 and 2002, there was a 42.5% increase in total Medicare patients, 131.7% increase in LBP patients, 310% increase in total charges, and 387.2% increase in LBP charges. In Pennsylvania (2000,2002), there was a 5.5% increase in LBP patients and 33.2% increase in charges (0.2% for PT, 59.4% for injections, 41.9% for MRI/CT, and 19.3% for X rays). Study 2: None of the 111 participants had red flags and 61% had undergone MRIs (29% with NC, 24% with failed back surgery syndrome). Conclusion., LBP documentation and diagnostic studies are increasing in Medicare beneficiaries, and evidence suggests that MRIs may often be ordered unnecessarily. Injection procedures appear to account for a significant proportion of LBP-associated costs. More studies are needed to examine the appropriateness with which imaging procedures and non-invasive/minimally invasive treatments are utilized, and their effect on patient outcomes. [source] Radiofrequency Neurotomy for Low Back Pain: Evidence-Based Procedural GuidelinesPAIN MEDICINE, Issue 2 2005W. Michael Hooten MD ABSTRACT Objective., This review was undertaken to outline the procedural limitations of the randomized controlled trials (RCTs) of radiofrequency (RF) neurotomy for low back pain. Second, the literature related to patient selection, diagnostic testing, and the technique of performing lumbar spine, RF neurotomy will be critically reviewed and analyzed. Based on these analyses, diagnostic and procedural guidelines will be proposed. Design., A Medline and EMBASE search identified three RCTs and two systematic reviews of RF neurotomy for low back pain. A similar search identified pertinent literature related to the method of patient selection for a diagnostic block, the medial branch and L5 dorsal ramus comparative block, and the anatomical and technical parameters of lumbar spine RF neurotomy. Results., Substantial procedural shortcomings were identified in all three RCTs. In the systematic reviews, these procedural limitations were not accounted for by the quality assessment of study design which resulted in an inaccurate estimate of clinical effectiveness. Analysis using likelihood ratios showed that screening criteria could increase the probability of zygapophysial joint pain before performing diagnostic blocks. Similar analysis showed that comparative medial branch blocks, rather than single blocks, must be used before RF neurotomy. Anatomical studies demonstrated that the shorter distal compared with the circumferential radius of the RF lesion necessitates placement of the electrode parallel to the course of the nerve along the base of the superior articular process. Conclusions., The evidence-based procedural guidelines provide consistent criteria for multisite studies that could enroll a sufficiently large homogenous study cohort. [source] Intrathecal Drug Delivery for Chronic Back Pain: Better Science for Clinical InnovationPAIN MEDICINE, Issue 1 2004MPH Editor in Chief, Rollin M. Gallagher MD No abstract is available for this article. [source] Low Back Pain, Health Status, and Quality of Life in Older Adults: Challenge and OpportunityPAIN MEDICINE, Issue 4 2003Rollin M. Gallagher MD No abstract is available for this article. [source] Evidence For and Against the Use of Opioid Analgesics for Chronic Nonmalignant Low Back Pain: A ReviewPAIN MEDICINE, Issue 3 2002J. D. Bartleson MD Abstract Introduction., Opioid analgesics are very effective for treating pain, but their chronic use in nonmalignant conditions is controversial. Low back pain is a common condition, and chronic low back pain (CLBP) is the most frequent regional pain syndrome in the United States. This article reviews the evidence for and against the use of chronic opioid analgesic therapy (COAT) for patients with CLBP unrelated to cancer. Methods., A literature review was conducted looking for reports of oral or transdermal opioid analgesic therapy for CLBP. Results., There are very few randomized controlled trials of COAT for CLBP. The scant evidence that is available suggests that over the short-term, COAT is helpful with patients with CLBP. In the published reports, most of which are brief in duration, COAT is associated with moderate side effects but a low risk of abuse or drug addiction. COAT was not associated with adverse long-term sequelae. Longer-acting opioid analgesics may be preferable to shorter-acting agents. Patient selection and close follow-up are critical to good outcomes. Conclusions., There is a place for the use of chronic oral or transdermal opioid analgesics in the treatment of some patients with CLBP. [source] Low Back Pain: Best Evidence,Best ToolsPAIN PRACTICE, Issue 3 2005Craig T. Hartrick MD No abstract is available for this article. [source] Intradiscal Electrothermal Coagulation and Percutaneous Neuromodulation Therapy in the Treatment of Discogenic Low Back PainPAIN PRACTICE, Issue 3 2005Dima Rozen MD Abstract: Low back pain (LBP) is a major physical and socioeconomic entity. A significant percentage of LBP is attributable to internal disc disruption. The management of internal disc disruption has traditionally been limited to either conservative treatment or spinal fusion. Intradiscal electrothermal coagulation (IDET) and percutaneous neuromodulation therapy (PNT) are now being performed as an alternative to these therapies. Scientific data regarding the pathophysiology, biologic effects, and clinical results are relatively scarce. Early biomechanical and histologic investigations into the effects of IDET are conflicting. However, in early prospective human trials, IDET seems to provide some benefit with little risk. PNT represents a new less invasive technique for the treatment of discogenic pain, but limited research is available to determine long-term clinical efficacy. IDET and PNT are potentially beneficial treatments for internal disc disruption in carefully selected patients as an alternative to spinal fusion. More basic science and clinical research with long-term follow-up evaluation is necessary. [source] Cell Types Obtained from the Epidural Space of Patients with Low Back Pain/RadiculopathyPAIN PRACTICE, Issue 3 2009James E. Heavner PhD Abstract Background: We investigated if correlations exist between medical history, tissue abnormalities, and cell types retrieved from the epidural space of patients with chronic low back pain (LBP) and chronic radicular pain (RP). Methods: Approval was obtained from the Institutional Review Board for the Protection of Human Subjects to study 191 patients undergoing epiduroscopy. Visual inspection was performed and abnormal areas were identified. A specimen obtained from the area using a cytology brush was processed by the Thin Prep technique. Patients were divided into four groups based on the presence or absence and intensity of LBP and RP. The gender and age of the patients were recorded, as was any history of prior back surgery. Areas of tissue abnormalities were rated according to changes in vascularity and amount of fat, fibrosis, and inflammation. Stenosis was assessed from magnetic resonance imaging or computerized tomography scan images. Cytologic assessments included notations of the presence or absence of erythrocytes, leukocytes, cell groups, lipocytes, spindled cells, and large round cells. Results: There was a significant difference in the number of patients from whom big round cells were obtained who had a high degree of LBP compared with the number of patients who had a high degree of both LBP and RP. Conclusions: The findings provide a foundation for future studies of cells obtained from similar patients with the goal of furthering the understanding of the pathogenesis of LBP/RP. [source] Schmorl's nodes: clinical significance and implications for the bioarchaeological recordINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 1 2008K. J. Faccia Abstract Back pain is one of the major contributors to disability and loss of productivity in modern populations. However, osteological correlates of back pain are often absent or, as yet, unidentified. As bioarchaeologists depend on osteological evidence to interpret quality of life in the past, back pain, with its profound effects on modern populations, is largely overlooked in archaeological samples. This study addresses this shortcoming in bioarchaeological analysis by exploring the relationship between a defined vertebral osteological lesion, the Schmorl's node, and its effect on quality of life in a clinical population. Using patient insight, healthcare practitioner diagnoses and MR imaging analyses, this study investigates: (1) Schmorl's nodes and sociodemographic factors; (2) the number, location and quantitative aspects (e.g. length, depth, area) of Schmorl's nodes, and how these influence the reporting of pain; (3) the dynamic effects of Schmorl's nodes, in combination with other variables, in the reporting of pain; and (4) the perception and impact of pain that patients attribute to Schmorl's nodes with regard to quality-of-life issues. The results of this study indicate that Schmorl's nodes located in the central portion of the vertebral body are significantly associated with patient reporting of pain, and that the presence of osteophytes, in the affected vertebral region, may increase the likelihood that an individual will report pain. This finding provides bioarchaeologists with an osteological correlate to begin interpreting the presence and impact of pain in archaeological populations, with implications for scoring Schmorl's nodes. Copyright © 2007 John Wiley & Sons, Ltd. [source] Epidemiology of low back pain in the United Arab EmiratesINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2004Abdulbari BENER Abstract Aims:, Low back pain (LBP), a common presenting problem in general practice in the United Arab Emirates (UAE), has received increasing attention in recent decades. We seek to investigate the prevalence of LBP and associated risk factors among people living in the typically hot, humid desert environment of the UAE. Methods:, A cross-sectional questionnaire survey was conducted. The setting was the Primary Health Care (PHC) Clinics in Al-Ain, UAE. The subjects were a multistage stratified sample of 1304 UAE nationals, 15,70 years of age, who attended PHC clinics for any reason. All subjects were invited to participate. The questionnaire used in the survey is a modified version of the Roland-Morris scale for evaluating low back pain. The questionnaires were administered during face-to-face interviews conducted in Arabic by qualified nurses. Results:, Of the total 1304 subject, 1103 (84.5%) living in both urban and rural areas agreed to participate and responded to the study; 586 (53.1%) were men and 517 (46.9%) women. The mean ages and SD of the subjects were 34.9 ± 13.4 years for the men and 33.5 ± 11.8 years for the women. The prevalence of LBP in the present study was 64.6% (95% CI = 60.7,68.5). The results revealed that there were statistically significant differences between men and women with respect to LBP and body mass index (BMI) (P < 0.001), marital status (P < 0.001), occupational status (P < 0.001), housing condition (P < 0.001), and smoking habits (P < 0.001). Back pain had a greater influence on the lifestyle habits of the women than men. Stepwise multiple regression analysis showed that only BMI (OR = 2.54, 95% CI = 2.30,281; P < 0.001), prolonged standing (OR = 6.22, 95% CI = 4.01,9.67; P < 0.0001), weakness in leg (OR = 2.11, 95% CI = 1.16,3.85; P = 0.0142), lifting heavy weights (OR = 6.34, 95% CI = 4.09,9.84; P = 0.019) regular exercise (OR = 12.47, 95% CI = 7.50,20.71; P < 0.001) and smoking habits (OR = 1.61, 95% CI = 1.08,2.38; P < 0.05) had a significant effect on the presence of LBP in these patients. Conclusions:, The study showed that the prevalence of back-related disability was higher among women than men in the UAE. Also, low socio-economic status and adverse lifestyle habits may constitute risk factors and predictors of LBP. [source] Periradicular infiltration for sciatica: a randomized controlled trial. (University Hospital of Oulu, Helsinki, Finland).PAIN PRACTICE, Issue 4 2001Spine. In this study, 160 consecutive, eligible patients with sciatica who had unilateral symptoms of 1 to 6 months duration, and who never underwent surgery were randomized for a double-blinded injection with methylprednisolone bupivacaine combination or saline. Objective and self-reported outcome parameters and costs were recorded at baseline, at 2 and 4 weeks, at 3 and 6 months, and at 1 year. Recovery was better in the steroid group at 2 weeks for leg pain, straight leg raising, lumbar flexion, and patient satisfaction. Back pain was significantly lower in the saline group at 3 and 6 months. Sick leave and medical costs were similar for both treatments, except for cost of therapy visits and drugs at 4 weeks, which were in favor of the steroid injection. By 1 year, 18 patients in the steroid group and 15 in the saline group underwent surgery. Conclude improvement during the follow-up was found in both the methylprednisolone and saline groups. The combination of methylprednisolone and bupivacaine seems to have a short-term effect, but at 3 and 6 months, the steroid group seems to experience a "re-bound" phenomenon. [source] Clinical images: Back pain, rash, and multiple spinal lesionsARTHRITIS & RHEUMATISM, Issue 12 2008Anthony Krajcer MD No abstract is available for this article. [source] ORIGINAL INVESTIGATIONS: Different Clinical Features of Aortic Intramural Hematoma Versus Dissection Involving the Descending Thoracic AortaECHOCARDIOGRAPHY, Issue 8 2005Mariano Falconi M.D. Objective: The objective of this study is to test the hypothesis that the absence of flow communication in aortic intramural hematoma (IMH) involving the descending aorta may have a different clinical course compared with aortic dissection (AD). Methods: We prospectively evaluated clinical and echocardiographic data in AD (76 patients) and IMH (27 patients) of the descending thoracic aorta. Results: Patients did not differ with regard to age, gender, or clinical presentation. IMH and AD had the same predictors of complications at follow-up: aortic diameter (>5 cm) at diagnosis and persistent back pain. Surgical treatment was more frequently selected in AD (39% vs. 22%, P < 0.01) and AD patients who underwent surgical treatment had higher mortality than those with IMH (36% vs. 17%, P < 0.01). There was no difference in mortality with medical treatment (14% in AD vs. 19% in IMH, P = 0.7). During follow-up, of 23 patients with IMH, 11 (47%) showed complete resolution or regression, 6 (26%) increased the diameter of the descending aorta, and typical AD developed in 3 patients (13%). No changes occurred in 14% of the group. Three-year survival rate did not show significant differences between both groups (82 ± 6% in IMH vs. 75 ± 7% in AD, P = 0.37). Conclusion: IMH of the descending thoracic aorta has a relatively frequent rate of complications at follow-up, including dissection and aneurysm formation. Medical treatment with very frequent imaging and timed elective surgery in cases with complications allows a better patient management. [source] Effect of local analgesia on movement of the equine backEQUINE VETERINARY JOURNAL, Issue 1 2006K. ROETHLISBERGER HOLM Summary Reasons for performing study: Diagnostic infiltration of local anaesthetic solution is commonly used in cases of equine back pain. Evaluation is subjective and it is not known how local analgesia of the back affects horses without clinical signs of back pain. Objectives: To evaluate the effect of infiltration of local anaesthetics on the movement of the back in horses without clinical signs of back pain, and to evaluate the usefulness of kinematic studies as an objective and quantitative tool in evaluating local analgesia in clinical practice. Methods: The kinematics of the back in 10 clinically sound horses were measured on 2 occasions at walk and trot before and after injections with mepivacaine and sodium chloride around the interspinous spaces between T16 and L2. The kinematics were compared between the 2 occasions before injections and before and after each injection. Results: The range of motion (ROM) for dorsoventral flexion-extension (FE) of the back was increased significantly in all measured segments other than T10 at walk, as was lateral bending (LB) at T10, L3 and L5 after injection of mepivacaine. For lateral excursion (LE), total movement increased at all measured segments. At trot the only affected segment was L3, where the injection with mepivacaine decreased the ROM for FE. After injection of sodium chloride the ROM for FE increased at T13 and T17 at walk. Lateral bending and LE were not affected at walk. At trot, LB increased at L3 and L5. Conclusions and potential relevance: Diagnostic infiltration of local anaesthetic solution affects the function of the back in clinically sound horses, which must be considered when interpreting the use of this clinical aid in assessing clinical cases of back dysfunction. Kinematics can qualitatively and quantitatively evaluate the effect of local analgesia of the back. [source] Spinal manipulation provides better short and long-term reduction in pain and disability for patients with non-specific chronic low back painFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2 2010Article first published online: 14 JUN 2010 [source] Acupuncture combined bee venom therapy for low back pain and disability: a pilot studyFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2006YD Kwon [source] A pilot randomised controlled trial comparing different frequencies of acupuncture for chronic low back painFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2006J Yuan [source] | ||||||||||||||||||||||||||||||||||||||||